FINEFINEFINE Flashcards
(335 cards)
1
Q
Appropriate therapy for MI
A
Aspirin + an antiplatelet (PY12 inhibitor) e.g. clopidogrel
2
Q
MOA of spironolactone
A
Spironolactone is an aldosterone receptor antagonist in the disual tubules
3
Q
Risk Factors For Hypertension
A
Afro-Caribbean Overweight Alcohol and smoking High caffeine consumption Type A personality
4
Q
A pansystolic murmur indicates
A
Mitral valve regurgitation
5
Q
First line anti-hypertensive
A
If above 135/75 and under 65 then ramipril
If Afro-Caribbean then CC e.g. amlodipine
6
Q
ST in ECG in MI
A
Can be either elevated or inverted
7
Q
QRISK2/3
A
2= risk of MI
3 - risk of MI and stroke
8
Q
ABCD2
A
Used to calculate risk of stroke after TIA
9
Q
CHA2DS2
A
Stroke risk in patients with AF
10
Q
Wells score
A
Used to determine risk of DVT or PE
11
Q
What is relative risk ?
A
The ratio of the probability of an event occurring in an exposed group compared to the probability of an outcome in an unexposed group
12
Q
Route of electrical conduction in the heart
A
SAN -> Atria -> AVN -> Bundle of His -> Purkinje Fibres -> Left/right bundle branches
13
Q
What is Conn’s syndrome ?
A
A malignancy in the adrenal medulla causing the overproduction of catecholamine (namely adrenaline)
14
Q
Zones of the adrenal gland and their productions
A
Glomerulus-MC-Aldosterone
Fasciculata- GC- Cortisol
Reticularis - Androgens
Medulla - Adrenaline
15
Q
What could be used to stabilise BP and K+ in Conns ?
A
Spironolactone - K+ sparing diuretic
16
Q
What is CCB
A
Amlodipine
17
Q
What is Addison
A
A deficiency in cortisol production
18
Q
What is Cushing’s
A
Overproduction of cortisol
19
Q
What test differentiates DI ?
A
Water deprivation test with desmopressin
20
Q
What HbA1 levels are required for DM diagnosis
A
48 mmol/mol
>7fasting >11 non-fasting
21
Q
What is HbA1
A
Average blood glucose levels (usually 2/3 months)
22
Q
Crows NESTS
A
No blood Entire GI Skip lesions Terminal ileum and transmural thickness Smoking if a RF
23
Q
CLOSE UP
A
Continous inflammatoin Limited to rectum and colon Only superficial mucosa effected Smoking is protective Excrete blood and mucus Use aminosalicylates Primary sclerosing cholangitis
24
Q
Gold standard for coeliac disease diagnosis
A
Endoscopy and intestinal biopsy
25
What AB would be present in a patient with coeliac disease ?
IgA tissue transgulataminase or IgA endomysial antibody
26
What is Rovsing's sign and what is it indicative of ?
Pain in the right iliac fossa when the left is palpated
27
What is normal urine osmolality ?
800mol/L
28
Osmolarity
Number of particles per L of solution
29
Osmolality
A measure of the number of osmotically active solute particles dissolved in a kilogram of solvent
30
What histological changes is seen after extended periods of acid reflux
Metaplasia of stratified squamous epithelium to simple columnar
31
Most common cause of peptic ulcers ?
H.Pylori
32
First line treatment for peptic ulcers ?
PPI + Amoxicillan + clarithromycin/metronidazole
33
What cells do PPI's act on ?
Parietal cells (which produce stomach acid)
34
Name a PPI
Omeprazole
35
Gold standard for loin pain ?
Non-contrast CT scan of kidney, ureter and bladder
36
Most common composition of renal stones ?
Calcium Oxalate
37
Second most common composition of renal stones ?
Calcium phosphate
38
What is tamsulosin used to treat ?
BPH
39
What is the MoA for Tamsulosin ?
Alpha-1 adrenergic antagonist
| Relaxes smooth muscle in the bladder, neck and prostate, allowing for increased urinary flow
40
Side effect of tamsulosin
Postural hypertension
Alpha-1 adrenergic receptors can also be found in the smooth muscle of the blood vessels and therefore alpha blockers can lower vascular resistance resulting in postural hypotension, dizziness and syncope
41
Most common bacterial causes of urinary tract infections ?
```
KEEPS
Klebsiella
E.coli
Enterococcus
Proteus/pseudomonas
Staphylococcus saprophyticus
```
42
What kind of syndrome is MCD ?
Nephrotic
43
What are the classical presentations of nephrotic syndrome ?
