2nd year stuff Flashcards
1
Q
what is the first line treatment for acne rosacea
A
topical metronidazole
2
Q
what is the first line treatment for acne vulgarisms
A
benzyl peroxide or topical clindamycin
3
Q
what is epidermolysis bullosa
A
inherited breakdown of anchoring between epidermis and dermis
4
Q
red, flaky, crusty patches skin patches covered with silvery scales normally on elbows, knees, scalp and lower back k
A
psoriasis
5
Q
treatment of psoriasis
A
corticosteroid or vitamin D3 analogue cream
coal tar/keratolytic
6
Q
what causes a neurogenic pruritus
A
an effect on the CNS receptors, thyroid disease or malignancy
7
Q
how are autoimmune blistering conditions confirmed
A
diagnostic biopsy with immunofluorescence
8
Q
what is toxic epidermal necrolysis
A
severe, acute superficial desquamating eruption secondary to a drug
9
Q
how does toxic epidermal necrolysis
A
fever
malaise
painful erosions
generalised erythema
10
Q
what do meissner’s corpuscles detect
A
vibration
11
Q
what do pacinian corpuscles detect
A
pressure
12
Q
what are risk factors for skin cancer
A
childhood sunburn occupation related to high sun exposure sun beds type 1 skin pre-cancerous lesions Fix of skin cancer immunosuppressed exposure to radiation treatment
13
Q
why are creams more likely to cause contact sensitisation than ointments
A
they contain preservatives
14
Q
what condition is dermatitis herpetiformis associated with
A
coeliac
15
Q
which type if insulin do you give once a day
A
basal (long acting)
16
Q
which diabetic drug is weight neutral
A
DPP4 inhibitors (gliptins) and metformin
17
Q
which diabetic drugs cause weight loss
A
GLP1 agonists
18
Q
which diabetic drug causes glycosuria
A
SGLT2 inhibitor
19
Q
‘strawberry milkshake coloured blood’
A
hyperlipidaemia
20
Q
what are features of hyperparathyroidism
A
bone disease renal stones GI complications depression lethargy seizures weakness fatigue calcification of aortic and mitral valves
21
Q
what are features of hypoparathyroidism
A
neuromuscular irritability Chvostek's sign Trousseau's sign emotional lability anxiety confusion psychosis basal ganglia calcification cataracts
22
Q
which hormone peaks before ovulation
A
LH about 12 hours before
23
Q
what hormone do you test to check for ovulation
A
progesterone
24
Q
what is the pathophysiology of Paget’s disease of bone
A
increased abnormal osteoclastic reabsorption followed by increased osteoblastic activity
results in abnormal bone structure with reduced strength and increased fracture risk
25
presentation of Paget's disease of bone
```
old man
bone pain (pelvis, lumbar spine, femur)
deformity
deafness
compression neuropathies
```
26
how is Paget's disease treated
bisphosphonates
27
what do osteoclasts do
breakdown bone for maintenance, repair and remodelling
28
what do osteoclasts do
synthesise and lay down new bone
29
what causes osteomalacia
vitamin D deficiency (malabsorption, poor diet, lack of sunlight)
30
what is the pathophysiology of osteomalacia
abnormal softening of the bone due to deficient mineralisation of osteoid (immature) bone
31
what are symptoms of osteomalacia
bone pain
tenderness
fractures (femoral neck)
proximal myopathy
32
what is the treatment for osteomalacia
vitamin D therapy with Ca and phosphate supplements
33
how do you assess the risk of osteoporosis
DEXA scan
34
features of grave's
```
gradual onset
mild/moderate thyroid enlargement
diffuse enlargement on palpation
hyperdynamic tachycardia
heat intolerant
eye disease
etc
```
35
TFTs in grave's
raised T4 and fT3, suppressed TSH
36
features of Hashimoto's
```
slow onset
firm and well-defined lymph nodes
bradycardia
cold intolerance
no tremor
hoarseness
dysphagia
etc
```
37
TFTs in Hashimoto's
low T4 and fT3
| raised TSH
38
symptoms of De Quervain's thyroiditis
```
acute, painful
moderate swelling
smooth, diffuse and tender bilateral swelling
transiently hyper dynamic and tremor
painful dysphagia
```
39
TFTs of De Quervian's thyroiditis
raised T4 and fT3
| suppressed TSH
40
what is the commonest thyroid cancer
papillary thyroid cancer
41
which thyroid cancer has a poor prognosis
medullary thyroid cancer
42
what is the purpose of thyroid remnant ablation
removes residual tissue to prevent recurrence
| always combined with surgery
43
what conditions are present in MEN1
hyperparathyroidism
prolcatinoma
pancreatic tumour
44
what conditions are present in MEN2a
parathyroid hyperplasia
medullary thyroid carcinoma
phaeochromocytoma
45
what conditions are present in MEN2b
