1
Q
What is tested for in the newborn blood spot screening?
A
2
Q
When is dysfunctional uterine bleeding more common?
A
Around the menarche and perimenopause
3
Q
Medical and surgical management options for dysfunctional uterine bleeding?
A
MEDICAL:
- First line: Levonorgestrel IUS if long term use (12 months) is anticipated
- Second line: TXA or NSAID or COCP
- Third line: Norethisterone 15mg OD from days 5-26 of the menstrual cycle or injected long acting progestogens
SURGICAL:
- Endometrial ablation
- Hysterectomy
SURGICAL
4
Q
A
5
Q
What is the difference between primary and secondary post parts bleeding?
A
Secondary occurs 24 hours AFTER delivery
Primary is around the time of childbirth and is set at losses > 500mls within 24 hrs of delivery
6
Q
Causes of secondary post party haemorrhage?
A
- RPOC
- Displacement of blood clot
- Infection
- Abnormal involving of placental site
- Choriocarcinoma
Note offensive discharge PV implies an infectious aetiology
7
Q
What is the management of secondary post party haemorrhage?
A
Broad spectrum abx whilst awaiting culture results from a HIGH VAGINAL SWAB
If there is heavy PV bleeding, a tender uterus with an open os, or ultrasound findings RPOC - OBSTETRIC EXPLORATION SURGICALLY
8
Q
Most common side effect of progesterone only pills?
A
Irregular vaginal bleeding
9
Q
What is the terrible triad in knee injury?
A
ACL,MCL and medial meniscus tears involving a valgus stress to the knee from a contact injury or high velocity trauma
10
Q
Which examination test is most sensitive in testing for ACL injury?
A
Lachmans test - on pulling anteriorly on the tibia, anterior translation of the tibia associated with a soft or mushy endpoint indicates a positive test
11
Q
What are the 2 most common types of patellar fracture?
A
- Stellate
- Transverse
12
Q
What examination helps differentiate the type of patellar fracture? And how so?
A
Straight leg test to assess the extensor mechanism. Displaced, transverse fracture results in inability to straight leg raise (also a feature of quadriceps tendon or patellar tendon)
13
Q
What is the management of patellar fracture?
A
Depends on fracture configuration. Ranges from POP immobilisation to ORIF
14
Q
2 mechanisms of injury for tibial plateau fractures?
A
- Most common - fall from height
- ‘Bumper fracture’ - knee struck violently from the side
15
Q
What is the investigation and management of suspected tibial plateau fractures?
A
- CT to assess the severity of comminution or depression
- SPECIALIST input from ortho - this is a complex fracture
16
Q
Both loop diuretics and corticosteroids can cause which electrolyte abnormality?
A
Hypokalaemia
17
Q
What age do epidermal cysts typically present?
A
40
18
Q
Presentation of epididymal cyst / examination finding?
A
- Often multiple and bilateral
- Fluctuant and transilluminate
- Testis is palpable SEPARATELY to the cyst (unlike hydrocoele)
19
Q
Management of epididymal cysts?
A
Treatment not necessary - safety net if increasing in size or become painful - Can treat with sclerotherapy or surgical excision
20
Q
A
21
Q
25M punched, presents to A&E with no improvement in pain. He is unable to oppose his teeth properly and has numbness over the left side of his chin. Which nerve is likely affected?
A
Mental nerve - supplies sensation to the chin and lower lip
22
Q
What is the most common lung injury following blunt chest trauma?
A
Pulmonary contusion
23
Q
A
24
Q
Etiology of lichen simplex?
A
It is not a primary process
Due to mechanical trauma to the point of lichenification e.g. scratching an itchy area
Most common initial cause is eczema - others e.g. insect bites, scars, venous insufficiency
25
Presentation of lichen simplex?
Localised demarcation plaque, usually with scaling, excoriating and lichenification
Lesion is itchy
Common sites - calf, elbow, behind neck and genitalia
Plaques usually > 5cm in diameter
26
Treatment options for lichen simplex?
Potent topical steroids
Tar
Ichthyol preparations
Occlusion dressings
Oral antihistamines
Intralesional steroid injections may be considered in most cases
27
Typical patients in whom otosclerosis presents?
- Female
- Presenty by the early Third decade of life
- Pregnancy and oestrogen therapy
- Family history
28
Otosclerosis - mostly unilateral or bilateral? Conductive or SSNHL? Finding on otoscopy?
- Bilateral in 70%
- Conductive hearing loss often to low volume speech - can perceive their own voices louder
- Otoscopy NAD
29
What is the management of otosclerosis?
Hearing aids early on
Stapedectomy eventually
30
28F presents at 32 weeks gestation with light vaginally bleeding. She is Rhesus D negative and has not received anti-D immunoglobulin during this pregnancy. How to manage? Do a kleihauer test?
No, give 500IU of anti-D immunoglpbulin within 72 hours
Any vaginal bleeding in a rhesus D negative pregnant woman is a potential sensitive event
Kleihauer test is used to quantify the volume of faetomatrnral haemorrhage to determine if additional doses of anti-D are required. Shouldn't delaybinitial administration of anti-D
31
What is the role of the Kleihauer test?
Kleihauer test is used to quantify the volume of faetomatrnral haemorrhage to determine if additional doses of anti-D are required. Shouldn't delaybinitial administration of anti-D
32
Indications for when a secondary cause of hypertension should be suspected warranting further investigation?
- < 40yrs
- Low K and high Na (suggests adrenal disease)
- High serum creatinine or low GFR < 60 suggesting renal or renovascular disease
- Proteinuria or haematuria (after exclusion of haematuria)
- Sudden onset, labeled or worsening of hypertension
33
Dislocation of the patella is common in what group of people?
Adolescent girls
34
How does dislocation of the patella present? How is the knee kept - in what position? Where does the patella often displace?
Knee held in flexion with lateral displacement of the patella
35
What does suckling do to uterine contractions?
Increases uterine contractions, thereby reducing incidence of post party haemorrhage
36
When is wayfaring preferred over DOACs in AF anticoagulation?
- eGFR < 30ml/min
- Significant liver dysfunction
- Weight > 120kg
37
List drugs that can cause lichenpid eruptions
- ACEis
- NSAIDs
- Methyldopa
- Chloroquine
- Oral antidiabetics
- Thiazide diuretics
- Gold
38
What is the typical appearance of red degeneration of fibroid on ultrasound?
Mixed echodense or echoluscent appearance
39
When does red degeneration of fibroid occur?
Between 12-20 weeks gestation
40
For how long should antidepressants be continued?
For at least 6 months after RECOVERY of symptoms
41
Key difference in Tietze's vs costochondritis?
Tietze's is characterised by swelling of the costal cartilages, while in costochondritis there is no swelling
42
Which oral antidiabetic medication is contraindicated in heart failure?
Pioglitazone. Worse when combined with insulin also
43
Pioglitazone is contraindicated in which two conditions?
Heart failure
Active bladder cancer / history of bladder cancer / uninvestigsted macroscopic haematuria
44
Management of cat scratch disease?
Supportive therapy with antipyretics / analgesics and local heat
Aspiration avoided but may be needed
Usually self limiting in immunocompetent individuals, lymph nodes typically regress over weeks / months without abx
Abx if needed - trimerhoprim-sulfamethoxazole, cipro or azithromycin
45
Which electrolyte abnormality causes j-waves?
Hypercalcaemia
46
47
What is the minimum observation period following recovery from an anaphylactic reaction?
6 hours - this is because biphasic reactions can occur
48
Holmes Adie vs Argyll Robertson pupil - which is large and which is small?
Holmes Adie - large
Argyll Robertson - small
49
What is the condition that describes a large irregular pupil that constricts slowly to light but accommodates normally?
Holmes Adie pupil
50
Features in glucagonoma?
'4D syndrome'
- Diabetes
- Dermatosis- necrolytic migratory erythema - painful and purification erythematous lesions which enlarge and coalesce to form bullous lesions - widespread
- DVT in 50%
- Depression in 50%
Also diarrhoea, weight loss
51
52
Where is the fracture site in a Bennett fracture? What is the mechanism of injury?
Intra-articular fracture-dislocation base of the first metacarpal
Axial loading of a partially flexed thumb - contact sports e.g. rugby
53
What differentiates Bennetts fractures from other fractures of the thumb base?
Fracture line extending into the first carpometacarpal joint. A small volar-ulnar fragment remains attached to the trapezium via the oblique poster medial ligament, while the larger metacarpal shaft is displaced dorsoradially under the influence of the abductor pollicus longus. This distinguishes it from other base of thumb fractures e.g. Rolando fractures, which are comminuted
54
What is the management of Bennett's fractures?
