Core conditions - difficult things Flashcards
1
Q
what does PANCREAS stand for in glasgow scoring system for pancreatitis
A
P = pO2 A = age N = neutrophilia C = calcium R = renal urea E = enzymes (LDH) A = albumin S = sugar
2
Q
5 drugs increasing risk of pancreatitis
A
thiazides azathioprine tetracyclines oestrogens valproic acid
3
Q
why give PPI/H2 receptor antagonist in chronic pancreatitis
A
reduce HCO3 secretion
4
Q
what is Ogilvie’s syndrome
A
intestinal pseudo-obstruction (massive dilation of colon)
5
Q
type of drugs to give in severe IBD
A
immunosuppressant drugs
6
Q
what is Rosvig’s sign
A
palpation of LLQ pain increases pain in RLQ in appendicitis
7
Q
2 scoring systems for appendicitis
A
Alvarado
RIPASA
8
Q
what is succussion splash a sign of
A
slow gastric emptying n PUD = distension
9
Q
when to do an endoscopy in PUD
A
over 55, red flags
10
Q
what is the triple therapy for H. pylori PUD
A
1 PPI and 2 antibiotics - e.g. omeprazole, metronidazole, clarithromycin
11
Q
2nd line treatment for H. pylori PUD
A
H2 receptor antagonist (e.g. ranitidine) + 2 antibiotics
12
Q
2 forms of treatment for NSAID PUD
A
8 weeks H2-receptor antagonist - raniditine, OR
2 months full dose PPI
13
Q
2 antispasmodics to use in IBS
A
limetropium
hyoscine
14
Q
4 drugs increasing risk of GORD
A
TCAs
anticholinergics
nitrates
CCBs
15
Q
2 grading systems of GORD
A
Savary Miller
Los Angeles grading
16
Q
treatment for GORD no RF symptoms
A
PPIs 1 month then step down
17
Q
1 gene causing gastric adenocarcinoma
A
HDGC
18
Q
what is Courvoisier’s sign
A
painless palpable gallbladder - sign of pancreatic cancer
19
Q
what is Trousseau’s syndrome
A
migratory thrombophlebitis - sign of pancreatic cancer
20
Q
2 LFTs in obstructive jaundice (can occur in pancreatic cancer)
A
increased ALP and bilirubin
21
Q
3 electrolyte imbalances in pancreatic cancer
A
hyperglycaemia
hypercalcaemia
hypokalaemia
22
Q
tumour marker in pancreatic cancer
A
CA19-9
23
Q
what can Reye’s syndrome, Wilson’s disease and alpha-1 antitrypsin deficiency all cause
A
chronic liver disease
24
Q
4 differential diagnoses for hepatic encephalopathy
A
- Wernicke’s encephalopathy
- ketoacidosis
- hypercapnia
- electrolyte imbalance
25
INR result in chronic liver disease
raised
26
bilirubin and ammonia result in chronic liver disease
raised
27
glucose result in chronic liver disease
low (give IV glucose)
28
2 drugs to decrease ammonia production in chronic liver disease
lactulose + neomycin
29
drug to decrease ICP in chronic liver disease
mannitol
30
2 serologic tests for coeliac disease
IgA antiboties to TTG
| IgA/IgG to deactivated gliadin
31
which type of malnutrition is low energy
Marasmus
32
treatment of refractory ascites
therapeutic paracentesis
33
treatment of malignant ascites secondary to epithelial cancers
catumoxomab
34
antibiotic in infective pancreatitis
cefuroxime/aztreonam
35
LFTs in acute hepatitis vs gallstones
acute hepatitis = increased AST and ALP
gallstones = increased bilirubin, ALT and ALP
36
what is Dieulafoy's disease
aneurysms in young people = gastric GI bleed?
37
cause of artoduodenal fistula
AAA repair - causes duodenal GI bleed
38
what can appendicectomy cause
CD
39
3 immunosuppressant drugs for IBD
cyclosporin
azathioprine
methotrexate
40
blood test for IBD
faecal calprotectin
41
treatment for GORD + oesophagitis
PPIs 2 months
42
most common location of pancreatic cancer
head
43
3 signs of pancreatic cancer
painless jaundice
pruritus
nausea
44
parasite increasing risk of CRC
schistosomiasis
45
drug protective for CRC
aspirin
46
what is Sister Mary Joseph nodule
nodule on umbilicus = sign of CRC
47
1 derm sign of coeliac
dermatitis herpetiformis
48
treatment of normal ascites
spironolactone, loop diuretics
49
2 leg signs of appendicitis
psoas sign - extend right thigh = pain RLQ
| obturator sign - internally rotate flexed right thigh = pain RLQ
50
point of abdomen most tender in appenditicis
McBurney's
51
gene increasing risk of CD
CARD15 (NOD2) gene
52
risk assessment for acute GI bleed
Rockall risk assessment
53
what is Murphy's sign
painful RUQ on examination but NOT on LUQ = gallstones?
