CCC Flashcards
1
Q
Causes of new LBBB
A
Always pathological- treat as STEMI
myocardial infarction
diagnosing a myocardial infarction for patients with existing LBBB is difficult
rhe Sgarbossa criteria can help with this - please see the link for more details
hypertension
aortic stenosis
cardiomyopathy
rare: idiopathic fibrosis, digoxin toxicity, hyperkalaemia
2
Q
How to define first degree heart block (criteria)
A
PR interval >200ms
It is usually asymptomatic and doesn’t require treatment
3
Q
What kind of drug is clopidogrel
A
Antiplatelet
Primary or secondary (?) prevention of cardiac events
4
Q
Hypertension with hypokalaemia and hypernatraemia 3 differentials
A
Primary hyperaldosteronism is the most common (often asymptomatic and no signs on PE)
Plasma renin:aldosterone and low- dexamethasone suppression test to figure out between Cushing and renal artery stenosis
NB that primary hyperaldosteronism may not present with hypokalaemia and is most commonly caused by idiopathic bilateral adrenal hyperplasia causing an adenoma that secretes aldosterone
5
Q
Which medication commonly causes low magnesium
A
PPIs
6
Q
What kind of drug is indapamide
A
thiazide-like diuretic.
Added when ACE- I isn’t enough (or CCB)
7
Q
old man, bone pain, raised ALP only
A
Pagets disease
Increased bone turnover
8
Q
What is pulses paradoxus
A
fall in systolic blood pressure of greater than 10mmHg with inspiration
can be measured using manual blood pressure recordings
9
Q
Triad of cardiac tamponade (fluid in pericardium)
A
raised JVP, pulses paradoxus and muffled/quiet heart sounds
10
Q
What type of drug is losartan
A
Angiotensin receptor blocker
Used first line in hypertension (either tat or ACE-I)
11
Q
What typically raises gamma GT levels
A
Alcohol consumption
12
Q
Treatment for acute heart failure (acronym
A
Pour SOD
Pour away fluids (reduce fluids)
Sit up right
Oxygen
Diuretics
13
Q
What do you give in chronic heart failure as first line treatment (with reduced LV ejection fraction)
A
Beta blocker and ACE inhibitor
Even if they would normally take CCB for HT give ACE-I
14
Q
If angina is not controlled with a beta blocker and GTN spray what should you add
A
Long acting dihydropyridine calcium channel blocker e.g. modified release nifedipine
Not verapamil or diltiazem as these has negative chronotropic effects
15
Q
New BP of more than 180/120, no other symptoms what do you do
A
Check for end-organ damage
By doing urgent ECG, urine dip and blood tests
16
Q
How do you treat a young person presenting with AF for the first time with symptoms but not too bad
A
Anticoagulants for 3 weeks then cardioversion to sort the rhythm
Don’t cardiovert instantly as there is a risk of atrial thrombosis
17
Q
Young woman with high BMI presents with bilateral headaches worse on bending over and visual symptoms e.g. optic disk blurring
A
Idiopathic intracranial hypertension
18
Q
“Starry sky” appearance on biopsy for raised lymph nodes
A
Non-Hodgkin’s lymphoma
19
Q
What do you give someone from black A/ A-C origin if their CCB isn’t enough
A
Give an ARB over an ACE-I e.g. losartan
20
Q
3 ECG signs of digoxin toxicity
A
Down-sloping ST depression (reverse tick)
Flattened/ inverted T waves
Short QT interval
21
Q
Is FEV1:FVC ratio low or high in obstructive and restrictive illness
A
In obstructive illness the ratio is low as it is difficult to get air out, but it eventually gets out (probs less than normal)
In restrictive illness the amount that can escape is reduced so ratio is. Normal but FVC will be low
22
Q
Is anterior or posterior MI more likely to cause LBBB
A
Anterior (or anteroseptal)
23
Q
Episodic pruritis after a hot bath, with elevated Hb and platelets and mild splenomegaly
A
Polycythaemia Vera
24
Q
Which organism most commonly causes infective exacerbations of COPD
A
Haemophilus influenzae
25
How can you differentiate between primary and secondary hyperparathyroidism on blood results
Both will have high parathyroid hormone
Primary will have high calcium (PTH should descrease as Ca increases and if it doesn’t you know its a problem with PT gland)
Secondary will have low/ normal calcium to counter the high Ca so you know it’s caused by something else. Secondary will also have high phosphate
26
ST elevation in ALL LEADS
Think pericarditis
Presents with chest pain eased on sitting forward, flu-like symptoms, breathlessness
“Saddle-shaped” ST elevation
PR depression is the most specific ECG marker for pericarditis
27
PR depression on ECg
Most specific ECG marker for pericarditis
28
First line Investigation for suspected pericarditis
Tranthoracic echocardiography
29
Pansystolic murmur 3 causes
Mitral regurgitation
Tricuspid regurgitation
VSD
30
4 features of multiple myeloma (acronym
CRAB
(hyper)Calcaemia
Renal failure
Anaemia (and thrombocytopenia)
Bone fractures
31
Does chrons have bloody or non-bloody diarrhoea
Non-bloody (usually)
