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Fine ? Flashcards

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1
Q

A 54 year-old patient presents with increased confusion. His family reports that over the past month he has become more irritable, and has complained about headaches and muscle cramps. He has recently been diagnosed with Small cell lung cancer. You suspect SIADH.
What U&E finding would you expect to see in SIADH?

A

Hyponatraemia

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2
Q

Why do patients with SIADH have hyponatraemia?

A

Too much water is reabsorbed and therefore blood constituents are diluted

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3
Q

Name a drug which could cause hypokalaemia ?

A

Salbutamol

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4
Q

Name a drug which can cause hyperkalemia ?

A

Ramipril

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5
Q

What test can diagnose a primary hyperaldosteronism ?

A

Aldosterone renin ratio

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6
Q

What PTH and Ca2+ levels suggest primary hyperparathyroidism ?

A

Normal PTH despite high Ca2+

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7
Q

What PTH and Ca2+ levels would be suggestive of secondary hyperparathyroidism ?

A

Ca2+ and P would be normal or low with PTH raised

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8
Q

Typical signs of Grave’s disease ?

A 
Tremor 
Palpitations 
Pretibial myxoedema 
Ophthalmopathy 
Weight gain
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9
Q

What is the pathology of Grave’s ?

A

TSH receptor antibodies

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10
Q

Which of the following is considered the gold standard diagnosis for phaeochromocytoma?

A

a) Elevated plasma free Metanephrine

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11
Q

What can occur with steroid withdrawal ?

A

Secondary adrenal insufficiency

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12
Q

Name a drug you would give in CML

A

Imatinib

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13
Q

MOA for Imatinib

A

Tyrosine kinase inhibitor

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14
Q

What would you expect to see on the blood film of a patient with multiple myeloma ?

A

Rouleaux formation

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15
Q

What is thrombotic thrombocytopenic purpura

A

Unknown pathology
Increased number of blood clots in the small arteries leads to an exhaustion of the bodies platelets and destruction of RBCs

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16
Q

Treatment for iron deficiency anaemia ?

A

Ferrous sulphate

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17
Q

Causes of thrombocytopenia

A

HIV
Alcohol excess
Myeloma
Heparin

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18
Q

The diagnostic test for sickle cell anaemia?

A

Hb electrophoresis

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19
Q

The infective stage of the malaria parasite?

A

Sporozite

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20
Q

What type of anaemia does chronic alcohol abuse result in ?

A

Macrocytic anaemia

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21
Q

Complications of ABVD chemo for Hodgkin’s lymphoma

A

Infertility
Cardiomyopathy
Peripheral neuropathy
Lung damage

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22
Q

ABVD chemo

A

Adriamycin
Bleomycin
Vinblastine
Dacarbazine

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23
Q

Septic arthritis RF

A 
Aged over 80 
Pre-existing joint disease 
DM 
Immunosuppression 
Recent joint surgery
Penetrating trauma 
Prosthetic joint
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24
Q