Proteinuria
Hypoalnuminemia
Peripheral oedema
44
What are the stages for CKD ?
```
Stage 1 100-90
Stage 2 89-60
Stage 3a 59-45
Stage 3b 44-30
Stage 4 29-15
Stage 5 < 15
```
45
How does furosemide work ?
Loop diuretic that works in the loop of Henle by blocking NKCC2 receptors
46
Histologically, how does one differentiate different types of leukaemia
1. ALL - blast cells
2. CLL - smudge cells
3. CML - granulocyte maturation or Philadelphia chromosome
4. AML - auer rods
47
Side effects of amitriptyline
Blurred vision, confusion, dry mouth and urinary retention
48
Phecohromocytoma
A neuroendocrine tumour of the chromaffin cells of the adrenal medulla (that can rupture)
49
A complication of clostridium difficile infection
Pseudomembranous colitis
50
What is co-amoxiclave ?
Amoxicillin + clavulanic acid
51
What is Neisseria spp ?
A gram negative diplococci
52
Deformities seen in Ra ?
Z thumb
Swan neck deformity (of finger)
Ulnar neck deviation
Boutonniere
53
In pseudogout what would be seen under light microscopy ?
Rhomboid positively bi-fringent crystals
54
What would be seen in gout under light microscopy ?
Needle shaped negatively bi-fingent crystals
55
What is first line treatment for osteoporosis ?
Aldonic acid
56
What is Denosumab ?
2nd line treatment for osteoporosis
57
Denosumab MoA
MCAB for RANK ligand
| Decreases osteoclast activity
58
MoA for bisphosphonates
Inhibit bone resorption through inhibition of FPS enzyme which reduces osteoclast activity
59
Acute gout treatment
Colchine
60
X-ray findings for osteoarthritis
Loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts
61
Rupture of what artery is commonly responsible for extramural haemorrhage
Middle meningeal artery
62
Muscle tone with UMN lesion ?
Increased
63
What is a CHADS VASc score ?
A scoring system used to calculate the stroke risk of patients with atrial fibrillation
64
What are the variables in a CHADS VASc score ?
```
Congestive heart failure
Hypertension
Age 75+
DM
Stroke
// TIA,, Thromboembolism //
Vascular disease
Age (65-74)
Sex (female)
```
65
An ejection crescendo-decrescendo systolic murmur would be suggestive of which valvular
pathology?
Aortic stenosis
66
What is pulses paradoxus ? ?
When BP drops severely during inspiration
67
What sound does aortic regurgitation produce ?
Early diastolic decrescendo murmur
68
What sound does mitral regurgitation produce ?
Apical pansystolic murmur.
69
What sound does mitral stenosis produce ?
Apical mid diastolic rumble
70
What sound does pulmonary stenosis produce ?
Ejection systolic murmur heard the loudest on inspiration
71
What are the cardinal signs of heart failure produce ?
Fatigue, shortness of breath, ankle oedema
72
What patients would receive ramipril ? And which would get amlodipine ?
Ask someone
73
What stage would blood pressure of 145/95 be classed as ?
Stage 1
74
What are the blood pressure classes ?
| Clinical readings
Stage 1= >140/90
Stage 2= >160/100
Severe HTN= >180/110
75
What are the blood pressure classes ?
| Ambulatory readings
145/95= Stage 1 HTN
165/105 =Stage 2 HTN
180/110= Severe HT
76
What is xanthelasma ?
Yellowish-white lumps of fatty material that accumulate under the skin on the inner parts of your upper and lower eyelids
77
What are signs of infective endocarditis ?
Splinter haemorrhages, Osler's nodes, Janeway lesions, Roth spots and fever
78
What are Osler's nodes
Painful, raised lesions found on the hand and feet
| Associated with infective endocarditis
79
What are Janeway lesions
Irregular non tender hemorrhagic macules located on the palms, soles, thenar and hypothenar eminences of the hands and plantar surfaces of the toes
Associated with bacterial endocarditis
80
What are Roth Spots ?
White centred retinal haemorrhage associated most commonly with bacterial endocarditis
81
What are splinter haemorrhages ?
Haemorrhages located under the nail associated with endocarditis
82
What is a Mallory Weiss Tear ?
A tear in the mucosal lining that occurs due to sudden increase in intra-abdominal pressure
Symptoms include recurrent retching, vomiting which can force the stomach contents into the oesophagus which dilates and tears resulting in haematemesis
83
In what 4 ways can peptic ulcers develop ?
NSAID use
H.pylori infection
Mucosal ischemia
Increased acid secretion
84
How does small bowel obstruction present ?
