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3B past papers Flashcards

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1
Q

What is the first investigation for PE?

A

Chest X-Ray, then Wells’ score

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2
Q

If PE is unlikely, what is the next investigation?

A

D-Dimer

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3
Q

If PE is likely, what is the next investigation?

A

CTPA (or V/Q scan)

USS Doppler lower leg within 4 hours if clinically indicated

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4
Q

Which investigation measures intra-ocular pressure?

A

Tonometry

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5
Q

What is the pathophysiology of pleural effusions?

A

Increased capillary permeability due to exudate

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6
Q

What is a differential of PCOS and what is the appropriate investigation?

A

Androgen secreting tumour

CT adrenals

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7
Q

What are the components of the sepsis 6 (BUFALO)?

A 
Blood cultures
Urine output
Fluids IV
Antibiotics IV
Lactate
Oxygen
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8
Q

What are some risks for non-accidental injury in children?

A

Domestic abuse
Parent with mental health problems
Delayed emotional attachment e.g. premature baby
Alcohol/drug use

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9
Q

If non accidental injury is suspected what is the investigation of choice?

A

Skeletal survey (X-Ray whole body)

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10
Q

What is seen on slit lamp examination in anterior uveitis?

A

Keratic precipitates on cornea
Ciliary flush/cell and flare
Hypopyon

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11
Q

What is an infective cause of anterior uveitis?

A

VZV

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12
Q

In secondary eczema infection with staph and/or herpes, what must be stopped?

A

Topical steroid creams

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13
Q

Which immunosuppressants are not used in SLE?

A

Anti-TNFs

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14
Q

Which drugs can cause low mood as a side effect?

A 
Isoretinoin
COCP
Lithium
Anti-epileptics
Doxycycline
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15
Q

What is seen on examination in a patient ascites?

A

Shifting dullness

Fluid thrill

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16
Q

What investigations are needed in a patient with ascites?

A

Diagnostic ascitic tap/paracetesis
Abdominal ultrasound
CT abdomen

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17
Q

What investigations are required in suspected Lymphoma patient?

A

FBC
BM biopsy
PET/CT

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18
Q

What is the treatment of primary generalised seizures?

A

Sodium valproate

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19
Q

What are the components of a health economic evaluation?

A

Cost-effectiveness of a treatment in terms of costs and benefits, and in terms of increments - can be measured in natural units, monetary, or QALY

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20
Q

Define QALY.

A

Quality of life (Y) x Quantity of life (X)

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21
Q

Define DALY.

A

Years lost to premature mortality x years lost due to disability

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22
Q

What does a QALY take into account?

A

Age, causality, rareity, severity, and end of life

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23
Q

What is a subarachnoid haemorrhage?

A

Bleeding between the arachnoid and pia mater

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24
Q

What is the cause of a fixed dilated pupil?