ABs associated with SLE

A

Anti-ANA

Anti-dsDNA

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25
Hand characteristics of RA
Swan neck deformity Boutonnière deformity Ulnar deviation Z-shaped deformity/Hitch-hikers thumb
26
ALP, Ca2+ and P seen in Paget's disease
ALP: high Ca2+ normal P normal
27
Paget's disease
Abnormal and uncontrolled bone resorption and deposition
28
Signs of SLE
``` Photosensitivity Lupus nephritis Pleuritis Peritonitis Myocarditis Oral mucosa ulcers Alopecia ```
29
What marker is used to monitor SLE ?
ESR
30
How are the skin related symptoms of SLE treated ?
Hydroxychloroquine NSAID Corticosteroids
31
A 28 year old woman presents to her with her 3rd recurrent miscarriage. She has a history of recurrent DVTs and one pulmonary embolism. On examination you identify a blotchy pattern on her skin. On investigation, her blood results show a prolonged APTT. What condition is the top differential?
Antiphospholipid syndrome
32
Give the typical presentation for fibromyalgia
Female 30-60
33
What reflex is lost with a nerve root lesion at S1 ?
Ankle jerk reflex
34
What spinal level is the knee jerk reflex associated with ?
L4/5
35
Pan-systolic murmur at the apex
Mitral regurgitation
36
GORD
Metaplasia from squamous to columnar
37
Which cells do PPIs act on?
Parietal cells
38
What is the most common composition of renal stones?
Calcium Oxalate
39
Following AKI which U&E should you be most concerned about ?
K
40
Furosemide can be used in which patients ?
Pulmonary oedema and chronic heart failure
41
Furosemide MOA
Loop diuretic which inhibits the luminal NA-K-Cl co-transporter ascending limp of the loop of Henle Thus causing more Na,CL and K to remain in the urine
42
A 24-year-old female presents to her GP with a single mass in her lower neck. It first appeared about 2 months ago. She recently moved to a new house and attributed her recent weight loss and night sweats to the stress of this. However, the lump in her neck has started to grow and she is getting worried as it now has a 3 cm diameter. On a recent girls night out, she found that it was very painful after drinking alcohol. What is the most likely diagnosis?
Hodgkin’s lymphoma
43
Causes of iron deficiency anaemia?
Chronic kidney disease, GI bleed, NSAIDS, Pregnancy
44
Features of iron deficiency anaemia
Brittle hair and nails, Koilonychia, Pale conjunctivae, Systolic flow murmur
45
Side effects of amitriptyline
Blurred Vision Confusion Dry Mouth Urinary retention
46
Amitriptyline is used for
Migraine prophylaxis
47
James, a 38-year-old golfer, is diagnosed with a pheochromocytoma and is scheduled for surgery in several weeks. What is the first drug his endocrinologist should prescribe to him to prepare him for the upcoming surgery?
Phenoxybenzamine
48
An 86-year-old lady has been diagnosed with osteoporosis. Which of these would be second line treatment for the condition?
Denosumab
49
Extradural haemorrhages associated with which blood vessel ?
MMA
50
Subdural haemorrhages associated with which blood vessel ?
Bridging veins
51
Symptoms of UMN disease
``` Babinski reflex Increased muscle tone Muscle weakness Overactive reflexes Spastic paralysis ```
52
What medications can be used to control jerky movements in Huntington's ?
Risperidone
53
Risperidone MOA
Antipsychotic
54
What is the treatment for Guillian-Barre syndrome?
IV immunoglobulins
55
PE treatment
Direct oral anticoagulants (DOACs) - apixaban
56
What is the antibody involved in Goodpasture’s Syndrome?
Anti-glomerular basement membrane
57
A 25-year-old man comes into A&E, after a motorcycle accident. He is unable to open his right fist and extend his wrist. Which nerve is most likely to be affected?
Radial nerve
58
A 60-year-old man comes in with dysarthria, dysphagia and regurgitation of fluids which can sometimes result in choking. When he talks to you, his speech is quite nasal and hoarse. On examination, his tongue is flaccid, and jaw jerk is absent. His sensation is intact and normal. What is the most likely diagnosis?
Progressive bulbar palsy
59
Jane a 30-year-old lady is referred to migraine clinic with shooting pains across the left side of her face. The shooting pains occur randomly, and only last a few seconds. They occur across her left cheek and jaw, and do not affect her forehead or eye. They occur three or four times per day. What condition ?
Trigeminal neuralgia
60
What would be the most appropriate first line medication for trigeminal neuralgia to help prevent symptoms?
Carbamazepine
61
Subarachnoid CT
Star shaped
62
Subdural CT and common presentation
Crescent shaped Alcoholics, elderly and children Damage to bridging veins
63
Extradural CT | and common presentation
Lentiform bi-convex CT | Trauma MMA
64
Extradural treatment
IV mannitol
65
Subdural treatment
Burr drill craniectomy
66
Parkinson's dual therapy
Co-careldopa | Co-beneldopa
67
Parkinson's triad of symptoms
Bradykinesia Rigidity Resting tremor
68
Parkinson's dopamine agonists
Bromocryptine
69
Parkinson's MAOB-I
Selegiline
70
Epilepsy medications
Sodium valproate Lamotrigine Carbamazepine
71
Features of a frontal lobe seizure
Motor features e.g. Posturing, peddling movements of legs. Jacksonian march (seizures march up and down the motor homunculus). Post-ictal Todd’s palsy (weakness, starts distally in limb then up to face)
