Final Year Passmed BITZ Flashcards
(112 cards)
1
Q
Thiazides electrolyte SE?
A
Hypercalcaemia
2
Q
Transfusion threshold for patients in ACS
A
80g/L
3
Q
ECG finding of deeply inverted or biphasic waves in V2-3 in a person with the previous history of angina
A
Wellen’s syndrome
CRITICAL STENOSIS OF LAD
4
Q
CRITICAL STENOSIS OF LAD
ECG finding of deeply inverted or biphasic waves in V2-3 in a person with the previous history of angina
A
Wellen’s syndrome
5
Q
Iron reduces the absorption of what drug?
A
Thyroxine
6
Q
String like sign seen in the terminal ileum on AXR for crohns
A
‘Kantor’s string sign’
7
Q
Burning thigh pain, what nerve and condition
A
meralgia paraesthetica - lateral cutaneous nerve of thigh compression
8
Q
Total anterior circulation infarcts (TACI, c. 15%)
A
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
9
Q
- involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
- 2 of the above criteria are present
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
A
Partial anterior circulation infarcts (PACI, c. 25%)
10
Q
- presents with 1 of the following:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- pure sensory stroke.
- ataxic hemiparesis
A
Lacunar infarct
11
Q
- involves vertebrobasilar arteries
- presents with 1 of the following:
- cerebellar or brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia
A
Posterior circulation infarcts (POCI, c. 25%)
12
Q
- ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
- contralateral: limb sensory loss
A
Lateral medullary syndrome (posterior inferior cerebellar artery)
13
Q
- ipsilateral III palsy
* contralateral weakness
A
Weber’s syndrome
14
Q
Left homonymous hemianopia, what side of brain is lesion
A
R
always contralateral
15
Q
Superior right homonymous hemianopia, where is the lesion
A
L Temporal lobe
Always contralateral
PITS
16
Q
Define nephrotic syndome in values
A
- proteinuria (> 1 g/m^2 per 24 hours)
- hypoalbuminaemia (< 25 g/l)
- oedema
17
Q
C5-6 pick up sticks C7-8 lay them straight L2-3 lift my knee L3-4 kick the door L4-5 toes point to the sky L5-S1 kick my bum S1-2 stand on my shoe
A
C5-6 pick up sticks C7-8 lay them straight L2-3 lift my knee L3-4 kick the door L4-5 toes point to the sky L5-S1 kick my bum S1-2 stand on my shoe
18
Q
age-related sensorineural hearing loss
A
Presbycusis
19
Q
A 61-year-old woman with a history of cardiac problems develops hearing loss after a prolonged admission in hospital. Drug toxicity is suspected.
Not gentamicin
A
Furosemide
20
Q
The sign is positive when bilateral arm elevation causes facial plethora.
A
Pemberton’s sign is used to evaluate venous obstruction in patients with goiters. The sign is positive when bilateral arm elevation causes facial plethora.
21
Q
1st line trigeminal neuralgia Rx
A
carbamazepine
100mg bd
22
Q
Screening for glaucoma, does it exist?
A
Those with a positive family history of glaucoma should be screened annually from aged 40 years
23
Q
Thrombectomy target time
A
The standard target time for thrombectomy in acute ischaemic stroke is 6 hours
24
Q
List motor reponse in GCS
A
- Obeys commands
- Localises to pain
- Withdraws from pain
- Abnormal flexion to pain (decorticate posture)
- Extending to pain
- None
25
List verbal response in GCS
5. Orientated
4. Confused
3. Words
2. Sounds
1. None
26
List eye response in gcs
4. Spontaneous
3. To speech
2. To pain
1. None
27
Carotid sinus hypersensitivity pathophysiology / types
Carotid sinus hypersensitivity may be cardioinhibitory (ventricular pause of >3 seconds) or vasodepressive (a fall in the SBP by >50mmHg)
28
PSA - don't test until:
* 6 weeks of a prostate biopsy
* 4 weeks following a proven urinary infection
* 1 week of digital rectal examination
* 48 hours of vigorous exercise
* 48 hours of ejaculation
29
Rx considered in anal issues refractory to conservative Rx + botox?
• Anal fissures - sphincterotomy may be considered for cases that do not respond to conservative management or botox
30
the investigation of choice in diagnosing bladder cancer
Cystoscopy
31
Secondary prophylaxis of hepatic encephalopathy
Lactulose and rifaximin are used for the secondary prophylaxis of hepatic encephalopathy
32
NBM for how long
The Royal College of Anaesthetists recommend that patients should have no food for 6 hours before the induction of general anaesthesia. Patients should be allowed to drink water or other clear fluids until 2 hours before the induction of general anaesthesia. This is to reduce the likelihood of pulmonary aspiration of gastric contents.