Prompt orthopaedic referral - surgical fixation urgent to restore joint congruent and minimise the risk of photos traumatic arthritis and chronic CMC instability
55
Incarcerated hernias cause small or large bowel obstruction?
Small bowel obstruction
56
Mild microcytic anaemia with compensatory increase in RBCs in an Asian lady - diagnosis?
Thalassemia trait
57
True or false, amiodarone can cause corneal deposits?
True
58
The following are features of wet or dry AMD:
1) Drusen
2) Choroidal neovascularisation
3) Geographic atrophy
1) Drusen - Dry AMD
2) Choroidal neovascularisation - Wet AMD
3) Geographic atrophy - Dry AMD
59
What is mortons neuroma etiology and where does it affect?
Irritation of an interdigital nerve by compression between metatarsal heads often in tighty fitting footwear
Commonest sites between the 3rd and 4th metatarsal heads
60
What imaging can be useful in suspected Morton's neuroma?
Ultrasound
61
What is an examination finding in Morton's neuroma?
Squeezing the metatarsal heads together elicits a painful click (Mulder's click)
62
Management of intermittent claudication in PAD?
First line is supervised exercise programme
If no improvement then consider naftidofuryl oxalate
Clopidogrel or other antiplatelet for secondary prevention in PAD
63
What is the main advantage of active over passive immunity?
Antibody persists for a longer period
64
Which organism is the most common cause in septic arthritis?
Staphylococcus Aureus
65
Features of floppy iris syndrome, and it is a complication of what?
- Iris billowing
- Prolapse
- Progressive miosis
Complication of cataract surgery
66
Floppy iris syndrome is a complication associated with cataract surgery and also strongly associated with which drugs?
Alpha-1 adrenergic antagonists especially tamsulosin
67
Which part of the large bowel is the commonest site for a colorectal carcinoma?
Rectum
68
Clinical presentation of tobacco-alcohol amblyopias?
Central loss of colour vision
Optic atrophy in severe cases
69
Management of tobacco-alcohol amblyopia?
It is thought to be a nutritional cause so adequate nutrition with additional thiamine, folic acid and vitamin b12 may reverse this
70
Causes of livedo reticularis?
- RA
- SLE
- PAN
- Lymphoma
- TB
- Polymyositis
- Raynaud's
71
What is the most common early neuro sign in Wilson's?
What is the common presentation in general?
Asymmetrical tremor
Severe depression or various neurotic behavioural patterns
72
True or false active breast cancer is a means for classifying a dvt as provoked?
False - provoked is if it occurs in the presence of a TRANSIENT risk factor, active cancer is not transient or correctable so its unprovoked technically
73
Characteristic skin colour in carbon monoxide poisoning?
Cherry red skin colour
74
Mechanisms of injury in calcaneal fractures?
Fall from height usually >/= 6 feet
Motor vehicle collisions
Impact on a hard surface while running or jumping
Avulsion injuries with abrupt contractions of the Achilles tendon
Overuse injury or stress fracture in athletes
75
Presentation of calcaneal fractures?
Characteristic sign?
Pain, oedema, ecchymosis, deformity of the heel or plantar arch, inability to weight bear on the injured foot
Mondor sign - bruising that tracks dismally to the sole of the foot
76
Treatment of calcaneal fractures?
Non-operative- cast immobilisation
Operative - closed reduction with percutaneous pinning, ORIF, primary subtalar arthrodesis
77
Typical age for menières disease and more common in men or women?
35-55 years
Men=Women
78
Menières typically unilateral or bilateral?
Mostly unilateral - bilateral in 15%
79
Management of Menières, including wha than be used during an acute attack and then vermeer attacks as prophylaxis
Lie down on firm surface and stay motionless as possible
Cinnarizine and prochlorperazine during acute attacks
Betahistine as prophylaxis
Surgery reserved for patients with severe menieres disease refractory to medical treatment
80
Which of the following antihypertensive drugs, when used in conjunction with simvastatin, restricts the maximum recommended daily dose of simvastatin to 20mg only?
A) Amlodipine
B) Bendroflumethiazide
C) Ramipril
D) Losartan
E) Methyldopa
A) Amlodipine
Amlodipine is a weak inhibitor of CYP3A4
N.b fluvastatin, pravastatin and rosuvastatin are not metabolised by CYP3A4 so no interaction
81
True or false, enterohaemorrhagic E.Coli is a notifiable disease?
True
82
Treatment of pericarditis is it:
A) Colchicine for three months
B) No treatment
C) NSAIDs for three months
D) NSAIDs until symptomatic resolution along with colchicine for three months
E) Oral steroids for three months
D) NSAIDs until symptomatic resolution along with colchicine for three months
83
Haematuria is common in pyelonephritis in women?
Yes - haemorrhagic cystitis occurs in 30-40% of women , often young women
84
24M presents with a 5 day history of abdominal cramps and watery diarrhoea. His symptoms started three days after he ate a reheated takeaway meal. Between C.Jejuni and Bacillus Cereus - which is the most likely causative organism?
C.Jejuni - because remember that Bacillus has a v short incubation period of 2-12 hours vs 2-5 in C.Jejuni
85
Antiretroviral therapy, usually given as combination therapy has aims for what level for the following:
1) Viral load?
2) CD4 count?
Viral count - < 50 copies / ml
CD4 count - >
86
What is the screening test for latent TB in at risk groups and what is a positive test indicated by?
Mantoux test - inject tuberculin intradermmally and observe reaction 2-3 days later
Type 4 hypersensitivity reaction in those who have active TB or had a BCG vaccine
Induration > 6mm is positive
Following a positive result, further investigations warranted to diagnose or exclude active TB infection
87
According to NICE, how should all patients < 30 with a new breast lump be managed (not suspcious of malignancy - which would warrant a 2WW referral instead)?
Routine referral to the breast surgery team and they would do triple assessment
88
What is the Karyotype of Klinefelter's?
48, XXXY
89
What is the deletion in DiGeorge syndrome?
Deletion of 22q11
90
A new born baby girl with lymphoedema of the feet, and low hairline and small chin - likely diagnosis?
Turner's syndrome
91
Rocker bottom feet, dysplastic heart valves and oesophageal atresia are features of what syndrome and which chromosomal abnormality is this?
Edward's syndrome - Trisomy 18
92
Holoprosencephaly and cyclops are features of what syndrome and which chromosomal abnormality is this?
Patau sydndrome (trisomy 13)
93
Is catatonia a good or bad prognostic indicator in schizophrenia?
Good, weirdly
94
What is a good and what is a bad prognostic factor in schizophrenia between a rapid vs insidious onset of illness?
Sudden onset - good
Insidious onset - bad
95
96
True or false, Crohn's predisposes to AA amyloidosis?
True
97
Treatment of giardiasis?
Oral metro and supportive care
98
What can happen with the oxygen saturations in carbon monoxide poisoning?
Can be misleadingly high
99
Newborn boy presents with low-set ears, cleft lip and palate, polydactyly and micro-ophthalmia. He is diagnosed with a condition where survival beyond a few weeks is rare - diagnosis?
Patau syndrome
100
Why can new onset AF be a feature of PE sometimes?
Atrial flutter, atrial fibrillation and premature beats can occur in PE, and may imply right heart strain (in a more severe clinical picture). < 10% of cases
101
How is diagnosis of dermatitis herpetiformis confirmed?
Skin biopsy
Direct immunofluorescence
102
2 things in management of dermatitis herpetiformis?
* Gluten-free diet
* Dapsone
103
What abnormalities to the fetus can be caused by use of alpha-blockers in pregnancy?
* Fetal growth retardation
* Fetal bradycardia
* Neonatal hypoglycaemia (after delivery)
104
What abnormalities to the fetus / pregnancy complication can be caused by use of ACE inhibitors in pregnancy?
* Renal impairment
* Skull abnormalities
* Oligohydramnios
105
As the first step of PPI treatment when treating dyspepsia with no red flags, do you give one month trial of full dose PPI or long term low dose PPI?
One month trial of full dose PPI
106
Management of vitiligo?
* Apply sunscreen to areas of affected skin - due to increased UV exposure and cancer risk
* Camouflaging makeup
* OD potent topical steroids for up to two months if criteria met
* If only partial or no response to steroids after two months, referral to derm must be done
* May be a role for topical tacrolimus and phototherapy but caution in light-skinned patients
107
46M presents to GP with a painful swelling above his right testis. It developed over the last four weeks following a recent vasectomy. What is the most likely diagnosis?