72
Features of a parietal lobe seizure
Sensory disturbances - tingling or numbness
73
Features of a temporal lobe seizure
The most commonly affected in complex partial seizures. Presents with aura (deja vu, hallucinations, funny smells). Post-ictal confusion is also common in complex seizures.
74
Features of a occipital lobe seizure
Visual phenomena
75
Wernicke's Encephalopathy occurs due to deficiency in which vitamin ?
B1 (thiamine)
76
How does a pancoast tumour present ?
Damage to the sympathetic nerves resulting in anhidrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)
77
How does Brown-Sequard Syndrome present ?
Ipsilateral loss of position, vibration sensation and motor control at the level of the lesion
78
What does Hypotonia mean ?
Decreased muscle tone
79
Name some UMN symptoms ?
``` Hyperreflexia Muscle wasting Spastic paralysis Positive Babinski sign Clonus ```
80
Name some LMN symptoms ?
``` Flaccid muscle tone Hyporeflexia Hypotonic Wasting atrophy Fasciculation Loss of voluntary movement ```
81
Loss of function in the right leg suggests dysfunction of what blood vessel ?
Left anterior cerebral artery
82
Loss of function in the right shoulder, arm, hand and face suggest dysfunction of what blood vessel ?
Left middle cerebral artery
83
Loss of/affected vision and coordination suggests dysfunction of which blood vessel ?
Posterior cerebral artery
84
What key part of the body does MND not affect ?
Eyes
85
What is Lambert Eaton syndrome ?
A presynaptic NMJ disorder where the muscles are unable to contract properly resulting in weakness, drooping eyelids, swallowing problems and dry mouth.
86
Non-motor symptoms of Parkinson's disease
REM sleep disorder Postural hypotension Constipation Depression
87
What condition is riluzole used to treat ?
MND - paritually ALS
88
You see an 8 year-old child in your clinic. His mother tells you that he has been complaining of weakness in his legs, particularly his feet. So far, he hasn’t complained of any issues above his knees. The child doesn't have any pain. On examination you note that he has decreased touch and vibration sensation in his feet and that he has Pes cavus. What is the most likely diagnosis for this child?
Charcot-Marie Tooth
89
What can lamotrigine be used to treat ?
Tonic clonic seizures - most useful in women of childbearing age
90
What is Phalen's test ?
A test for CTS where the patient places the wrist in complete unforced flexion for at least 30 seconds
91
Jane is a 28 year-old lady who is complaining of pain in the back of her legs, and the outer side of her right leg. She also says that she is having problems lifting her ankle up. Which nerve root would cause this type of radiculopathy?
L5
92
Name a tool which can be used to calculate a patient's risk of a stroke when in AF
CHADS VASc
93
Name the components of a CHADS VASc score
CHF, HTN, Age (75+), DM/Stroke/TIA/TE = 2 | VD, Age (65-74) Sex (female)
94
What does a collapsing pulse suggest ?
Aortic regurgitation
95
What does a irregularly irregular pulse suggest ?
Atrial fibrillation
96
What does a pulsus paradox mean ?
BP drops significantly during inspiration suggesting severe Asthma, COPD, blood loss and cardiac conditions
97
What is a radio-radial delay pulse ?
When the pulse is significantly stronger in one arm than the other seen in coarctation of the aorta
98
An ejection crescendo-decrescendo systolic murmur would be suggestive of which valvular pathology?
Aortic stenosis
99
What does an R wave in V1 and Slurred S wave in V6 suggest ?
Right bundle branch block
100
What does an R wave in V6 and Slurred S wave in V1 suggest ?
Left bundle branch block
101
What are the features of tetralogy of Fallot ?
Ventricular septal defect and an overriding aorta which leads hypertrophy of the left ventricle, causing pulmonary stenosis and eventually hypertrophy of the right ventricle eventually leading to heart failure
102
How are blood pressure readings taken in a clinic classified ?
Clinic Readings: Stage 1= >140/90 Stage 2= >160/100 Severe HTN= >180/110
103
How are blood pressure taken by an ambulatory readings classed ?
145/95= Stage 1 HTN 165/105 =Stage 2 HTN 180/110= Severe HTN
104
Name some triggers of acid secretion ?
Gastrin release (from G cells) Triggers release of histamine Increases parietal cells mass Decreases somatostatin (released from D cells)
105
What is Achalasia ?
A condition in which the lower oesophageal sphincter fails to open during swallowing causing a backup of food into the
106
Where are the majority of colon cancers found?
Distal colon
107
Differentials for a 19-year-old presents with abdominal pain in their umbilical region which has now migrated to the right iliac fossa. They are pyrexic and vomiting.
``` Diverticulitis Ectopic Pregnancy Food poisoning Perforated ulcer UTI ```
108
Causes of diverticulum?
Low fibre diet Obesity NSAIDs Smoking
109
Differentials for rectal bleeding ?
``` Anal Fistula Anal Fissure Inflammatory Bowel Disease Haemorrhoids Rectal Cancer ```
110
What is Reiter’s syndrome ?
Classic triad of conjunctivitis, urethritis and arthritis occurring after an injections
111
What is the urgent gold standard treatment for someone with TTP?