marfanoid body habitus
mucosal neuroma
medullary thyroid carcinoma
phaeochromocytoma
46
what is the function of oxytocin
breastfeeding let down reflex
| induction of labour
47
how are ketone bodies generated in DKA
lipolysis
48
which drug classes are associated with reactivation of latent TB
TNF alpha inhibitor (etanercept, infliximab)
49
what causes cubital tunnel syndrome
compression of ulnar nerve n cubital fossa
50
presentation of cubital tunnel syndrome
tingling in ring and pinky finger
51
how do you treat necrotising fasciitis
debridement + penicillin + clindamycin
52
which DMARD causes interstitial pneumonitis
methotrexate
53
which drug used in the management of rheumatoid conditions can cause black tarry stool
NSAIDs
| gastric ulcer
54
which rheumatoid drugs are nephrotoxic
gold
| penicillamine
55
which DMARD causes bone symptoms
prednisolone
56
what type of hypersensitivity is RhA
type IV
57
what is the pathophysiology of RhA
synovial fills with macrophages, fibroblasts and giant cells
| the membrane expands and erodes bone and cartilage
58
what are signs of poor prognosis in RhA
```
pre-menopausal status
smoker
young onset
high inflammatory markers at onset
positive RF
```
59
what are X-ray signs of OA
loss of joint space
osteophyte formation
subchondral sclerosis/cysts
60
where are hederden's and Bouchard's nodes found
DIP and PIP respectively
61
```
20-55 years old
well patient
back/buttock/thigh pain
normally neurology
pain changes with position of movement
```
simple backache
| mechanical
62
```
unilateral leg pain
paraesthesia in same distribution
leg>back pain
abnormal neurology
weakness
reflex/sensory changes
nerve stretch pain
```
nerve root pain
63
```
osteoporosis/long term steroid use
premature menopause
cancer Hx
weight loss
unremitting pain
sleep loss
under 20 or over 55
```
serious spinal pathology
64
saddle anaesthesia
altered bladder control
bowel incontinence
gait disturbance
cauda equina syndrome
65
treatment of carpal tunnel
corticosteroid injection, splint, workplace task modification, standard open carpal tunnel release, arthroscopic
66
cubital tunnel treatment
splint
neurolysis
anterior transposition
67
dupuytren treatment
radiation therapy
needle aponeurotomy
collagenase injection
68
trigger finger treatment
corticosteroid injection
| surgery
69
which nerve is most likely to be damaged in humeral shaft fractures
radial nerve
70
which nerve is most likely to be damaged in a supracondylar fracture of distal humerus
median nerve damage
71
how does dupuytren's contracture develop
nodule develop
| during active contractile phase, contraction forms because of contractile myofibroblasts within the lesion
72
why is hydroxyquinolone used as a last-line treatment in RhA
rarely causes retinopathy
73
Charcot foot is often associated with which condition
diabetes
74
how does Charcot arthropathy present
unilateral ankle swelling with no pain
slight erythema
paraesthesia of the foot ankle instability
75
what are typical features of seronegative arthritis
sacra-iliac joint erosions
soft tissue swelling
irregular peri-articular new bone formation
pencil-in-cup deformity
spinal ligament ossification (syndesmophyte)
76
how does RhA present
symmetrical polyarthritis usually affecting small peripheral joints with red hot swelling and raised inflammatory markers
77
which antibody is associated with RhA
anti-CCP
78
which antibody is associated with APS
anti-cardiolipin
79
which conditions is investigated by anti-centromere antibodies
systemic sclerosis
80
features of ankylosing spondylitis
acute pain and stiffness of cervical spine
bilateral foot pain
trouble breathing
81
signs of prolapsed disc
pain and numbness in spinal nerve distribution with foot drop
82
signs of burst fracture
severe lumbar pain following a fall from height or severe axial loading
83
what causes a colles fracture
FOOSH
84
what are features of a colles fracture
extra-articular fracture of distal radius
dorsal angulation
dorsal displacement
85
what are complications of colles fracture
median nerve compression
EPL rupture
CRPS
loss of grip strength
86
what are features of bone mets
high calcium
osteoclast proliferation
bone pain
87
what causes inflammation and degeneration of skeletal muscle throughout the body
polymyositis
88
features of polymyalgia rheumatica
pain or stiffness, usually in the neck, shoulder, upper arms and hips
89
signs of systemic sclerosis
```
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasia
```
90
