finals Flashcards
(376 cards)
1
Q
Bloods in IDA?
A
low serum iron, low transferrin <16%, High TIBC
2
Q
Investigation of IDA?
A
Endoscopy and colonoscopy, biopsies for coeliac
3
Q
Who to refer based upon Hb in iron deficiency anaemia?
A
Any age men <12 post menopause woman less than 10
4
Q
When to check Hb again after treatment?
A
2-4 weeks should be rise >2g/l
5
Q
Over age of what and IDA to refer?
A
> 60
6
Q
If Hb not risen after 2-4 weeks then what?
A
Check compliance, refer
7
Q
Normal endoscopies but IDA?
A
Consider H.pylori testing
8
Q
Increased risk of what with pernicious anaemia?
A
Gastric cancer
9
Q
Cause of pernicious anaemia?
A
Gastric parietal cell atrophy
10
Q
Causes of B12 deficiency?
A
Gastrectomy, PPis, Metformin, reduced intake
11
Q
Causes of folate deficiency?
A
Alcohol, low intake, Methotrexate and trimethoprim crohns
12
Q
Bloods results b12/folate?
A
Macrocytic, can do lfts to look for alcoholic cause
13
Q
How and how often replace B12?
A
1mg IM every 3 months
14
Q
Folic acid doses?
A
5mg for 4 months
15
Q
First sensory loss in sub acute degeneration of cord?
A
Proprioception
16
Q
Classic features of migraine?
A
Unilateral behind eye, phonophobia, vomiting, photophobia +/- aura
17
Q
Triggers for migraine?
A
Hypoglycaemia, cheese, chocolate, alcohol, stress, sleep lack, strong smells
18
Q
Conservative measures for migraine?
A
Avoid triggers, headache diary 8 weeks
19
Q
Preventative measures for Migraine?
A
propranolol (not asthma) Topirimate, accupuncture
20
Q
Chronic tension headache time?
A
15 days or more
21
Q
Chronic tension treatment?
A
Accupunture or amitryptiline(off label)
22
Q
Cluster headache?
A
red watery eye, ice pick in eye (periorbital), sweating rhinorrhoea, eyelid oedema
23
Q
Cluster headache duration?
A
1-3hrs often same time of day like early morning waking you up
24
Q
Treatment of cluster headache?
A
High flow oxygen, subcut/intranasal triptan (oral not good)
25
Chronic cluster?
1 year no remission
26
Cluster headache history presents to GP?
referral to neuro or gpsi
27
prevention of cluster headache?
Verapamil
28
Single most important risk factor for ARMD?
Smoking
29
Myeloma what is it?
proliferation of plasma cells, which produce immunoglobulin
| usually IgG too much and dopsition
30
Myeloma on blood film?
Roleaux formation and anaemia
31
Testing myeloma?
Bence jones, serum electrophoresis
32
CRAB acronym
calcium >2.6 Renal problems, Anaemia, Bone pain (back particularly) Can also have low WCC
33
First line imaging for myeloma?
Skeletal survey whole body MRI
34
Most diagnostic for myeloma?
Bone marrow trephine and biopsy
35
Treatment of myeloma?
Stem cell transplant
36
Pain in myeloma?
Lumbar and thoracic back pain
37
Most common pathogens for otitis media?
Strep pneu moniae and haemophillus
38
Symptoms of otitis media and onset?
Rapid onset, earache, membrane red, air fluid level or perforations
39
Otitis externa symptoms?
Aural fullness develops in 48hrs and causes eczematous, weeping soreness in canal
40
Acute otitis externa acute vs chronic?
3 weeks vs 3 months
41
Cause of otitis externa?
Usually swimming but can be soborrhoeic dermatitis
42
Treatment of otitis externa? Conservative?
abx drops and steroid, plus analgesia ear plugs avoiding swimming etc
43
Malignant otitis externa?
Exposed bone and granulation, very high fever, facial nerve paralysis, progressive hearing loss
44
Treatment of malignant otitis externa?
ABX tazocin, cipro for 6-8 weeks oral too
45
What is stable angina?
Stable predictable chest pain on exertion, lasting no more than 10mins when using gtn or resting
46
First line for angina?