Plasma exchange
112
What does TTP stand for ?
Thrombotic thrombocytopenia pupura
113
Management of Venous Thromboembolism in post-hip replacement patients states
Either A low molecular weight heparin followed by low-dose aspirin Or a low molecular weight heparin administered for 28 days in combination with anti-embolism stockings until discharge, or rivaroxaban
114
What is the ideal first line treatment for severe/complicated malaria?
IV Artesunate
115
Treatment for uncomplicated malaria ?
Oral chloroquine
116
What is the name for a malignant tumour of smooth muscle?
Leiomyosarcoma
117
Aetiology liver failure ?
Alcohol overuse Budd-Chiari syndrome Haemochromatosis Wilson’s Disease
118
Aetiology for Pancreatitis
``` GET SMASHED Gall stones Ethanol excess Trauma Steriods Mumps Autoimmune Scorpion venom Hyperlipidemia ERCP or emboli Drugs ```
119
Side effects that can occur with Alendronic Acid use?
Oesophagitis
120
Medications which can cause Gout ?
Methotrexate | Thiazide and loop diuretics
121
Risk factors for pseudogout
IV fluids and parathyroidectomy (the benign tumour in his neck) as these can derange calcium levels.
122
What is an osteopenic suggesting T-score ?
-1 to -2.5
123
What is dsysdiadochokinesis
Loss of ability to perform rapid alternating movements
124
Name focal neurological signs caused by mass effect of brain tumours
Dysdiadokinesis, ataxia, nystagmus, intention tremor, slurred/stacatto speech, hypotonia
125
What is the commonest cause of an infective exacerbation of COPD?
Haemophilus Influenzae
126
Which type of lung cancer is most commonly seen in non-smokers?
Adenocarcinoma
127
Which type of lung cancer is most commonly seen in smokers ?
Small cell carcinoma
128
What is the best investigation in a patient with chronic diarrhoea and malabsorption ?
Small intestine biopsy
129
How does a large bowel obstruction present compared to a small bowel obstruction ?
Constipation before vomiting
130
How does a small bowel obstruction present compared to a large bowel obstruction ?
Vomiting before constipation
131
Features of primary sclerosing cholangitis
Patchy inflammation, fibrosis, and strictures in intra- and extrahepatic bile ducts. Symptoms include pruritus and fatigue.
132
What histological features will an endoscopy with duodenal biopsy find if a patient has coeliac disease
Villous atrophy Crypt hyperplasia Intraepithelial lymphocytosis Proliferation & invasion of lymphocytes
133
What is the name of the at home bowel cancer screening test kit ?
Faecal immunochemical test
134
Causes of peptic ulcers
NSAIDs Helicobacter pyloric infection Haemodynamic shock Stress
135
Signs of chronic liver disease
Palmar erythema Clubbing Dupuytren's contracture Spider naevi
136
Name signs of oesophageal cancer
B symptoms Slow onset difficulty swallowing Haematopoiesis Anorexia
137
Name as many types of diarrhoea as possible
``` Secretory Osmotic Exudative Inflammatory Dysentery ```
138
Features of inflammatory diarrhoea
Severe diarrhoea Blood in stool Fever Abdominal pain
139
What clinical tool is used to classify faees ?
Bristol stool chart
140
What are red flags for GI cancers ?
Rectal bleeding Abdominal mass Change in bowel habit >6 weeks
141
Symptoms of bowel obstruction
Vomiting (first in SBO) Constipation (first in LBO) Abdominal distention Abdominal pain
142
What radiological findings would confirm a SBO ?
Dilated jejunum/ileum | Absence of gas in bowel distal to obstruction
143
Treatment/Management for SBO
``` Rehydration with IV fluids Antiemetics Analgesia Nil by mouth Insertion of nasogastric tube to decompress the bowel Urinary catheter ```
144
Name a complication of SBO which would lead to emergency surgery
Bowel ischaemia or strangulation
145
List 3 causes of gastritis
``` Autoimmune Helicobacter pylori Alcohol abuse Bile reflux Mucosal ischaemia ```
146
How do you prove H.pylori infection
H.pylori urea breath test | H.pylori faecal antigen test
147
Name 3 clinical features of haemorrhoids
``` Bright red bleeding Discomfort/pain Pruritus ani Mucus discharge Pain on passing stool (external haemorrhoids only) ```
148
Pathology of haemorrhoids
Swelling and inflammation of veins in the rectum and anus
149
Management of haemorrhoids
``` Stool softeners/laxatives High fibre diet Adequate fluid intake Topical hydrocortisone Topical anusol Band ligation Haemorrhoidectomy Sclerotherapy ```
150
Symptoms of IBS
``` Abdominal pain or discomfort that is relieved by defecation Altered bowl frequency or stool form Bloating Symptoms made worse by eating Passage of mucus ```
151
List 5 causes of acute diarrhoea
``` E.coli Celiac disease (food allergy) Abx use - pseudomembranous colitis Drugs e.g. NSAIDs/chemo/PPIs Anxiety ```
152
What AB associated with coeliac disease
IgA tissue transglutaminase
153
List 4 potential complications of diverticulitis
Bowel obstruction Bleeding Mucosal inflammation Bowel perforation
154
First line and second line drug treatment for haematemesis from ruptured oesophageal varices
IV terlipressin | IV somatostatin
155
Possible differentials for acute appendicitis
Crohn's disease - causing acute terminal ileitis Ectopic pregnancy UTI Diverticulitis
156
Which tumour marker is most likely to be raised in suspected testicular cancer?