54
blood test for acute hep C
HCV
55
2 tests for acute hep A
lab IgM
| serum aminotransferase + AST
56
3 stages in acute hep A
```
prodromal = flu and GI
icteric = jaundice, pale faeces, hepatomegaly
convalescent = weight loss, tenderness, muscle weakness
```
57
3 monoclonal antibodies to determine stage of breast cancer
ER
PR
HER2
58
biopsy to determine stage of breast cancer
Sentinel LN biopsy
59
4 presentations of ductal papilloma
bloody discharge
palpable mass within 4cm of nipple
inversion/retraction
microcalcification on mammogram
60
biopsy for non-palpable breast lump
core needle, open
61
biopsy for a palpable breast lump
FNA, core needle, excision (<4cm), incision (<4cm)
62
4 hormonal therapies for breast cancer if +ve for hormonal receptors
tamoxifen
SERMs
aromatase inhibitor
hormone antagonists e.g. anastrozole
63
thing increasing fibroadenoma
oestrogen
64
type of ductal papilloma more common in young women (usually in older women)
multiple (central types more common in older)
65
type of cardiomyopathy causing stable angina
hypertrophic
66
2 drugs increasing risk of AF
bronchodilators
| thyroxine
67
syndrome increasing risk of AF
diabetes
68
2 drugs for thromboprophylaxis in AF
DOACs
| vit K agonist - warfarin
69
monotherapy in AF
beta blockers or CCBs
70
what to do if monotherapy in AF is unsuccessful
either 2 of beta blocker, digoxin or dilimiazem
71
when to use UFH in DVT (usually use LMWH, fondaparinux and warfarin)
CKD 4/5
72
beta blocker to use in CCF
carvedilol
73
what is cardiorenal syndrome a complication of
CCF
74
what can IE cause
MI - from coronary embolus
75
3 signs on auscultation in MI
3rd and 4th heart sound
systolic murmur
pericardial rub
76
2 times there is a systolic murmur in MI
mitral regurgitation
| ventricular septal defect
77
when to give GTN in MI
hypertensive
| acute LVF
78
2 anticoagulants to inject in MI treatment
bivalirudin
| enoxaparin (LMWH)
79
when to do immediate angiography in MI
STEMI or high risk NSTEMI (otherwise before 3 days)
80
when to give ACEi after MI
if LV dysfunction, hypertension or DM
81
2 conditions associated with severe postural hypotension
multiple system atrophy (Shy-Drager syndrome)
| pure autonomic failure (Bradbury-Eggleston syndrome)
82
how to treat paroxysmal AF
monotherapy digoxin
83
what is post-thrombotic syndrome
chronic venous hypertension - may develop after DVT
84
when to give CCB or thiazide in 1st line hypertension treatment
if >55 or black (otherwise ACEi or ARB)
85
when to give thiazide instead of CCB in 2nd line hypertension treatment
heart failure
86
cause of delayed femoral pulses in hypertension
coarctation of aorta
87
what is graves
autoimmune TSH receptor stimulating antibodies = increased T3 and T4
88
what can increased iodine and smoking cause
graves
89
4 symptoms of thyroid storm
fever
D+V
jaundice
seizures
90
4 drugs to treat thyroid storm (thyrotoxicosis)
beta blockers
antithyroid drugs
potassium iodide
corticosteroids
91
what can palmar erythemabe a sign of
hypertyhyroidism
92
TSH and T4/T3 levels in hyperthyroidism
TSH low
| T4/T3 high
93
result of Tc99m scan in GD vs multinodular goitre
```
GD = diffuse uptake
MNG = nodular uptake
```
94
1st line antithyroid drug to use in hyperthyroidism
carbimazole - decreases action of perixodase enzyme = decreased output of T4/T3
95
2 types of hypothyroidism
atrophic (T cell mediated cytotoxicity)
| Hashimotos (goitre)
96
what can iodine deficiency cause
hypothyroidism = goitre
97
what can hypopituitarism cause
hypothyroidism (isolated TSH deficiency)
98
2 causes of primary thyroid disease (causing hypothyroidism)
autoimmune
| radio iodine damage
99
5 conditions associated with Hashimotos
```
T1 DM
Addisons
SLE
CD
pernicious anaemia
```
100
when is there increased levels TPO in blood
Hashimotos
101
what can deep voice and carpal tunnel be a sign of
hypothyroidism
102
TSH level in hypothyroidism
high
103
what is normal/low TSH and T4 deficiency a sign of
non-autoimmune hypothyroidism
104
2 drugs increasing risk of thyroid lump
amiodarone
| lithium
105
type of thyroiditis occuring after a viral infectino
De Quervains
106
why do basal plasma calcitonin and carcinoembryonic antigen (CEA) test for thyroid lumps
medullary cancer
107
type of biopsy for thyroid lumps
FNA
108
3 antibodies for T1 DM
HLADR3
HLADR4
islet cell
109
drugs increasing risk of T2 DM
combined use thiazide + beta blocker
statins
110
2 derm symptoms of all types of diabetes
boils
| pruritus vulvae
111
random and fasting plasma glucose levels in diabetes
```
random = >11.1
fasting = >7
```
only one needed in symptomatic, 2 fasting samples in asymptomatic
112
what is OGTT
2 hour venous plasma glucose >11.1 2 hours after 75g glucose
113
2 types of insulin if you dont want to inject much
```
2X daily (isoprene insulin)
long-acting insulin analogues
```
114
3 features of DKA
acidosis
hyperglycaemia
ketonuria
115
3 treatments for DKA
fixed rate IV insulin infusion (FRIII)
IV 0.9% saline
replace K+ if 3.5-5.5
116
4th step in T2 DM treatment
lifestyle + metformin + secondary drug + insulin
add on each one with each step
117
secondary drug in T2 DM
sulphonylurea e.g. gliclazide
118
type of Cushing's syndrome causing increased ACTH
ACTH-dependent
119
what is Cushing's disease
ACTH-dependent Cushing's - pituitary
120
2 other causes of ACTH-dependent Cushings (apart from cushings disease)
- ectopic ACTH-producing tumours e.g. lung cancer
| - excess ACTH administration
121
2 causes of non-ACTH dependent Cushing's syndrome
- excess glucocorticoid administration (most common)
| - adrenal adenomas/carcinomas
122
ACTH levels in dependent vs non-dependent cushings syndrome
```
dependent = increased ACTH
non-dependent = no ACTH but increased serum cortisol
```
123
2 types of endogenous Cushings i.e. ACTH-dependent but from inside body
```
corticotropin dependent (most common)
corticotropin independent
```
124
2 types of corticotropin dependent Cushings
```
pituitary adenomas (Cushings disease - 80%)
ectopic corticotropin syndrome (20%)
```
125
2 types of corticotropin independent Cushings
```
adrenal adenoma (60%)
adrenal carcinoma (40%)
```
126
lipid profile in Cushings
decreased lipids
127
syndrome sometimes caused by Cushings
diabetes = thirst etc
128
3 diagnostic tests for Cushings
- 24hour urinary free cortisol (2+ collections, >3x upper limit)
- 1mg overnight dexamethasone suppression test
- late night salivary cortisol (11pm-1am)
129
4 tests for ACTH-dependent Cushings
- high dose dexamethasone suppression test
- inferior petrosal sinus sampling (IPS)
- MRI pituitary
- chest and abdo CT - ectopic?