Also commonly presents with weight loss and abdominal pain (rarer in UC) due to malabsorption
UC usually has bloody diarrhoea
32
What is first line anticoagulants now in stroke prevention
Factor Xa inhibitors
E.g. rivaroxaban,apixaban, edoxaban
33
How to differentiate between pericarditis and Dressler’s syndrome
Dressler’s syndrome typically occurs weeks/months after an MI/ cardiac surgery (thought to be autoimmune response)
Pericarditis would typically present sooner after an event
34
How to differentiate between bilateral adrenal hyperplasia and renal artery stenosis (both causes of high blood pressure)
Renin levels
If high then secondary cause e.g. renal artery stenosis
35
Secondary prevention drugs after cardiac event
DABS
Dual antiplatelet therapy (clopidogrel/ticagrelor and aspirin)
ACEi
Beta blocker
Statin
36
Which endocrine deficiency can come after thyroid gland removal
Hypocalcaemia due to dmaage to parathyroid gland
Presents with paraesthesia, muscle cramps, spasms
Long QT on ECG
37
How does hypocalcaemia present on ECG
Long QT
38
What is guttate psoriasis
Following streptococcal infection, common in young people
‘Tear drop’ scaly papules on trunk/ limbs, acute onset
Autoimmune reaction p, could never have it again, could have chronic psoriasis
39
What is the most common cause of blepharitis (swollen, itchy eyelids)
Seborrhoeic dermatitis
Normally causes lesions in the scalp p, periorbital p, auricular and nasolabial folds. Can also cause otitis external
40
Kaposi's sarcoma
caused by HHV-8 (human herpes virus 8)
presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)
Indication of underlying HIV infection
41
What is th3 most common cardiac manifestation of SLE
Pericarditis
42
Most specific ecg finding in pericarditis
PR depression
43
Most common side effects of Tamsulosin
Dizziness and postural hypotension
Relaxes smooth muscle in prostate and bladder, but also causes systemic vasodilation hence SE
44
What is first line in smoking cessation
patients should be offered nicotine replacement therapy (NRT), varenicline or bupropion - NICE state that clinicians should not favour one medication over another
Bupropion is an Atypical antidepressant which lowers seizure threshold
45
Which blood test indicates proteinuria
Albumin to creatinine ratio
>3mg/mmol means protein in urine
46
How do you treat proteinuria in CKD
ACE-I or ARB first line
Then
SGLT-2 inhibitors
Mitigate hyperfiltration so stop protein being leaked out into urine
(Also used in type 2 diabetes but makes glucose get excreted)
47
What is first line anticoagulant in AF
DOACs
E.g. apixaban, dabigatran, edoxaban, rivaroxaban
Warfarin is second line
48
What is first line Abx in COPD when someone is allergic to penicillin
Doxycycline/ clarithromycin
Not erythromycin (indicated if pregnant)
49
Is the Total Gas Transfer (TLCO) raised or lowered in asthma
Raised as the alveoli are healthy and trying to compensate for the lower air flow
50
How does prolactinoma present in a woman `
Excess prolactin:
- amenorrhoea
- infertility
- galactorrhoea
- osteoporosis
- headache
- visual disturbance (near optic chiasm- classically lateral visual fields impaired)
51
Is bronchiectasis obstructive or restrictive
Obstructive
Damaging and widening of the airways due to insult e.g. infection, inflammation (most commonly CF, TB)
52
What do you give first line in COPD
A SABA or a SAMA
So salbutamol or a SAMA like ipratropium
53
What is first line Abx in COPD prophylaxis
Azithromycin
54
Pityriasis versicolor typical presentation
Young man just been on holiday
Patches of skim discoloration mainly on trunk (pale/brown/pink/ depigmented)
Flaky/ itchy skin often
Treat with topical anti fungal e.g. ketoconazole shampoo
55
How to treat pityriasis veriscolor
Topical antifungals
Ketoconazole shampoo first line
If doesn’t work probably something else
56
Lichen planus classic presentation
purple, pruritic, papular, polygonal rash on flexor surfaces
Treat with potent topical steroids
57
How to treat lichen planus
Potent topical steroids
58
Flaky and itchy scalp with hair loss
Tinea capitis
Seborrheic dermatitis would have greasy scalp and no hair loss
59
Which joints are affected in rheumatoid, psoriatic, osteoarthritis
Rheumatoid= proximal interphalangeal joints
Psoriatic= distal interphalangeal joints
Osteoporosis= larger joints
60
What is the most common cause of primary hyperparathyroid
Parathyroid adenoma 80%
Parathyroid hyperplasia 15%
Parathyroid carcinoma 1%
61
Which t2dm medication does not cause weight gain
DPP-4 inhibitor (weight neutral)
62
Common side effects of opioids for pain relief
Constipation (always prescribe laxative)
N nd v (prescribe prn antiemetic)
Drowsiness (often temporary)
Confusion/ delirium/ hallucinations (consider dose reduction if pain free)
resp depression (low sats and low RR)
63
Top 5 cytotoxic chemotherapy side effects