33
When to start LMWH after hip replacement?
For elective total hip replacement surgery NICE recommend commencing a low molecular weight heparin 6-12 hours after surgery
34
When to add second drug in T2DM
A second drug should be added in type 2 diabetes mellitus if the HbA1c is > 58 mmol/mol
* if despite this the HbA1c rises to, or remains above 58 mmol/mol(7.5%) then triple therapy with one of the following combinations should be offered:
* → metformin + gliptin + sulfonylurea
* → metformin + pioglitazone + sulfonylurea
* → metformin + sulfonylurea + SGLT-2 inhibitor
* → metformin + pioglitazone + SGLT-2 inhibitor
* → OR insulin therapy should be considered
35
Acute cholecystitis Rx
intravenous antibiotics + early laparoscopic cholecystectomy within 1 week of diagnosis
36
An isolated result of high protein in the CSF is indicative of
An isolated result of high protein in the CSF is indicative of GBS
37
upstroke of the pulse alternatives between strong and weak. It indicates systolic dysfunction and is seen in patients with heart failure.
Pulsus alternans
38
Angina Rx
1st step: Beta-blocker or Ca2+-channel blocker (non-dihydropyridine or dihydropyridine).
2nd step: Beta-blocker + Ca2+-channel blocker (never non-dihydropyridine when in combination with beta-blocker).
3rd step: Add long acting nitrate or ivabradine
39
Use of the anion gap
* Raised anion gap seen in e.g. diabetic ketoacidosis or,
| * Normal anion gap seen in patients with diarrhoea due to gastrointestinal bicarbonate loss.
40
Causes of normal anion gap
AKA
Hyperchoraemic metabolic acidosis
ANION GAP +
(na+k)-cl-hco3
Normal anion gap ( = hyperchloraemic metabolic acidosis)
* gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
* renal tubular acidosis
* drugs: e.g. acetazolamide
* ammonium chloride injection
* Addison's disease
41
Causes of raised anion gap
* lactate: shock, sepsis, hypoxia
* ketones: diabetic ketoacidosis, alcohol
* urate: renal failure
* acid poisoning: salicylates, methanol
42
Differentiate between seizure and pseudoseizure
• Prolactin can be used to differentiate between a true seizure and a pseudoseizure
43
Preferred opioids in CKD
• Alfentanil, buprenorphine and fentanyl are the preferred opioids in patients with chronic kidney disease.
44
How does nephrotic syndrome cause hyper coagulable states?
Nephrotic syndrome is associated with a hypercoagulable state due to loss of antithrombin III via the kidneys
45
Raised AST with statins. When do you discontinue the statins
Treatment with statins should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range.
46
What is gallstone ileus
This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.
Abdominal pain, distension and vomiting are seen.
47
What does P mitrale represent?
P Mitrale represents left atrial hypertrophy/strain e.g. in mitral stenosis
48
Terminal ileitis is associated with what?
Terminal ileitis (Crohn's) is associated with gallstones
49
Isolated fever in well patient in first 24 hours following surgery?
Think physiological reaction to operation
50
Who do you 2WW with for UGI?
All patients who've got dysphagia
All patients who've got an upper abdominal mass consistent with stomach cancer
Patients aged >= 55 years who've got weight loss, AND any of the following:
* upper abdominal pain
* reflux
* dyspepsia
51
How do you test for H pylori?
* initial diagnosis: NICE recommend using a carbon-13 urea breath test or a stool antigen test, or laboratory-based serology 'where its performance has been locally validated'
* test of cure: carbon-13 urea breath test
52
What is the L 1 caveat with SCC or herniation?
Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion
53
Turbid effusion with pH<7.2, Low glucose, High LDH
• Empyema
54
Asymmetric septal hypertrophy and systolic anterior movement (SAM) of the anterior leaflet of mitral valve on echocardiogram or cMR
HOCM
55
Liver failure following cardiac arrest
ischaemic hepatitis
56
black hairy tongue
Tetracyclines
57
Painkiller in kidney stones
Guidelines continue to recommend the use of IM diclofenac in the acute management of renal colic
58
Main cause of peritonitis in peritoneal dialysis
Coagulase-negative Staphylococcus is the most common cause of peritonitis secondary to peritoneal dialysis
59
Neutropaenic sepsis Rx
Tazocin is recommend as the first-line antibiotic by NICE. G-CSF is not used routinely in neutropenic sepsis.