BB or rate limiting CCB
47
anti-platelets for angina?
usually low dose aspirin 75mg if not on clopidogrel already for other problems
48
Peripheral arterial disease anti platelets?
Clopidogrel
49
Unstable angina?
Chest pain at rest or ecg changes such as t wave inversion etc in the absence of biochemical features of damage (trop)
50
Unstable angina treatment?
Aspiring 300mg
51
When to offer fondaparinux to patients?
NSTEMI and unstable angina if not planned to go to PCI
52
GRACE score?
Risk of future cardiovascular problems in hospital 6 month and 3 year mortality
53
Unstable angina secondary prevention considerations?
BB, ACEi and High dose statin,
54
NSTEMI?
Non ST ecg ischaemic changes such as T wave abnormalities or ST depression, with a rise in troponin
55
NSTEMI treatment?
Aspirin 300 & Clopidogrel 300, Morphine, GTN, 02 maintain normal sats
Fondaparinux unless PCI planned in which case unfractionated heparin used and in renal issues
56
Who to offer oxygen to in MI?
Sats <94%
57
What to offer after NSTEMI platelet wise?
Clopidogrel 12 months after event, aspirin indefinitely
58
Features of STEMI?
ST elevation and or new onset LBBB
59
Q waves normal in which leads?
Small ones in msot leads bigger acceptable in III or AVR
60
Q waves abnormal where?
Chest leads usually and if contiguous
61
When is PCI undertaken?
Within 12 hrs or thrombolysis if PCi cannot be delivered within 2 hrs
62
Do fibrinolysis then ECG 1 hr later and STEMI still there then what?
Then sent for immediate angiography with follow on PCI if needed
63
STEMI management?
Aspirin, Morphine, TN, 02 if needed Anti emetic too
Ticagrelor 180mg loading
If going for PCi need LMWH or unfractionated - Check with cardio
64
ACS conservative measures?
Weight loss, alcohol, smoking, diet, cardiac rehab, exercise, flu vaccine
65
Type of hearing loss is presbycussis?
Sensorineural
66
Audiogram in bilateral sensorineural and where affected in ear?
drops off at high frequency- inner ear affected
| Conductive and bone is affected
67
Labrynthitis signs and symptoms?
Spinning room, vertigo nausea vomiting, Tinnitus/hearing loss (sensorinerual)
Nystagmus- unidirectional
68
Conductive hearing loss causes?
Tumours, cholesteatome, otosclerosis, wax perforation
69
Menieres disease?
Episodic vertigo, roaring tinnitus, can have hearing loss, sometime the episodes are preceded by a change in tinnitus. Refer to ENT
70
Acoustic neuroma/schwannoma investigation?
MRI gadolinium enhanced
71
Treatment of acoustic neuroma?
Small observe or not radiation/surgery
72
Bone disease presenting with hearing loss?
Pagets
73
BPPV?
short episodic, not tinnitus associated with rolling over in bed use dix hallpike to diagnose.
74
Cause of BPPV? What treats?
Otoliths use epley manouvre review 4 weeks
75
How do carbonic anhydrase inhibitors work in glaucoma?
Reduce production of aqueous fluid
76
What drugs to use in acute glaucoma?
Acetazolomide, timolol, pilocarpine
77
Procedure to treat acute angle closure?
iridotomy
78
iridotomy complication?
Retinal vein occlusion/vision loss
79
Blood pressure aim for SAH?
High normal
80
SAH CT features?
Blood in sulci etc and if really bad in ventricles
81
Common electrolyte problem in SAH?
Hyponatraemia from SIADH
82
Most common cause of subdural bleed? Damaging what?
Trauma Damaging bridging veins
83
Risks for subdural?
Alcoholism, atrophy of brain
84
Signs of subdural haematoma?
Fluctuating GCS, unsteadiness and headaches
85
GCS score eyes?
4 eyes- open spont
3-open to voice
2- open to pain
86
What should never be done in a patient with an extradural haematoma?
Lumbar puncture
87
GCS scores for head CT's?
<13 initial assessment and <15 2hrs post injury
88
Other than GCS what indications for immediate head CT scan?
Suspected depressed skull, or basal skull (panda or battles)
Post traumatic seizure
Focal neuro
>1 vomit
89
CT head in 8 hrs?