1) Neutropenia- more susceptible to infection/ sepsis
2) Nausea and vomiting
3) Hair loss
4) Mucositis (inflammation of mouth/ gut)-> diarrhea, sores, pain
5) VTE
Also consider weight loss and anaemia
64
What other kind of drug if often given as a pre-med alongside antiemetics in chemo
Steroids e.g. dexamethasone
Weigh up against side effects of steroids
65
Top 5 immunotherapy side effects
1) Rash
2) Pneumonitis
3) Diarrhoea and colitis
4) Thyroid issues-acute thyroiditis then hypothyroid
5) Adrenal insufficiency and crisis
66
Give 3 components of the immune regulatory system that is faulty in cancer and commonly targeted in immunotherapy
Cytotoxic T Lymphocyte Antigen 4 (CTLA4) expressed on T Lymphocytes
Programmed Cell death protein 1 (PD1) expressed on lot of immune cells
Programmed death ligands 1 (PDL1) expressed on lots of cells
67
How do you manage severe rash in immunotherapy (acute)
High dose IV steroid
Specialist referral
68
How does Pneumonitis present in immunotherapy side effects
Cough (often dry)
SOB
Reduced exercise tolerance
Fatigue
69
How to treat pneumonitis in immunotherapy side effects
Oral steroid (high dose))
If opportunistic infection developed will need antibiotics
70
How can hepatitis present in immunotherapy side effect
Jaundice
Right sided abdominal pain
Fatigue
May also be asymptomatic
71
How’s does nephritis present in immunotherapy side effects
Often asymptomatic at first
Weakness, fatigue, anorexia, malaise
Thirst
Reduced urine output
72
How to treat hyperthyroidism as a result of immunotherapy
Carbimazole/ propranolol
Not steroids
Can continue cancer therapy, may be on thyroid meds for life
73
Side effects of high dose steroid use in immunotherapy side effects
Sleep disturbance
Mood change
Indigestion
GI bleed
Weight gain
Hypertension
Increased infection risk
74
What are the 4 types/indications of cancer treatment
Radical/ curative- only/main method of treatment
Adjuvant- following another type of treatment
Palliative- symptom control
Neo-adjuvant- prior to surgery
75
What is the most common type of radiotherapy
Photon- penetrates tissue and then produces secondary electrons which cause DNA damage
Other types include electrons and protons
76
How long after radiotherapy would you expect to get pneumonitis
6-8 weeks after RT- treat with high dose steroids and oxygen
77
How to treat neuropathic pain
Antidepressants and anticonvulsants
E.g. amitriptyline and gabapentin/ pregablin
78
How long do fentanyl transdermal patches last for
72 hours
79
What is xerostomia
Dry mouth
80
Which hormonal therapy for breast cancer in ER positive
Pre and post menopausal
Tamoxifen in pre/perimenopause
Aromataze inhibitors e,g, letrozole in post-menopausal
81
Acute sarcoidosis presentation
acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
82
Which two cancers most commonly cause bowel obstruction
Ovarian
Bowel
83
Symptoms of bowel obstruction
N and V
Colicky pain
Abdo distension
Dull aching pain
Diarrhea/ constipation
84
What are the two types of antispasmodics
Antimuscarinics (anticholinergics) e.g. hyoscine butylbromide)
Smooth muscle relaxants
85
Features of pulmonary oedema
Dyspnoea
Orthopnoea
Foaming at the mouth
Paroxysmal nocturnal dyspnoea
Distress
Diagnosed on CXR
86
How to treat pulmonary oedema
Diuretics
Dimorphine
87
3 drugs for congestive cardiac failure
Diuretics , digoxin , ACEi
88
What is the commonest region for metastatic spinal cord compression
Thoracic (2/3)
Cervical and lumbar also
89
How do you diagnose MSCC
MRI scan
90
How do you manage MSCC
Corticosteroids (dexamethasone 16mg)
Surgery often favored when there is a mechanical collapse of the vertebral body, but less likely to be used if here is extensive disease elsewhere
Can also try chemo and radiotherapy
91
What is the most common causing problem in SVCO
Extensive lymphadenopathy in the upper mediastinum e.g. in lung cancer we or lymphoma
92
How do you manage SVCO
High dose corticosteroids (Dexamethasone 16mg daily)
Urgent vascular stenting is treatment of choice often followed by chemo / radiotherapy
93
What two blood tests do you need to order if thinking hypercalcaemia
Serum calcium corrected for serum albumin so order LFT’s and calcium
94
How does albumin levels affect calcium levels
Calcium and albumin bind to each other so when albumin is low calcium is low
95
How do you manage hypercalcaemia
Rehydration using normal saline
IV bisphosphonate e.g. pamidronate
Bisphosphonates inhibit bone resorption which decreases the amount of calcium being released into the blood stream
96
Which 2 anti-emetics are most likely to cause skin irritation through a syringe driver
Cyclizine
Levomepromazine
97
Which benzo can you not give in a syringe driver
Diazepam
98
How does headache secondary to raised intracranial pressure in malignancy present
Headaches worse in mornings, improves on standing
Occasional visual changes
Papilloedema?