130
result of dexamethasone suppression test in Cushing's disease (pituitary adenoma) and ectopic ACTH
>90% decreased
131
IPS result in ectopic ACTH
<1.8
132
IPS result in pituitary adenoma (Cushings disease)
>2
133
2 drugs for Cushings to decrease cortisol
metyrapone
| ketoconazole
134
complication of surgery to remove adrenal glands in Cushing's disease
Nelson's syndrome = enlargement of pituitary, development of adenomas
135
what is secondary HPT
hyperplasia + increased PTH in response to hypocalcaemia
136
usual cause of secondary HPT
renal failure
137
most common cause of primary HPT
single adenoma
138
calcium levels in primary HPT
high = osteoporosis, kidney stones, increase in 24 hour urinary calcium excretion
139
phosphate levels in HPT
low
140
3 syndromes associated with parathyroid adenoma (most common cause of PHPT)
MEN1
MEN2
jaw tumour syndrome
141
3 causes of primary addison's disease
adrenal dysgenesis/destruction
autoimmune adrenalitis
TB
142
cause of secondary Addisons
decreased ACTH secretion
143
treatment of secondary Addisons
long term steroids
144
what can postural hypotension and hyponatraemia be a sign of
Addisons
145
what can decreased RBC synthesis cause
macrocytosis
146
what can decreased Hb production cause
microcytosis
147
3 signs of macrocytosis
high output HF
bounding pulse
systolic murmur
148
what can decreased B12/folate cause
megaloblastic anaemia (macrocytic - from decreased DNA synthesis)
149
drug causing non-megaloblastic anaemia
azathioprine (affects DNA)
150
4 other causes of non-megaloblastic anaemia
alcohol
liver disease
hypothyroidism
reticulocytosis
151
most common cause of B12 deflciency
autoimmune Addisonian pernicious anaemia
152
2 other causes of pernicious anaemia
diabetes
| hypothyroidism
153
4 drugs causing folic acid deficiency
alcohol
anticonvulsants
methotrexate
trimethoprim
154
treatment of B12 deficiency
injection continued for life -(hydroxocobalamin)
155
why start B12 injections before folate if deficient in both
increases SCDC
156
Hb cut offs for ID anaemia
```
men = 13 (<11 = 2ww)
women = 12 (<10 = 2ww if not menstruating)
```
157
4 drugs decreasing iron absorption
tetracyclines
quinolones
antacids
PPIs
158
2 head and neck signs of anaemia
glossitis
| tinnitus
159
what is Paterson-Brown-Kelly syndrome
dysphagia from ID anaemia
160
nail symptom of ID anaemia
koilonychia
161
what is anisocytosis
variation in RBC size (ID anaemia)
162
what is poikilocytosis
abnormal RBC shape (ID anaemia)
163
poisoning showing symptoms similar to ID anaemia
lead poisoning
164
2 locations of mets in lymphoma
liver
| breast
165
CXR in Hodgkin lymphoma
mediastinal widening (hilar LNs)
166
2 types of non-Hodgkin lymphoma
indolent (not curable)
| aggressive
167
2 types of indolent nHL
follicular
| marginal zone
168
2 types of aggressive nHL
DLBCL (B cell)
| Burkitt
169
chemotherapy for low grade lymphoma
chlorambucil
170
CHOP chemo for aggressive nHL
cyclophosphamide
doxorubicin
vincristine
prednisolone
171
drug to treat DLBCL
rituximab (monoclonal antibody)
172
2 signs of nerve root compression
clonus
| positive Babinski
173
what drug to use to reduce muscle spasms in prolapsed disc
benzodiazepines
174
most common organism causing septic arthritis
s. aureus
175
2 conditions showing similar symptoms to septic arthritis
lyme disease
| IE
176
antibiotic for normal septic arthritis
flucloxacillin (clindamycin if allergic)
177
antibiotic for ?MRSA septic arthritis
vancomycin
178
antibiotic for gonococcal septic arthritis or gram =ve
cefotaxime
179
3 drug risk factors for gout (increase uric acid)
diuretics
chemotherapy
low-dose salicylate e.g. aspirin
180
4 condition risk factors for gout
hypertension
CHD
DM
hyperlipidaemia
181
1 derm condition risk factor for gout
psoriasis
182
what is chronic tophaceous gout
large crystal deposits produce firm nodules around extensor surfaces
183
what confirms diagnosis of gout
MSU crystals in synovial fluid or tophi
184
3 XR findings in chronic gout
tophi
sclerosis
punched out lesions
185
2 first line drugs for gout
NSAIDs
| colchicine
186
when to use canakinumab in gout (inhibitor of IL-1)
if no response with 1st line drugs or 3+ attacks in 12 months
187
3 drugs for gout prophylaxis
allopurinol
febuxostat
uricosurics (increase secretion)
188
side effect of febuxostat
anaphylaxis
189
when to use drug prophylaxis for gout
NOT during acute attack - 2+ in 1 year, tophi, renal impairment, need diuretics
190
2 nerve complications of gout
nerve impingement
| carpal tunnel
191
steroid dose increasing risk of osteoporosis
prednisolone >7.5 mg/day for >3 months
192
2 haematological causes of osteoporosis
myeloma
| haemoglobinopathies