```
Warfarin
Any bleeding disorders
dangerous mechanism (>1metre fall)
>30mins retrograde amnesia
>65 years
```
90
When is unfractionated heparin preferred for prophylaxis of VTE
When eGFR less than 30mls
91
Rules for meals and Variable insulin for operations?
If only one meal missed can be managed with modification of regime. If expected to miss>1 meal should have variable rate.
If managed by lifestyle or OD metformin only variable rate if glucose >12 on 2 occasions
92
When should variable rate insulin be used peri-op in patients taking metformin once daily or lifestyle managed t2dm?
Only if glucose >12 on two occasions
93
Instructions for metformin when having operation?
Take as normal if only taken once or twice daily
94
Instructions for gliclazide/sulphonyureas when having operation?
Take before day of operation, omit dose on day if once a day and omit morning dose if twice daily.
95
What to do when starting variable rate re-drugs?
Stop all and only resume when eating and drinking
96
Pioglitazone, exenitide and gliptin rules for operations?
Take as normal regardless
97
Warfarin stopped before op?
Yes 5 days and LMWH if high risk
98
NOAC stopped when if normal renal and bleeding risk?
Day before
99
Main causes of heart failure?
Ischaemia, HTN, cardiomyopathy and valve disease, pericarditis
100
Drugs to avoid in Heart failure?
Morphine, pioglitazone, NSAIDS, Diltiazem and verapamil
101
Left sided heart failure?
Orthopnea, PND, Pink/white frothy sputum, bibasal creps,SOB
102
Right sided heart failure?
JVP raised, hepatosplenomegaly, Pitting peripheral oedema, Ascites
103
Criteria for heart failure diagnosis?
Framingham- 2 major or 1 major +2 minor
104
Major criteria heart failure-
third heart sound, PND, raised JVP, cardiomegaly, weight loss
105
Minor criteria heart failure?
Bilat ankle oedema, nocturnal cough, SOBE
106
BNP value >400?
Refer for echo 2 weeks
107
BNP value >100-400
Refer 6 weeks echo
108
Who to measure NT-BNP in?
All patients suspecting HF not just those who did not have MI in past.
109
CCF ecg?
Axis deviation and LVH strain, AF
110
HF management?
ACEi, Beta blockers, Spironolactone- (nitrates and hydralazine) reduce mortality
Statins used and loop diuretics for symptom management but do not alter course of disease
111
Acute heart failure treatment?
Oxygen, sit them up, diuretics, CPAP consider Morphin and nitrates (not routinely)- monitor weight renal urine output
112
Severe aortic stenosis and HF?
Consider for valve replacement
113
Loss of central vision, blurring of lines crooked or bent?
ARMD
114
VEGF useful in which ARMD?
Wet
115
Paroxysmal AF ?
>30sec but <7 days self terminating
116
Persistent AF?
>7 days
117
Permanent AF?
Fails to terminate with cardioversion or longstanding >1year
118
Causes of AF?
Infection, Alcohol, Structural heart disease- Aortic stenosis, Ischaemic heart disease, Hyperthyroidism
119
ECG AF?
Irregularly irregular, no P waves
120
Fast AF?
>160bpm
121
Chadsvasc items?
Cardiac failure, stroke(2), diabetes, age 2 points >75 1 point 64+, HTN, female(1 point)
122
Chadsvasc score for anticoagulation?
>2 everyone or 1 or greater in men consider
123
INR range for AF?
2-3
124
DOAC considerations in elderly?
Kidney issues can cause bleeding
125
Strategy for Paroxsysmal AF?
Anticoag if needed and consider pill in pocket if cardiovascularly well
126
When to consider rhythm control?
With new-onset AF.
Whose AF has a reversible cause (for example a chest infection).
Who have heart failure thought to be primarily caused, or worsened, by AF.
With atrial flutter who are considered suitable for an ablation strategy to restore sinus rhythm
127
If the onset of AF is within 48 hours with non-life threatening haemodynamic instability
Offer rate, or admit for consideration of cardioversion <48hrs no need for anticoag
128
Arrhythmia >48hrs but want to cardiovert?
Need to anticoag for ~3 weeks before
129
First line treatment in AF?
Beta blocker or if contraindicated (asthma) rate limiting calcium channel blocker (contra in HF)
130
unilateral polyps? or unusual/bleeding
Refer 2 week
131
Stage 1 hypertension <80 years when to offer drugs?