Abdominal pain higher up in the abdomen
Early onset vomiting
Constipation and bloating
Appendectomy can lead to development of adhesions
If large bowel obstruction, then inability to pass stools would occur much closer to the onset of symptoms
85
What is the first line when investigating a bowel obstruction ?
Abdominal X-ray
86
What is achalasia ?
A rare disorder where the lower oesophageal sphincter fails to open during swallowing to allow food to travel back up the oesophagus
87
When is a duodenal ulcer likely to cause pain ?
Several hours after eating due to presence of acid from the stomach entering the duodenum
88
When does a gastric ulcer cause pain ?
Abdominal pain that is relieved by eating
89
What is a diverticulum ?
A pouch or pocket in the bowel wall usually ranging in size from 0.5-1cm
90
What are haemorrhoids ?
Anal vascular cushions that become enlarged and swollen
91
What is the most common cause of AKI
Acute tubular necrosis
92
What is acute tubular necrosis ?
Where tubular epithelial cells of the kidney die impairing the kidneys ability to filter waste products
93
How does BPH cause AKI ?
Urinary tract is obstructed and this increases intra-tubular pressure which decrease GFR and so increases urea and creatinine remaining in the blood
94
eGFR 82, 32 and 46 are what stages ?
Stage 2, 3a and 3b
95
Which organisms most commonly cause a UTI ?
```
Klebsiella
E.coli
Enterococcus
Proteus
Staphylococcus-saprophyticus
```
96
What is pyelonephritis ?
A type of UTI where the one or both kidneys become infected
97
What is prostatitis ?
Inflammation of the prostate
Characterised by pelvic or perineal pain lasting longer than 3 months
Trauma causing nerve damage in the LUT is a risk factor
98
What antibiotic is contraindicated in pregnancy ?
Trimethoprim
99
What is a complication of chlamydia, which involves reddening of the eyes, ankle and feet swelling ?
Reiter's syndrome
- Reactive arthritis
- Conjunctivitis
- Urethritis
100
Gold standard treatment for someone with thrombotic thrombocytopenic purpura? ?
Plasma exchange
101
What is the treatment for H.pylori caused peptic ulcers
Omeprazole + Amoxicillin + clarithromycin
102
What score can be used to determine the management of patients at risk of DVT ?
Wells DVT score
103
Complications of chemo
```
Hair loss
Secondary malignancy
Infertility
Nausea/vomiting
Diarrhoea
```
104
What is the appropriate thromboprophylaxis regiment following a hip replacement ?
Dalteparin acutely and then maintain treatment with apixaban
105
What is the protein target of Rituximab- ?
MCAB which targets CD20 protein on B cells
| Used to treat Non-Hodgkin's lymphoma
106
What is the ideal first line treatment for severe/complicated malaria ?
IV Artesunate
107
What is the first line treatment in patients with uncomplicated malaria ?
Oral chloroquine
108
What are the 5 key signs of inflammation ?
Rubor, dolor, calor, tumour and loss of function
109
What is the name of a malignant tumour of the smooth muscle ?
Leiomyosarcoma
110
Malignant tumour of the striated muscle ?
Rhabdomyosarcoma
111
What type of cells are associated with acute inflammation ?
Neutrophils
112
What type of cells are seen during inflammation ?
B-lymphocytes, macrophages, T-lymphocytes
113
What is acute cholecystitis ?
Acute inflammation of the gallbladder
114
What is the definition of a granuloma ?
Aggregate of epithelioid histiocytes
115
What are the components of atherosclerotic plaques ?
```
Foam cells - lipid laden macrophages
T-lymphocytes
Smooth muscle cells
Cholesterol, lipid deposits
Fragments of destroyed internal elastic lamina
```
116
Metaplastic change seen in Barrett's oesophagus ?
Stratified squamous to simple columnar
117
What can alcohol excess, Budd-Chaiari syndrome, haemochromatosis and Wilson's disease all result in ?
Liver failure
118
What is Budd Chaiari syndrome ?
A condition in which the hepatic veins are blocked or narrowed by a clot which causes blood to back up into the liver causing it to enlarge and eventually fail
119
What is Wilson's disease
A rare genetic disorder characterised by excess copper stored in various body tissues, particularly the liver, brain and corneas of the eyes
120
What are Kayser-Fleischer Rings ?
Rust coloured rings around the iris in the eye caused by deposition of copper as a result of Wilson's disease
121
What signs other than jaundice would you associate with liver failure
Asterixis
Dupuytren's contractures
Leukonychia
Spider naevi
122
What is an asterisks ?
A flapping tremor of the hand, when the wrist is extended, sometimes said to resemble a bird flapping
123
What are Dupuytrens contractures ?