193
2 respiratory causes of osteoporosisq
COPD
| CF
194
1 metabolic cause of osteoporosis
homocystinuria
195
4 drugs causing osteoporosis
heparin
ciclosporin
anti-convulsants
aromatase inhibitors (breast cancer)
196
1 anabolic treatment for osteoporosis
teriparatide (PTH analogue)
197
3 antiresorptive treatments for osteoporosis
SERMS e.g. raloxifine
bisphosphonates
RANK-L inhibitor e.g. denosumab
198
2 genes increasing risk of RA
HLADR1
| DR1
199
3 hand deformities in RA
```
ulnar deviation
piano key deformity (wrist)
Z deformities (thumbs)
```
200
when is there a +ve ANA result in RA
if also has SLE
201
urinalysis result in RA
microscopic haematuria/proteinuria
202
4 drugs for RA
NSAIDs
DMARDs
corticosteroids
COX-2 drugs e.g. celexobib, etoricoxib
203
4 XR findings in OA
osteophytes
joint space narrowing
bone cysts
subarticular sclerosis
204
3 conditions DDs for OA (apart from obvious ones)
ankylosing spondylitis
sarcoidosis
IE
205
topical adjunct treatment for knee and hand OA
topical capsaicin
206
what is delirium tremens
delirium from alcohol withdrawal
207
type of seizures from alcohol withdrawal
tonic clonic
208
what type of drug is librium (for alcohol)
benzodiazepine - chlordiazepoxide
209
what can liver cirrhosis cause
diabetes
210
why can alcohol cause oedema
decrease albumin levels
211
5 consequences of alcohol on blood
```
atherosclerosis
hypertension
increased MCV
folic acid and B12 deficiency
BM damage
```
212
consequence of alcohol on heart
alcoholic cardiomyopathy (= AF?)
213
2 consequences of alcohol on nervous system
Korsakoff's syndrome
| peripheral neuropathy
214
what is Korsakoff syndrome
irreversible cerebellar damage from thiamine deficiency
215
type of diuretics to give in alcohol withdrawal
K+ sparing
216
CAGE questions for alcohol abuse
CUT down
ANNOYED you by criticising drinking
GUILTY about drinking
EYE-OPENER (needing a drink first thing in the morning)
217
5 features of dementia with Lewy bodies
```
fluctuations in consciousness
hallucinations
sleep disruption
falls
Parkinsonian features
```
218
6 treatable causes of dementia
```
substance abuse
hypothyroidism
SoLs
normal pressure hydrocephalus
B12 and folate deficiencies
pellagra
```
219
what is pellagra
B3 deficiency
220
treatment for mild to moderate AD
AChE inhibitors e.g. donepezil
221
treatment for moderate-severe AD
NMDA antagonists e.g. memantine
222
2 treatments for somatisation
CBT
| antidepressants e.g. duloxetine
223
2 antipsychotics sometimes used in delirium psychotics
haloperidol
olanzapine
NEVER in LB dementia or PD
224
6 drugs which can cause delirium
```
benzos
analgesics
anticholinergics
anticonvulsants
anti-parkinsonism
steroids
```
225
4 toxic substances which can cause delirium
CO
alcohol
heavy metals
barbituate withdrawal
226
3 deficiencies which can cause delirium
B1 (thiamine)
B2
B3 (niacin)
227
3 diagnostic criteria for GAD
4+ symptoms with 1+ autonomic arousal symptom
anxiety more days than not for 6+ months
exclusion of panic disorder, phobic anxiety disorder, OCD
228
2 drugs for GAD
SSRIs (pregabalin if cant tolerate)
| SNRI (venlaxafine)
229
3 self report symptom scales for depression
patient health questionnaire (PHQ-9)
hospital anxiety and depression (HAD) scale
Beck's depression inventory
230
diagnostic criteria for depression
5+ symptoms 2+ weeks, one of which is a core symptom
231
2 core symptoms depression
feeling down
| little pleasure
232
7 other symptoms of depression
```
fatigue
worthlessness
thoughts of suicide
decreased ability to concentrate
psychomotor changes
insomnia/hypersomnia
appetite increased/decreased
```
233
what is dysthymia
sub-threshold depression (2-5 symptoms) present >2 years
234
5 other types of antidepressants
```
NaSSA e.g. mirtazapine
moclobemide
reboxetine
SNRI e.g. venlaxafine, duloxetine
TCA e.g. amitriptyline
```
235
when to take antidepressants for >2 years (usually 6+ months)
2+ depressive episodes
236
3 types of partial seizures
simple
complex
secondary generalised
237
lobe of brain in complex partial seizures
temporal
238
2 features of simple partial seizures
conscious
| weakness of limbs (Todd's paralysis)
239
duration of complex partial seizures
>30 seconds
240
consciousness level in complex partial seizures
decreased
241
4 symptoms of complex partial seizures
deja vu/jamais vu
vertigo
hallucinations
tachycardia
242
3 signs of tonic phase in tonic clonic
rigidity
incontinence
hypoxia
243
3 signs of clonic phase in tonic clonic
convulsing
eye rolling
tachycardia
244
ECG in absence seizures
3Hz spike
245
2 features of absence seizures
conscious but unresponsive
| muscle jerking
246
why do do bloods for seizures
diabetes?