Spermatocoele
This is a cystic dilation of the epididymal ducts and can occur after a vasectomy due to obstruction of sperm flow. It presents as a swelling above the testis and can be painful, especially if it becomes large or infected
Typically palpable as distinct from the testis and can be confirmed with ultrasound if needed. Usually benign and may not require treatment unless symptomatic
108
How is Rabies diagnosis investigated?
Clinical diagnosis
Or PCR test
(unless the index animal can be trapped, killed and biopsied)
109
Legionella is is gram +ve or -ve and what is the morphology?
Gram negative rod
110
What is the management for dialysis amyloidosis?
Renal transplantation
111
71F with CKD in her 6th year of haemodialysis. Visits GP with pain, numbness and tingling in both hands during the early hours of the morning. Also complains of stiffness in her shoulders, hips and knees - diagnosis?
Dialysis amyloidosis
112
A newborn baby girl is brought to the ED cyanosed, with no audible murmur and oligaemic lung fields on imaging. What is the most likely cardiac defect?
A) Dextrocardia
B) PDA
C) Pulmonary atresia
D) TGA
E) VSD
C) Pulmonary atresia
Pulmonary valve does not form properly, preventing blood flow from the right ventricle to the lungs. This results in cyanosis due to inadequate oxygenation of the blood. Absence of a murmur and oligaemic lung fields are indivative of severely reduced pulmonary blood flow. In such cases, maintaining a patent ductus arteriosus is vital to allow some blood to reach the lungs for oxygenation
113
Bulbar palsy carries a better or worse prognosis than ALS or progressive muscular atrophy in MND?
Worse
114
Progressive muscular atrophy in MND primarily affects lower or upper motor neurones?
Lower
115
Most common cause of Cushing's
Exogenous steroids
116
35M with long-standing HIV infection presents to the ophthalmology department with progressive visual deterioration. On examination, there are large, multiple cotton-wool spots in both eyes
CMV
CMV retinitis is an opportunistic infection. Presents with visual disturbances due to retinal involvement, characterised by 'pizza-pie' appearance of retinal lesions, which includes cotton-wool spots. Can lead to blindness
117
What might be seen on ophthalmoscopy in CMV retinitis?
'Pizza-pie' appearance of retinal lesions, which includes cotton-wool spots
118
How is sub-acute sclerosing panencephalitis diagnosed? What is it often secondary to?
Brain biopsy - elevated measles-specific immunoglobulin G in the CSF, brain biopsy may show inflammation and neuronal degeneration
Persistent measles infection
119
Wasting of thenar or hypothenar eminence in carpal tunnel syndrome?
Hypothenar eminence
120
Nails are yellow, slow-growing and onycholysis is present. This condition is often associated with lymphoedema - diagnosis?
Yellow nail syndrome
121
Which medication can cause blue-grey staining of the nails?
Minocycline
122
Which of the following is the most common cardiovascular abnormality in an adult patient with Marfan syndrome?
A) Aortic regurgitation
B) Aortic root dilatation
C) Mitral regurgitation
D) Mitral annular calcification
E) Aortic dissection
B) Aortic root dilatation
In 70-80% of cases of Marfan's
123
42M presents to the GP with proximal muscle weakness, without tenderness or fatigability. Diagnosis?
Myopathy - characterised by muscle weakness without tenderness or fatigability. It can be associated with various endocrine disorders, e.g. hyperthyroidism or Cushing's syndrome, and can also be drug-induced.
124
Complex regional pain syndrome is most commonly secondary to which 2 fractures?
* Colles' fracture
* Ankle fracture
125
How does complex regional pain syndrome present?
* Pain predominant
* Shiny skin, which may be acutely sensitive to touch
* On palpation the affected limb feels cold
* Limb is swollen, purplish in colour and may have increased sweating
* Trophic changes with loss of hair and changes in the nails
126
Management of complex regional pain syndrome?
* Specialist pain services
* CBT
127
Management in retinal artery occlusion?
* Reduce risk factors for atherosclerosis
* Optimise hypertension management
* Statins prophylaxis
* Low dose aspirin
* Carotid endarterectomy may be necessary depending on the degree of carotid occlusion and local policy
* Ophthalmic follow up in the eye department
* Referral to low vision aid clinics
* DVLA notification
128
Inheritance pattern of red-green colour blindness?
X-linked
129
Neonatal complications from parvovirus B19?
* Hydrops fetalis
* Hepatitis
* Severe anaemia
* Cardiac inflammation
* Maternal infection in the first trimester is associated with a 19% risk of fetal death
130
Neonatal complications of CMV?
* IUGR
* Microcephaly
* Ventriculomegaly
* Soft tissue calcification
131
Which sign is pathognomic on examination of the tympanic membrane in otosclerosis?
Schwartz's sign - pink tinge of the tympanic membrane
132
What is Schwartz's sign in the ear? What is it indicative of?
Pinke tinge to the tympanic membrane - otosclerosis
133
Treatment for cataracts?
Phacoemulsification
134
Treatment for thrombosed rectal haemorrhoids?
Thrombectomy. Surgical excision or incision and evacuation of the clot is typically performed within the first 72 hours to relieve symptoms rapidly
135
Which eye condition with change in pupil size is also associated with loss of deep tendon reflexes e.g. knee and ankle jerk reflexes?
Holmes-Adie syndrome
136
True or false, cystic fibrosis can lead to meconium ileus?
True
137
Is the hypotonia distal or proximal in duchenne muscular dystrophy?
Duchenne muscular dystrophy characterised by progressive muscular degeneration and weakness, particularly affecting the proximal muscles of the lower limbs. Hypotonia is evident in the hips, pelvic area, and thighs. This condition is due to mutations in the dystrophin gene, leading to muscle fibre damage and degeneration. The positive Gower's sign is indicative of proximal muscle weakness, a key feature of this disorder
138
Which organism is the most frequent cause of hospital acquired infections?
Staphylococcus Aureus
139
Difference between clinical presentation in IgE vs non-IgE mediated cows' milk protein allergy?
Eczematous rash - non-IgE mediated
Urticarial rash - IgE mediated
IgE mediated reaction would also occur immediately after milk was ingested
140
What monitoring is required in patients once commenced on ACEi's?
Urea and electrolytes every 12 months
141
Monitoring once started on statins?
Check LFTs and lipid profile at 3 months, check LFTs again at 12 months
Aim for a > 40% reduction in non-HDL cholesterol
142
Between seminoma and non-seminomatous germ cell neoplasia for testicular cancer, which ones are associated with a rise in AFP, and which are not?
Seminona - no rise in AFP
Non-seminomatous germ-cell neoplasia - rise in AFP
143
How soon should babies born after 36 weeks in the breech position undergo an ultrasound scan of the hips?
Before 6 weeks of age
144
In which condition is Zanamivir contraindicated and why, what about in mild form of this?
Severe asthma
Mild asthma - advised to keep a bronchodilator to hand
145
A newborn girl presents to the paediatric department with jaundice, a distended abdomen, organomegaly and microcephaly. What is the most likely diagnosis?
Congenital CMV infection
146
What is the investigation for gonorrhoea?
PCR testing of urine or swab
147
How is Brucellosis contracted? Travel to what region is typical?
* From animals or thorugh unpasteurised millk
* Middle East
148
Symptoms / signs of Brucellosis?
* Fevers
* Joint pain
* Hepatosplenomegaly
* Epididymo-orchitis
* Sacro-ilitis
149
30F complains of high fever at least daily for several weeks. She has painful, swollen small joints and a faint-pink, non-itchy rash on her trunk, most notable during fever. On examination, she has cervical lymphadenopathy and hepatosplenomegaly. What is the most likely diagnosis?
Adult Still's disease - rheumatic disease characterised by arthritis, recurrent feer and typical rash with unknown cause. Rash is typically non-itchy small spots that are salmon pink in colour, usually affecting the limbs and trunk and appearing more when the patient is febrile. Other associated features include sore throat. lymphadenopathy, hepatosplenomegaly, anaemia, raised WCC and pericarditis.
Treatment may include NSAIDs, steroids or biological agents
150
60F has corneal calcification, she also complains of thirst and is mildly confused. What is the most likely diagnosis?
Hyperparathyroidism
Calcific band keratopathy is the term used to describe the deposition of calcium in the cornea, which can be seen in hypercalcaemia.