Alpha feto-protein (AFP)
157
What is the gold standard investigation to confirm diagnosis of a transitional cell carcinoma ?
Cystoscopy
158
What is the staging system used for prostate cancer?
Gleason scoring
159
What are Anti-Ro and Anti-La Abs associated with ?
Sjogrens syndrome
160
What Abs are associated with SLE ?
Anti-ANA | Anti-DsDNA
161
What Abs are associated with vasculitis ?
Anti-ANCA
162
What is the criteria for complicated UTIs ?
``` Pregnant Males Children Recurrent UTIs Elderly people Patient’s with an abnormal urinary tract Systemic disease involving the kidney ```
163
Name an alpha blocker used to treat BPH
Terazosin
164
What would be the findings of a patient with nephrotic syndrome ?
Low plasma albumin Proteinuria High serum triglycerides
165
What is the most common histological form of renal malignancy ?
Renal cell carcinoma
166
What is a common complication of renal cell carcinoma and what is the cause ?
Hypertension caused by excessive renin secretion
167
Name some symptoms of RCC
Loin pain, loin mass Bilateral ankle oedema Fever, weight loss and malaise Enlarged lymph nodes
168
What scoring system is used to stage renal cell carcinoma ?
TNM system
169
Define hydrocele
Abnormal collection of fluid within the remnants of the processus vaginalis
170
What medication is used to treat urge incontinence ?
Antimuscarinics e.g. oxybutynin
171
Name 3 types of nephrotic syndrome
``` MCD IgA nephropathy Focal segmental glomerulosclerosis Membranous nephropathy Amyloidosis Diabetic glomerulonephropathy ```
172
What is the treatment for MCD ?
Corticosteriods | Adjunct ACE-I and prophylactic anticoagulation
173
Name 4 classes of diuretic
Loop diuretics e.g. Furosemide Thiazide diuretics e.g Chlorothiazide Angiotensin receptor antagonists e.g. Azilsartan ACE-inhibitors e.g. ramipril
174
What may the secretion of be reduced in CKD ?
Erythropoietin | Vit D
175
What is first line treatment for CKD hypertension and what can be a side effect
ACE-I e.g. ramipril, captopril or enalapril | Hyperkalaemia
176
Signs and symptoms of patient with CKD
``` Pruritus Fatigue Hypertension Swelling in arms and legs Increased need to urinate Anaemia ```
177
Bones, stones, groans and moans
Hypercalcaemia
178
Name 3 ways in which an AKI can be classified
eGFR Creatinine levels Urea levels
179
What ratio would be used to monitor renal function ?
Urea:creatinine
180
3 most common areas for a renal stone to become lodged
Pelviureteric junction Pelvic brim Vesicoureteric junction
181
Risk factors for renal stone formation
``` Dehydration Infections Hypercalcaemia Corticosteroids Aspirain Diet: chocolate, tea and strawberries Gout/FHx ```
182
Give examples of what a patient could do in the future to prevent the recurrence of renal stone formation
Maintain hydration Low Ca2+ Reduce BMI Exercise
183
What antibiotic would you give to treat Neisseria gonorrhoeae
IM Ciprofloxacin
184
Which ECG leads cover the lateral aspects of the heart ?
I, aVL and V5-6
185
Which ECG leads cover the inferior aspects of the heart ?
II, III and aVF
186
Which ECG leads cover the anterior/septal leads ?
V1-V4
187
Which blood vessel perfuses the right atrium and right venticle
Right coronary artery
188
Which leads cover the left ventricle ?
V1-4
189
Which medications are involved in the management of a patient who has previous suffered an MI ?
Aspirin and clopidogrel Propranolol Ramipril Atorvastatin
190
ABCDE of Heart Failure
``` Alveolar oedema Kerley B lines Cardiomegaly Dilation of the upper lobe vessels Pleural effusion ```
191
Which heart conditions show ST-elevation ?
STEMI Pericarditis Prinzmetal angina
192
What ECG changes would a NSTEMI show ?
ST depression Deep T wave inversion Pathological Q waves
193
What ECG changes would unstable angina show ?
ST depression and flat T waves | But could be normal
194
What is a Valsalvar manoeuvre ?
Acute management of supraventricular tachycardia (SVT) | Holding the nose and mouth during forceful expiration to return the vagus nerve to normal sinus rhythm
195
Tool to assess risk of stroke for a patient in AF
CHADS VAS score
196
Tool used for risk of stroke after suspected TIA ?
ABCD2
197
What is the most appropriate diagnostic investigation for aortic stenosis
Echocardiogram
198
How will a patient with aortic stenosis present ?
SOB with exertion Angina Syncope
199
What investigation is essential for aortic stenosis diagnosis ?
Doppler echo
200
What blood markers would be seen in a patient with heart failure ?
Raised BNP levels | Also troponin I, troponin T, creatine kinase
201
Define atherosclerosis
The accumulation of the lipids, macrophages and smooth muscle cells in the intima of the large and medium sized arteries
202
Classical symptoms of a heart attack
``` Excessive sweating Anxiety/feeling of dread Short of breath Pallor Nausea/vomiting Light headed/dizzy Crushing chest pain ```
203
Name the 4 cardiac defects seen in the tetralogy of fallot
Ventricular septal defect Overriding aorta Right ventricular hypertrophy Pulmonary stenosis
204
Define a thrombosis and an embolism
``` Embolism = blockage of a vessel caused by a forgien body e.g. blood clot or air bubble Thrombosis = formation of blood clot inside a blood vessel which obstructs the flow ```
205