247
1st line treatment for status epilepticus
benzos
248
2nd line treatment for status epilepticus
phenobarbital
249
3rd line treatment for status epilepticus
phenytoin IV
250
2 drugs for absence seizures
ethosuximide
| sodium valproate
251
what drug not to use for absence seizures
phenytoin
252
1st line treatment for partial seizures
carbamazepine
253
1st line treatment for generalised seizures
sodium valproate
254
definition of chronic migraine
15+ days per month, or 8+ if other symptoms, includes menstrual migraine
255
mnemonic for remembering triggers or migrinaes
CHOCOLATE
```
Ch = chocolate and cheese
O = OCP
C = caffeine/withdrawal
Ol = alcohol
A = relaxation
T = travel
E = exercise
```
256
4 diagnostic criteria of migraines if there is no aura
5+ attacks
no secondary cause
2+ of unilateral pain, pulsing, from decreased activity
1+ of N+V, photophobia, phonophobia
257
6 symptoms of migraine aura
```
depression
tiredness
stiff neck
food cravings
visual disturbance
sensory symptoms (moving from hands to arms then face)
```
258
3 types of drugs for migraine during an attack
antiemetics e.g. metoclopramide
5-HT agonists
anticonvulsants e.g. lamotrigine
259
3 prophylactic drugs for migraines
antihistamines
propanolol
amitriptyline
260
most common cause of SAH
aneurysm rupture
261
3 complications of SAH
TIA/stroke (from vasospasm)
secondary hydrocephalus
re-bleeding (<7 days)
262
what is sentinel headache
headache prior to SAH in 6%
263
5 grades of SAH
```
1 = no signs
2 = neck, CN
3 = drowsy
4 = hemiplegia
5 = coma
```
3-5 = 50% mortality
264
CT result in SAH
star-shaped lesions
265
drug to use in SAH to decrease vasospasm
CCB - e.g. nimodipine
266
mnemonic for causes of peripheral neuropathy
```
DAVID:
D - diabetes
A - alcohol
V - vit B12 deficiency
I - infection/inherited
D - drugs
```
267
drug causing peripheral neuropathy
isoniazid
268
2 inherited disorders causing peripheral neuropathy
Guillain Barre
| Charcot-Marie-Tooth
269
2 biopsies for peripheral neuropathy
nerve
| skin
270
4 treatments for peripheral neuropathy
anticonvulsants e.g. gabapentin
TCAs
elastic stocking
self-catheterisation
271
4 bacteria causing chronic cervical lymphadenopathy
non-TB mycobacteria
TB mycobacteria
Bartonella
toxoplasma gondii
272
what can connective tissue disorders cause in the neck
cervical lymphadenopathy
273
why do serology in cervical lymphadenopathy
cat scratch?
274
why do tuberculin test in cervical lymphadenopathy
TB - chronic
275
antibiotic for CL
clindamycin
276
what is Kernig's sign (meningitis, SAH)
cant straighten leg when hip at 90 degrees
277
what is Brudzinskis sign (meningitis)
hips and knees flex when neck is flexed
278
4 viruses causing viral meningitis
herpes
mumps
echo
influenza
279
3 bacteria causing meningitis when 0-3 months
E. coli
group B strep
Listeria
280
3 bacteria causing meningitis when 3 months +
n. meningitidis (meningococcal)
s. pneumoniae
h. influenzae
281
2 features of meningococcal meningitis
cold peripheries
| no fever or increased WCC
282
when to give prophylaxis for meningococcal meningitis
rifampicin to household contacts of patient
283
4 cancers causing malignant meningitis
leukaemia
lymphoma
breast (met)
bronchial (met)
284
lumbar puncture results in viral vs bacterial meningitis
```
viral = lymphocytes (colourless)
bacterial = polymorphs
```
285
type of antibiotic for bacterial meningitis
3rd gen cephalosporin - e.g. cefotaxime, cephalexin IV
286
drug to lower risk of complications of bacterial meningitis
dexamethasone
287
4 complications of bacterial meningitis
hearing loss
vasculitis
cerebral infarct/abscess = epilepsy
hydrocephalus/subdural effusion
288
type of drugs causing drug-induced Parkinsonism
tranquillisers for psychosis
289
2 toxins causing Parkinsonism
CO
| carbon disulphide
290
Hz of resting tremor in PD
4-6
291
gait in PD
festinating
292
what is PD dementia
1+ year after onset of PD
293
6 diagnostic criteria for PD alongside exclusion criteria
```
unilateral
rest tremor
progressive
response to L-dopa
hyposmia
visual hallucinations
```
294
isotope scan for PD
daTSCAN
295
2 dopadecarboxylase inhibitors for PD
carbidopa
| cocareldopa
296
example of a dopamine agonist for PD
apomorphine
297
2 MOA inhibitors for PD
selegiline
| rasigiline
298
most common cause of infarct stroke
arterial embolism (usually carotid, sometimes heart valves)
299
drug causing infarct stroke
cocaine
300
5 other causes of infarct stroke
```
venous/fat/air infarct
MS
mass lesion
migraine
amyloidosis
```
301
inherited cause of stroke
cadasil (defective NOTCH3 gene)
302
what is a lacunar infarct
deep artery infarct stroke
303
4 symptoms of lacunar infarct
aphasia
hemiparesis
hemisensory loss
unilateral ataxia
304
what is Webers syndrome
infarct on one side of midbrain
305
2 symptoms of Webers syndrome
ipsilateral CNIII paralysis
| contralateral hemiplegia
306
why do ESR for stroke
check for GCA
307
3 treatments for ischaemic stroke
thrombolysis OR aspirin
dipyridamole
carotid entarterectomy
308
3 optic signs of MS
neuritis
disc swelling
RAPD
309
what is Uthoffs phenomenon
MS symptoms worse on hot days
310
what is Lehrmitte sign
MS - electric shock on flexing head
311
CSF result in MS
oligoclonal bands
312
VEP result in MS
lesions in visual pathway
313
diagnostic criteria for MS
1+ attack and >1 plaque MRI
OR
1 attack, >1 plaque MRI and VEP etc.