99
High urea levels in GI bleed- upper or lower
Upper
100
Which lung cancer causes Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
Small cell lung cancer
Increased water retention due to overproduction of ADH x hyponatraemia
101
Oral codeine to oral morphine conversion
Divided by 10
100mg of oral codeine= 10mg morphine
102
Oral morphine to sub-cut morphine conversation rate
Divide by 2
20mg oral morphine to 10mg sub-cut morphine
103
Oral morphine to oral oxycodone conversion
Divide by 2
20mg oral morphine =10mg oral oxycodone
104
Oral oxycodone to sub-cut oxycodone
Divide by 2
105
Which stage of lung cancer is the most common stage to present with
Stage 4
Associated with the worst prognosis (most advanced stage)
106
What is the most common subtype of lung cancer
Adenocarcinoma (usually associated with non-smoking but still more common in smokers)- 50%
Squamous cell carcinoma- 30%
Small cell carcinoma- 15%
Large cell carcinoma- 5%
Increase in adenocarcinoma in smokers due to fine filters being introduced
107
Give 3 paraneoplastic syndromes that can occur due to small cell lung cancer
Ectopic ACTH production
SIADH syndrome of inappropriate ADH production
Eaton Lambert Sydrome (big like myasthenia gravis)
108
Which type of lung cancer causes paraneoplastic syndromes including SIADH, ectopic ACTH production and Eaton lambert syndrome
Small cell lung cancer
109
Where else do you target with radiotherapy in small cell lung cancer
Brain because that is the place that it is most likely to relapse to
Improves survival by 5%
110
TNM staging for lung cancer
T= Tumour.
T1= contained within the lung (a,b,c is <1-3cm)
T2= either 3-5cm (a,b) or involved main bronchus/ visceral pleura or lung collapse
T3= 5-7 cm or more than one tumour or involved chest wall, parietal pleura, phrenic nerve or pericardium
T4= >7cm or more than one lobe or involved diaphragm, mediastinum, heart, major vessel, trachea, vagus nerve, oesophagus, spinal bone, carina
N= Node
N0= no lymph node involvement
N1= lung/ hilum lymph nodes
N2= mediastinum or under the carina lymph nodes
N3= contralateral lung, supraclavicular or apical lymph node involvement
M= metastasis
M0= no metastasis to other lobe/ anywhere else
M1= cancer has spread:
M1a= both lungs, pleura, pericardium, malignant pleural effusion.
M1b= single area of cancer outside the chest e.g. liver/ brain/ lymph node
M1c= more than one area of cancer elsewhere
111
T part of TNM staging for lung cancer
T= Tumour.
T1= contained within the lung (a,b,c is <1-3cm)
T2= either 3-5cm (a,b) or involved main bronchus/ visceral pleura or lung collapse
T3= 5-7 cm or more than one tumour or involved chest wall, parietal pleura, phrenic nerve or pericardium
T4= >7cm or more than one lobe or involved diaphragm, mediastinum, heart, major vessel, trachea, vagus nerve, oesophagus, spinal bone, carina
112
N part of TNM staging for lung cancer
N= Node
N0= no lymph node involvement
N1= lung/ hilum lymph nodes
N2= mediastinum or under the carina lymph nodes
N3= contralateral lung, supraclavicular or apical lymph node involvement
113
M part of TNM staging for lung cancer
M= metastasis
M0= no metastasis to other lobe/ anywhere else
M1= cancer has spread:
M1a= both lungs, pleura, pericardium, malignant pleural effusion.
M1b= single area of cancer outside the chest e.g. liver/ brain/ lymph node
M1c= more than one area of cancer elsewhere
114
First line in confusion without a reversible cause
Haloperidol
Could also choose chlorpromazine or levomepromazine
If in terminal phase then treat with midazolam
115
What is the difference between hyoscine hydrobromide and hyoscine butylbromide
Both used for secretions in end of life care
BUTYLBROMIDE does not cross the blood brain barrier and so has no CNS effect
Hydrobromide does cross the blood brain barrier and can cause sedation/ confusion
So use hydrobromide is used when you want calming/ sedation effects alongside reduced secretions
116
What is the indication for oxycodone over morphine
Renal impairment
117
What is the indication for 2 week wait for bladder cancer
Over 60 patient with unexplained non-visible haematuria AND either dysuria or raised white cells
118
What is the 2 common cancers associated with lynch syndrome (HNPCC- hereditary non-polyposis colorectal cancer)
Colorectal (80%)
Endometrial (60%)
119
What is the most common specific side effect of axillary node clearance in breast cancer
Lymphedema in the arm causing functional arm impairment
120
How does silicosis present
Persistent cough
Increasing exertional dyspnoea
Often mining occupation
Egg-shell calcification of the hilar lymph nodes
Upper zone fibrosis
121
Contraindications for lung cancer surgery
SVCO
FEV <1.5
MALIGNANT pleural effusion
Vocal cord paralysis
Due to extent of spread making it unlikely to be curative
122
How to interpret plasma and urine osmalality
Plasma osmalality= concentration of stuff in plasma- high osmalality means lots of stuff (concentrated)
Urine osmalality= content ration of stuff in urine- high osmalality means concentrated urine
So in SIADH the urine osmalality is increased as water is retained
123
Order of the large bowel
Caecum
Ascending colon
Hepatic flexure (top right)
Transverse colon
Splenic flexure (top left)
Descending colon
Sigmoid colon (back to midline)
Rectum
124
Classic triad of renal cell carcinoma
Flank pain
Haematuria
Palpable abdominal renal mass
Around 20% have fever
125
What is the difference between fibroadenoma and fibroadenosis
