FINALS Flashcards
(442 cards)
1
Q
AF and CCB or flecainide
A
Contraindicated if structural heart disease
2
Q
Metallic click on auscultation
A
Metallic valve replacement, should be on warfarin with INR 3-4
3
Q
Bleeding on dabigatran
A
Only DOAC with reversal agent, idarucizumab
4
Q
1st line investigation for AF
A
ECG- irregularly irregular, absent P waves
5
Q
Unstable patient with AF
A
Urgent DC cardioversion
6
Q
First line for AF presenting within 48 hours without a precipitating cause
A
Rate control with beta blocker
7
Q
All patients with AF should be assessed with
A
CHADsVASc and HASBLED
8
Q
What is first line treatment for heart failure which improves mortality
A
Bisoprolol and Ramipril
9
Q
Symptomatic relief in heart failure and given even when ejection fraction is preserved
A
Furosemide
10
Q
Why bumetanide over furosemide
A
Better oral bioavailability
11
Q
Why cant you give ACEi and Valsartan (entresto)
A
Risk of angioedema
12
Q
1st line investigation in heart failure
A
BNP
13
Q
How do you make a heart failure diagnosis
A
Specialist does based on echo
14
Q
First line treatment for all heart failure with reduced ejection fraction
A
Bisoprolol and Ramipril (even if has COPD)
15
Q
Monitoring for ACE-i and Spironolactone
A
Renal function checked 2 weeks after starting or changing dose
16
Q
ACS, cold peripheries and poor urine output
A
cardiogenic shock
17
Q
PCI with stents ongoing treatment
A
DAPT for atleast 12 months
18
Q
ACS, bradycardia and AV node block
A
Inferior MI
19
Q
First line investigation for ACS
A
ECG and troponin
20
Q
Initial treatment of ACS
A
Morphine, Metaclopromide, Oxygen (if sats <94), Nitrates (GTN infusion), Aspirin (300mg)
21
Q
Risk score for NSTEMI/ Unstable Angina
A
GRACE
22
Q
Headache, sweating and palpitations with severe hypertension
A
Phaeochromocytoma
23
Q
Pedal oedema resistant to diuretics
A
CCB side effect
24
Q
AV nipping on fundoscopy
A
Hypertensive retinopathy
25
1st line investigation for hypertension
Ambulatory blood pressure monitoring or Home blood pressure monitoring
26
Threshold for HTN in normal people in clinic and home
140/90 in clinic, 135/85 at home
27
Target BP in diabetics
130/80
28
Target BP in over 80s
150/90
29
Which HTN patients need same day assessment
Severe (>180/120) or symptomatic
30
What does increased compliance of lung indicate
Emphysema
31
FEV1/FVC >0.7
Obstructive lung pathology
32
T2 respiratory failure with raised bicarbonate
Chronic T2RF, aim for sats 88-92
33
First line investigation for pneumothorax
Chest XR
34
What to do if Pneumothorax and underlying lung condition so is secondary pneumothorax
Always admit
35
How do you treat tension pneumothorax
Wide bore cannula into 2nd intercostal space mid clavicular line
36
FEV1/FVC more than 0.8 with reduced FVC
Restrictive lung disease
37
COPD exacerbation, pH <7.3 despite nebulisers
BiPAP
38
Nausea, refractory hypokalaemia and patient on theophylline
Theophylline toxicity
39
Cor Pulmonale first line investigation
Clinical diagnosis, echo to confirm
40
Symptoms of cor pulmonale
Peripheral oedema, raised JVP, loud P2
41
Big requirement for LTOT
Stop smoking
42
Pulmonary hypertension criteria
pulmonary artery pressure over 20
43
Recurrent miscarriages, prolonged APTT and thrombocytopenia
Antiphospholipid syndrome
44
ECG- ST depression, T wave inversion V1-4, 1,2 and aVF
Right ventricular strain
45
skin necrosis after warfarin
Protein C deficiency
46
1st line investigation in PE
CXR
47
Unprovoked PE and symptoms of possible malignancy
CT TAP
48
Most common ECG finding in PE
Sinus tachycardia
49
How long should a cancer patient be on a DOAC after PE
6 months
50
SCLC, Muscle strength improving on repetitive movement
Lambert eaton
51
Breast cancer or SCLC with progressive muscle stiffness
Stiff man syndrome, antiamphiphysin
52
SCLC, cerebellar symptoms and sensory neuropathy
Anti hu
53
1st line investigation for lung cancer
Chest XR
54
Consequences of SCLC
SIADH, Cushings, Lambert Eaton Syndrome
55
Why do Squamous cell cancers get hypercalcaemia
Parathyroid hormone related protein release
56
Chronic diarrhoea, bloating and scleroderma
Small bowel bacterial overgrowth
57
Bile acid malabsoprtion
SeHCAT test
58
Middle aged female, bloating, CA125
Ovarian Cancer
59
Barley Wheat and Rye