Thirst and confusion are also symptoms of hypercalcaemia
151
BRCA-1 vs BRCA-2 mutations - in both list the cancers that are associated
BRCA-1 TSG on Chromosome 17 - breast cancer, ovarian cancer, prostate cancer, pancreatic and colorectal cancer
BRCA-2 TSG on Chromosome 13 - breast cancer, ovarian cancer, prostate cancer
N.b BRCA-2 is also associated with Fanconi anaemia
152
True or false, Fanconi anaemia is associated with BRCA-2 mutations?
True
153
Lithium is contra-indicated when also administered alongside which blood pressure medications?
ACEi's and diuretics - increase the risk of lithium toxicity due to renal dysfunction. NSAIDs decrease the renal excretion of lithium, thus increasing the plasma level, leading to toxicity. Therefore these medications are contraindicated with lithium
154
Acarbose mechanism of action?
Acarbose inhibits enzymes (glycoside hydrolases) needed to digest carbohydrates, specifically alpha-glucosidase enzymes in the brush border of the small intestine and pancreatic alpha-amylase
155
Features of Reye's syndrome?
* Acute encephalopathy
* Liver dysfunction
* Vomiting
156
25M presents to ED after jumping from a garage roof and injuring both heels. He also complains of low back pain and is tender over the first lumbar vertebra. What is the most likely diagnosis?
Vertebral burst fracture - typically occurs due to an acute hyperflexion injury with a loading force, such as a fall from height. The first lumbar vertebra is a common site due to the maximal force experienced there. These fractures can be unstable and may require urgent neurosurgical intervention, especially if there are signs of cauda equina syndrome. The presence of tender lumbar vertebrae and a history of trauma strongly suggest a burst fracture
157
How long is antibiotic prophylaxis with penicillin V required in sickle cell disease?
Lifelong
Amoxicillin can be used as alternative if patient needs coverage haemophilus influenzae B or erythromycin for penicillin allergy
158
4F brought to GP. 5 day history of abdominal pain and fever. She seems to have lost weight and has been waking in the night with night sweats for the last two weeks.
On examination there is a large palpable abdominal mass and splenomegaly. A urine dipstick is negative for blood, protein, leucocytes and nitrates.
Diagnosis?
Burkitt's lymphoma - a high grade B-cell non-Hodgkin's lymphoma. Affects children > adults. 3 types: endemic (equatorial africa, strongly associated with EBV and malaria), sporadic (europe, associated with EBV), and immunodeficiency associated (with HIV or immunosuppressant drugs)
Sporadic Burkitt's lymphoma typically presents with abdominal pain, ascites, an abdominal mass and splenomegaly. There may also be associated B-symptoms, such as fever, weight loss and night sweats
159
What is the treatment in endometriosis when it is unresponsive to NSAIDs, COCP or POP and are not suitable for surgical intervention?
Danazol
160
Which anti-hypertensive can cause gum hypertrophy?
Nifedipine
161
Heart complication in Q fever?
Endocarditis
162
Q fever is caused by what organism and what are the vectors?
Coxiella Burnetii. Often transmitted by ticks or through contact with cattle, goats and sheep
163
Presentation of Q fever?
Rare form of atypical pneumonia
Fever, flu-like symptoms
Dry cough 2-4 weeks after exposure
Hepatosplenomegaly and respiratory symptoms e.g. crepitations
164
Adult onset Still's disease presentation?
High spiking fevers, arthritis and salmon-coloured rash
It does not typically present with respiratory symptoms or hepatosplenomegaly following a tick bite
165
40M presents with severe thumb pain. Examination reveals swelling of the thenar emninence, palmar bruising and inability to move the thumb. Most likely diagnosis?
Bennett's fracture
Fracture at the base of the first metacarpal bone, presenting with swelling of the thenar eminence, palmar bruising and inability to move the thumb
Often results from axial loading on a partially flexed thumb, e.g. during sports activities
166
Treatment in Bennett's fracture?
* Immobilisation
* Surgical intervention to restore joint stability and function
167
50M presents with difficulty using his right arm, slow walking and occasional loss of balance. He has a broad-based gait, with cogwheel rigidity and resting tremor of his right arm. His BP i s140/80 sitting and 100/60 standing. Which of the following is the most likely diagnosis?
A) Idiopathic Parkinson's Disease
B) Multisystem atrophy (MSA)
C) Progressive supranuclear palsy (PSP)
D) Corticobasal degeneration
E) Drug-induced parkinsonism
B) Multisystem atrophy (MSA)
168
What is the inheritance pattern of sickle cell disease and what is the chromosome affected?
Autosomal recessive
Point mutation in the beta-globin gene on chromosome 11
169
Which hormones affected in craniopharyngioma the most classically, and what age of patients affected typically?
Growth hormone deficiency
Children 5-14
170
Which type of lung cancers are HPOA associated with and what are the symptoms?
Squamous cell carcinoma mostly, also pleural mesothelioma
Finger clubbing, painful symmetrical arthropathy involving the wrist, hand, ankle and knee joints
171
55F presents with a violaceous rash on her eyelids, associated orbital oedema and retinal haemorrhages. Which of the below is the most likely diagnosis?
A) AIDS
B) Dermatomyositis
C) Diabetes mellitus
D) Hyperthyroidism
E) Wilson's disease
B) Dermatomyositis
This is an inflammatory condition characterised by muscle weakness and distinctive skin rashes. The violaceous rash on the eyelids is the heliotrope rash, and this along with orbital oedema is classic in dermatomyositis. Retinal involvement with haemorrhages is possible due to associated vasculitis.
172
What is Waldenstrom's Macroglobulinaemia and what are the symptoms / signs?
Rare, chronic B-cell lymphoproliferative disorder characterised by a monoclonal IgM paraprotein.
WM is associated with hyperviscosity syndrome. peripheral neuropathy and cold agglutinin disease.
Symptoms - weight loss, purpura, GI bleeding, retinal haemorrhage, headache, dizziness and blurred vision and tiredness.
173
Low set ears, cleft lip palate, polydactyly, micro-ophthalmia and learning disability. Babies rarely survive for more than a few weaks - likely diagnosis?
Patau's syndrome
174
How is pemphigus vulgaris diagnosed?
Skin biopsy
175
Treatment for pemphigus vulgaris?
High dose corticosteroid or other immunosuppressive drugs
176
Offensive vaginal bleeding 5 days after a normal delivery - what investigation and what is likely happening?
High vaginal swab, endometritis
177
Bullous pemphigoid vs pemphigus vulgaris - in which are there antibodies against desmosomes and in which are there antibodies against hemidesmosomes?
* Pemphigus vulgaris - antibodies against desmosomes
* Bullous pemphigoid - antibodies against hemidesmosomes
178
25F presents with pain in her thumb and examination reveals subluxation of the metacarpophalangeal joint of the thumb with abduction. What is the most likely diagnosis?
Gamekeeper's thumb - chronic ulnar collateral ligament rupture at the metacarpophalangeal joint of the thumb, leading to subluxation and pain upon abduction. Often occurs due to repetitive stress or acute trauma, such as during skiing accidents. Treatment may involve immobilisation or surgical repair, depending on the severity of the ligament damage
179
Insufficiency in which vein is the most common cause for varicose veins?
Long saphenous vein
180
What test is used to investigate a suspected diagnosis of dumping syndrome?
Prolonged glucose tolerance test
181
How is dumping syndrome managed?
Frequent, small meals
182
What is the method for surveillance for patients who are confirmed carriers of the HNPCC gene, and from what age?
Screening with colonoscopy beginning from 25-30 years of age
183
What happens to the PR interval in Wolff-Parkinson-White?
Short PR
184
Thiazide diuretics can cause what neonatal complications in pregnancy if taken by pregnant lady?
Neonatal thrombocytopaenia, bone marrow suppression, jaundice, electrolyte disturbance, hypoglycaemia, reduced placental perfusion
185
What statin and what dose is given for primary prevention of cardiovascular disease?
Atorvastatin 20mg
186
Mode of action of lansoprazole?
It inhibits the H+/K+ ATP proton pump
187
A 50yr old refugee from Iraq presents with weight loss, cough, diarrhoea, recurrent fevers and epistaxis. He is pale and has massive splenomegaly. Hb is 80g/l, WCC 2.0x10^9/l, platelets 70 x 10^9/l, albumin 22g/l. Likely diagnosis?