60
Discuss timeframe in IgA vs post-strep glomerulonephritis
IgA characteristically causes visible haematuria a few days after URTI (post-infectious GN has lag time of around 2 weeks before haematuria occurs and would be a less benign presentation if associated with visible haematuria).
61
In which part of the brain are changes most likely to be found in early Alzheimer’s disease –
temporal lobe
62
What is Hoover’s sign of leg paresis
Hoover’s sign of leg paresis is a specific manoeuvre used to distinguish between an organic and non-organic paresis of a particular leg. This is based on the concept of synergistic contraction. If a patient is genuinely making an effort, the examiner would feel the 'normal' limb pushing downwards against their hand as the patient tries to lift the 'weak' leg. Noticing this is indicative of an underlying organic cause of the paresis. If the examiner, however, fails to feel the 'normal' limb pushing downwards as the patient tries to raise their 'weak' leg, then this is suggestive of an underlying functional weakness, also known as 'conversion disorder'.
63
triad of sudden onset abdominal pain, ascites, and tender hepatomegaly
Budd chiari
64
Budd chairi triad
triad of sudden onset abdominal pain, ascites, and tender hepatomegaly
65
A low fibrinogen level is the major criteria determining the use of cryoprecipitate in bleeding
A low fibrinogen level is the major criteria determining the use of cryoprecipitate in bleeding
66
Management of uncomplicated dissection of the aorta?
An uncomplicated dissection of descending aorta may be managed medically – bblckers + analgesia
67
* lesion of optic chiasm
| * upper quadrant defect > lower quadrant defect
inferior chiasmal compression, commonly a pituitary tumour
68
• lower quadrant defect > upper quadrant defect =
superior chiasmal compression, commonly a craniopharyngioma
69
superior chiasmal compression, commonly a craniopharyngioma
What defect
• lower quadrant defect > upper quadrant defect = CRANIO-LOW
70
inferior chiasmal compression, commonly a pituitary tumour
What defect
upper quadrant defect > lower quadrant defect
71
• The patient has been diagnosed with maturity onset diabetes of the young (MODY) - type Hepatic Nuclear Factor 1 Alpha (HNF1A). HNF1A accounts for 70% of MODY cases.
Optimum Rx?
Sulfonylureas (e.g. gliclazide)
72
High quality evidence suggests that _____ helps to accelerate the return of normal bowel function after abdominal surgery
epidural anaesthesia
73
chemotherapy used in breast cancer patients who are node +ve
FEC-D
74
severe alcoholic hepatitis Rx?
corticosteroids
75
_______ is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds
Whole breast radio
76
Reinfection with syphilis should be suspected if the RPR rises by
4-fold or more
77
What common drug is a risk factor for Clostridium difficile infection - not the ABx
PPIs are a risk factor for Clostridium difficile infection
78
ABPI interpretation
* > 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
* 1.0 - 1.2: normal
* 0.9 - 1.0: acceptable
* < 0.9: likely PAD. Values < 0.5 indicate severe disease which should be referred urgently
79
Prophylaxis in oesophageal bleeding
• A non-cardioselective B-blocker (NSBB) is used for the prophylaxis of oesophageal bleeding
80
benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space. The female to male ratio is around 4:1.
Mortons
Features
* forefoot pain, most commonly in the third inter-metatarsophalangeal space
* worse on walking. May be described as a shooting or burning pain. Patients may feel they have a pebble in their shoe
* Mulder's click: one hand tries to hold the neuroma between the finger and thumb. The other hand squeezes the metatarsals together. A click may be heard as the neuroma moves between the metatarsal heads
* there may be loss of sensation distally in the toes
81
The concurrent use of methotrexate and trimethoprim containing antibiotics may cause
bone marrow suppression and severe or fatal pancytopaenia
82
exacerbated by walking on tip toes unlike subcalcaneal bursitis and is the most common cause of heel pain in adults.
This is typical of plantar fasciitis
83
Most common organism found in central line infections
Staphylococcus epidermidis
84
Breast cancer staging
: T1 <2cm, T2 2-5cm, T3 5+cm, T4a invades chest wall, T4b invades skin (includes ulceration or oedema), T4c invades chest wall and skin, T4d inflammatory breast cancer
85
: T1 <2cm, T2 2-5cm, T3 5+cm, T4a invades chest wall, T4b invades skin (includes ulceration or oedema), T4c invades chest wall and skin, T4d inflammatory breast cancer
Breast cancer staging
86
Use of what drug will slow bone healing
Use of NSAIDS will slow bone healing
87
Strange trigger for liver decompensation
Constipation can be a trigger for liver decompensation in cirrhotic patients
88
a common and benign condition characterised by the development of a painful nodule on the ear. It is thought to be caused by factors such as persistent pressure on the ear (e.g. secondary to sleep, headsets), trauma or cold. CNH is more common in men and with increasing age.