Fibroadenoma is common in women under 30- discrete, non-tender, highly mobile lumps (breast mice)
Fibroadenosis is lumpy, painful breasts worse before menstruation. Common in middle aged women. Aka fibricystic disease
126
Which breast condition resembles eczema of the nipple/areola
Paget’s disease of the breast
= intraductal carcinoma
Associated with reddening and thickening of the area
127
How to differentiate between a femoral and inguinal hernia
?femoral more common in females
Femoral= below and lateral to pubic tubercle
Inguinal= above and medial to pubic tubercle
128
Why do small cell lung cancers cause paraneoplastic syndrome
They contain neurosecretory granules that can release neuroendocrine hormones
129
Which lung cancer is linked to asbestos
Mesothelioma
Malignancy affecting the mesothelial cells
Large latent period and prognosis is very poor
130
Which nerve gives you a hoarse voice in lung cancer
Recurrent laryngeal nerve
131
which nerve causes diaphragm weakness and SOB in lung cancer
Phrenic nerve palsy
132
What is Pemberton’s sign
Raising the hands over the head causes facial congestion and cyanosis
Sign of SVCO
Medical emergency
133
what is Horner’s syndrome
Triad of partial ptosis, miosis, and anhydrosis caused by a Pancoast tumour (pulmonary apex) pressing on the sympathetic ganglion
134
Which type of lung cancer causes Hypercalcaemia
Squamous cell carcinoma
Ectopic parathyroid hormone production
135
How do you manage breast cancer prior to surgery
If palpable lymphadenopathy do axillary node clearance (risk of arm lymphadema and arm impairment)
If no lymphademopathy then do a sentinel node biopsy to assess the nodal burden
136
Which HPV subtypes are cancerous
16 and 18 and 33?
6 and 11 are associated with genital warts
137
Which cancer does high amounts of HPV infections cause
Anal cancer
138
What is pernicious anaemia
Autoimmune disorder affecting the gastric mucosa resulting in b12 deficiency
- intrinsic factor antibodies → bind to intrinsic factor blocking the vitamin B12 binding site
- gastric parietal cell antibodies → reduced acid production and atrophic gastritis. Reduced intrinsic factor production → reduced vitamin B12 absorption
vitamin B12 is important in both the production of blood cells and the myelination of nerves → megaloblastic anaemia and neuropathy
139
Occupational risk factor forbladder cancer
Dye and rubber workers
Aromatic amines
Also found in cigarettes
140
Which type of cancer do rubber/ dye workers get
Transitional cell carcinoma of the bladder
141
Risks of TRUS biopsy
Recital discomfort
Blood in urine / semen
Urine infection potentially leading to sepsis (3%)
Trans rectal ultrasound biopsy
142
T staging of prostate cancer
T1 is not palpable or visible (only found on biopsy)
T2 is within prostate
T3 is breaching prostrate capsule
T4 is cancer growing into rectum/ bladder
143
What is the systemic medical treatment for metastatic prostate cancer
Androgen deprivation therapy
Also consider chemo, enzalutamide
Prostate cells require testosterone to grow
144
Side effects of androgen deprivation therapy ADT
Hot flushes
Sexual function
Muscle loss
Memory problems
Weight gain
Fracture
145
What is neutropenic sepsis
Neutrophils of less than 1 and either
Temp above 38
Or
Other signs
146
When after chemo does neutropenic sepsis normally present
7-14 days
147
How does malignancy case hypercalcaemia
Transforming Growth Factor Alpha:
- produced by tumour cells
- powerful stimulator of bone resorption
Parathyroid hormone related peptides:
-mimics PTH, stimulating bone resorption increasing plasma calcium
148
How to manage hypercalcaemia
Rehydrate with IV fluids
If needed (Ca above 3) give bisphosphonates e.g. zalendronic acid
If bad renal function give pamindronate
149
What are the two choices of bisphosphonates given in malignant hypercalcaemia
Zalendronic acid
If bad renal function give
Pamindronate
150
What is a bruit heard in the upper abdomen indicative of
Intestinal angina
151
What does a low and high dose dexamethasone test help you diagnose and how
Cushing’s disease
In the test, patients are given dexamethasone to mimic cortisol- should reduce ACTH through negative feedback
If the ACTH is suppressed by high-dose dexamethasone and not low dose then it is a pituitary problem (pit is high up, high dose)
In a normal person it would be suppressed by low-dose
152
What is the surgical procedure to remove a distal transverse or descending Colon cancer
Left hemicolectomy
Respects descending an distal part of transverse colon- anastomosis to join proximal and distal bowel segments
153
Which type of thyroid cancer has raised calcitonin levels
Medullary
Perhaps might lead to decreased calcium as calcitonin decreases calcium levels
154
Which type of obstruction has high serum amylase levels
Small Bowel
Due to pressure on the pancreatic duct or a reflex response to the obstruction and change in digestive processes
Basically it just happens in small Bowel
155
Which testicular lesion is usually palpable separate and posterior to the testicle
Epididymal cyst
Can be painless or tender if infected
156
Painless obstructive jaundice and palpable gallbladder
Most likely cancer
Think pancreatic- unlikely to be gallstones (Courvoisier’s law)
157
What sign can be seen on CT in pancreatic cancer
Double duct sign
Combined dilation of the common bile duct and pancreatic duct
158
How does subacute thyroiditis (de Guervain’s thyroiditis) present
Hyperthyroidism
Tender goitre
After recent viral infection