```
target organ damage
established cardiovascular disease
renal disease
diabetes
10-year cardiovascular risk equivalent to 20% or greater
```
132
Stage 2 hypertension treatment?
Any age offer
133
Cant tolerate ACEi what next?
ARb
134
Target BP (clinic) for treatment?
140/90
135
Black or african on calcium channel blocker needs intensifying consider what?
ARB not ACEi
136
Step 2 htn?
Offer treatment with a CCB in combination with either an ACE inhibitor or an ARB - id ccb not good eg oedema offer diuretic
137
Step 3 HTN?
ACE inhibitor or angiotensin II receptor blocker, a calcium-channel blocker, and a thiazide-like diuretic.
138
HTN in diabetes?
Give ACEi
139
Statin therapy in type 1?
>10 years, >40 years or nephropathy
140
Qrisk and statins?
10% consider statin and lifestyle is >20% offer statin 20mg atorvo
141
Which Tb drugs given for only 2 months?
Pyrizimide, ethambutol
142
Which Tb drugs continued for whole of 6 months?
Rifamp and
143
GCS scores for voice?
5-speech- Oriented
4-confused
3-Inappropriate words
2-incoherent mumbling
144
GCS scores for motor
```
6-Movement- Obeys
5-Localises to pain
4-Withdraws from pain
3-flexes to pain
2-extends pain
```
145
Anaphylaxis process?
Adrenaline 0.5ml 1/1000 IM
Fluid challenge
Chlorphenamine 10mg
Hydrocortisone 200mg
Check Tryptase - Initially then 1-2hrs then 24hrs
146
How often parkinsons reviews?
6-12 months
147
What can be used to prevent breakdown of dopamine peripherally?
co-benaldopa
148
Dopamine agonist example?
Ropinirole
149
Anaphylaxis process?
Adrenaline 0.5ml 1/1000 IM
Fluid challenge
Chlorphenamine 10mg
Hydrocortisone 200mg
Check tryptase - Initially then 1-2hrs then 24hrs
150
Most commonly affected joints in OA?
Knee, Hip, hands (DIPS, PIPS, Thumb) lumbar and cervical spine
151
Joint pain and stiffness when and worse with?
Morning but only for ~ 30 mins Activity or use of joints
152
Radiographical features of OA?
```
LOSS:
Loss of joint space(asymetrical)
Osteophytes
Sclerosis
Cysts
```
153
Which nodes seen in OA and where?
Heberdens DIP
| Bouchards PIP
154
Plantar spur and pencil in cup deformity?
Psoriatic arthritis
155
Rheumatoid Xray changes?
LESS:
Loss of joint space symetrical
Erosions
Soft bones and soft tissue
156
Ankylosing spondylosis pelvic xray?
Sacroilitis
157
Carpal tunnel syndrome which MSk problem can be find with this?
RA
158
A 35-year-old female presents with pain on the radial side of the wrist and tenderness over the radial styloid process.
abduction of the thumb against resistance is painful?
De quervains, common in 30-50yrs
159
When to consider urgent referal to rheum in 3 days?
Affects small joints of hands or feet
More than one joint
delay of >3 months
160
Cant make a fist which arthritis more likely?
Rheumatoid
161
Elderly female polydipsia, polydipsia, aches and pains ?
Hyperparathyroidism
162
Most common cause of hyperparathyroidism
Solitary adenoma
163
Bloods in hyperparathyroid?
Raised calcium Raised PTH low phosphate
164
Pyoderma gangrenosum associated what looks like?
IBD looks like margherita pizza
165
What is marjolins ulcer
SCC at site of inflammation
166
typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
aching, morning stiffness in proximal limb muscles
PMR
167
Xray described linear calcification of articular cartilage plus an effusion?
Pseudo gout xray describes calcinosis
168
5 A's of ank spon?
```
Anterior uveitis,
Achilles tendinopathy
Aortic regurg
Atlanto instability
Apical fibrosis
```
169
Risk factors for Osteporosis?
Early menopause, Rheumatoid arthrtiis
170
Femoral nerve compression may cause referred pain?
In hip
171
Can gout be seen on xray?
No only pseudo gout chondrocalcinosis of cartilage
172
Limited cutaneous CREST?
Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
173
Anti-body for Limited cutaneous sclerosis?
Anti-centromere
Crest (C)
Cutaneous (C)
174
Mcmurrays test for what?
Meniscal tear
175
Advise to give in OA conservative?
Lose weight and do exercise particularly muscle strengthening
176
Normal straight leg raise makes what less likely in back pain?
Prolapsed disc
177
Which nerve root fr foot drop?
L5
178
Most common complication of measles?
Otitis media
179
Lymphoma associated with ebv?
Burkitts
180
Most common cause of non hodgkins?
Diffuse large b cell
181
Upper zone fibrosis (CHARTS)
```
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
```
182
High calcium with normal/high PTH?
Hyperparathyroidism
183
Bloods in primary hyperparathyroidism?
High or inappropriately normal PTH with a HIGH Calcium
184
Secondary hyperparathyroidism?
High PTH and low calcium
185
Low TSH High T4?
Hyperthyroidism
186
Most common cause of hyperthyroidism? Other causes?
Graves, toxic multinodular goitre, de quervains(initially)
| Amiodarone
187
Most common cause of Hypothyroidism?
Hashimotos
188
secondary hypothyroidism bloods?
Low TSH Low T4
189
Primary hypothyroidism?
High TSH low T4
190
Poor compliance thyroid functions?
Normal T4 but high TSH
191
Anti bodies in graves?
TSH receptor
192
Antibodies hashimotos?
Anti TPO
193
Patchy uptake thyroid scan?
Toxic multinodular
194
Signs of lobar collapse Xray?
tracheal deviation towards the side of the collapse
mediastinal shift towards the side of the collapse
elevation of the hemidiaphragm
195
Electrolyte disturbance causing digoxin toxicity?
hypokalaemia
196
3 s's plus an | for erythema nodosum?
Strep, Sulphonamines, Sarcoid, IBD
197
burning sensation over the antero-lateral aspect of her right thigh which nerve?
Lat cutaneous
198
Section 3 mental health act?
Treatment
199
Section 2 mental health act?
Admission for assessment 28days
200
Section 5 2 mental health?
Doctors holding 72hrs
201
Hip dislocation ?
Internal rotation (usually posterior) Ext with ant and prostheses
202
Increased risk of what in RA?
IHD
203
IVDU ill, and pain in back and hip extension?
Psoas abscess
204
Classic history for PCL injury?
Car crash
205
PCL injury what sign?
Tiba is displaced backwards
206
Loss of knee jerk and sensory loss over knee which nerve root?
L4
207
On examination, he has tenderness over the proximal part of his forearm, and has severely restricted supination and pronation movements?
Frac of radial head
208
A T-score less than -1.5
Start bisphos, if going to be on steroids long term
209
A FRAX score of 10% or greater do what?
Order DEXA
210
Hiatus hernia types?
Sliding most common, rolling uncommon (paraoesophageal)
211
Hiatus hernia treatment?
PPI rarely surgery
212
Vagus nerve lesion what happens?
Uvula deviates away from side of lesion, loss of gag reflex
213
Cranial nerve palsy in stroke, likely area of infarction?
Posterior/brainstem
214
Deviation of tongue which nerve palsy which side?
12th nerve towards lesion
215
PMR commonly associated with?
GCA/Temp art
216
Capillaroscopy used fro?
Systemic sclerosis
217
TACS stroke?
Homonymous hemianopia
Unilat sensory or motor loss
Dyphasia or higher functioning loss
218
PACS stroke?
Two from:
Homonymous hemianopia
unilat sensory or motor loss
Dyphasia or higher functioning loss
219
Tacs and pacs vessels?
Middle cerebral and anterior
For pacs, smaller branches affected
220
Lacunar infarct ?
one of:
Unilateral weakness
Pure sensory loss
Ataxic hemiparesis
221
Where are lacunar infarcts?
| Which arteries?
involves perforating arteries around the internal capsule, thalamus and basal ganglia
222
POCI stroke?
LOC
or Cerebellar brainstem syndromes
or isolated homonymous hemianopia
223
Arteries for posterior stroke?
Vertebrobasilar
224
ABCD2 score > what for high risk?
>4
225
When to give NAC in paracetamol overdose?