List the effect of the RAAS
Increased sympathetic activity Increased tubular reabsorption of Na, Cl and K+ excretion and H20 retention Increased aldosterone secretion resulting in increased Na reabsorption in the DCT Arteriolar vasoconstriction ADH secretion leading to H20 reabsorption Overall salt and water retention and increase in BP
206
What is the difference between essential HTN and secondary HTN
Essential is HTN with unknown cause | Secondary is HTN with a identifiable cause
207
Name diseases/conditions that can cause HTN
``` CKD Graves Stress Primary hyperaldosteronism Renal artery stenosis ```
208
Name 3 contraindications to performing a lumbar puncture
Cardiovascular compromise Decreased GCS Infection at site Signs and causes of raised ICP
209
What Ab can be given as prophylactic treatment for meningitis ?
Benzylpenicillin
210
What is seen histologically and from which artery is a biopsy taken from in Giant Cell Arteritis
Temporal artery | Multinucleated giant cells
211
What can occur if a patient suddenly stops taking steroid medication ?
Withdrawal induced adrenal crisis
212
What might you see on physical examination of a patient with a cluster headache ?
``` Rhinorrhoea - runny nose Lid swelling Lacrimation - flow of tears Miosis - pupil constriction Sweating ```
213
What is acute treatment for a cluster headache ?
100% oxygen | SC sumatriptan
214
What is prophylaxis for a cluster headache ?
CCB
215
What is encephalitis ?
Inflammation of the brain parenchyma usually caused by viral infection
216
What is the most common cause of encephalitis in immunocompetent patients ?
Herpes simplex virus - type 1
217
What would be diagnostic in a patient with encephalitis ?
Lumbar puncture and viral PCR
218
What is first line treatment for encephalitis ?
IV acyclovir
219
Name triggers for a migraine
``` Cheese Caffeine Alcohol Anxiety/stress Sleep Exercise ```
220
What would acute medical management for migraines be ?
NSAIDs e.g. ibuprofen | Triptans e.g. sumatriptan
221
Risk factors for AD
FHx Down's syndrome CVD Advance age
222
What pathological features are seen in AD
``` Atrophy of the cortex (hippocampus) Amyloid plaques Tau neurofibrillary tangles Increased CSF proteins Damaged synapses ```
223
What medication can be used to help manage symptoms of AD ?
Acetylcholinesterase inhibitors e.g. donepezil, galantamine and rivastigmine
224
Classic triad of Parkinsons
Bradykinesia Resting tremor Rigidity
225
Medical management of patient with Parkinsons
``` MAO-B inhibitors e.g. selegiline Dopamine agonists e.g. ropinirole or pramipexole Levodopa + decarboxylase inhibitor Co-careldopa Co-beneldopa ```
226
3 causes of Guillain-Barre Syndrome
Campylobacter jejuni Cyclomegalovirus Epistein Barr virus
227
4 clinical features of Guillain-Barre Syndrome
Bilateral motor weakness Paraesthesia Respiratory involvement HR changes and BP changes
228
How is diagnosis of Guillain-Barre Syndrome
Lumbar puncture with raised CSF proteins
229
What is treatment for Guillain-Barre Syndrome
IV immunoglobulins Plasma exchange Supportive in HUD or ITU
230
What is the name for lack of sensation in gential area ?
Saddle anaesthesia
231
What is a risk factor and why for cauda equina syndrome ?
Metastatic prostate cancer | Can reach the spine via venous blood flow and can metastasize and compress spinal cord
232
Differentials for acute onset facial drooping
Bell's palsy Stroke TIA
233
When you speak to this patient, he appears to understand what you are saying, but is struggling to speak and is slurring his words. What type of aphasia is this?
Brocca's aphasia
234
Which artery is affected in 90% of TIAs
Anterior cerebral artery
235
An 18-year-old female comes in having had a two seizures in the last 24 hours. Her mother describes she just dropped to the floor with no warning and started ‘fitting’ where she would tense and then contract and relax rapidly. She lost control of her bladder and bit her tongue. She was confused both times for several hours after. What type of seizure is this?
Generalised tonic-clonic seizure
236
What test can confirm a clinical suspicion of generalised tonic-clonic seizure
Electroencephalogram EEG
237
Seizure medications with aren't tertrogenic
Lamotrigine Carbamazepine | Levetiracetam
238
Name 2 tests for caral tunnel syndrome
Phalen's test | Tinels test
239
What nerve roots of the median nerve
C6-T1
240
What can be given as treatment for trigeminal neuralgia to prevent symptoms
Carbamazepine
241
Distinguishing feature of granulomatosis with polyangiitis ?
Saddle shaped nose
242
Treatment for MG
Pyridostigmine Prednisolone Thymectomy
243
70-year-old man comes into your clinic with history of seizures. His wife attends with him and describes he lost awareness and was confused when he came round. During the period of lost awareness, she describes he was fiddling with the buttons on his jacket and was smacking his lip Which lobe is affected ?
Temporal lobe complex partial seizure
244
A 60-year-old man comes in with dysarthria, dysphagia and regurgitation of fluids which can sometimes result in choking. When he talks to you, his speech is quite nasal and hoarse. On examination, his tongue is flaccid, and jaw jerk is absent. His sensation is intact and normal. What is the most likely diagnosis?