Chondrodermatitis nodularis helicis (CNH)
89
Orthostatic hypotension definition
Orthostatic hypotension can be diagnosed when there is a drop in SBP of at least 20 mmHg and/or a drop in DBP of at least 10 mmHg after 3 minutes of standing
90
most common cause of death following a myocardial infarction.
Ventricular fibrillation
91
used to identify patients at risk of pressure sores
Waterlow score
92
CLumsy kLumpke fell and cLung on (where L= Lower brachial plexus, C8-T1)
CLumsy kLumpke fell and cLung on (where L= Lower brachial plexus, C8-T1)
93
PCI for angina?
Primary percutaneous coronary intervention (PCI) does not provide any prognostic benefit over optimal medical therapy for stable angina i.e. PCI does not improve survival (see BARI2D and COURAGE trials)
94
ECG with tall R waves V1-2
Posterior MI typically present on ECG with tall R waves V1-2
95
Lithium range
• range = 0.4 - 1.0 mmol/l
96
When do you measure cyclosporin post dose
• trough levels immediately before dose
97
When do you measure digoxin post dose
• at least 6 hrs post-dose
98
* bradycardia
* 'J' wave - small hump at the end of the QRS complex
* first degree heart block
* long QT interval
* atrial and ventricular arrhythmias
hypothermia
99
Intermittent locking in flexion
| finger
Trigger finger
100
fixed flexion finger
Dupuytren's
101
fixed flexion of the DIP after injury
| finger
Mallet finger
102
* U waves
* small or absent T waves (occasionally inversion)
* prolong PR interval
* ST depression
* long QT
ECG features of hypokalaemia
103
Lymphatic drainage of rectum
Pararectal lymph nodes drain the upper part of the rectum and parts of the colon. The testes and ovaries drain to the lumbar lymph nodes.
104
investigation of choice to detect liver cirrhosis
Transient elastography is now the investigation of choice to detect liver cirrhosis
What is transient elastography?
* brand name 'Fibroscan'
* uses a 50-MHz wave is passed into the liver from a small transducer on the end of an ultrasound probe
* measures the 'stiffness' of the liver which is a proxy for fibrosis
105
A high SAAG (>11g/L) indicates
portal hypertension and the ascitic fluid is a transudate. Causes of this include liver cirrhosis, hepatic failure, venous occlusion (e.g. Budd Chiari syndrome), alcoholic hepatitis, and kwashiorkor malnutrition.
106
A low SAAG (<11g/L)
suggests the ascitic fluid is an exudate. Causes of this include malignancy, infection, pancreatitis and nephrotic syndrome. Therefore, bowel malignancy, nephrotic syndrome and pancreatitis are incorrect.
107
Adjuvant hormonal therapy for ER +ve breast cancer: in post-menopausal women
Adjuvant hormonal therapy for ER +ve breast cancer: anastrozole in post-menopausal women
108
The patient has an unprovoked DVT. Patients should be offered what?
The patient has an unprovoked DVT. Patients should be offered CT scan abdomen and pelvis to help identify possible malignancy
109
How to monitor respiratory function in myasthenic crises
Myasthenic crisis is an acute respiratory failure characterised by forced vital capacity (FVC) below 1 L, negative inspiratory force (NIF) of 20 cm H2O or less, and the need for ventilatory support. The use of accessory muscles indicates significant inspiratory weakness. Weak cough indicates weakness of expiratory muscles. Arterial blood gas analysis commonly shows hypercapnia before hypoxia. There should be a low threshold for endotracheal intubation due to rapid deterioration of bulbar and respiratory muscles.
110
Recurrent candidiasis indicates the need to test for
Recurrent candidiasis indicates the need to test for diabetes mellitus.
111
Rx for superior vena cava obstruction
The patient has superior vena cava obstruction. The standard initial treatment is dexamethasone to reduce tumour swelling. There is no evidence of thrombus to justify systemic anticoagulation and systemic thrombolysis has no place. Intravenous mannitol is not used. It is worth noting that although dexamethasone is commonly recommended there is limited controlled data confirming its effectiveness. Insertion of endovenous stent would be considered if there was stridor, but would likely follow intubation and steroids. The following guideline is of use:
112
Should diabetic patients have normal medications omitted?
Patients with diet or tablet controlled diabetes may be managed using a policy of omitting medication and checking blood glucose levels regularly. Diabetics who are poorly controlled or who take insulin will a require variable rate intravenous insulin infusion. Potassium supplementation should also be given.