>150mgḱg,
if taken >4g over >1hour
If at 4 hrs they are above treatment line
226
When to take paracetamol levels?
At 4 hrs post ingestion
227
Tricyclic overdose management ?
Acidosis correction, magnesium if torsades
| Cannot dialyse
228
Crescendo TIA how treated?
As high risk
229
The combination of deranged LFTs combined with secondary amenorrhoea ?
Autoimmune hepatitis
230
Colorectal cancer increased risk with which IBD?
UC
231
No inflammation beyond submucosa which IBD?
UC
232
Leadpipe colon on xray
Chronic UC
233
Extraintestinal features of IBD?
```
Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis
Clubbing,
pyoderma
Uveitis
```
234
bloody diarrhoea
urgency
tenesmus
abdominal pain, particularly in the left lower quadrant
UC
235
Screening for type 1 diabetes ?
Autoimmune disease such as coeliac and thyroid
236
Carcinoma associated with GORD?
Adeno
237
Causes of cellulitis?
Streptococcus and staph
238
Progressive dysphagia is characteristic of ?
esophageal carcinoma
239
Achalasia increased risk of?
Oesophageal carcinoma
240
Splenic flexure most often associated with what?
Ischaemic Colitis
241
CVD raised lactate and soft tender abdo
Mesenteric ischaemia
242
The only recommended test for H. pylori post-eradication therapy?
Urea breath test
243
When should urea breath test not be performed?
Within 4 weeks of antibacterial or 2 weeks of ppi
244
Suspected GI bleed when to endoscope?
All patients with suspected upper GI bleed require an endoscopy within 24 hours of admission
245
Gastric ulcer risks what to do?
Biopsy and rescope as risk of cancer.
246
Electrolyte imbalance in refeeding?
Hypophosphataemia
247
Most strongly associated condition with h.pylori?
Duodenal ulcer
248
Raised ACE?
Sarcoid
249
Chronic mesenteric ischaemia triad?
Colicky pain, Bruit and weight loss
250
Addison's pigmentation and blood tests?
Gums and palms, Hyperkalaemia and Hyponatraemia
| Hypoglycaemia
251
Treatment of C-diff
Mild-moderate metro TDS oral 10-14 days severe vanc
252
Best investigation for ischaemic colitis?
CT
253
Conn's syndrome blood gas?
Metabolic alkalosis, hypokalaemic
| Hypernatraemia
254
NAFLD blood test?
Enhanced liver fibrosis (ELF) blood test
255
Initial UC treatment? if no improvement after 4/52?
Aminosalicylates, add pred if no improvement
256
Crohns first treatment?
Steroids also stop smoking
257
When to consider MRCP?
If USS shows no stones but bileduct is dilated and or LFTs deranged
258
How soon to do cholecystectomy if has acute cholecystitis?
Within 1 week
259
Managing common bile duct stones?
Offer bile duct clearance and laparoscopic cholecystectomy to people with symptomatic or asymptomatic common bile duct stones.
260
Leuokocytes and blood no nitrates in urine with pain think what?
Renal stones
261
Iron test if unwell?
Transferrin as less likely to be raised due to inflammation
262
Wilsons bloods?
Reduced copper and reduced caeruloplasmin
263
Possible treatments for hepatorenal syndrome?
Terlipressin
264
Bloods in diabetes insipidus?
high plasma osmolality, low urine osmolality
265
a urine osmolality of >700 mOsm/kg excludes
DI
266
Vitiligo more common which condition?
Thyroid/autoimmune
267
Tests to determine whether a pre-renal uraemia or tubular necrosis?
Urine sodium high >30mmol for acute tubular necrosis
268
Does acute tubular necrosis respond to fluid challenges?
No
269
Erythropoetin side effects?
HTN, flu like, bone pain, encephalopathy, red cellm aplasia
270
Failure of Erythropoietin?
iron deficient, inadequate dose, hyperparathyroid, infection,
271
Haemolytic uraemic syndrome cause most likely?
E-coli 0157
272
CKD haemodialysis cause of death?
IHD
273
Symptoms of goodpastures?
pulmonary haemorrhage
followed by rapidly progressive glomerulonephritis
Can have fever arthralgia etc too
274
```
nose, stuffiness, sinus infections and nosebleeds.