314
3 drugs for preventing MS relapse
beta interferon
natatizumab
baclofen
315
drug to use during an acute MS attack to induce remission
steroids
316
what can spermicide, DM and pregnancy increase risk of
cystitis
317
2 postmenopausal syndromes which are DDs for cystitis in women
atrophic vaginitis
| urethritis
318
when to do urine culture for cystitis
high risk
| male
319
3 times to refer for cystitis
haematuria
women with recurrence
men 2+ 2 months
320
3 complications of asymptomatic bacteruria in pregnancy
UTI
preterm delivery
anaemia
321
1st line treatment for adults with pyelonephritis
ciprofloxacin/co-amoxiclav 7 days
322
1st line treatment children with pyelonephritis
co-amoxiclav
323
2nd line treatment children with pyelonephritis
cefixime
324
when to give prophylactic trimethoprim for pyelonephritis
women 3+ per year
325
USS result chronic pyelonephritis
thin and small
326
3 IV pyelogram results chronic pyelonephritis
small
dilatation
cortical scarring
327
t99m result chronic pyelonephritis
scars
328
what can secondary hypertension, CKD and pyonephrosis be a complication of
chronic pyelonephritis
329
urine test result hydropnephrosis
haematuria
330
definition of AKI
<0.5ml/kg/hr for 6+ hours
| increased creatinine and urea
331
most common type of AKI
pre-renal
332
3 causes of pre-renal AKI from hypotension
septic shock
LVF
anaphylaxis
333
3 causes of pre-renal AKI from oedema
HF
cirrhosis
nephrotic syndrome
334
3 causes of pre-renal AKI from hypoperfusion
NSAIDs, ACEis, ARBs
AAA
renal artery stenosis
335
8 signs of AKI
```
increased BP
large painless bladder
postural hypotension
oedema/pulmonary oedema
increased JVP
pallor/bruising
vascular disease/emboli/DIC
pericardial rub
```
336
what can be a cause of metabolic acidosis and hyperkalaemia
AKI
337
what can use of iodinated contrast agents increase risk of
AKI (if also unwell)
338
when to do doppler USS renal artery and veins
AKI
339
7 causes of CKD
```
arteriopathic renal disease
hypertension
high calcium
glomerulonephritis
SLE
DM
neoplasms, myeloma
```
340
drugs increasing risk of CKD
chronic NSAIDs
341
derm symptom of CKD
pruritus
342
4 groups of signs of CKD
- skin: pigmentation/pallor
- BP: hypertension, PH
- heart: LVH, peripheral oedema, pleural effusions
- neuro: PVD, peripheral neuropathy, RLS
343
Ca2+ result in CKD
decreased
344
Phosphate and PTH result in CKD
increased
345
5 urinalysis results in CKD
```
proteinuria
haematuria
glycosuria
WCC
decreased creatinine clearance
```
346
why use statins in CKD
for CVD
347
what is renal replacement therapy
dialysis + transplant
348
symptom score for BPH
international prostate symptom score (IPSS) - 0-7 = mild, 8-19 = moderate, 20-35 = severe
349
width of prostate in BPH
2+ fingers
350
cut off PSA values
40-49 = 2
50-59 = 3
60-69 = 4
70+ 5
screening 50+
351
e.g. of an alpha-adrenergic antagonist for BPH
tamsulosin for IPSS >8
352
2 e.g.s of 5-alpha reductase inhibitors for BPH
finasteride
| dutasteride
353
gene increasing risk of prostate cancer
BRACA
354
what can haematospermia, symptoms of AKI/CKD, impotence and tenesmus be a symptom of
locally invasive prostate cancer
355
where can prostate cancer met to
bones = bone pain/sciatica
356
why can prostate cancer cause loin pain/anuria
LN obstruction of ureter if metastatic
357
what is palpable in DRE for prostate cancer
seminal vesicles
358
urine test for prostate cancer
PCA3
359
what does TRUS show in prostate cancer
hypo echoic area in preipheral zone
360
grading system for PC
gleason
361
gold standard anti-androgen therapy for PC
bilateral orchiectomy - castration
362
2 drugs for anti-androgen therapy for PC
enzalutamide
| abiraterone + prednisolone
363
composition of struvite stones
magnesium ammonium phosphate
364
what can sarcoidosis cause
hypercalcaemia
365
when to do USS For kidney stones
pregnancy (otherwise non-contrast CT)
366
2 smooth muscle relaxants for kidney stones
alpha receptor blockers (tamsulocin)
| CCBs (nifedipine)
367
treatment if kidney stones dont pass
extracorporeal shock wave lithotripsy
368
3 syndromes associated with RCC
cushings
hypercalcaemia (PTH)
polycythaemia (erythropoietin)
369
cancer syndrome associated with RCC
von hippel lindau
370
most common risk factor for RCC
smoking
371
why can RCC cause anaemia
tumour suppresses EPO = increased ESR
372
why can RCC cause hypertension
renin secreted by tumour
373
4 carcinogens for UCC
smoking
arylamines
cyclophosphamide
radiotherapy
374
most common sign of UCC
painless haematuria, negative for bacteria
375
treatment of bladder tumours depending on tumour size
```
pTa = transurethral resection
pT1 = immunotherapy (intravesical BCG)
pT2+ = radical cystectomy (<70), radiotherapy (>70)
```
376
2 bacteria causing HAP
gram -ve bacilli
| s aureus
377
bacteria causing pleural rub in pneumonia