Coeliacs should avoid
60
1st line investigation for Coeliac
Serum IgA antiTTG and IgA levels
61
Definitive diagnosis of coeliac
Endoscopy and duodenal biopsy
62
Which HLA is coeliac
DQ2/8
63
Ulcerating legion on lower limb and PMH IBD
Pyoderma gangrenosum
64
Acute red eye, hypopyon, intense photophobia
Acute uveititis
65
IBD history, assymetrical joint swelling and HLA B27
Enteropathic arthritis
66
1st line investigation for IBD
Faecal calprotectin
67
First line investigation for bloody diarrhoea
Colonoscopy
68
How do you manage acute severe UC flares
In hospital with IV hydrocortisone
69
How do you treat mild-moderate UC
Topical mesalazine then oral if no response in 4 weeks
70
What do you have to do before you prescribe infliximab
Interferon gamma test and CXR (exclude TB)
71
middle aged female with very serious itching and anti mitochondrial antibody positive
Primary biliary cholangitis
72
pan acinar emphysema, early onset liver disease, PiZZ phenotype
Alpha 1 antitrypsin deficiency
73
Raised transferrin saturations, tanned, diabetes
Hereditary haemochromatosis
74
First lines investigation for decompensated liver disease
LFTs, U and Es, albumin, INR
75
Features of decompensated liver disease
Ascites, encephalopathy and coagulopathy
76
How to improve mortality in severe ALD
IV steroids
77
Most common causes of cirrhosis
Alcohol, NAFLD, Hep B and Hep C
78
AST/ ALT raised on LFT
Hepatitis picture
79
Bilirubin/ ALP raised on LFT
Cholestatic picture
80
AST more than double ALT
Alcohol related (shots, shots, shots)
81
Hep C, purpuric rash, deteriorating renal function
Type 2 cryoglobulinaemia
82
Needle stick injury from hep B patient and no previous vaccination
Accelerated Hep B vaccination
83
Raised BMI, raised ALT and AST
Non alcoholic fatty liver disease
84
1st line investigation for hepatitis
Liver screen including hepatitis A B and C serology
85
What must be present in the serology for it to be an active hepatitis B (both acute and chronic)
HBsAg
86
Which hepatitis is most likely to progress to chronic liver disease
Hepatitis C
87
First line treatment for Hep B
Interferon alpha
88
First line treatment for Hep C
Direct acting anti virals
89
Painless palpable gallbladder and jaundice
Pancreatic cancer
90
Small bowel obstruction after cholecystitis
Gallstone ileus
91
Beads on a string on ERCP
Primary sclerosing cholangitis
92
1st line investigation for gallstones
Ultrasound abdomen
93
What requires an urgent laparoscopic cholecystectomy
Pancreatitis, Cholecystitis, choledocholithiasis
94
What is the definitive treatment for any gallstone related disease
Laparoscopic Cholecystectomy
95
No CBD stone but deranged LFTs or bile duct dilatation on ultrasound
MRCP needed to clarify pathology and anatomy
96
Which operation leads to an ileostomy
Right hemicolectomy
97
What staging for colon cancer
TNM
98
Thousands of colonic polyps and autosomal dominant APC gene mutation
FAP
99
Mutation in the mismatch repair gene (MMR)
HNPCC (lynch syndrome)
100
Small bowel polyps, melanotic macules in lipds or genitals and STK11 gene mutation
Peutz Jueger Syndrome
101
1st line investigation for colorectal cancer
Coloscopy
102
Who gets FIT or FOB testing
Everyone 60-74
103
How is colorectal cancer diagnosis made
Colonoscopy
104
Closed loop obstruction
High risk of bowel ischaemia
105
Right iliac fossa pain after appendectomy
Meckels diverticulum
106
Unexplained acute LBO
Ogilvies syndrome
107
1st line investigation for acute abdomen (no indications for CAT 1 lap i.e. unstable patient)
CT abdomen and pelvis
108
How will SBO present
Colicky abdominal pain, vomiting and absolute constipation
109
What to do with patients in refractory shock i.e. shock even after fluids w/ acute abdomen
category 1 emergency laparotomy
110
What is the most common cause of SBO and how do you treat if no ischaemia or necrosis
Adhesions and conservative, IVI and NG tube
111
Screening for AAA
Every man over 65 gets a one off ultrasound
112
IVC collapse or halo sign on CT
Hypovolaemic shock
113
Anurysmal sac enlarging after AAA repair
Endoleak
114
Chest pain and connective tissue disorder like marfans
Aortic dissection
115
1st line investigation for stable AAA patient with suspicion of rupture
CT angiography
116
AAA screening