159
What type of procedure for rectal tumours (apart from lower-rectal tumours)
Anterior resection
160
What is the procedure for lower rectal tumours
A domino-perineal excision of the rectum
161
Which type of lung cancer is associated with gynecomastia
Adenocarcinoma
162
What are the types of testicular cancer
Over 95% are germ cell which has 2 divisions:
- seminomas
- non-seminomas (e.g. teratoma)
Non-seminoma germ cell testicular tumours are associated with raised hCG and AFP
163
What do you give to patients with a sore mouth (especially at the end of life)
Benzydamine hydrochloride
164
First line inv for stable angina
Contrast-enhanced CT coronary angiogram
165
What type of antihypertensive is contraindicated in renovascular disease
ACEi
166
What is first line investigation for someone with stable angina
CT coronary angiography
To assess blood flow through the coronary arteries to look for narrowing or blocking
167
What ENT condition is a common complication of seborrhoeic dermatitis
Otitis externa
168
What do you give first line meds in diabetes with bad kidney function (<30)
Not metformin
Give a DPP-4 inhibitor instead (e.g sitagliptin)
169
What do you give in T2DM patients after metformin with heart failure/ heart disease/high risk of developing a CV disease
SGLT-1 inhibitor (gliflozins e.g. dapagliflozin)
170
What are the only two T2DM drugs you can add dapagliflozin to for triple therapy
Metformin and a sulfonylurea
Don’t add it onto pioglitazone
171
If a skin lesion is describes as violaceous what is a likely other part of the body to be affected
Mucous membranes
Lichen planus (purple, pruritic, polygonal, papular rash on flexor surfaces)
Up to 70% of patients have mucous membrane involvement
172
How do you assess exocrine pancreatic function in chronic and acute pancreatitis
For acute measure serum amylase
For chronic measure faecal elastase
173
What investigation do you do when someone presents with a hydrocele
Urgent USS to find underlying cause e.g. tumour
Other cases e.g. epididymo-orchitis, torsion
174
What is a common complication of DKA causing seizures
Cerebral oedema
Caused by rapid fluid resuscitation in DKA
Causes headache, irritability, seizures and ultimately coma and death
Occurs in 1% of DKA treatment
175
What kind of a murmur is caused by atrial septal defect
Ejection systolic
Louder on inspiration
Fixed splitting of the second heart sound
176
What is the first line anti-hypertensive in CKD if the albumin-creatinine ratio is >30
ACEi e.g. ramipri
Helps to manage protein getting excreted in the urine
177
What are the 6 causes of macrocytic anaemia
FAT RBC
Foetus (preg)
Alcoholism
Thyroid (hypo)
Reticulocytosis
B12/folate
Cirrhosis
178
Weight effect of SGLT2 inhibitors e.g. gliflozins
Weight loss to due excretion of glucose
179
Erratic blood glucose control, bloating and vomiting in T1DM with early satiety
Think gastroparesis
180
Which type of lung cancer is associated with Cavitating lesions
Squamous cell carcinoma
Also associated with clubbing
181
Which antiemetic would you prescribe for gastric stasis
Metoclopramide
182
Which anti-emetic would you give for an intracranial cause of nausea and vomiting
Cyclizine
183
How does idiopathic pulmonary fibrosis present
Gradual onset of SOB
Dry cough
Clubbing
End-ispiratory crackles in both bases
Restrictive spirometry
Diagnose with a CT scan
manage with pulmonary rehab, meds not that effective
Poor prognosis 3-4 years
184
First line investigation for suspected testicular cancer
Testicular USS
185
What is the most common type of prostate cancer
Adenocarcinoma
186
Which type of thyroid cancer has increased calcitonin
Medullary thyroid cancer
Papillary is the most common
187
What pain relief should be given in mild/moderate and severe renal impairment
In mild/moderate give oxycodone
In severe give either buprenorphine or fentanyl
188
How do you get from oral morphine to sub-cut diamorphine
Divide by 3
Diamorphine and morphine are different
189
What is a big risk factor for squamous cell carcinoma of the bladder
Schistosomiasis
= a Parasitic worm disease
190
What is the most common side effect of finasteride for BPH
Gynaecomastia
Also can have low libido and ejaculation disorders
Due to decrease in testosterone
191
Double duct sign on imaging
Pancreatic cancer
Due to dilatation of the pancreatic and common bile ducts
192
Coffee bean sign on abdo X-ray
Sigmoid volvulus
Twisting of the sigmoid colon (bottom S shaped bit)
Causes LBO
193
What is the normal method of treatment in small cell lung cancer
Chemotherapy
with adjuvant radiotherapy when the disease is well limited
194
On barium swallow how to differentiate between achalsia and cancer
Achalasia gives a birds beak appearance (smooth, well-defined edges)
Cancer gives an apple core appearance
195
First line investigation when suspecting pancreatic cancer
CT abdomen
196
Nitrofurantoin can be given for UTI unless what
EGFR <45
197
What is first line Abx for animal bites
Co-amoxicillin
198
What to give instead of fluclox in penicillin allergy
Erythromycin
At least for skin infections
199
What to do in subclinical hypothyroidism when they arent very symptomatic
Do not give levothyroxine instantly
Redo TFT in 3 months
200
Which anti-emetic in chemical/ toxic cause of vomiting e.g. in chemo
Haloperidol
201
Which antihypertensive is the most likely to cause low sodium
Thiazide-like diuretics
202
What is an alternative to amitriptyline in diabetic neuropathy management
Duloxetine
?pregablin?
