Extra Notes

Question 1

Which vitamin, if taken in high doses, can be teratogenic?

Answer 1

Vitamin A is teratogenic in high doses

Question 2

The combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggestive of which condition

Answer 2

Autoimmune hepatitis

Question 3

Facial rash:

Raised purple plaque of indurated skin

Affects the tip of the nose and the skin around the right nostril

Neither itchy or painful

What is the diagnosis

Answer 3

A cutaneous manifestation of sarcoidosis

Most frequently affects the nose, cheeks, lips, ears, and digits

Not normally itchy or painful but can be disfiguring.

Question 4

The gene encoding which protein is mutated in familial hypercholesterolaemia

Answer 4

The gene encoding the low-density lipoprotein (LDL) receptor

Question 5

What is the abnormality that can be seen in this erect chest x-ray

Answer 5

Pleural plaques - seen as irregular lesions bilaterally

Question 6

Pleural plaques are a consequence as an exposure to what substance?

Answer 6

Pleural plaques are a consequence of asbestos inhalation and develop over 2 to 4 decades from exposure

Question 7

Fever, abdominal pain, hypotension during a blood transfusion

What is the diagnosis

Answer 7

Acute haemolytic reaction

Positive Coombs direct test indicates antibodies bound to red cell antigens, in keeping with an acute haemolytic reaction.

Question 8

The radial nerve is most susceptible to damage from a fracture where in the arm?

Answer 8

Fracture of the shaft of the humerus.

Question 9

What is the treatment for non-shockable rhythm

Answer 9

Adrenaline

Question 10

When should adrenaline be used in shockable rhythms?

Answer 10

Adrenaline should be given after the third shock, and then during alternate cycles.

Question 11

When should Amiodarone be used in shockable rhythms?

Answer 11

Should be given after the third shock, and another dose considered after five shocks.

Question 12

What is the main ECG abnormality seen with hypercalcaemia

Answer 12

Shortening of the QT interval

Question 13

SSRIs such as sertraline are major risk factors for what GI condition?

Answer 13

Duodenal ulcers

Question 14

A history of Painful shin rash and cough is suggestive of what condition?

Answer 14

Sarcoidosis

Question 15

What is the most significant issue with mechanical heart valves when compared to bioprosthetic valves?

1. Arrhythmias
2. Infective endocarditis
3. Limited lifespan
4. Early failure after surgery
5. Thrombus formation

Answer 15

Thrombus formation

Question 16

Which of his medications may be contributing to weight gain?

a) Metformin
b) Losartan
c) Clopidogrel
d) Gliclazide
e) Simvastatin

Answer 16

d) Gliclazide - Sulfonylureas

Question 17

Define Dressler’s syndrome

Answer 17

Acute pericarditis that occurs several weeks following MI

Question 18

Public health act 2008 part 2 is for what

Answer 18

Nortifiable diseases and notifiable organisms

Responsibility to notify upon a clinical suspicion of an infection

Question 19

At what stage should you notify public health about a notifiable disease

Answer 19

Responsibility to notify upon a clinical suspicion of an infection

Question 20

What is the incubation period

Answer 20

The period between a patient being exposed to developing symptoms

Question 21

Name the 3 types of post exposure prophylaxis

Answer 21

Antibiotics

Vaccination

Immunoglobulins

Question 22

Describe the audit cycle

Answer 22

1) Identify the issues
2) Obtain or define standards
3) Collect data
4) Compare performance with standards
5) Implement change
6) Re-audit

Question 23

What are the four classical presentation of Meniere’s disease

Answer 23

Recurrent attacks of vertigo

Hearing loss

Tinnitus

Sensation of aural fullness

Question 24

What are the components of the GCS

Answer 24

Motor response - 6

Verbal response - 5

Eye opening response - 4

Question 25

If a patient is: opening eyes to speech Confused Able to follow motor commands What is their GCS

Answer 25

eyes to speech (E - 3/4), is confused (V - 4/5), and is able to follow motor commands (M - 6/6) =\> GCS = 13

Question 26

How long after treating hypogylcaemia should the BM be rechecked

Answer 26

10-15 minutes

Question 27

Which process might alcohol metabolism inhibit, preventing the liver from transforming non-carbohydrate substrates to glucose and therefore worsening hypoglycaemia?

Answer 27

The metabolism of alcohol influences the intracellular redox state of hepatocytes, inhibiting key stages of gluconeogenesis. gluconeogenesis is the transformation of non-carbohydrate into glucose This increases the chance, and severity of, hypoglycaemia.