why should tetracycline not be prescribed to children under 12 years
causes permanent tooth discolouration and occasional dental hypoplasia
91
what are features of Aspergers
impaired social interaction without delays in cognition or language development
92
2-day-old infant with non-projectile bilious vomiting
volvulus
93
4-day-old infant with projectile vomiting and associated constipation, eager to feed
pyloric stenosis
94
week old infant vomiting small amount after every feed, child well and gaining weight
gastro-oesophageal reflux
95
placental artery carries oxygenated/deoxygenated blood
deoxygenated blood
96
placental vein carries oxygenated/deoxygenated blood
oxygenated blood
97
how long do episodes of BPPV last
seconds to minutes
98
how is BPPV diagnosed
hallpike
99
treatment of BPPV
epley manoeuvre
100
compression of CN VII in facial canal
Bell's palsy
101
what causes Ramsay Hunt Syndrome
reactivation of VZV n geniculate ganglion of CN VII
102
what are features of Ramsay hunt syndrome
auricular pain
facial nerve palsy
vesicular rash around ear, vertigo and tinnitus
103
management of Ramsay hunt syndrome
oral acyclovir and corticosteroids
104
which condition causes aural fullness
meniere's disease
105
symptoms of labyrinthitis
dizziness
hearing loss
vertigo
106
signs of vestibular schwannoma
loss of corneal reflex
sensorineural hearing loss
vertigo
tinnitus
107
bilateral vestibular schwannoma is a feature of...
neurofibromatosis II
108
which nerve supplies sensory innervation of the cornea
ophthalmic division of the trigeminal nerve
109
what is central scotoma
absence of central vision
110
what type of visual loss is associated with dry ARMD
central scotoma
111
signs of CN III palsy
eye looking down and out
fixed dilated pupil
proptosis
ptosis
112
signs of CN IV palsy
eyes look upwards
vertical diplopia
cannot look down and in
head held tilted
113
signs of CN VI
horizontal diplopia
eyes medially deviated
cannot move laterally from midline
convergent squint
114
what causes cataracts
denaturation of the lens protein as part of ageing
115
gradual painless loss of vision, reduced visual acuity, diminished red reflex
cataracts
116
sudden painless profound loss of central vision in one eye following few days distorted vision
ARMD
117
what causes wet ARMD
neovascularisation leads to large solitary haemorrhage at the macula leading to scarring
118
what are characteristics of primary open angle glaucoma
raised IOP
disc cupping
field defects
119
red irritable sticky eyes with normal visual acuity
bacterial conjuncitivitis
120
red irritable itchy eyes with normal visual acuity
allergic conjunctivitis
121
sudden onset unilateral visual loss associated with poorly controlled diabetes
retinal haemorrhage
122
what is the first line treatment for BPH
alpha blocker (tamsulosin)
123
what is second line treatment for BPH
5 alpha reductase (finestride)
124
what is the biggest cause of kidney disease
diabetes
125
what is the first line investigation for a hydrocele
doppler ultrasound with colour
126
non-transilluminable scrotal swelling
testicular tumour
| torsion
127
hard lump scrotal swelling
testicular tumour
| torsion
128
scrotal swelling associated with absence of cremasteric reflex
torsion
129
scrotal swelling associated with a 'blue dot' sign
torsion of appendix
130
CKD stage 1
GFR >90
| evidence of kidney damage (proteinuria, haematuria or abnormal imaging)
131
CKD stage 2
GFR 60-90
| with evidence of kidney damage (proteinuria, haematuria or abnormal imaging)
132
CKD stage 3
GFR 30-60
| dependent on GFR alone
133
CKD stage 4
GFR 15-30
| dependent on GFR alone
134
CKD stage 5
GFR <15 or on renal replacement therapy
135
what do you give in proteinuria and HTN
ACEI
136
what is the commonest cause of glomerulonephritis
IgA nephropathy
137
HSP is associated with which type of glomerulonephritis
IgA nephropathy
138
IgA nephropathy pathology
mesangial cell proliferation and expansion on light microscopy with IgA deposits in mesangium
139
minimal change glomerulonephritis is common in which age group
children
140
how is minimal change glomerulonephritis managed
oral steroids
141
what is seen on EM in minimal change glomerulonephritis
foot process fusion
142
what antibody is associated with Churg-Strauss (eGPA)
p-ANCA
143
which antibody is associated with GPA (Wegner's)
c-ANCA
144
rhinitis, epistaxis, saddle nose deformity, conductive hearing loss
GPA
145
investigations for suspected renal colic caused by obstruction
KUB X-ray
| CT non-contrast or MRI