Coughing, sometimes with bloody phlegm.
Shortness of breath or wheezing.
Fever.
Fatigue.
```
?antibody
Granulomatosis with polyangitis (wegeners)
C-ANCA
275
Antibody in goodpastures?
anti-glomerular basement membrane (GBM)
| All the G's
276
Renal biopsy in goodpastures shows?
linear IgG deposits along basement membrane
G's good patures
277
Goodpastures treatment?
Plasma exchange, steroids cyclophosphamide
278
Acute rejection of kidney transplant time frame?
<6 months
279
Commonest extra-renal polycystic complication?
Liver cysts
280
Urine shows what in intrinsic AKI?
Protein- specific
281
Kidney disease and contrast if needed?
Offer IV fluids
282
Gold standard for bladder cancer diagnosis?
Cystoscopy
283
Painless frank haematuria, do what?
Cystoscopy
284
K+ greater then 6 do what ? Greater than 6.5 do what?
ECG and if >6.5 treat regardless
285
Addisons ABG?
metabolic acidosis with a normal anion gap
286
Aspirin, lactic acidosis, DKA all cause?
Metabolic acidosis with raised anion gap
287
Interstitial nephritis vs tubular necrosis?
Nephritis inflammatory so +++white cells
288
>45 unexplained frank haematuria?
2 week referral to urology
289
Calculate anion gap how what normal?
(sodium + potassium) - (bicarbonate + chloride) normal 8-14
290
Osmalality in DI?
Raised plasma and low urine
| Often raised serum sodium
291
Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness
HUS
292
Penicillin can cause which renal disorder?
acute interstitial nephritis
| eosinophillic casts seen
293
fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension?
Acute interstitial nephritis
294
CAnca association with disease and renal biopsy?
Wegeners, crescenteric glomerulonephritis
295
AKI unknown cause?
USS
296
Glucose IV needs per day ?
50-100g regardless of weight
297
Vit D type supplement in CKD?
alfacalcidol no activation needed
298
Detriment of high phosphate in CKD?
Pulls calcium from bones
299
Severe hypokalaemia?
| How managed?
<2.5 should have IV replacement in high care area with ECG monitoring
300
Purely nephrotic syndrome cause in adult?
Focal segmental
301
Differentiate between IGA and post strep?
IgA haematuria soon after, Young male
post strep primarily proteinuria 1-2 weeks after
302
Nephrogenic DI treatment?
Can use thiazide
303
solid organ transplant recipients virus?
CMV
304
Bilateral renal stones what blood test to do?
U&Es
305
Urea a lot higher than creatinine AKI cause?
Dehydration
306
Nephrotic syndrome direct risk of what?
VTE give LMWH
307
Chronic diabetic nephropathy USS?
Bilateral large kidneys
308
CKD kidneys on USS?
Bilateral small
309
Sepsis ABG?
↑lactate This gives them a metabolic acidosis with a raised anion gap.
310
Acidosis, peristent K↑ Uraemic encephalopathy and pericarditis are indications for?
Dialysis
311
Organism in peritoneal infections due to dialysis?
Staph epidermis
312
Minimal change management?
Steroids! 80% respond
313
Warfarin use in breast feeding?
YES
314
Squamous cell lung cancer paraneoplastic features? This type common in who?
Secrete TSH, hyperthyroid
Secrete PTH ↑ Ca2+
Most common in smokers
315
Wells score for PE likely /unlikely?
4 or less is unlikely 5 or more is likely
316
Wells score for DVT likely/unlikely?
2 or more likely 1 or less unlikely
317
Wells score of 1 for DVT do what?
Order d-dimer if +ve do USS
318
Wells score of 5 for PE do what?
CTPA
319
Wells score of 4 for PE do what?
D-dimer and if +ve CTPA
320
First radiological Investigation when symptoms of PE?
CXR to rule other cause out
321
Treatment of DVT?
Rivaroxaban
322
Fasting glucose normal value? Impaired?
<5.5
| 5.5-6.9 impaired
323
Value after 2 hrs for non diabetic OGTT?
<7.8
324
7.9-11 after OGTT?
Impaired
325
Hba1c normal impaired and diabetes?
Normal <42
Impaired 42-47
Diabetes >48
326
COPD initial management?