One off ultrasound to every male at 65
117
Which AAA require intervention
>5.5cm or symptomatic
118
Microcytic anaemia and disproportionately low MCV
Thalassaemia
119
Normocytic anaemia and reduced renal function
CKD related anaemia
120
Macrocytic anaemia and mixed upper/lower neuro signs
B12 deficiency causing subactue degeneration of the cord
121
First line investigation if IDA and over 60
2WW colonoscopy
122
Dyspepsia and IDA investigation
2WW UGI-endoscopy
123
Asthma, eosinophila and pANCA
Churgg Strauss Syndrome
124
Obesity, Type 2 respiratory failure and obstructive sleep apnoea
Obesity hypoventilation syndrome
125
Asthmatic and pCO2 of 6.5
Near fatal asthma attack
126
Asthma diagnostic investigation
Clinical diagnosis, can use spirometry to confirm
127
Initial management of asthma
SABA (and ICS if symptoms)
128
How long before you know if LTRA isnt helping
8 weeks
129
Define life threatening asthma
PaCO2 above 6
130
Ankle swelling, erythema, loss of foot sensation and T2DM
Charcot arthopathy
131
Metformin and CKD
Stop metformin in eGFR under 30
132
Insulin and driving
DVLA must be informed and patient must record blood sugar every 2 hours
133
1st line investigation for diabetes
HbA1c or fasting blood sugar
134
When to intensify diabetes medication regime
HbA1c remains over 58
135
When to consider insulin in T2DM
When 3 oral medications are still not helping
136
How to treat hyperosmolar hyperglycaemic state
IV fluids and sometimes FRII
137
thunderclap occipital headache and reduced GCS
Subarachnoid haemorrhage
138
Temporal headache, jaw claudication, raised ESR
Giant cell arteritis
139
LP in last 24 hours, headache worst when upright
Low pressure headache
140
1st line investigation for migraine
Clinical diagnosis. Neuroimaging if red flags
141
1st line treatment for migraine
Sumatriptan and Ibuprofen
142
First line prophylaxis for migraine
Propanolol
143
Topiramate CI
Pregnancy. Make sure on reliable contraception
144
Multiple flat light brown plaques, waxy surface along the scalp or back
Sebhorreic keratosis
145
Multiple scaly thick plaques on sun exposed areas
Acitinic/ solar keratosis
146
A hard raised grown with an ulcerated centre that began as a boil
Keratoacanthoma
147
1st line investigation for skin cancer
Excision biopsy and breslow thickness
148
What to do with melanoma lesions
Excise and send for histology to guide staging
149
What stage is a melanoma with nodal involvement
3
150
What stage is a melanoma with metastases
4
151
How to treat basal or squamous cell carcinomas
Excision or topical chemotherapy
152
Visual hallucinations and macular degeneration
Charles Bonnet Syndrome
153
Parkinsonism, visual hallucinations and memory impairment
Lewy body dementia
154
Deranged LFTs, asterixis and confusion
Hepatic encephalopathy
155
Delirium first investigation
Clinical diagnosis but look for cuases
156
What to do if patient lacks capacity
Treat them in their best interests under the mental capacity act
157
Bisphosphonate use, jaw pain and swelling
Osteonecrosis of jaw
158
Fall onto outstretched hand and dinner fork deformity
Colles Fracture
159
Normal serum calcium and phosphate with elevated alk phos
Pagets disease of the bone
160
1st line investigation for osteoporosis
DEXA scan
161
Who gets osteoporosis commonly
Long term steroids and post menopausal
162
How do you calculate risk of osteoporosis
FRAX
163
What supplements might you need if have osteoporosis
Calcium and vitamin D
164
Involuntary upward eye movements
Oculogyric crisis
165
Alternating deep then shallow breathing with recurrent apnoea
Cheyne Stokes breathing
166
Prolonged QT interval and twisting of QRS complexes
Torsades de Pointes
167
First line investigation for end of life
Clinical assessment but need to rule out reversible causes
168
What needs to be considered in palliative care
Psychological, social and spiritual factors
169
What to do if frequently using as needed medications
Replace with syringe driver
170
Dendritic pattern on fluorescin stained cornea
Herpes simplex virus
171
Young female, very high BMI, on the pill with headaches
Check for papilloedema, idiopathic intracranial HTN (therapeutic LP)
172
White fluid level visible in the anterior chamber of the eye
Hypopyon
173
First line investigation for diabetic retinopathy