146
investigation of macroscopic haematuria in over 50
CT urography
| cystoscopy
147
investigation of macroscopic haematuria in under 50
US
cystoscopy
CTU when other two fail
148
when might CTU be contraindicated
contrast allergy
renal impairment
pregnancy
149
investigation for renal mass
CT
US for simple cyst
MRI with contrast instead of CT if young/pregnant
150
how to assess AKI
```
USS
U&E
coat screen
urinalysis
immunology
protein electrophoresis
```
151
what is reabsorbed in the proximal convoluted tubule
```
all glucose
all amino acids
sodium
Cl-
water
phosphate
sulphate
lactate
```
152
what is secreted in the proximal convoluted tubule
```
H+
hippurates
bile pigments
uric acids
drugs
toxins
```
153
the descending limb is permeable to
water
154
the descending limb is impermeable to
NaCl
155
what is reabsorbed in the ascending limb
Na+ and Cl-
156
which diuretics work on the PCT
carbonic anhydrase inhibitors
157
which diuretics work on the thick ascending limb of the loop of henle
loop diuretics
158
which diuretic work on the DCT
thiazides
159
which diuretics work on the collecting tubule
potassium-sparing diuretics
160
signs of kyperkalaemia on ECG
peaked T waves
widened QRS
small or absent P waves
161
how to treat hyperkalaemia
```
calcium glutinate (stabilise myocardium)
insulin glucose IV infusion (insulin drives K+ into cells, glucose maintains blood glucose)
NEB salbutamol (drives K+ into cells)
calcium resonium (bind K+ in the large intestine to be excreted)
```
162
which Ig is found in mucosa
IgA
163
what bacteria produces endotoxin
gram negative
164
what is a side effect of ACEI
dry cough
165
ACEI are contraindicated in
renal stenosis
166
inferior MI shows up on which ECG leads
2, 3, avF
167
which artery is blocked in inferior MI
right coronary
168
lateral MI affects which leads
1 and avL, V5, V6
169
sharp stabbing chest pain which worsens on breathing in
sudden breathlessness
dry cough (maybe blood)
PE
170
risk factors for PE
OCP
| long haul flight
171
investigation of PE
CXR
CTPA
ventilation-perfusion scan
172
management of PE
LMWH
| warfarin
173
sudden severe ripping/tearing chest pain that radiates down back LOC
SOB
Hx of HTN
aortic dissection
174
management of campylobacter
clarithromycin/azithromycin
175
management of salmonella
ciprofloxacin
176
management of E coli
supportive
177
management of C diff
oral metronidazole
178
what are the 4Cs
cephalosporin
clindamycin
ciprofloxacin
clarithromycin
179
bird pneumonia
chlamydiophilia psittaci
180
sheep/farmer pneumonia
coxiella burnetti
181
water foreign holiday air conditioner pneumonia
legionella
182
what is the incidence
the number of NEW cases within a specified time period divided by the size of the population initially artist
183
what is the prevalence
the number of people found to have the condition with the total number of people studied
184
how is carpal tunnel syndrome caused
the median nerve passes through the carpal tunnel at the level of the wrist
if the contents of the tunnel swells, the space is too small and the nerve is compressed
185
which fingers are affected by carpal tunnel
thumb
index
middle
lateral side of ring
186
what imagining is required for a scaphoid fracture
two obliques
AP
lateral
(4 in total)
187
Paget's disease predisposes to which malignancy
osteosarcoma
188
side effects of methotrexate
myelosuppresssion
liver cirrhosis
pneumonitis
189
side effects of sulfasalazine
rashes
oligospermia
Heinz Body anaemia
190
side effects of leflunomide
liver impairment
ILD
HTN
191
side effects of hydroxychloroquine
retinopathy
| corneal deposits
192
side effects of prednisolone
```
cushingoeid features
osteoporosis
impaired glucose tolerance
HTN
cataracts
```
193
side effects of gold
proteinuria
194
side effects of penicillamine
proteinuria
| exacerbation of myasthenia graves
195
side effects of etanercept
demyelination
| reactivation of TB
196
side effects of mabs
reactivation of TB
197
what causes sjorgens
lymphocytes invading glands
198
what do people with systemic sclerosis die of
pulmonary hypertension
199
dermatitis herpeticum looks like
monomorphic punched out lesions
200
dermatitis herpeticum is caused by
secondary infection of eczema by HSV
201
what are gout crystals made of
monosodium urate
202
gout crystal birefringence
negatively birefringent needle shaped crystals
203
pseudo gout crystals are made of
calcium pyrophosphate dehydrate
204
pseudo gout crystal birefringence
positively birefringent rhomboid-shaped crystals