Visceral leishmaniasis
Second largest parasitic killer in the world after malaria. Protozoan parasite of Leishmania species. Migrates to internal organs such as liver and spleen and bone marrow and, if left untreated, will always result in death of the host. Signs and symptoms include fever, weight loss, mucosal ulcers, fatigue, anaemia and substantial swelling of the liver and spleen
188
What is the most discriminatory investigation in suspected salmonella typhi infection?
Blood culture
Stool culture is often negative during the first week, but blood culture is quite sensitive
189
What is the most common site of metastasis in patients with osteosarcoma?
The lungs are the most common site of metastasis for osteosarcoma due to the tumour's propensity to spread through the bloodstream to the pulmonary circulation. Lung mets can often be asymptomatic or present with symptoms such as breathlessness or cough
190
How does ezetimibe work?
Blocks a protein mediator of cholesterol absorption, Niemann-Pick C1-like 1 NPC1L1 on small intestine epithelial cells, therefore selectively inhibiting uptake of cholesterol
191
Pulmonary manifestations of rheumatoid arthritis?
* Pleural effusion
* Pleural nodules
* Pleurisy
* Pulmonary fibrosis
* Bronchiolitis obliterans
192
25F presents to the ED with a sudden onset of a rash characterised by target lesions. She reports a recent outbreak of cold sores. What is the most likely diagnosis?
Erythema Multiforme - hypersensitivity reaction often associated with infections, particularly HSV. It is characterised by target lesions with a dark centre, a pale oedematous ring, and an outer red ring. The condition may present acutely and often precipitated by viral infections e.g. herpes. Management focuses on treating the underlying infection and providing supportive care for the skin lesions
193
Causes of cataracts?
* Ageing
* Trauma
* Radiation exposure (mostly UV light)
* Genetic causes
* Myotonic dystrophy
* Diabetes mellitus
* Hypoparathyroidism
* Drugs (e.g. corticosteroids)
* Intrauterine infection (syphilis, rubella, CMV)
194
True or false, in children who have been admitted with an asthma attack and has now become stable after 24 hours on inhaled salbutamol five puffs four times a day vai a spacer and twice-daily steroid inhaler should be kept in hospital for monitoring until salbutamol is no longer required?
False - according to BTS guidelines, children may be discharged from hospital once stable on 3 to 4 hrly bronchodilators which can be continued at home
195
7M presents to ED with abdominal pain and anaemia on investigation. A blood film also shows basophilic stippling of the RBCs. What is the most appropriate investigation to perform to aid diagnosis?
Lead levels
Basophilic stippling is indicative of lead poisoning, which disrupts haemoglobin synthesis
Lead poisoning can cause abdominal pain due to its neurotoxic effects and can lead to anaemia.
196
What are the most common type of kidney tumours in adults?
Renal cell carcinomas are the most common type of kidney tumours in adults. They make up 80% of renal cancers and are divided into clear cell (most common), papillary, chromophobe and collecting duct carcinomas
197
What monitoring is required in methotrxate and how often?
FBCs, U+Es, and LFTs every 2-3 months once therapy has been stabilised (every 1-2 weeks until then)
198
Which skin rash can occur in reactive arthritis?
Keratoderma blenorrhagica - characteristic skin lesion often on palms or soles
199
29M sewage worker presents with bilateral knee pain and stiffness. He also mentions that red spots on his feet are turning into pustules. These symptoms started a few days after an episode of gastroenteritis. Likely diagnosis?
Reactive arthritis. May starter GI infection or UTI. Classic triad of arthritis, conjunctivitis, and urethritis. May be associated with the characteristic skin lesion of keratoderma blenorrhagica
200
43F presents to obs department at 14 weeks of gestation. She wants to know for certain whether her fetus is trisomic. What is the most appropriate diagnostic test to obtain a fetal karyotype?
Chorionic villus sampling - the most appropriate diagnostic test for obtaining a fetal karyotpye between 11-14 weeks of gestation. Allows for early detection of chromosomal abnormalities, including trisomy, by sampling placental tissue. CVS is preferred over amniocentesis at this stage due to the earlier gestation age at which it can be performed. It provides definitive results, unlike screening tests like triple testing that only assesses risk
201
A patient's jaw moves to the left when opened. There is reduced facial sensation on the left, with loss of corneal reflex. Which nerve is affected?
5th cranial nerve
Causes the jaw to move towards the affected side. Muscles of mastication, but not facial expression, are affected
202
How does oesophagitis present?
May be asymptomatic
May present with epigastric or substernal burning pain, which is normally increased when lying down or straining
Can result in dysphagia
Most commonly results from GORD, a common side-effect from taking bisphosphonates such as alendronic acid
203
In iritis is the pupil big or small?
Small and often distorted
204
You are advising a patient with regards to malaria chemoprophylaxis for their upcoming holiday to the coast of Kenya. It is a knwon malaria area with widespread chloroquine resistance. The species of malaria in the area include P.Falciparum, P.Vivax and P.Ovale. The patient is fair skinned, and has a known psychiatric history. Based on this info, which anti-malarial would you recommend?
A) Atovaquone / Proguanil (aka Malorone)
B) Doxycycline
C) Chloroquine
D) Mefloquine
E) No chemoprophylaxis required
Malaria chemoprophylaxis is important for persons entering a known malaria area, esp when known presence of P.Falciparum which can cause cerebral malaria.
Atovaquone/Proguanil (Malarone) is used in both prevention and treatment of malaria. It is well tolerated, once daily medication which should be started 24 hrs before entering a malarial zone and continued for seven days following the departure of the malaria zone
205
Varicocoeles more common on the left or right side?
Left side
N.B patients with an isolated varicocoele on the right should be investigated for retroperitoneal pathology (e.g. RCC)
206
Hemineglect is seen in stroke affecting which artery / stroke territory?
Middle cerebral artery
207
Signs of graft versus host disease?
Watery diarrhoea
Rash (painful, red-violet rash predominantly affects hands and feet but may spread anywhere on the body)
Raised bilirubin
208
What is the treatment in graft versus host disease?
The original immunosuppressant e.g. tacrolimus, with the addition of methylprednisolone
209
How is defintive diagnosis of graft versus host disease made?
Biopsy of the affected area, typically the skin, colon or liver
210
Exclamation mark hairs, or short tapered hairs proximally at the edges of the bald patch are characteristic of what cause of baldness?
Alopecia areata
211
About one third of patients with alopecia areata also have what other dermatological condition?
Atopic dermatitis
212
In people with hepatitis, when are patients maximally infectious?
Before the onset of jaundice
213
Vaccines to hepatitis B may reduce the incidence of .....
Vaccines to hepatitis B may reduce the incidence of hepatoma
214
Fall on outstretched hand, with tenderness in the area between the extensor and abductor pollicis longus tendons - likely fracture?
Fracture of the scaphoid bones
215
2M presents due to episodes of facial grimacing and hand spasms. He recently had a mild viral infection and, on examination, is noted to have distinctive facial features, including a short philtrum, hypertelorism and low-set ears. A cardiac murmur is also detected, and lab tests reveal hypocalcaemia. Likely diagnosis?
DiGeorge Syndrome
216
How long do migraines last for?
The international headache society - part of the diagnostic criteria of migraine - lasts between 4-72 hours
217
Mother with emphysema. A few hours after delivery, the baby is noted to be jaundiced, and the bilirubin level is above the treatment line for phototherapy. Most likely diagnosis?
Alpha-1 anti-trypsin deficiency
218
Which lab test is highly raised in duchenne's muscular dystrophy?
Creatine kinase (may be up to 200x the upper limit of normal) and genetic testing
Muscle biopsy may also be required
219
What is the 'too late triad' in renal cell carcinoma?
Haematuria, flank pain and a palpable mass
In 10-15% of patients
By the time all 3 are shown, the prognosis is very poor
RCC arises from the epithelial lining of the proximal convoluted tubule, it has a tendency to metastasise haematogenously
220
Which fracture causes wrist drop and a small batch of sensory loss at the base of the thumb?
Humerus fracture
221
Indications for LTOT?
PaO2 7.3-8kPa when stable if they have one of the following co-morbidities:
- Secondary polycythaemia
- Peripheral oedema
- Pulmonary hypertension
The need for oxygen therapy should also be assesed in patients with very severe (FEV1 < 30%) or severe (FEV1 30-49%) airflow obstruction, cyanosis, raised JVP and oxygen sats
222
Why might a patient with necrotising fasciitis of the upper limb for example, develop paraesthesiae e.g. of the fingers?
Development of a compartment syndrome. Surgical emergency and must go to theatre immediately for debridement, with IV antibiotics thereafter
223
25F referred to obs department for a detailed fetal ultrasound at 22 weeks of gestation. The scan reveals intracerebral calcifications and ventriculomegaly in the fetus. Likely cause?