Question 28

Following an epsode of severe hypoglycaemia. What is the driving regulations

Answer 28

Patient should inform the DVLA However a single episode of severe hypoglycaemia in the past 12 months should not prevent the patient from driving a car

Question 29

What bedside tests are important to do in a patient with symptoms of T1DM (but not formal diagnosis)

Answer 29

Urinary HCG - to rule out pregnancy Urinalysis Blood glucose

Question 30

Define osmolality

Answer 30

How concentrated the blood is

Question 31

What is the equation for osmolarity

Answer 31

Osmolarity = 2[Na+] + Glucose + Urea

Question 32

Name the cations that are found in the blood

Answer 32

Cations are positive ions Most important * Sodium * Potassium Others * Calcium * Magnesium * Proteins

Question 33

Name the anions that are found in the blood

Answer 33

Anions are negative ions Most important * Chloride * Bicarbonate Others * Sulphates * Phopshates * Negatively charged protein - noteably albumin

Question 34

How is the equation used to calculate the anion gap

Answer 34

Net charge is 0 Anion Gap = (Na⁺ + K⁺) - (Cl^- + Bicarb) Note: K⁺ is sometimes omitted as the value is so low

Question 35

What is the normal level of anion gap

Answer 35

8-16 mmol/L

Question 36

An elevated anion gap strongly suggests what

Answer 36

metabolic acidosis

Question 37

What are the causes of high anion gap metabolic acidosis

Answer 37

Addition of organic acid e.g. high lactate, ketones Decrease in hydrogen excretion e.g. renal These decrease the bicarb in the equation

Question 38

What are the causes of normal anion gap metabolic acidosis

Answer 38

"CAG" C - Chloride excess A - Acetazolamide/Addison's disease G - GI loss of bicarb

Question 39

How does albumin levels affect the anion gap

Answer 39

Hypoalbuminaemia leads to an underestimation of the anion gap i.e. masking a high anion gap

Question 40

What is the main target of treatment in DKA

Answer 40

Acidosis not hyperglycaemia

Question 41

Why during period of sickenss patients have an increased insulin requirement despite not eating and drink as much as they would

Answer 41

Hormones e.g. cortisol raise the blood glucose level leading to an increase in insulin demand

Question 42

What questions make up the AMT4 assessment

Answer 42

* Patients DoB * Patient age * Where they are * What year it is

Question 43

What scoring system is used in pneumonia

Answer 43

CURB-65 - marker of severity and prognosis

Question 44

What are the components of the CURB-65 scoring

Answer 44

C - Confusion U - high Urea (\>7 mmol/L) R - Respiratory rate (\> 30 breaths/min) B - Blood pressure (low) 65: Age \>= 65

Question 45

When should patients be placed on a varialbe rate insulin infusion

Answer 45

If they are fasting for more than 12 hours and miss two or more meals

Question 46

Metformin is contra-indicated in what level of creatinine

Answer 46

Creanintine \< 150 umol/L

Question 47

Which bronchus is foreign objects likely to go down and why?

Answer 47

Right main bronchus as it is wider, shorter and more vertical than the left.

Question 48

A low phosphate and high PTH and calcium level indicates what type of hyperparathyroidism

Answer 48

Primary hyperparathyroidism ## Footnote *as opposed to secondary (which would have a low calcium level) or tertiary (which would have a high phosphate level).*

Question 49

Patients with SVT who are haemodynamically stable and who do not respond to vagal manoeuvres, what is the next step of management

Answer 49

IV adenosine

Question 50

Describe the pattern of administration of intravenous adenosine for the treatment of SVT

Answer 50

rapid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg

Question 51

What is Whipple’s triad of symptoms and was condition is it a hallmark for

Answer 51

1) hypoglycaemia with fasting or exercise 2) reversal of symptoms with glucose 3) recorded low BMs at the time of symptoms Hallmark for an insulinoma

Question 52

What is an adverse effect of calcium channel blockers such as amlodipine

Answer 52

Ankle swelling

Question 53

What is a common adverse effect of ACE inhibitors

Answer 53

A dry cough

Question 54

What is a side effect of thiazide-like diuretics such as indapamide

Answer 54

Sexual dysfunction

Question 55

What are the 5 medications that should be started as secondary prevention following an MI

Answer 55

Dual antiplatelet therapy (aspirin plus a second antiplatelet agent) ACE inhibitor beta-blocker statin

Question 56

Which murmur am I referring to: Ejection systolic louder on expiration

Answer 56

Aortic stenosis

Question 57

Which murmur am I referring to: Ejection systolic louder on inspiration

Answer 57

Pulmonary stenosis

Question 58

Which murmur am I referring to: pansystolic murmur louder on inspiration

Answer 58

Tricuspid regurgitation

Question 59

Which murmur am I referring to: pansystolic murmur louder on expiration

Answer 59

mitral regurgitation

Question 60

Which murmur am I referring to: Early diastolic murmur

Answer 60

aortic regurgitation

Question 61

Which murmur am I referring to: Mid-late diastolic murmur

Answer 61

mitral stenosis

Question 62

Which medication will improve symptoms of heart failure but have no effect on overall mortality?

Answer 62

Diuretics e.g. furosemide

Question 63

For poorly controlled angina despite maximum beta-blocker therapy, what medication should be added.

Answer 63

A long-acting calcium-channel blocker such as amlodipine

Question 64

Diltiazem and verapamil are rate-limiting calcium-channel blockers and must not be combined with beta-blockers. Why?

Answer 64

They can cause severe bradycardia and heart failure.

Question 65

Which antifungal treatment interacts with warfarin and thus careful monitoring of INR is required

Answer 65

Fluconazole

Question 66

Hypothermia can cause what ECG changes

Answer 66

J waves on ECG

Question 67

Thiazide diuretics can cause which two electrolyte abnormalities

Answer 67

Hypercalcaemia - high calcium level in the blood hypocalciuria - low calcium level in the urine Thiazide diuretics work by blocking the Na-Cl symporter in the distal convoluted tubule. This indirectly also leads to hypercalcaemia