Fundoscopy
174
When does diabetic retinopathy become symptomatic
When it becomes proliferative
175
What is treatment of diabetic retinopathy
Radical control of Diabetes, Blood Pressure and Lipids
176
Is diabetic retinopathy reversible
No
177
Pigment in the anterior vitreous on fundoscopy
Schaffer sign of retinal detachment
178
Pale retina without cherry red spot on fundoscopy
Ophthalmic artery occlusion
179
Pale retina with cherry red spot on fundoscopy
Central retinal artery occlusion
180
Visual blurring made worse with heat
Optic neuritis (Uhthoffs Phenomenon)
181
Acute, painless loss of vision unilaterally
Vascular in origin
182
Bilateral acute visual field loss
TIA/Stroke/Optic chiasm i.e. not optic
183
Amaurosis Fugax
Associated with carotid artery stenosis and predicts future stroke
184
Chinese, facial pain, double vision and lymphadenopathy
Nasopharyngeal carcinoma
185
Young child with recurrent epistaxis and purpuric lesions on fingertips and tongue
Hereditary haemorrhagic telangiectasia
186
Evolving sunburn like erythema and confusion 48 hours after nasal packing
Toxic shock syndrome
187
Nose bleed first line investigation
Nasal speculum examination
188
Where do most nosebleeds come from
Anterior= first aid, then silver nitrate cautery then rapid rhino unilateral anterior packing
189
What to do if posterior bleed (profuse, bilateral, cant see bleeding point)
Posterior packing and antibiotics
190
Diabetic with persistent otalgia despite antibiotics
Malignant otitis externa
191
Progressive hearing loss and aural fullness with a persistent foul smell
Cholesteatoma
192
Vertigo, tinnitus, aural fullness, facial weakness +- neurofibromatomosis type 2
acoustic neuroma
193
First line investigation for vertigo
Thorough history and examination
194
First line investigation for menieres disease
Audiometry
195
Which direction is the dizziness in tru vertigo
Rotational
196
What is peripheral vertigo (ears)
Reproducible, fatiguable, horizontal nystagmus and no neuro signs
197
What is central vertigo (brain)
Doesn't fatigue and cant be reproduced, multidirectional nystagmus, other neuro signs
198
Drooling, stridor and tripod sitting in a toxic looking child
Epiglottitis
199
Bilateral cervical lymphadenopathy, fever, myalgia and testicular swelling
Mumps
200
Acrid/bitter teast in mouth while eating, pain in parotid/ submandibular region
Salivary duct stones
201
First line investigation in tonsilitis
Oropharyngeal examination
202
FeverPAIN
```
Fever
Pus on tonsils
Attended in 3 days
severely Inflamed tonsils
No cough or coryza
```
203
FeverPAIN 2-3=
back up prescription(Phenoxymethylpenicillin) , self care advice
204
FeverPAIN 4+=
Phenoxymethylpenicillin
205
FeverPAIN 0-1=
Self care advice
206
Acute retention, acute glaucoma and tachycardia
Anticholinergic effects
207
LUTS with nocturnal enuresis
high pressure chronic urinary retention
208
Prolonged large urine production after catheter
Post obstructive diuresis
209
Acute retention first line investigation
Bladder scan if in doubt
210
Chronic retention first line investigation
Ultrasound KUB
211
Urgent first line treatment in acute retention
Catheterise first ask questions later !
212
What does failed TWOC suggest in acute retention
Chronic urinary retention
213
How to diagnose most causes of acute retention
Drug chart review, urine dip and bloods
214
Post URTI with flank pain
IgA nephropathy
215
Dry cough, dry/red eyes, sinusitis, joint pain and nephritis syndrome
Granulomatosis with polyangitis
216
Pulmonary haemorrhage, rapidly progressive GN and anti GBM antibodies
Goodpastures syndrome
217
1st line investigation in glomerulonephritis
Urine dip for protein and blood
218
3 signs of nephritis syndrome
Oedema, hypertension and haematuria
219
3 signs of nephrotic syndrome
Oedema, hypoalbuminaemia and proteinuria
220
Whats the main treatments for GN
Steroids and immunosuppressants
221
Painless testicular lump in male over 60
Benign seminoma
222
Painless testicular lump in a young male with positive bHCG
Non seminoma
223
Prolonged (longer than 1 day) pain and swollen testicle
Epididymoorchitis
224
What two things cause epididymoorchitis
STI and E Coli
225
1st line investigation for severe testicular pain
Surgery if torsion suspected !