CMV
This can cause intracerebral calcifications and ventriculomegaly, these findings are indicative of CMV's impact on the developing CNS
224
How to titrate levothyroxine management in a patient?
Start with starting dose at 25ug OD. Response to treatment should be checked every 3-4 weeks until stable TSH achieved. After that, perform a blood test every 3-4 weeks until stable TSH. Then perform blood test at 4-6 months and annually thereafter
225
Causes of secondary membranous nephropathy?
* Autoimmune diseases (e.g. systemic lupus erythematous)
* Infectious diseases (e.g. hepatitis B/C)
* Malignancy
* Drugs - captopril, gold, lithium, penicillamine
N.B - NSAIDs are usually associated with minimal change disease instead
226
Which antibiotics for acute bacterial sinusitis?
Phenoxymethylpenicillin, doxycycline or erythromycin, or if penicillin allergic - clarithromycin
227
Inheritance pattern of duchenne's muscular dystrophy?
X-linked
228
Is cholangiocarcinoma associated with a rise in AFP?
No
229
UC and related PSC can progress to which cancer?
Cholangiocarcinoma
230
How is acute idiopathic or viral pericarditis managed?
High dose NSAIDs or aspirin in combination with colchicine is the initial treatment. Duration of NSAID or asipirin treatment is depedent up on symptom resolution and normalisation of CRP. At this point, tapering begins. On the other hand, colchicine treatment is continued for three months using a low, weight adjusted dose.
Restrictrion of physical activitity until symptoms resolution and normalisation of inflammatory markers, gastroprotection with a PPI
231
What is the reason for male infertility in cystic fibrosis mostly due to?
Obliteration or failure of development of the vas deferens
232
85M presents to GP as struggling to sleep on his side due to ear pain. Examination reveals a small, firm, tender nodule with a central crust located on the helix of his ear. Most likely diagnosis?
Chondrodermatitis nodularis
233
A rash that can appear on the hands to leave white scars with follicular openings on them?
Nodular prurigo - this is characterised by discrete, firm, scaly and itchy nodules on the skin. It can appear on the hands, as well as the extensor surfaces of the arms and legs. It can be difficult to treat and tends to leave behind scarring, it is one of many causes of rash to the hands
234
2 week old boy presents with stridor that is worse when he cries or is excited. Investigation by barium swallow shows an oblique filling defect in the mid-thoracic region. What is the most likely diagnosis?
Vascular ring - a congenital anomaly where abnormal formation of the aorta and its branches encircle and compress the trachea and oesophagus. This can lead to respiratory symptoms such as stridor and feeding difficulties. The barium swallow showing an oblique filling defect is indicative of compression by the vascular structure. This conditino is usually diagnosed in infancy due to the presence of symptoms shortly after birth
235
What is the treatment for giardiasis?
Oral metronidazole
236
How long to avoid driving as per DVLA for unexplained syncope?
Six months
237
Over what period of time is considered a staggered overdose?
Over one hour
238
Most common dysrhythmia in digoxin toxicity?
Premature ventricular beats
239
What is the gold standard investigation for diagnosis of renal artery stenosis?
Intra-arterial renal arteriography - IF > 70% luminal occlusion of both renal arteries (or if flow is reduced in one renal artery in a patient with only one functioning kidney)
240
78M presents with a woody, hard swelling in the right lobe of his thyroid with a change in voice. Two weeks later, the swelling has enlarged by 1cm. Most likely diagnosis?
Anaplastic carcinoma - aggressive thyroid cancer, often presenting in elderly patients with a rapidly enlarging neck mass. The change in voice suggests local invasion affecting the recurrent laryngeal nerve. The rapid growth over a short period and the patients age strongly suggests anaplastic thyroid cancer. Poor prognosis
241
How does follicular thyroid cancer tend to spread?
Haematogenously
242
Which thyroid cancer tends to present as a solitary thyroid nodule and more commonly in middle-aged individuals?
Follicular thyroid carcinoma
243
How might lymphoma affecting the thyroid gland present?
May present with a rapidly enlarging mass, but more likely to cause systemic symptoms e.g. night sweats and weight loss
244
How might papillary carcinoma present?
Usually indolent and presents with a thyroid nodule that spreads to local lymph nodes
245
Pulsus alternans is pathognomic of what?
LV failure
246
What kind of pulse is seen in aortic stenosis?
Plateau pulse - characterised by a slow upstroke, prominent in the brachial and carotid pulses. The time taken to reach the peak is prolonged, and the entire wave is flattened and of small amplitude
247
What type of pulse can be observed in mixed aortic stenosis and incompetence?
Bisferiens pulse - a rapid rising, twice beating pulse where both waves are felt during systole. The percussion wave is felt first, followed by a small wave. It is in mixed aortic stenosis and incompetence, as well as idiopathic hypertrophic subaortic stenosis
248
35M presents with left-sided chest pain and tachycardia after a blunt thorax trauma. His heart rate is irregular. What is the most likely diagnosis?
Cardiac contusion - a common result of blunt chest trauma and can lead to chest pain an arrhythmias, e.g. high heart rate. The trauma can lead to direct injury to the heart muscle, leading to impaired cardiac function
249
Hypoparathyroidism can cause cataracts - true or false?
True - can have intracranial calcifications and cataract formation
250
Myotonic dystrophy can cause cataracts true or false?
True
251
Rubella can cause cataracts true or false?
True
252
List some causes of cataracts
- Rubella
- Diabetes
- Hypoparathyroidism
- Myotonic dystrophy
253
Indication for ESWL in kidney stones?
Asymptomatic calculi should generally be treated in fit people to reduce the risk for future complications - cant just manage conservatively. ESWL is suitable for uncomplicated calculi < 1.5cm in size in patients with normal renal anatomy
254
Indications for nephrectomy in kidney stones?
Poorly functioning kidneys (< 10% split function) that are symptomatic should be removed. Laparoscopic nephrectomy is the procedure of choice
255
What is the treatment option for renal stones when ESWL has failed?
Flexible ureterorenoscopy with Holmium laser
256
A 1cm renal stone with ground glass appearance on x-ray in a recurrent stone former - what is the management?
Alkaline diuresis - likely cystine calculi because they have classically ground glass appearance on KUB x-ray and are usually recurrent
257
A 7M is brought in by his mother, who reports that the child experiences constant urinary dribbling and dampness. A urine dipstick was negative. Which drug is more appropriate to prescribe - desmopressin or oxybutynin?
Oxybutynin
Day and night time symptoms are suggestive of overactive bladder. Oxybutynin is licensed for use in children >/= 5 years.
Desmopressin is used to treat nocturnal enuresis
258
Which toxicities can cause the following - different ones for each:
A) Child presents with colicky abdominal pain, constipation, vomiting, headache, drowsiness and the examination reveals papilloedema
B) Child presents with severe vomiting and GI bleeding followed 24hrs later by increasing drowsiness and signs of cardiovascular compromise
A) Lead encephalopathy
B) Iron toxicity
259
Which bone problem can also be associated with high output cardiac failure?
Paget's disease
260
36F presents to derm clinic with a red, scaly patch on her face. A biopsy shows a full thickness atypia that is confined to the epidermis, with an intact basement membrane. What is the likely diagnosis, and how to treat?
Bowen's disease - a very early form of squamous cell cancer. Also called squamous cell carcinoma in situ. Invasive SCC extends beyond the basement membrane, penetrates the dermis and may invade deeper structures. Bowen's disease displays a full thickness atypia that is confined to the dermis with an intact basement membrane.
For Bowen's disease on the face, therapies such as curettage, cryotherapy or topical chemotherapy are usually offered as first line of treatment.
For non cosmetically sensitive locations, if lesions dont respond to treatment or there is reoccurence, surgical excision or Mohs micrographic surgery is done
261
Which congenital heart defect is common in Noonan's syndrome?
Pulmonary stenosis
262
5M presents to paeds department with bowing of the legs, and a pigeon chest. X rays show cupping, splaying and fraying of the epiphyses. What is the most likely diagnosis?
Rickets - a condition resulting from vitamin D deficiency in children, leading to impaired bone mineralisation. Presents with characteristic skeletal deformities e.g. bowing of the legs and a pigeon chest. X-ray findings include cupping, splaying and fraying of the epiphyses. These features are indicative of defective bone growth and mineralisation
263
Osteopetrosis associated with what symptoms?
