Acute medicine

Question 1

Difference between stable and unstable angina

Answer 1

Relieved by rest OR GTN spray

Question 2

Gold standard investigation for stable angina

Answer 2

CT coronary angiogram

Question 3

3 parts of medical management of stable angina

Answer 3

Immediate symptomatic relief - GTN spray
Long term symptomatic relief - BB or CCB
Secondary prevention - Aspirin, statin, ACEI, (BB or CCB)

Question 4

4 drugs patient with stable angina should be on

Answer 4

ACEI
BB or CCB
Statin
GTN

Question 5

What is the GRACE score after a NSTEMI

Answer 5

The 6 month risk of death or a repeat MI

• Medium or high risk (>5%) PCI within 4 days

Question 6

When does Dresslers syndrome occur

Answer 6

2-3 weeks after MI

Question 7

Management of Dresslers syndrome

Answer 7

NSAIDS ?steroids and occasionally pericardiocentesis

Question 8

Secondary prevention of an MI

Answer 8

6 A’s

Aspirin
Another anti-platelet for up to 12 months
Atorvastatin (75mg)
Ace inhibitor
Atenolol or other BB

Aldosterone antagonist if heart failure

Question 9

Artery affected in anterolateral MI

Answer 9

Left coronary

Question 10

Artery affected in anterior MI

Answer 10

LAD

Question 11

Artery affected in lateral MI

Answer 11

Circumflex

Question 12

Artery affected in inferior MI

Answer 12

RCA

Question 13

Other causes of raised troponin

Answer 13

Renal failure
Sepsis 
Myocarditis
Aortic dissection
PE

Question 14

3 features of pneumonia on examination of chest

Answer 14

Bronchial breath sounds
Fine course crackles
Dull ness to percussion (thicker due to collapse or consolidation)

Question 15

Score for CAP

Answer 15

CURB-65

Confusion
Urea >7
RR >30
BP<90 s
>65

Question 16

Most common cause of pneumonia in UK healthy (ish) people

Answer 16

Streptococcus pneumoniae

Question 17

What is the definition of atypical pneumonia

Answer 17

Organism that cannot be cultured in a normal way or detected by gram stain

Question 18

30s male presents unwell after a cheap holiday and is hyponatraemic

Answer 18

Legionella

SIADH

Question 19

How does mycoplasma pneumoniae present

Answer 19

Young patient with neurological symptoms
Erythema multiform - target lesions
Mild pneumonia

Question 20

MCQ about a farmer with a flu like illness

Answer 20

Coxiella burnetill (Q fever)

Linked to animal exposure

Question 21

Pneumonia associated with birds and parrots

Answer 21

Chlamydia psitacia

Question 22

Two most common classes of ABX for pneumonia

Answer 22

Amoxicillins or macrolides

Question 23

When can a DVT present as a stroke

Answer 23

Patients with an ASD

Question 24

Main contraindication for anti-embolic compression stockings

Answer 24

PAD

Question 25

What is a significant difference in calf sizes in the context of DVT

Answer 25

Greater than 3 cm

Question 26

When should a DVT USS be repeated

Answer 26

If positive d dimer and wells score: likely 7 days after negative USS

Question 27

How may management change for a illofemoral DVT

Answer 27

Catheter thrombolysis directly to clot

Question 28

When may IVC filters be used

Answer 28

IN recurrent PEs | Patients unsuitable for anticoagulation

Question 29

What should patients with an unprovoked DVT have after they finished treatment

Answer 29

Physical exam and bloods Antiphospholipid antibodies Thrombophilias if have a first line relative with a DVT or PE

Question 30

What is Budd Chari syndrome

Answer 30

Thrombosis in hepatic vein Abdominal pain, hepatomegaly and ascites Acute hepatitis

Question 31

3 most common causes of cellulitis

Answer 31

Staph A | Group A and group C strep

Question 32

Classification of cellulitis and range

Answer 32

ERON 1-4 4= sepsis

Question 33

DKA criteria

Answer 33

Glucose >11 Ketosis >3 Acidosis <7.3

Question 34

Treating DKA

Answer 34

FIG PICK Fluids Insulin Glucose Potassium Infection Chart Ketones

Question 35

T1DM patient presents with little hard lumps on their abdomen

Answer 35

lipodystrophy

Question 36

Alcohol dependance effect on FBC MCV

Answer 36

Raised MCV

Question 37

Treatment for acute alcoholic hepatitis

Answer 37

Steroids

Question 38

4 stages of alcohol withdrawal by time

Answer 38

6-12: tremor, sweating, headache and craving 12-24: hallucinations 24-48: seizures 24+: DT

Question 39

Symptoms of DT

Answer 39

``` Acute confusion Severe agitation Delusions and hallucinations Tremor Tachycardia, HTN, hyperthermia Ataxia ```

Question 40

Assesment scale for alcohol withdrawal

Answer 40

CIWA-Ar

Question 41

Which vitamin does alcohol excess lead to deficiency in

Answer 41

B1

Question 42

What comes first Wernickes or korsakoffs

Answer 42

W then K

Question 43

3 features of Wernickes 2 features of Korsakoff's

Answer 43

Confusion, oculomotor disturbances, ataxia Memory impairment and behavioural changes

Question 44

What causes vasodilation in sepsis

Answer 44

Nitrous oxide

Question 45

What causes oedema and capillary leaking in sepsis

Answer 45

Cytokines: interlukins and TNF

Question 46

What may thrombocytopenia concerning in a septic patient

Answer 46

Possible DIC

Question 47

What should be measured during a anaphylactic attack

Answer 47

Serum mast cell tryptase within 6 hours

Question 48

COPD dyspnoea scale

Answer 48

MRC 1-5 5 cannot leave house

Question 49

What is PESI score

Answer 49

PE severity index | 1-2 get sent home same day

Question 50

PE treatment

Answer 50

DOAC

Question 51

Can pregnancy or breast feeding women have DOACs

Answer 51

Not good data so LMWH used instead

Question 52

When can a PERC be used and what score rules out a PE

Answer 52

When clinically unlikely 0 = very low risk

Question 53

Other than TTTW what else can be seen in hyperkalemia

Answer 53

Flat p waves Sloping ST Broad QRS

Question 54

Management and doses of hyperkalemia

Answer 54

Calcium glutinate 30ml 10% bolus Then 5mh salbutamol or 10 units in 50ml 50% insulin dextrose

Question 55

Best initial delirium test

Answer 55

SQID " is this patient more confused"

Question 56

What is AMT4

Answer 56

Test for delirium in patients with acute confusion

Question 57

High level of epithelial cells on urine culture dx:

Answer 57

Contamination, do not treat