SABA or SAMA
327
COPD SABA and SAMA but still exacerbating- No asthmatic?
Offer LABA or LAMA
328
COPD SABA and SAMA still exacerbating but asthmatic features?
Consider LABA+ICS
329
COPD has LABA +ICS but still troubled?
Consider LABA + ICS+LAMA
330
Features of Life threatening asthma?
```
Hypotension,
Peak flow <33%
spo2 <92%
Arrhythmias,
silent chest or cyanosis
Normal Co2
Pa02 <8
```
331
Features of acute severe asthma?
PEFR 33-50%
RR>25
HR>110
No complete sentences
332
Increasing symptoms, peak flow 50-74%
| No other features
Moderate asthma
333
H pylori treatment?
PPI BD
Amox plus clarithro or metro for 7 days
If pen allergic Clarithro plus metro
334
Optic neuritis features?
Eye movement painful, RAPD, Red desaturation
335
Peri ureteric fat stranding?
Passage of stone recently or if round kidney pyelonephritis
336
Usual target BP in diabetics no organ damage vs normal person target?
140/80
| vs 140/90
337
>80 years BP target?
150/90
338
BP target diabetics organ damage?
130/80
339
Adverse signs warranting cardioversion?
shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating,
cold, clammy extremities, confusion or impaired consciousness
syncope
myocardial ischaemia
heart failure
340
Trachea pulled to side of white out 2 differentials?
Collapse or pneumonectomy
341
Trachea deviated away from white out?
Pleural effusion
342
How many scales on the MRC dyspnoea ?
5
343
Adenosine contraindicated in who?
Asthmatics
344
Most common pathogen for meningitis in adults?
Strep pneumoniae, HIB Meningitidis
345
Infants and young children meningitis cause?
HIB
346
Most useful test in determining cause of hypocalcaemia?
PTH
347
Signs of CCF CXR?
```
Alveolar oedema (bat’s wings)
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
```
348
Gout changes on Xray?
Soft tissue swelling, erosions at joint particularly 1st MTP- overhanging edges
349
Osteomyelitis vs gout?
Likely high WCC more insidious onset
350
Ace inhibitor can cause a falsely low result for what blood test?
BNP
351
Initial therapy for rheumatoid?
DMARD + Short steroid course
352
Transjugular shunt joins what?
Hepatic vein and portal vein
353
benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space
Mortons neuroma
May feel "pebble in shoe"
354
Osteopaenia vs osteoporosis?
Osteopaenia
355
Bakers cyst signs?
arthritis or gout and following a minor trauma to the knee lump becomes tense on extension of knee
356
Bicarb normal values?
22-26mmol
357
Where does paget's usually affect?
skull, spine/pelvis, and long bones
Imaginary line down centre of body of person
358
Gout worsened by?
Thiazide
359
First line imaging for angina?
CT coronary angiography
360
First line investigation angina?
ECG
361
Is amylase or lipase included in glasgow pancreas score?
No LDH and AST are enzymes included
362
Lupus pernio what looks like associations?
Purple on nose and nostrils, Sarcoid
363
Postural HYPOtension no change in HR?
Diabetes
364
Oesophagitis proven?
ppi full dose 1 months assess response if good use low dose if not double dose
365
FEV1 and FVC increased reduced restrictive?
FEV1 and FVC both reduced and ration normal or increased
366
Obstructive causes of lung disease?
Asthma
COPD
Bronchiectasis
367
Restrictive causes of lung disease
Fibrosis, sarcoidosis bone deformity, neuromuscular
368
Upper resp infections when to give abx?
children younger than 2 years with bilateral acute otitis media
children with otorrhoea who have acute otitis media
patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present
369
INR 5-8 no bleeding?
Withhold 1-2 doses then reduce maintenance
370
INR > 8.0
| No bleeding
vitamin K orally
371
High INR major bleeding?
IV vit K stop warfarin and giv prothrombin
372
Joint effect in rheumatoid?
Symmetrical
373
Toxic megacolon size where?
>6cm and transverse mainly
374
K less than what to add spiro for BP control?
<4.5mmol
375
Antibodies myasthenia and lambert eaton ?
Myasthenia Ach lambert eaton voltage gated
376
Peri ureteric fat stranding?
Passage of stone recently or if round kindey pyelonephritis