Anaemia
Nerve compression
264
Waldenstrom macroglobulinaemia is a lymphoproliferative disorder characterised by the production of .... ....., leading to hyperviscosity syndrome.
What are the symptoms?
Waldenstrom macroglobulinaemia is a lymphoproliferative disorder characterised by the production of IgM paraprotein, leading to hyperviscosity syndrome
Symptoms of blurred vision, headaches, and retinal haemorrhage are classic signs of hyperviscosity. Elevated IgM levels confirm the diagnosis. Raised ESR also supports WM diagnosis
265
Which congenital abnormality can cause lymphoedema of the feet and hands?
Turner's
266
Straight leg raise is not impaired in ACL injuries - true or false?
True
267
33F presents to the ED after tripping and falling over an uneven paving slab. She reports hearing a crack at the time of the fall and is now unable to bear weight on the affected leg. On examination, there is considerable bruising and swelling around the knee, and she is unable to lift her leg off the couch. What is the most likely diagnosis?
Patellar fracture - this occurs when the patella is subjected to a forceful contraction of the quadriceps against resistance, often accompanied by a cracking sound. The inability to bear weight and perform a straight leg raise suggests a disruption of the extensor mechanism, which is consistent with a patellar fracture, along with bruising and swelling around the knee. Immediated weight bearing difficulty and the mechanism of injury make a fracture the most likely diagnosis
268
Features of anticholinergic syndrome?
* Flushing and dry skin / mucous membranes are common manifestations of anticholinergic syndrome
* Mydriasis (dilatation of the pupil) with loss of accomodation is a common feature
* Altered mental status
* Fever
* Sinus tachycardia
* Hypertension
269
Management of anticholinergic syndrome?
* Activated charcoal
* Gastric lavage followed by activated charcoal is acceptale for patient presenting with altered mental status within 1 hr of ingestion
* Antidote is physostigmine salicylate. Mostly not necessary, but is recommended when tachydysrhthmia is present
270
True or false, placenta praevia is not a contraindication for ECV?
False - placenta praevia is in fact a contraindication to ECV
271
What is the consideration for mode of delivery in placenta praevia?
In general, the mode of delivery is directed by the proximity of the leading edge of the placenta in realtion to the internal os of the cervix. Several studies recommend delivery by elective c-section when the placenta is < 2cm from the internal os
272
What nail changes can be seen in alopecia areata?
Nail pitting or roughness
273
28F contacts her GP to discuss screening for TB for herself and her three children. Her husband has recently been diagnosed with active TB and started on treatment following release from prison. She and the children are all completely asymptomatic. What is the apppropriate screening for the family?
Mantoux test - do this first to screen for latent TB - if this yields a positive result then do...
Chest x-ray to screen for active TB
274
What is the key investigation in suspected schistosomiasis?
Urine microscopy
275
What kind of swabs for NAAT for testing for chlamydia?
Endocervical or vulvovaginal - not high vaginal swabs
276
Which vitamin should be avoided by pregnant women?
Vitamin A
277
How long is the aspirin therapy used in Kawasaki's, and at what dosages?
Initially at higher doses (e.g 30mg/kg per day) for up to 2 weeks and then continued at lower doses (3-5mg/kg per day) until a review of echocardiogram, which is usually 6-8 weeks after the onset of illness
If echo shows no evidence of coronary artery aneurysms, then aspirin is stopped
278
5 year old girl referred to paeds gynae with a 2 day history of a sore vagina and offensive discharge. What is the best initial investigation?
Vaginoscopy - in a young child presenting with a sore vagina and offensive discharge, a careful examination is essential to rule out the presence of a foreign body, infection, or signs of abuse. Vaginoscopy allows for a thorough visual inspection of the vaginal cavity without causing trauma
279
Herpes zoster ophthalmicus management?
Oral aciclovir 800mg five times a day for 7 days
Urgent referral to ophthalmology is warranted in the presence of eye involvement. The presence of orbital oedema is an ophthalmological emergency
280
What is the mechanism of injury in acriomoclavicular dysfunction?
Fall laterally with an outstretched hand
281
First line treatment for conjunctivitis in pregnant women?
Topical fusidic acid
282
BRCA-1 is on which chromosome? It is associated with which cancers?
BRCA-2 is on which chromosome? It is associated with which cancers?
BRCA-1 is on chromosome 17 - associated with breast, ovarian, prostate, pancreatic and colorectal cancers
BRCA-2 is on chromosome 13 - associated with breast, ovarian, prostate cancers
283
What rash appears as a result of hypersensitivity to herpes simplex virus (HSV)?
Erythema Multiforme
284
A 38F in labour with her second baby, becomes haemodynamically unstable. Loss of uterine contractility, fetal distress and recession of the presenting part are also noted. Likely diagnosis?
Uterine rupture
285
Myopia or hyperopia is associated with complications such as retinal detachment, glaucoma and cataracts?
Myopia
286
How does familial primary pulmonary hypertension present?
Presents with breathlessness, fatigue, angina (due to right ventricular ischaemia) or presyncope / syncope.
Elevated JVP, left parasternal heave, pansystolic murmur (tricuspid regurgitation), right ventricular S4 and peripheral oedema
287
24F presents to the GP with complaints of increased clear, non-offensive vaginal discharge and occasional post-coital spotting since restarting the pill after her last pregnancy. She is otherwise symptomatic. What is the most likely diagnosis?
Cervical ectropion
288
What is the most common site for bony metastasis from the prostate?
The spine
289
What condition is characterised by yellow, slow-growing nails with onycholysis and is often associated with lymphoedema or pleural effusion?
Yellow nail syndrome
290
In breast cancer, how does age affect prognosis (is being younger or older protective or worse prognosis)?
Young age is a poor prognostic factor
291
What investigation must be done in suspected endometritis?
High vaginal swab
292
Rotavirus vs norovirus - which typically affects adults / older adults and which typically is in the paeds population?
Rotavirus - paeds
Norovirus - adult
293
50F presents to the GP with rotational vertigo, hearing loss, and a feeling of fullness in her left ear. On examination, she has horizontal nystagmus on her right gaze. Her audiogram shows a low-pitch sensorineural hearing loss. Likely diagnosis?
Meniere's disease
294
How might TCA overdose present?
Agitation, hallucinations, cardiovascular effects e.g. tachycardia, postural hypotension and slowed cardiac conduction
Supraventricular tachycardia observed on ECG is classic as TCA anticholinergic effects potential for causing arrythmias
295
Mandatory inclusion criteria for PSP include?
* Onset > 40 years
* Gradually progressive
* Vertical (upward or downward gaze) supranuclear palsy and prominent postural instability with tendency to fall in the first year of disease onset
296
32 pregnant woman in her third trimester presents to ED with concerns about reduced fetal movements. An ultrasound confirms intrauterine death, and the amniotic fluid appears green and discoloured. What is the most likely cause of the intrauterine death:
A) CMV
B) GBS
C) Listeriosis
D) Parvovirus
E) Syphilis
C) Listeriosis
Bacterial infection that can cross the placenta leading to severe outcomes such as stillbirth or neonatal death. The presence of green discoloured amniotic fluid suggests meconium-stained liquor which can occur in cases of fetal distress or infection
Listerior is known for causing flu-like symptoms in the mother and can lead to intrauterine death, particularly in the third trimester.
Versus GBS is primarily associated with neonatal infections rather than intrauterine complications, it is a leading cause of neonatal sepsis and meningitis, but is not known for causing stillbirth or green discoloured amniotic fluid during pregnancy
297
34F attends GP with a rapidly growing lesion to the tip of her index finger. It started as a small spot but has grown quickly in size over the past few days. It is dark red in colour and causes discomfort and easy bleeding when working in her cafe. What is the most likely diagnosis?
Pyogenic granuloma - benign, rapidly growing vascular lesions. Easy bleeding after minimal trauma. They appear as a solitary, fleshy nodule and can be polypoid. Most common sites are the fingers and hands. Minor trauma is often an initiating factor. Most commonly in children, young adults and pregnancy but can arise at any age
Lesions requiring treatment are best removed by deep curettage and cauterisation, or excision and sent for biopsy
298
3 year old boy brought to the ED with mum as he became distraught whilst she helped him get dressed. He started screaming as she took off his vest and since then, he has not moved his left arm. The elbow is extended, and the forearm pronated, with no bruising, swelling or bony tenderness of the elbow. What type of fracture does this patient most likely have?