226
What surgery is done for torsion
Bilateral orchidopexy
227
What is the ischaemic time for a testicle
4-8hours
228
Young patient treated for DKA with reduced GCS, severe acidosis and relative bradycardia
Cerebral oedema
229
Metformin use, impaired kidney and acidosis
Metformin induced lactic acidosis
230
Elderly patient, T2DM, hyperglycaemia and hypernatraemia
Hyperosmolar hyperglycaemic state
231
First line investigation for DKA
Venous blood gas and serum ketones
232
First line treatment in DKA
0.9% sodium chloride fluid bolus
233
How to avoid complications in DKA
Monitor glucose and potassium
234
When does a DKA require critical care input
If not resolved in 24hours
235
Sudden decline in GCS after correcting hyponatraemia
Osmotic demyelination syndrome
236
Polydipsia, normal glucose and high end of normal sodium
Diabetes insipidus
237
Large hands and jaw and bilateral hemianopia
Pituitary tumour with acromegaly
238
First line investigation for hyponatraemia
Paired osmolalities (serum and urinary)
239
First line treatment if hyponatraemic with symptoms
3% hypertonic saline in higher level care
240
If hyponatraemic but no symptoms or chronic then
Assess fluid status and do urinary sodium
241
How do you treat SIADH
Fluid restrict and look for cause
242
Whats diagnostic for SIADH
High urinary sodium in euvolaemic patient
243
Young female with resistant hypertension and hypokalaemia
Conns syndrome
244
Headache, sweating, tachycardia and hypertension
Phaeochromocytoma
245
Unduppressed cortisol levels following high dose dexamethasone suppression test
Cushings disease (pituitary adenoma). High dose= high up cause i.e. in brain i.e. pituitary adenoma
246
First line investigation for cushings syndrome
Urinary cortisol collection, low dose dexamethasone suppression test or salivary cortisol collection
247
What can happen if you suddenly stop long term steroids
Addisonian crisis
248
Hoarse voice post thyroidectomy
Recurrent laryngeal nerve injury
249
Low calcium, high phosphate, high PTH, short fingers
Pseudohypoparathyroidism
250
Facial twitching after tapping anterior to tragus
Chvosteks sign, hypocalcaemia
251
First line investigation in hypercalcaemia
Bone profile and parathyroid hormone
252
Normal treatment for primary hyperparathyroidism
Parathyroidectomy
253
Normal treatment for secondary hyperparathyroidism
Treat CKD and give phosphate binders for high phosphate
254
Normal treatment for tertiary hyperparathyroidism
Self limiting. Normally post kidney transplant when body readjusting.
255
primary parathyroid adenomas are associated with which gene
MEN
256
Philadelphia chromosome
Chronic Myeloid Leukaemia
257
Auer Rods
Acute Myeloid Leukaemia
258
DIC and t(15;17)
Acute promyelocytic leukaemia
259
1st line investigation in leukaemia
Peripheral Blood film
260
2nd line investigation in leukaemia
Bone marrow biopsy
261
First line treatment for CML
Imantinib
262
Treatment of CML when imantinib fails
stem cell transplant
263
Menorrhagia and prolonged bleeding time
Von Willebrands disease
264
Low platelets and low fibrinogen
DIC
265
Raised INR, low platelets and deranged LFTs
Liver cirrhosis
266
1st line investigation for haemophillia
Factor 8 and 9 assay levels
267
How do you treat life threatening bleeding in haemophilia A
Factor 8 concentrate
268
What is the most common presentation of haemophillia A
Bleeding into joints
269
Whats the difference between haemophillia and von willebrands
Von Willebrands has a prolonged bleeding time
270
Red scaly lesions on finger joints
Gottrons papules (dermatomyositis)
271
Episodes of white cold digits
Raynauds phenomenon
272
Telescopic digits
Arthitis mutilans
273
1st line investigation for polyarthritis
Bloods: RF, AntiCCP, ESR/CRP and XR affected joints
274
How do you treat acute flares of inflammatory arthritis
Bridging steroids and DMARDs
275
Urethritis, conjuncitivitis, arthritis
Reactive arthritis
276
Assymetric polyarthralgia, tenosynovitis and skin lesions
Gonococcal arthritis
277
HLA B27 POSITIVE
Seronegative spondyloarthropatheis
278
First line investigation of a hot swollen joint
Needle aspiration
279
First line investigation of a hot swollen joint
Needle aspiration
280
Hot swollen joint
Assume septic until proven otherwise
281
Should you give antibiotics straight away in septic arthritis
Aspirate first !!