Capsaicin cream if localised pain?
203
What is the ACR threshold for a lower clinic BP target of 130/80
70
204
How does proctitis present
Proctitis= inflammation of the rectum not prostate (but is a common complication of prostate cancer radiotherapy)
Bloody diarrhea
Tenesmus
Able pain
Similar to UC which also inflames the rectum
205
In HNPCC which is the most common male and female cancers after colon
Endometrial in women
Prostate in men
206
What is the most common type of colorectal cancer
Adenocarcinoma
207
New vertigo, loss of balance, Mild past pointing
Think posterior stroke and refer asap
208
What are the 4 statuses that need to be established to guide breast cancer treatment
BRCA status
ER/PR status (hormonal therapy)
HER2 status
PDL-1 status (immunotherapy)
209
Why is left sided varicocele more common
Angle at which the left testicular vein enters the left renal vein
210
What is the strongest risk factor for anal cancer
HPV
211
Which cancer does Sjögren’s syndrome put you at risk of
Lymphomas
212
How to distinguish between pancreatic and liver cancer from LFTs
Pancreatic cancer shows a cholestatic patter (ALP disproportionately high compared to ALT and AST)
Liver cancer may cause hepatocellular pattern which is higher ALT or AST
213
If ALP is raised how can you make sure that it is a liver problem and not being produced by the bone or placenta
Whenever the source of elevated ALP is the liver, gamma-glutamyl transpeptidase (GGT) levels are also raised.
I’m primary biliary cholangitis AMA is also high
214
Which to our marker is used to monitor colorectal cancer
Carcinoembryonic antigen
215
Asian heritage predisposes you to which type of ENT cancer
Nasopharyngeal
216
Which vaccine do you give to people with coeliac
Pneumococcal
Their spleen can be dysfunctional due to disease meaning that the immune system is weak to ‘encapsulated organisms’’
217
Two drugs for orthostatic hypotension
Fludrocortisone and midodrine
218
side effects of ACEi counselling
common= GI upset, nausea, rash
dry cough- can change if problematic
postural hypotension- lower dose
angiodema- <1%= swollen face and lips- emergency
219
monitoring counselling ACEi
UandEs before giving to check renal function
yearly BP checks and yearly UandEs
220
how to take bisphosphonates
once a week on the same day every week
take first thing in the morning 30 mins before food with a big glass of water
after taking sit/ stand up for 30 mins
will take 6 months to kick in
if you forget to take then just take asap dont take two
221
side effect counselling bisphosphonates
GI/ oesophageal irritation, nausea
muscle pain
above should settle in a month
osetonecrosis of the jaw is rare but serious- mouth ulcers that wont heal, pain in mouth and swelling of face. if happens seek urgent medical advice
222
how to differentiate between metastatic prostate cancer and myeloma in back presentation
myeloma is lytic (osteoclast activity whilst suppressing osteoblast activity)
prostate metastasis is sclerotic (slow growing changes over time?)
223
medical Mx options for migraine
NSAIDs
Paracetamol
Triptans- take a second dose if it resolves, if it doesnt work dont take another dose
Antiemetics if vomiting e.g. metoclopramide
dont use opioids
224
how do triptans work in migraines
5-HT receptor agonists (bind to serotonin receptors)
effects:
- cranial vasoconstriction
- inhibits pain transmission
- inhibits inflam neuropeptide release
CI in hypertension, previous cardiac event due to vasoconstriction
225
how do you prevent migraines
avoid triggers e.g. foods like chocolate, cheese, stress, bright lights, dehydration, not enough sleep
prophylactic meds e.g. propanolol, amitriptyline.
you can give prophylactic triptans for menstrual migraines
226
what is MS
autoimmune disease where the WBC in ur body attack the myelin sheath in your CNS (oligodendrocytes). this causes a range of symptoms depending on where but commonly causes optic neuritis (unilateral reduced vision, pain on movement)
some patients can relapse and remit for life and some progress
diagnosis is made on the clinical picture, excluding other causes for Sx and MRI scans/ LP to detect oligoclonal bands
227
what on LP demonstrates MS
oligoclonal bands in the CSF
228
how do you manage MS
Symptomatically
high dose steroids either oral or IV methylpred on acute flares
disease modifying drugs e.g. natalizumab IV
229
most common presentation of MS
optic neuritis (unilateral reduced vision, pain on movement)
can present in a number of sub-acute attacks which will mostly relapse and remit
230
231
Which antidiabetic drug would you add to metformin in someone with a high bmi
DPP4 Inhibitor e.g. gliptin
Or
SGLT2 inhibitor e.g. gliflozin
232
Which Abe do u give in UTI with bad kidney function
Trimethoprim
Nitro CI in egfr lt 45
233
4 parts of CENTAUR criteria
1) History of fever 2) tonsillar exudates 3) no cough 4) tender anterior cervical lymphadenopathy.