Progressive bulbar palsy
245
Nerve associated with opening, extending and flexing wrist
Radial nerve
246
A 24-year-old male presents to A&E after having a seizure. On questioning, he said that he felt the seizure coming on, smelt strange smells, and experienced deja vu. He then had periods where he had no idea what was happening and afterwards he was incredibly confused. What lobe was the patient having a complex seizure in?
Temporal lobe
247
What is Brown-Sequard Syndrome ?
Ipsilateral loss of position, vibration sensation and motor control at the level of the lesion
248
UMN signs
Hyperreflexia HypotoniaC. Muscle wasting Spastic paralysis Positive Babinski Sign
249
Dysfunction of what artery will cause loss of function in the right leg ?
Left anterior cerebral artery
250
Subarachnoid medical before surgery
Nimodipine (CCB)
251
Non-motor symptoms of Parkinsons
REM sleep disorder Postural hypotension Constipation Depression
252
Medication which aids with MND and ALS
Riluzole
253
You see an 8 year-old child in your clinic. His mother tells you that he has been complaining of weakness in his legs, particularly his feet. So far, he hasn’t complained of any issues above his knees. The child doesn't have any pain. On examination you note that he has decreased touch and vibration sensation in his feet and that he has Pes cavus. What is the most likely diagnosis for this child?
Charcot-Marie Tooth
254
A 20 year-old woman presents to A&E following a suspected seizure. She lost consciousness and her boyfriend reported jerking movements that lasted about a Minute. What should be prescribed and what shouldn't
Lamotrigine | Topiramate
255
Medical management of Huntingtons
Antipsychotics e.g Haloperidol or Sulpiride Anti-depressants e.g Sertraline Sulpiride Benzodiazepines e.g. Diazepam Dopamine-depleting agents e.g. tetrabenazine
256
Which nerve root is dysfunctional in foot drop
L5
257
Which gene is mutated in cystic fibrosis?
Transmembrane conductance regulator gene
258
Isoniazid side effects
Fever, jaundice and nausea
259
Pyrazinamide side effects
Hyperuricemia (gout) and therefore hepatotoxicity
260
Ethambutol side effects
Optic neuritis, colour blindness
261
What’s the most common type of lung cancer?
Adenocarcinoma
262
In bronchiectasis, what’s the common finding on CT?
Signet ring sign
263
What kind of lung disease is TB ?
Restrictive
264
What is CURB-65 used to calculate ?
Mortality risk assessment for HAP
265
What are CURB-65 components
``` Confusion Urea >7mmol/l RR >30/min BP <90/60 Age over 65 ```
266
What causes type 1 respiratory failure ?
Low Co2 with normal CO2: Occurs as a result of a ventilation-perfusion mismatch
267
What causes type 2 respiratory failure ?
Low Co2 and High Co2: Occurs as a result of alveolar hypoventilation which prevents the patient from being able to adequately oxygenate and eliminate enough CO2 from their blood.
268
Examples of Type 1 Failure
``` Nephrotic syndrome (deficient ventilation) Pulmonary embolism (deficiency perfusion) Asthma (deficient ventilation) COVID-19 (deficiency ventilation) ```
269
Examples of Type 2 Failure
COPD Pneumonia Reduced strength of respiratory muscles e.g. Guillain-Barre/MND Opiate overdose
270
Most common causative organism in HAP
Pseudomonas aeruginosa
271
What is the most appropriate site for a needle thoracostomy to treat this tension pneumothorax?
2nd intercostal space, midclavicular line, on the same side as the pneumothorax
272
Which of the following signs would further support a diagnosis of tension pneumothorax?
Tracheal deviation away from the affected lung, hypotension and hypoxia
273
What is the Gold-standard imaging technique for diagnosing a PE?
CT pulmonary angiography (CTPA)
274
Which TLRs are intracellular receptors ?
3,7,8 and 9
275
What does TLR-2 do ?
Detects Lipoteichoic acid on gram positive bacteria as well as TB and other mycobacteria
276
What does TLR-4 do ?
LPS on the surface of Gram negative bacteria
277
Which innate immune cells display TLR-4 ?
All of them
278
What does TLR-7 do ?
Detect single stranded RNA
279
What does TLR-9 do
Detect unmethylated nucleotide motifs
280
What types of organisms does TLR-10 specifically detect ?
Listeria and influenza
281
What is the MOA for B-lactams
Inhibiting the synthesis of the peptidoglycan layer of the bacterial cell walls
282
What is the MOA for Polymyxins
Target the cell membrane of gram negative bacteria
283
What is the MOA for Sulfonamides and trimethoprim
Inhibit folate synthesis (and so are teratogenic)
284
What is the MOA for Macrolide
ABs target 50S ribosomal subunits
285
Example of a macrolide ABs
Erythromycin Azithromycin Clarithromycin
286
What is dobutamine and what is it used for ?
B1-agonist which acts as a positive inotrope that increased heart muscle contractility and tries to increase cardiac output
287
Name an Alpha-1 blocker and what is it used for ?
Doxazosin - Competitively antagonises noradrenaline for alpha-1 receptors on the post-synaptic membrane causing a relaxation of the smooth muscle Used in BPD
288
Desmopressin
An ADH analogue as is used to distinguish between neurogenic and cranial DI
289
TLR5 detects
Flagellin
290
What type of lymphocyte would you find in CSF of a patient suffering from bacterial meningitis