282
Lateral tibial plateaux fracture
ACL rupture
283
Strong lateral blow to the knee
ACL, MCL and medial meniscus tears
284
Anterior drawer test for the ankle
Tests talofibular ligament
285
Light bulb sign on shoulder XRay
Posterior dislocation of the shoulder
286
Pain on palpation of the anatomical snuff box
Scaphoid fracture (AVN risk)
287
Paradoxical breathing after trauma to the chest
Flail segment
288
First line investigation for ankle fracture
AP, lateral and oblique XR of the ankle
289
What is the ottawa rule
A number of rules where you cant rule out ankle fracture if its yes to any
290
Ottawa rules
1. Inability to weight bear immediately after injury and in A and E
2. Pain on palpation of lateral malleolus
3. Pain on palpation of medial malleolus
291
What happens if its yes to an ottawa rule
Lateral and AP XRs
292
What happens if a fracture is unstable
More likely to need surgery
293
If it is a closed fracture dislocation what should be done
Closed reduction in A and E
294
Heavy smoker and recurrent digit ischaemia
Thromboangitis obliterans
295
Haemoptysis, haematuria and antiGMI
Goodpastures syndrome
296
New agitation and hallucinations on prednisolone
Steroid induced psychosis
297
Fever >5 days, conjunctivitis and strawberry tongue
Kawasakis disease
298
Transmural inflammation and beads on a string angiography
Polyarteritis nodosa
299
Recurrent mouth and genital ulcers not due to infection
Behcet syndrome
300
First line investigation for vasculitis
Rheumatological antibody screen
301
Vasculitis plus renal, lung or skin involvement then what is needed for diagnosis
Biopsy
302
First line treatment for all small vessel vasculitis
Cyclophosphamide and corticosteroids
303
Ongoing treatment for small vessel vasculitis
Low dose steroid and Methotrexate or mycophenolate or azathioprine
304
LP= oligoclonal bands and high protein
Multiple sclerosis
305
Campylobacter, ascending polyneuropathy and antiGM1
Guillain Barre syndrome
306
Spinal cord lesion, normal MRI and anti-aquaporin4 positive
Nueromyelitis optica
307
First line investigation for MS
MRI head and spine
308
What is required for MS diagnosis
MRI/ clinical findings disseminated in both time and space
309
First line treatment for spasticity in MS
Baclofen or gapapentin
310
MS acute exacerbation medication
methylprednisolone
311
DMARD for MS
Interferon beta
312
Coarse tremor, confusion, hallucinations with history of alcohol excess
Delerium tremens = chlordiazepoxide
313
Alcoholic excess, metabolic acidosis and ketosis
Alcoholic ketoacidosis
314
Disulfiram
Promotes alcohol abstinence, inhibits acetaldehyde dehydrogenase
315
1st line investigation for wernickes encephalopathy
clinical diagnosis
316
What is wernickes encephalopathy
thiamine deficiency causes acute neurological symptoms: nystagmus, ataxia, confusion
317
What is korsakoffs
Chronic memory problem (retrograde and antegrade amnesia with confabulation) caused by thiamine defiency
318
What should you be aware of in wernickes encephalopathy
Hypoglycaemia
319
Cape like distribution of pain/ temperature loss
Syringomelia
320
Sensory level L1-2, up going plantars, absent knee reflexes
Conus medullaris lesion
321
VDLR positive, loss of vibration/proprioception
Tabes dorsalis (tertiary syphilis)
322
First line investigation for traumatic spine injury
CT spine
323
First line investigation for non traumatic spine injury
MRI spine
324
If spinal cord injury is secondary to trauma what should you do first
spinal immobilisation
325
RF for anterior spinal artery syndrome
Atherosclerosis, aortic aneurysm and dissection
326
Where should spinal cord injuries be managed
Tertiary neurosurgical centres
327
Hypertension, bradycardia and kussmaul breathing
Cushings triad of raised ICP
328
Fall in elderly patient on warfarin
Possible subdural, consider prothrombin complex if INR raised
329
High suspicion of SAH but normal CT
Lumbar puncture at 12 hours for Xanthochromia
330
First line investigation for intra cranial haemorrhage
CT Head
331
3 categories of traumatic subdural haematoma
Acute (1-2days, hyperdense)
Subacute (3-14 days, isodense)
Chronic (15 days, hypodense)
332
What to do if signs of raised ICP
Urgent referral to specialist neurosurgical centre
333
What to do in stroke prior to treatment
CT Head because might be secondary to haemorrhage
334