s. pneumoniae
378
CURB score
```
confusion (AMTS <8)
urea >7
RR >30
BP <90/<60
>65
```
>3 = severe, IV abx
379
4 lung complications of pneumonia
pleural effusion
empyema
lobar collapse
pneumothorax
380
cause of PSP
rupture of pleural bleb - congenital
381
connective tissue disorder increasing risk of PSP
marfans
382
3 signs of all pneumothorax
decreased breath sounds
hyper resonance
hypoxia no hypercapnia
383
complication of tension pneumothorax
cardiac arrest
384
3 haemodynamic signs of tension pneumothorax
hypotension
tachycardia
increased RR
385
type of alkalosis in pneumothorax
respiratory
386
treatment of PSP (>2cm and SOB) and secondary pneumothorax
O2
chest drain
aspiration then chest drain if unstable
387
treatment of tension pneumothorax
aspirate before CXR and chest tube ASAP
388
difference between transudate and exudate pleural effusion
```
transudate = not inflammation, protein <25m/L
exudate = inflammation, protein >35g/L
```
determine using pleural aspiration/tap
389
4 causes of transudate pleural effusion
hypoalbuminaemia
Meig's syndrome
hypothyroidism
cardiovascular (overload, HF, constrictive pericarditis)
390
3 causes of exudate pleural effusion
inflammation e.g. RA, SLE, infarction
malignancy
infection
391
1 infection causing chronic exudate pleural effusion
TB
392
horizontal pleural effusion?
coexisting pneumothorax
393
2 causes of high amylase in pleural effusion
carcinoma
| pancreatic disease of oesophageal rupture
394
treatment for exudate effusion
treat cause and drain (dont drain for transudate)
395
surgical treatment for exudate effusion
pleurodesis - pleural spaces removed and stuck together with tetracycline, talc or bleomycin drugs
396
4 types of bronchial carcinoma
small cell
adeno
squamous
large cell
397
cells causing small cell BC
endocrine (Kulchitsky) - secrete polypeptides
398
cells causing adeno BC
mucous cells in bronchial epithelium
399
why does squamous BC cause infection and hypercalcaemia
obstructs bronchus
400
why does large cell BC met early
less differentiated version of SCC and adeno
401
3 endocrine complications of small cell BC
bad ADH secretion = hyponatraemia
ectopic ACTH = cushings
hypercalcaemia (PTH
402
3 neurological complications of BC
polyneuropathy
cerebellar degeneration
Lambert-Eaton
403
does small cell BC cause clubbing
no
404
2 signs OE if BC is in large bronchi
lung collapse
| obstructive emphysema
405
when can't you operate BC
if in the 1st 2cm of the main bronchi
406
chemotherapy for small cell BC
cyclophosphamide + doxorubicin + vincristine + etoposide
OR
cisplatin + radiotherapy
407
is T1 and T2 BC operable
yes
408
2 chemo drugs for T4 BC
gemcitabine
| carboplatin
409
blood test result in acute asthma
peripheral blood eosinophilia
410
FEV1/FVC ratio in acute asthma
>15% improvement + volume increase of >200ml after beta 2 agonist
411
2nd step in asthma treatment
inhaled steroid 200-800mcg/day beclomethasone (+ SABA)
412
3rd step in asthma treatment
add on therapy (LABA) not in addition to inhaled steroid - add steroid if doesn't help
413
what to do if 3rd step asthma treatment doesnt work
leukotriene receptor antagonist or sustained release theophylline
414
4th step in asthma treatment
increase steroid to 2000mcg/day and/or add 4th drug (leukotriene receptor antagonist, SR theophylline or beta 2 agonist tablet)
415
5th step in asthma treatment
oral steroids + inhaled
416
investigation for Wells 2+
CTPA (D-dimer if <2)
417
what can chronic thromboembolic pulmonary hypertension (complication of PE) cause
HF
418
type of shock in PE
cardiogenic
419
why can PE cause pyrexia
WBC break down clot
420
3 heart sounds in PE
gallop heart rhythm
widely split 2nd heart sound
tricuspid regurgitant murmur
421
ECG in PE
might have ST depression
422
what is alpha-1 antitrypsin deficiency a risk factor for
COPD
423
spirometry result in COPD
FEV1/FVC <0.7 post-bronchodilator
FEV1 <80%
424
4 classifications of COPD
```
1 = mild - FEV1 >80%
2 = moderate - FEV1 50-79%
3 = severe - FEV1 30-49%
4 = very severe - FEV1 <30% or <50% and respiratory failure
```
425
dyspnoea scale for COPD
MRC (1-5)
426
what can secondary polycythaemia be a complication of
COPD
427
2 vaccines to give in COPD
pneumococcal
| influenza
428
treatment for COPD if exacerbations despite SABA and FEV1 <50%
LABA + inhaled steroid (prednisolone 30mg/day for 7-14 days), or LAMA
if still = LAMA and LABA + inhaled corticosteroid
429
when to use theophylline for COPD
after SABA/LABA or can't inhale
430
FEV1/FVC in pulmonary fibrosis
>80% - decreased compliance (restrictive)
431
4 Ds in the symptoms of pulmonary fibrosis
dry cough
dyspnoea
digital clubbing
diffuse inspiratory crackles
432
2 treatments for pulmonary fibrosis
prednisolone - high dose 6 weeks then reduce