A

3rd (oculomotor) nerve palsy

Increased ICP from posterior communicating artery aneurysm/SAH

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25
What is the management of SAH?
``` ABCDE Phone neurosurgery IV fluids, analgesia, pre-op bloods CT and CT angiogram for aneurysm Nimodipine to reduce vasospasm LP after 12h if CT -ve ```
26
What is seen on CT in SAH?
Pooling of blood in cisterns, ventricles, and sulci
27
Name three complications of SAH.
Rebleeding Hydrocephalus Cerebral ischaemia
28
Name four features of brainstem death.
``` Absent pupillary response Absent corneal reflex Absent gag reflex Absent cough reflex No motor response No respiratory movement when patient is disconnected from a ventilator ```
29
What is done in GP as part of screening for microvascular complications of diabetes?
Fundoscopy eGFR/urine A:C ratio Neurological and diabetic foot examination
30
What class of drug is an atypical antipsychotic?
Dopamine antagonist
31
What talking therapies are available for psychotic patients?
CBT Family therapy Interpersonal therapy
32
What is important to check on breast examination?
Axillary and cervical nodes | Check other breast
33
What three investigations are required in suspected retinal detachment?
Visual field testing (peripheral loss) Fundoscopy - detached retinal fold Slit lamp microscopy - detached retinal fold
34
Give three causes of retinal detachment.
Recent eye surgery Eye trauma and vitreous haemorrhage Diabetic retinopathy
35
What are the guidelines with eye conditions and driving?
One eye affected - ask if treatment affects driving. Treatment in both eyes - inform DVLA
36
Where is transitional cell carcinoma found?
Bladder, renal pelvis, ureter
37
What are four risk factors for bladder cancer?
``` Smoking Aromatic amines Aniline dye/rubber Schistosomiasis Cyclophosphamide ```
38
Where does cauda equina start?
L1
39
What are the bowel/urinary symptoms of cauda equina?
Retention first, incontinence later
40
What are the investigations for lung cancer?
Bronchoscopy and biopsy CT whole body PET scan +/- bone scan
41
What features suggest small cell cancer
Paraneoplastic features | Central tumour
42
What is the surgical treatment of lung cancer?
Lobectomy Pneumonectomy Wedge resection
43
Give four causes of constipation in an elderly patient.
Dehydration Malignancy Immobility Lack of fibre
44
What are the components of the health transaction?
Persons health needs and demands Providers services that are supplied How is it paid for
45
What is the main difference between different healthcare systems?
How it is paid for
46
Name 5 barriers to accessing healthcare.
``` Costs Geography Awareness/education Risk perception Physical barriers ```
47
What are the components of health economics?
Opportunity cost Economic efficiency Equity Economic evaluation
48
What is opportunity cost?
Sacrifice e.g. benefits lost from not allocating resources to the next best activity
49
What is economic efficiency?
Resources allocated to maximise benefit
50
What is an economic evaluation?
Comparative study of costs and benefits of healthcare interventiosn
51
What does a QALY measure?
Disease burden
52
What is the incremental cost analysis ratio?
Cost intervention A - cost intervention B / Benefit intervention A-benefit intervention B
53
What type of antibiotic is tazocin?
``` Tazobactam = b-lactamase inhibitor Piperacillin = penicillin ```
54
What is the most common type of renal cancer?
Renal (clear) cell carcinoma
55
What is the treatment of stable angina?
Aspirin and statin if not CI GTN for symptoms BB or CCB (non-dihydropyridine)
56
What is seen on spirometry in asthma?
FEV1 <70% predicted | FEV1/FVC ratio <0.7
57
What is the ABPI value that indicates ischaemia?
0.9-0.6 = intermittent claudication 0.3-0.6 = rest pain 0-0.3 = impending gangrene
58
When is a stem cell transplant given?
When patient is in remission
59
What is the treatment of acute heart failure?
``` LOON IV furosemide Morphine Oxygen Vasodilators/inotropes Discontinue beta blockers ```
60
Define incidence.
Number of new cases per 100,000 per year
61
Give an example of confounding?
Grey hair gives you AMD
62
What are three talking therapies for psychosis?
CBT Interpersonal therapy Family therapy
63
What test shows chronic hepatitis B?
HbsAg - surface antigen | HbcAb - core antibody
64
What is the mechanism of aspirin?
Thromboxane A2 inhibitor
65
When should IV amiodarone and IV adrenaline be given in cardiac arrest?