Type 1 hypersensitivity reaction
IgE mediated mast cell degranulation and histamine release (anaphylaxis)
335
Anaphylaxis to penicillin
3rd gen cephalosporins in 3%
336
Fever, rash, lymphadenopathy, deranged LFTs and eosinophilia
Drug reaction with eosinophilia and systemic symptoms
337
1st line investigation to confirm anaphylaxis
Mast cell tryptase
338
Initial treatment in anaphylaxis
0.5mg (0.5ml) 1:1000 Adrenaline
339
What should you try and do early on when treating anaphylaxis
Remove the source
340
How long should you monitor for after an anaphylactic reaction
6 hours in case theres a biphasic reaction
341
Treatment to a contact of a patient with meningococcal meningitis
Ciprofloxacin 500mg STAT
| Ceftriaxone in preg
342
Gram negative diplococci on CSF gram stain
Neisseria meningitides
343
Encapsulated yeast on india ink staining of CSF
Cryptococcal meningitides (as seen in HIV)
344
First line investigation for meningitis
Lumbar puncture
345
First line investigation for sepsis
Lactate, cultures and urine output
346
How quickly do you have to do sepsis 6
Everything including Abx administration within 1hr
347
What to do if septic patient not responding to initial treatment
Consider ICU
348
Which antibiotic in neutropenic sepsis
Piperacillin Tazobactam
349
Flushed, dry, tachycardia and dilated pupils
Anticholinergic syndrome
350
Reduced GCS, pupillary changes and cardiorespiratory depression
Sedative syndrome- opioids, benzos, baclofen, barbituates
351
Confusion, autonomic instability and neuromuscular hyperactivity
Serotonin syndrome
352
First line investigation for overdose
Blood gas and ECG
353
First line treatment for TCA overdose
Sodium bicarbonate 8.4% and supportive measures
354
How to treat paracetamol overdose
N acetylcysteine according to nonogram
355
What do you have to be careful of when giving naloxone
Opioids have a longer half life than naloxone so might have to give as infusion
356
Facial nerve palsy following head injury
Basal skull fracture
357
What is mannitol
Hypertonic saline used to lower ICP
358
Unilateral ptosis and down and out eye and fixed dilated pupol
Surgical/ Traumatic 3rd nerve palsy
359
Inability to abduct eye after head injury
6th nerve palsy in raised ICP
360
1st line investigation in head injury
CT head
361
What to do if reduced GCS more than 2 hours since head injury
CT head within the hour
362
Where should you also assess if someone is coming in with a head injury
Cervical spine
363
Head injury + GCS 15 + no concerning clinical or imaging features
Discharged without supervision
364
When does an alcohol withdrawal seizure last
12-48 hours after last drink
365
Focal weakness after seizures
Todds Paralysis
366
Acute paralysis and dysarthria following treatment for hyponatraemia
Osmotic demyelination syndrome
367
Status epilepticus first line investigation
Clinical diagnosis (Elevated lactate, prolactin and creatine kinase can help distinguish true seizures)
368
What is a common and reversible cause of seizure
Hypoglycaemia
369
First line treatment for status epilepticus
IV lorazepam, Buccal Midazolam or Rectal Diazepam and repeat if needed
370
How long can you not drive for with a seizure of any type
6 months
371
Flexed internally rotated and ADducted hip
Posterior hip dislocation
372
Hypoxia, neurological signs and petechial rash after long bone fracture
Fat embolus syndrome
373
Pain out of proportion to the trauma
Compartment syndrome
374
First line investigation for hip fracture
AP pelvis XR and lateral XR of affected hip
375
Preoperative preparation for hip fracture surgery
Analgesia, fluid restriction, stop blood thinning medication, early surgery
376
How to treat intracapsular displaced fractures
Femoral head replacement, consider prior mobility
377
Postoperative preparation for hip fracture surgery
Thromboprophylaxis, early mobilisation
378
Hyperkalaemia ECG
Absent P waves, tall T waves, broad QRS
379
Sharp chest pain relieved by leaning forwards, saddle shaped ST segments
Pericarditis
380
Polyarthropathy, fractures and calcific skin lesions with CKD
Osteodystrophy
381
First line investigation for acute renal failure
U and Es
382
What determines the severity of AKI
Rise in basline creatinine
383
What are indications for renal replacement therapy in AKI
Refractory to treatment and