| immunosuppression including azathioprine and cyclophosphamide and steroids
433
cause of secondary varicose veins
pelvic/abdominal masses
434
3 symptoms of varicose veins
prutitus
night cramps, heavy, aching
RLS
435
5 complications of varicose veins from venous hypertension
```
oedema
venous ulceration
pigmentation
lipodermatosclerosis
varicose eczema
```
436
2 examinations for varicose veins
cough impulse - saphenofemoral junction
| trendelenbergs
437
investigation for varicose veins
colour doppler venous scans
438
screening for AAA
one USS for men 65+
439
weird risk factor for AAA
not having diabetes
440
what can hydronephrosis and limb ischaemia (embolism?) be a sign of
unruptured AAA
441
when to do AAA surgery
ruptured/rapid expansion or >5.5cm
442
4 drugs to reduce expansion/monitor AAA
doxycycline/erythromycin
ACEIs/ARBs
statins
low dose aspirin
443
4 infections causing AAA
brucellosis
salmonellosis
TB
HIV
444
2 inflammatory disorders causing AAA
Behçets
| Takayaus
445
3 signs of AAA on CT
mural thrombus
crescent sign (imminent rupture)
para-aortic inflammation
446
what is Leriche syndrome
erectile dysfunction from PVD
447
main test for diagnosing PVD
doppler USS
448
ABPI values for PVD
0.6-0.9 = claudication
0.3-0.6 = rest pain
<0.3 = gangrene
449
2 tests to do for PVD if under 50 years old
thrombophilia screen
| serum homocysteine levels
450
condition associated in 60% of people with PVD
CHD
451
most common valvular disease
aortic stenosis - hypertrophy + dilatation
452
murmur in aortic stenosis
ejection systolic
453
3 causes of aortic stenosis
<65 = calcified bicuspid valve
>65 = senile calcification
rheumatic fever/congenital
454
4 risk factors for aortic stenosis
age
congenital bicuspid valve
rheumatic disease
CKD
455
9 symptoms of aortic stenosis
```
angina
exertional dyspnoea
chest pain
syncope
plateau pulse
narrow pulse
low systolic BP
heave apex
systolic thrill + radiation to carotids
```
456
treatment for aortic stenosis stable vs unstable
```
stable = valve replacement
unstable = valvuloplasty
```
457
why are most drugs contraindicated in aortic stenosis
vasodilatory effects
458
3 complications of aortic stenosis
CHF
prosthetic valve infection
thrombosis (mechanical valve)
459
murmur in aortic regurgitation
diastolic murmur
460
6 causes of aortic regurgitation
```
bicuspid valve (most common)
infective endocarditis
rheumatic fever
arthropathies
aortic stenosis
Marfans
```
461
9 symptoms of aortic regurgitation
```
dyspnoea
orthopnoea
PND
mottled extremities
increased JVP
lung crepitations
head bobbing
collapsing pulse
wide pulse pressure
```
462
3 treatments for acute regurgitation
inotropes
vasodilators
aortic valve replacement
463
3 treatments for chronic regurgitation
reassure
vasodilator
TAVI (transcatheter aortic valve replacement)
464
murmur in mitral stenosis
diastolic murmur (more common than mitral regurgitation)
465
3 heart features in mitral stenosis
congestion
decreased cardiac output
right ventricular overload
466
5 risk factors for mitral stenosis
```
streptococcal infection
female
rheumatic fever
small volume AF
pulmonary hypertension
```
467
6 symptoms of mitral stenosis
```
malar flush
dyspnoea on exertion
orthopnoea
PND
cough
haemoptysis
```
468
5 differentials for mitral stenosis
```
obstruction
atrial myxoma
cardiomyopathy
atrial regurgitation
tricuspid stenosis
```
469
3 treatments for mitral stenosis
valve repair
diuretic
anti-coagulants
470
3 complications of mitral stenosis
AF
stroke
IE
471
murmur in mitral regurgitation
pan systolic murmur (throughout systole - merge over 2nd heart sound)
472
5 casues of mitral regurgitation
```
rheumatic fever
floppy valves (prolapse?)
rupture after infective MI
hypertrophic cardiomyopathy
connective tissue disorders
```
473
6 symptoms of mitral regurgitation
```
exertional dyspnoea
palpitations
fatigue
extremity oedema
pulmonary oedema
bibasal fine crackles?
```
474
5 DDs for mitral regurgitation
```
ACS
IE
mitral stenosis
aortic stenosis
atrial myxoma
```
475
5 treatments for. mitral regurgitation
surgery
diuretics
chronic = ACEis, BB, surgery
476
3 complications of mitral regurgitation
pulmonary hypertension
LV dysfunction
CHF
477
diagnostic criteria for infective endocarditis
Duke's
478
most common organism in IE
staph aureus
479
3 organisms in IE if own valve
viridians group strep
S. aureus
enterococci
480
3 organisms in IVDU IE
s aureus
strep
gram negative bacilli
481
3 organisms in prosthetic valve IE
coagulase negative staph
s aureus
enterococci
482
symptoms in IE (FROM JANE)
F - fever
R - roth spots
O - oslers nodes
M - murmur (new)
J - janeway lesions
A - anaemia
N - nails (splinter haemorrhages)
E - emboli
483
blood cultures to do in IE
3 sets 1 hour apart before abx
484
3 differentials for IE
rheumatic fever
atrial myxoma
Libman-Sacks endocarditis (SLE)