Subluxation of the radial head - aka pulled elow, common in young children and typically occurs when a sudden pull is applied to an extended arm. The child presents with the arm held in pronataion and reluctance to move it, but without swelling or bruising. The diangosis is usually clinical, and is treated with a simple reduction maneouvre
299
What eye pathology can cause corneal ulcers, particularly near the visual axis and cause severe eye pain, photophobia and a gritty sensation in the eyes?
Keratitis
N.b corneal ulcers can be similar but dont cause the corneal ulcers, and there would be a history of trauma
300
Which type of ulcers are commonly found on the dorsum of the foot or toes?
Arterial ulcers
| W
301
Which type of ulcers are typically painful and have a punched out appearance?
Arterial ulcers
302
What kind of scotoma is associated with toxic or nutritional optic neuropathies such as those caused by alcohol abuse or vitamin B12 deficiency?
Centrocaecal scotoma - involves the central visual ffield and the blind spot, often affecting the macula. The deect is due to damage to the optic nerve, particularly affecting the papillomacular bundle
303
An infant is jaundiced at birth and is found on examination to have a distended abdomen with organomegaly and microcephaly. What is the likely diagnosis?
Congenital CMV infection
Congenital infection must always be considered in any child born jaundiced. The baby can present with pneumonia, purplish rash, low birthweight, seizures and a small head size as well. Microcephaly and organomegaly can also be found in congenital rubella and toxoplasma infection
304
Serum CK is significantly raised in which cause of symmetrical proximal muscle weakness?
Polymyositis
305
Which cause of hair loss causes broken exclamation mark hairs and well demarcated patches of hair loss?
Alopecia areata
306
Which antihistamine is safe for lorry drivers?
Loratadine - a non sedating antihistamine
307
What test is useful for predicting survival and prognosis in multiple myeloma?
Beta-2 microglobulin - higher levels indicate poorer prognosis. Correlates with clinical stages in the Durie-Salmon stagin system. Combined with albumin levels forms the basis of the international staging system
308
IV labetalol is reserved for which life threatening complications in hypertensive emergencies?
* Hypertensive encephalopathy
* Stroke
* Aortic Dissection
309
What investigation is used to test for alpha-1-antitrypsin deficiency?
Blood test for alpha-1-antitrypsin
310
What is the key investigation in osteomalacia?
Serum 25-hydroxyvitamin D measurement
311
Seminomas have elevated AFP or not?
Do not have elevated AFP in seminomas
312
Mode of injury in supracondylar fracture of the humerus?
Common in children following a fall on an outstretched hand
313
5M presents to ED following a fall onto his outstretched hand. He has pain and swelling around his elbow and bruising in the antecubital fossa. He is unable to flex the interphalangeal joint of his thumb or the distal interphalangeal joint of his index finger? Diagnosis?
Supracondylar fracture of humerus
314
What nerve can be involved in injury in supracondylar fracture of the humerus? What pattern of deficit does it cause?
Anterior interosseous nerve - inability to flex the IP joint of the thumb and DIP joint of the index finger
315
Mechanism of injury in olecranon fracture?
Direct blow or fall onto the elbow
316
What is the motor weakness in olecranon fractures?
Inability to extend the elbow due to triceps muscle disruption
317
28M presents to ophthalmology clinic with a red eye and reports that the pupil in the affected eye is small and irregularly shaped. He is experiencing eye pain and sensitivity to light. What is the most likely diagnosis?
A) Acute glaucoma
B) Conjunctivitis
C) Iritis
D) Keratitis
E) Subconjunctival haemorrhage
C) Iritis
Iritis causes a small, often irregularly shaped pupil. Presents with eye pain, redness, and photophobia, and may result in blurred vision. Prompt treatment with corticosteroids and pupil-dilating drops is necessary to prevent complications such as synechiae and vision loss
318
List some antimicrobial agents that interact with warfarin to increase the anticoagulant effect?
* Azole antifungals
* Macrolides
* Quinolones
* Co-trimoxazole
* Penicillins
* Cephalosporins
319
Common medication causes of acute tubulointerstitial nephritis?
* Antibiotics (esp beta-lactams)
* NSAIDs
* PPIs
* Allopurinol
320
58M presents to the genetic counselling clinica as he has recently been diagnosed with colon cancer as part of hte national bowel cancer screening programme. He was adopted as a child and is not aware of his biological familys history. What is the most appropriate genetic condition to test for in this patient?
Lynch syndrome - most common genetic cause in colorectal cancer any patient of any age diagnosed with colorectal cancer should be offered genetic testing for this condition
Lynch syndrome also increases the risk of developing many other cancers. These include endometrial, stomach, breast, ovarian, small bowel, pancreatic, prostate, urinary tract, kidney and liver cancer
321
22M admitted to hospital with a 5 day history of headache, fever, severe myalgia and a petechial rash. He is jaundiced, febrile, has tachycardia and has not passed urine for over 14 hours. His urea level is raised and LFTs indicate hepatocellular damage. Which of the following is the most likely diagnosis?
A) Brucellosis
B) Lyme disease
C) Orf
D) Rat-bite fever
E) Weil's disease
E) Weil's disease - severe form of leptospirosis, bacterial infection. Transmitted by animals especially rodents. Usually a short history of flu-like symptoms with or without GI symptoms and a severe headache. Petechial or purpuric rashes and epistaxis are common. Jaundice, renal failure, meningism and multiorgan failure may then develop in this severe type of leptospirosis. Patients may require admission to an ICU
322
Plateau pulse seen in what?
Aortic stenosis, where there is a slow upstroke and a prolonged time to peak in the pulse waveform. This is due to obstruction of blood flow through the aortic valve, resulting in a delayed and prolonged systolic ejection. The pulse is most noticeable in the brachial and carotid arteries. This type of pulse is a classic sign of aortic stenosis, helping to differentiate it from other cardiac conditions
323
Bisferiens pulse seen in which conditions?
Mixed aortic stenosis and incompetence
Hyertrophic cardiomyopathy
Characterised by a double peak per cardiac cycle
324
Pulsus alternans seen in which condition
LV failure. Characterised by strong and weak beats
325
Management in acute idiopathic or viral pericarditis?
NSAIDs until symptomatic resolution along with colchicine for three months
326
What effect can chronic excess alcohol consumption have on thyroid function?
Hypothyroidism
327
Best initial investigation in suspected Crohn's?
CT
328
Which immunodeficiency disorder can make patients prone to recurrent bacterial infections, in particular infeciton with Neiserria meningitidis or Neisseria gonorrhoeae?
Membrane attack complex formation deficiency
329
What is the characteristic scotoma in glaucoma?
Arcuate
330
What is the characteristic scotoma in toxic neuropathy?
Centrocaecal
331
What is the characteristic scotoma in retinitis pigmentosa?
Ring scotoma
332
What is the characteristic scotoma in diseases affecting the macula?
Central scotoma
333
What is the first line investigation in suspected sialolithiasis?
X-ray sialogram
334
What is the management for endometriosis in patients in whom other medical therapies have failed (NSAIDs and COCP, POP) and are not fit for surgical procedures?
Danazol - a synthetic steroid that suppresses production of gonadotrophins, leading to a hypoestrogenic state that reduces endometriosis symptoms
335
What is the most common subtype of renal cell carcinoma?
Clear cell carcinoma
336
What is the most common site of metastatsis from osteosarcomas?
Lung
337
What is the gold standard initial diagnostic test for ruptured AAAs?
Abdominal ultrasound
338
What is the shrug test in knee examination?
Manual compression of the patella whilst the quadriceps are tight, elicits pain
339
Which investigation is a key confirming test for chondromalacia patellae?
MRI
340
What is the management in chondromalacia patellae?
Physiotherapy to alter the patella-femoral alignment, analgaesia, ice
341
Long term use of oral contraceptive is associated with an increased risk of which type of cancer in particular?
Cervical cancer, particularly squamous cell carcinoma, the most common type
342
Thenar eminence swelling, palmar bruising and inability to move thumb, likely fracture?
Bennet's fracture - a fracture of the base of the metacarpal of the thumb. It causes pain and swelling of the thenar eminence and an inability to move the thumb
343
Subluxation of metacarpophalangeal joint of thumb with abduction. Likely diagnosis?
Gamekeeper's thumb (chronic ulnar collateral ligament rupture of the thumb)
344
Which investigation is used for investigation of dumping syndrome?
Prolonged glucose tolerance test
345
First line treatment in HfpEf?
SGLT2 + MRA
346
MSRA
flashcards
Decks in class (3)
# Cards
-
Key Links
-
Subjects
-
Company
-
Find Us
-