| Hyperkalaemic, acidotic, encephalopathic or fluid overloaded
384
Post operative hypotension
Common side effect of epidural and spinal anaethesia
385
Pain associated with renal colic
Responds well to PR diclofenac
386
Trigeminal neuralgia first line medication
Carbamazepine
387
Diabetic painful neuropathy first line medication
Duloxetine
388
Why might you use several analgesics at once
Reduces total dose of each so less chance of side effects
389
When to avoid NSAIDs
Elderly, pregnancy, asthmatics and renal impairment
390
How to treat neuropathic pain
Non opioid analgesics
391
Which diabetes medication causes weight gain and fluid retention
Pioglitazone
392
Which diabetes medications cause weight gain and hypoglycaemic events
Sulphonylureas and IV insulin
393
How to manage insulin when diabetic patient started on NG feeding or TPN
Variable rate insulin infusion
394
What drugs to give after surgical resection of phaeochromocytoma
Alpha blockage then beta blockade
395
First line investigation for diabetes
Capillary blood glucose and HbA1c
396
How should you plan diabetics elective surgery
Delay until glucose control optimised (<69)
397
What should you do with basal insulin during surgery
Continue it all the way through at a low dose
398
How do you take someone off VRII
continue it 30 mins after first SC insulin
399
Acute worsening of infection after starting ART in HIV patient
IRIS- immune reconstitution inflammatory syndrome
400
Reduced visual acuity and perivascular infiltrates in HIV patient
CMV retinitis
401
Odonophagia and white mucosal plaques at endoscopy in HIV patient
Oesophageal candidiasis
402
HIV patient and desaturation on exertion
Pneumocystis jirovecii pneumonia
403
HIV patient and brain MRI demonstrating ring enhancing lesions
Toxoplasmosis encephalitis
404
HIV patient and violet plaques and human herpes virus 8
Kaposis sarcoma
405
First line investigation for HIV
Combined HIV antibodies and p24 antigen
406
What to do if positive HIV test
Repeat to confirm
407
What to do if negative HIV test
Repeat in 12 weeks
408
How to limit spread of HIV
Appropriate use of condoms, safe needle use and post exposure prophylaxis
409
Gential ulcer, acute fever, headache and myalgia just after starting treatment for syphilis
Jarisch Herxheimer reaction
410
Genital ulcer, painful unilateral inguinal lymphadenopathy and proctocolitis
Lymphogranuloma Venereum
411
Painful ulcer and lymphadenopathy
Chancroid
412
What should you always test for in a patient with STI
HIV
413
CSF with low glucose, high protein and lymphocytes
TB meningitis
414
Orange stained body fluids
Rifampicin therapy
415
Red green colour vision disturbance
Ethambutol induced optic neuritis
416
First line investigation for active TB
CXR and sputum
417
First line investigation for latent TB
Mantoux test or interferon gamma assay
418
How long treatment does active TB need
6-12 months
419
How long treatment does latent TB need
3-6 months
420
What should you test for if a patient has latent TB
HIV
421
Polyarthralgia, conjuncitivits and mouth ulcers
Reactive arthritis
422
Chronic abdominal pain, altered bowel habit with no identifiable cause
Post infectious IBS
423
Campylobacter, ascending bilateral limb weakness and loss of reflexes
Guillain Barre Syndrome
424
First line investigation for infectious diarrhoea
Stool sample
425
Whats the treatment for travellers diarrhoea
Supportive measures
426
General malaise, relative bradycardia and rose spots
Salmonella typhi
427
Fever, headache, retro orbital pain, myalgia and rash
Dengue
428
Bulls eye rash
Lyme disease
429
Fist line treatment for malaria
Prompt Artemisinin combination therapy
430
Why do travellers get more severe malaria
Low immunity
431
Things to consider in returning traveller
Could be something normal or malaria, influenza, hepatiis, HIV
432
Rheumatoid factor
Rheumatoid arthritis
| Sjogrens
433
Anti cyclic citrullinated peptide
Rheumatoid arthritis
434
ANA positive
```
SLE
SS
Sjogrens
Poly/Dermato-myositis
AI Hepatitis
```
435
Anti dsDNA and Anti Smith
SLE
436
Anti centromere
Limited systemic sclerosis
437
Anti mitochondrial
Primary biliary cirrhosis
438
Anti-Scl-70 (anti topoisomerase)
Diffuse systemic sclerosis
439
Anti Ro and Anti La
Sjogrens
440
Anti Jo (synthetase) and AntiMi2
Poly/Dermatomyositis
441
Anti histone
Drug induced lupus
442
ANCA
Vasculitis