If pulseless electrical activity in VT, if three shocks have been given with no response
66
Give two medications used to maintain sobriety.
Antabuse (disulfiram) - makes you feel sick when you drink | Acamprosate - stops cravings
67
How is Conn's syndrome diagnosed, apart from renin:aldosterone ratio and hypokalaemia?
Selective adrenal venous sampling
68
Which medications interact with lithium?
Amiodarone Amitriptyline St Johns Wort
69
What are the symptoms of serotonin syndrome?
Altered mental state Autonomic excitation eg hyperthermia Neuromuscular excitation
70
What is the treatment of serotonin syndrome?
Cyproheptadine
71
Why is lorazepam preferred to diazepam?
Decreased risk of respiratory depression
72
What are the components of the paediatric sepsis 6?
High flow oxygen IV/IO access and take blood cultures and bloods IV/IO antibiotics IV fluids Involve specialist help early Consider inotropes early: dopamine or adrenaline given via peripheral line
73
What are the risk factors of oesophageal cancer?
Barrett's oesophagus Obesity Smoking Alcohol
74
What score indicates prognosis of PE within 30 days?
Pesi score
75
What are the doses of adrenaline in anaphylaxis and cardiac arrest?
Anaphylaxis: 0.5mls of 1 in 1000 IM Arrest: 10mls of 1 in 10000 IV
76
What is the pathophysiology of Graves' eye disease?
TSH receptors on extra ocular muscles | TSH receptor stimulating antibodies
77
What is a side effect of levothyroxine?
Can worsen angina
78
What is the score that predicts a difficult intubation?
Mallon-Pati
79
Morphine --> diamorphine
divide by 2
80
How is compartment syndrome prevented against?
Ice and elevation to decrease pressure in the compartment
81
What is the mode of action of rivaroxaban?
Factor Xa inhibitor
82
What are the transmission rates following a needle stick injury in HBV, HCV, and HIV?
HBV - 30% HCV - 3% HIV - 0.3%
83
What is the mode of action of hydroxyurea in sickle cell anaemia and polycythaemia?
SC: increases foetal haemoglobin PV: decreases platelets
84
When is BiPAP and CPAP given?
CPAP - type 1 resp failure | BiPAP/NIV - Type 2 resp failure
85
Name four thromboprophylaxis measures for PE.
Compression stockings Encourage mobilization Leg elevation Intermittent compression device - flowtron
86
What are the two causes of Down's syndrome?
Trisomy 21 | Non-disjunction
87
What drug class is colchicine?
Plant alkaloid
88
Which antibodies are present in coeliac disease?
Anti-gliaden Anti-endomysial Anti-tissue transglutaminase
89
What are the deficiency states of vitamins D, E, A, and K?
D - osteomalacia E - peripheral neuropathy K - bleeding disorder A - night blindness
90
Why might malaria prophylaxis not work?
Poor compliance Resistance in that area Incorrect prophylaxis e.g. for plasmodium falciparum
91
What is the diagnostic test for malaria?
Thick and thin blood films, 3 taken on 3 subsequent occasions
92
What are the signs of cerebral malaria?
Confusion, seizures, coma
93
What are the signs of lithium toxicity?
Tremor Confusion Ataxia Irritability
94
What must you check before starting lithium?
TFTs eGFR FBC
95
What nerve root corresponds to the median nerve?
C8-T1
96
What are the signs of bulbar palsy?
Dysarthria and dysphagia Drooling Absent gag reflex Tongue fasciculations
97
What is amiodarone and its mechanism?
Class III anti-arrhythmic agent - K+ channel blocker
98
What is flecainide and its mechanism?
Class Ic anti-arrhythmic agent - Na+ channel blocker
99
In Ramsey Hunt syndrome, where does the HSV virus reside?
Geniculate ganglion of facial nerve
100
What enzyme do NSAIDs inhibit and what substances do they inhibit the production of?
Cyclo-oxygenase Prostaglandin and thromboxane
101
What is the cause of confusion in myeloma?
Hypercalcaemia | Uraemia
102
Which bone scan Is used in myeloma and why?
Skeletal survey - technetium scan looks at osteoblastic activity and plasma cells secrete IL-6 which inhibits osteoblasts and increases osteoclasts
103
How can a person apply for non-NICE funded treatment?
Private funding Charity drug fund Individual funding - consultant can apply
104
Where does spironolactone act?
Collecting ducts
105
What are the components of the mental state examination
Appearance, behaviour, mood/affect, speech, thoughts, insight, cognition
106
What is the treatment of erythema nodosum?
Analgesia, compression, elevation

Phase 3B (20 decks)

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