234
Which ABbx can u not take with alcohol
Metronidazole
235
Which antihypetensive causes side effects with statins
CCB e.g. amlodipine with simvastatin causes muscle weakness and myalgia
236
Give an example of a mildly, moderately, potent and very potent topical corticosteroids
Mildly potent= hydrocortisone 0.1/0.5/1.0/2.5
Moderately potent= betamethasone valerate 0.025% (betnovate) or eumovate
Potent= betametasone valerate 0.1% (stronger betnovate) or diprosone
Very potent= clobetasol propionate 0.05 (Dermovate)or Nerison Forte
237
How strong a topical steroid is hydrocortisone
Mildly potent
238
How strong Betnovate-RD
Moderately potent- 0.025%
If it was 0.1% betamethasone valerate it would be potent
239
How to grade CKD based on eGFR
G1-G5
G5= eGFR<15
G4= 15-30
G3b= 30-45
G3a= 45-60
G2= 60-90
G1 >90
240
How to grade CKD based on ACR
A1= <3
A2=3-30
A3= >30
241
When are people with CKD offered ACEi
If they have an urine ACR>70
If they have hypertension and an ACR>30
if they have diabetes and an ACR >3
Make sure to monitor for hyperkalaemia as can be caused by CKD and ACEi
242
When is dapagliflozin offered to patients with CKD
It is an SGLT-2 inhibitor
Given to diabetics with a urine ACR>30
Also considered in any diabetic with a urine ACR between 3 and 30
And in any patient with an ACR>22.6
243
What are the two medical Tx for BPH and side effects
Alpha-blockers e.g. tamsulosin
- relaxes smooth muscle
- improves symptoms
- causes postural hypotension
5-alpha reductase inhibitors e.g. finasteride
- converts testosterone to androgen
- gradually reduces size of the prostate
- causes sexual dysfunction
You can take both of them if you’re symptomatic and want to reduce prostate size
244
Which T2DM medications cause weight gain
Insulin
Sulphonylureas
Also thiazolidinediones and meglitinides but who cares
245
Which T2DM drugs cause hypos
Insulin
Sulphonylureas
SGLT-2 inhibitors e.g. gliflozins
246
Which types of cancer are more likely to present with neutropenic sepsis
Haematological
Germ cell
Breast
As they have more intense chemo regimes and it is the chemo which targets the bone marrow - neutropenia
247
What do they give in patients with a high risk of neutropenia
GSCF (fligrastim or lenograstim)
Haematopoitic growth factors and they pr,ote stem cell proliferation
Shortens the duration of time that someone is neutropejic for
248
Most common cancers that have an MSCC
Breast
Lung
Prostate
Haematological
249
Management of suspected MSCC
16mg dex with PPI cover
Urgent MRI spine
If positive consider surgery / radiology but would refer to oncology
250
Which parts of the colon are most commonly cancerous
Rectum (1/3)
Sigmoid colon (whole left side = 1/3)
The rest is 1/3
251
Gout medical management options and when you would choose one over the other
NSAIDs or Colchicine
Not NSAIDs if renal impairment, cardiac failure and ischaemic heart disease
252
Central and peripheral lung cancers which type
Squamous and Small cell are Sentral and associated with Smoking
LA is on the coast (Large cell and Adenocarcinoma are peripheral)
253
Steroid and dose in initial Mx of MSCC
dexamethasone 16 mg
254
Where is the chemoreceptor trigger zone that signals nausea in toxicity e.g. chemo
Floor of the fourth ventricle Outside the blood brain barrier
Haloperidol and levomepromazine are the antiemeitcs of choice (levo is more sedating
And also used in end of life but not in Parkinson’s
Detects things that cause vomiting in the blood
255
3 common side effects of cyclizine
Dry mouth
Hypotension
Drowsiness
256
Difference between metoclopramide and domoeridone
Both strong dopaminergic prokinetics
Metoclopramide is central And domperidone is peripheral only
Useful for gastric causes
Domperidone can be used in PD , meto can’t
257
Most common side effect of ondnsetron
Comstipation
258
Which antiemetic is a 5HT-3 antagonist
Domperidone
259
Which paraneoplastic syndromes are not caused by small cell lung cancer
Hypercalcaemia caused by SCC
Gynaecomastia caused by adenocarcinoma
Rest caused by SCLC
260
How to differentiate between gout and pseudo gout on joint fluid examination
monosodium urate crystals of gout are needle-shaped and negatively birefringent of polarised light.
The calcium pyrophosphate crystals of pseudogout are rhomboid-shaped and positively birefringent.