Neutrophils
291
Which of the following mechanisms best describe the way furosemide acts as a diuretic?
Na+/K +/2Cl-2 inhibitor in the thick ascending loop of Henle
292
Thiazide diuretics MOA
Inhibit NaCl transport at the distal convoluted tubules
293
Spironolactone is a
ARA causing Na+ excretion and decreased K+ and H+ excretion in the collecting tubules
294
SLE is which type of hypersensitivity reaction ?
Type 3 - involves antibody-antigen complexes
295
What is involves in a Type 1 hypersensitive reaction ?
Mass cell degranulation mediated by antigen-IgE linkage on their surface e.g. anaphylaxis and atopy
296
What is involves in a Type 2 hypersensitive reaction ?
IgM and IgG linkage of antigens on the surface of cells to tissue components e.g. Goodpasture's syndrome, autoimmune haemolytic anaemia
297
What is involves in a Type 4 hypersensitive reaction ?
Mediated by T-cells
298
What is involves in a Type 5 hypersensitive reaction ?
Stimulatory antibodies e.g. Grave's disease
299
Which leukocyte in this man’s peripheral blood can become pulmonary macrophages?
Monocytes
300
Which Ab is responsible for the initial humoral immune response
IgM
301
What is secreted by virally infected cells ?
Interferon-A
302
Name some AIDS defining illnesses
``` Kaposi's sarcoma Pneumocystis jirovecii pneumonia Extrapulmonary Cryptococcus Mycobacterium avium complex Oesophageal candidiasis ```
303
Which is the most common AIDS defining illness ?
Pneumocystis jirovecii pneumonia (~40%)
304
CXR findings in pneumocystis jiroveci pneumonia
Bilateral mid and lower zone interstitial shadowing
305
Treatment for penumocystis jiroveci pneumonai
Co-trimoxazole and IV pentamidine
306
What is Kaposi's sarcoma
present in ~35% of AIDs-defining illnesses and is a HIV related cancer and is associated with HHV8
307
Which pathogen is most commonly isolated in cases of chronic diarrhoea associated with HIV?
Campylobacter
308
Rifampicin SE
Red tears / sweat / saliva/ pee
309
Isoniazid SE
Fever, jaundice and nausea
310
Pyrazinamide SE
Hyperuricemia (gout) and therefore hepatotoxicity
311
Ethambutol SE
Optic neuritis, colour blindness
312
Obstructive lung disease
Asthma COPD Bronchiectasis Bronchiolitis
313
Name processes that can happen at the end of acute inflammation?
Resolution Suppuration (pus) Organisation Progression to chronic inflammation
314
Define a Granuloma
An aggregate of epithelioid histiocytes
315
You suspect a patient has Sarcoidosis, which blood marker do you investigate?
ACE - released by granulomas
316
Give the classes of drug used to treat i) arterial thrombosis ii) venous thrombosis (2)
Arterial - antiplatelets e.g. aspirin/clopidogrel | Venous - anticoagulants e.g warfarin or heparin
317
Give the names of a benign neoplasm of the secretory epithelium and a malignant neoplasm of connective tissue?
Adenoma | Sarcoma
318
What are the most common cancers that spread to bone?
``` Breast Lung Thyroid Kidney Prostate ```
319
What is the sequence of events that take place for metastasis to occur?
Invasion - erosion of tissue boundaries Intravasion - gasin access to metastatic route e.g. blood/lymph Evasion of host defence Extravasation - colonisation of new site Angiogenesis - develops its own blood supply
320
Give 3 examples of antigen-presenting cells?
Macrophages Dendritic cells B cells
321
Describe how you would identify a bacteria as Salmonella using Microbiology tests including differentiating it from Shigella?
Gram-stain: salmonella is gram negative (pink) Bacilli appearance = rod shaped MacConkey Agar (tests for lactose fermentation) - salmonella does not (plate remains clear, fermenters go pink) Serotyping to confirm
322
Age group that make up 50% of new infections
19-24
323
Name the different types of polymorphonuclear leukocytes which is the most abundant?
Neutrophil, basophil and eosinophil | Neutrophil is most abundant
324
What is the role of the Major Histocompatibility Complex (MHC)
To present antigen showing self or non-self on cell surface
325
Eosinophils, Basophils and Mast Cells are mainly associated with what type of infection and what type of reaction?
Hypersensitivity reaction | Parasitic infection
326
The action of a drug can be either receptor-related or tissue-related, which of these do the principles of affinity and efficacy influence? What do agonists / antagonists show?
Efficacy and efficacy relate to receptors Agonists show affinity and efficacy Antagonists show affinity only
327
What class of drug is Candesartan?
Angiotensin 2 receptor blocker
328
Which common condition often diagnosed in childhood is a contraindication of beta blockers and why?
Asthma | Beta blockers would cause a constriction of the airways smooth muscle
329
What do NSAIDs inhibit and what is the result?
Inhibit COX | Prevents the conversion of arachidonic acid to prostaglandin
330
What are the 4 stages of Pharmacokinetics?
Absorption Distribution Metabolism Excretion
331
What is the definition of bioavailability?
Amount of a drug taken up into the systemic circulation of a proportion of the amount administered
332
What T score suggests osteopenia
-1 to -2.5
333
What T score denotes osteoporosis

Flash Cards From Mocks (5 decks)

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