When 1 or more fingers bend in towards the palm
124
What are Leukonychia ?
White discoloration of the nail
125
What is a classical presentation of pancreatitis ?
Elevated amylase - severe surgical emergency
| Pain the epigastric region radiating to the back
126
What is Primary Biliary Cholangitis ?
An autoimmune condition that damages the interlobular bile ducts in the liver
Very slow to present and often found as incidental finding due to raised ALP
127
How is Primary Biliary Cholangitis treated ?
Treat symptomatically so pruritus with rifampicin or cholestyramine
Late stage treatment is a liver transplant which is curative
128
What is Mumps ?
A viral infection which causes prodrome (flu-like symptoms) which occur a few days before parotid swelling
129
What is the presentation of ascending cholangitis ?
RUQ pain made worse by eating fatty meals and jaundice
| Charcot's triad = RUQ pain, fever and rigors
130
What is the first concern in a patient undergoing alcohol withdrawal ?
Seizures
| And so chlordiazepoxide is prescribed
131
What is ascending cholangitis ?
Bacterial infection of the bile ducts as a result of infection
132
Wernicke's Encephalopathy is a complication of alcoholism caused by the deficiency of which vitamin ?
Vit B1 (Thiamine)
133
What is Wernicke's Encephalopathy ?
A complication of alcoholism caused by a mixture of diet and increased use of thiamine in patients with persistent high levels of blood alcohol
134
What are symptoms of Wernicke's encephalopathy ?
Ataxia, confusion and ophthalmoplegia
135
What are the cancers most likely to metastasise to bone ?
```
BLT KP
Breast
Lung
Thyroid
Kidney
Pancreatic
```
136
What is a common side effect of alendronic acid ?
Oesophagitis
137
What does LOSS stand for ?
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
138
What is Sjogren's Syndrome ?
Autoimmune destruction of exocrine glands and often presents with arthritis
Often presents with arthritis, dry eyes and dry mouth
139
How could one test for Sjogren's Syndrome ?
Schrimer's test
| Involves placing a small strip of paper in the eye to measure tear production
140
Which condition is an X-ray finding of pencil in a cup indicative of ?
Psoriatic arthritis
141
First line treatment for moderate ankylosing spondylitis ?
Ibuprofen
| PPI if long term NSAID use
142
Risk Factors for pseudogout presentation
IV fluids and parathyroidectomy
143
Prevention of acute gout attacks?
Colchicine
144
Prevention of gout long term ?
Allopurinol
145
What is osteopenia ?
Loss of bone mass
146
What T score is indicative of osteopenia ?
-1 - - 2.5
147
What is Reiter's Triad ?
Conjunctivitis
Arthritis
Urethritis
(Can't see, pee or tree)
148
What is amaurosis fugax ?
Pointless, unilateral loss secondary to emboli such as blockage of the retinal artery
149
First line for generalised seizures
Sodium valproate
150
What is Cauda Equina Syndrome
Inability to open bowels/urinate, reduced anal tone, saddle anaesthesia
Caused by prolapsed disk going into the cauda equina and pressing onto the sacral nerves
151
Patients with strokes should receive alteplase
4.5h
152
What is the most common cause of infectious exacerbation of COPD?
Haemophilus influenzae
153
Which of the following is a sign of life threatening asthma attack ?
Sp02 92%
154
How does a salbutamol inhaler work ?
Beta 2 adrenergic agonsit
| Causing relaxation of the smooth muscle of the airways
155
Side effect of salbutamol inhalers
Tremor
156
Most common lung cancer seen in non-smokers
Adenocarcinoma
157
Lung cancer from asbestos
Mesothelioma
158
Classic PE
Pleuritic chest pain
Shortness of breath
Haemoptysis
159
First line treatment in patient with a STEMI within 2 hours of onset ?
Percutaneous cardiac intervention
160
What is first line treatment in a patient with STEMI after 2 hours and before 12 hours ?
Fibrinolysis with IV tenecteplase
161
What is the NICE recommended investigation for heart failure ?
NT-proBNP (BNP) levels
162
What is 2nd line for hypertension treatment ?
Thiazide like diuretics, e.g. bendroflumethiazide
163
Ejection systolic murmur
Aortic stenosis
164
X-ray signs of heart failure
```
ABCD
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels (pleural effusion)
```
165
Difference between alveolar oedema and pleural effusion ?
Alveolar oedema = fluid inside the lungs (alveoli)
| Pleural effusion - fluid in the plural cavity
166
Gold standard investigation for valvular disease
Echocardiogram
167
ECG change in AF
Absent P waves
168
ECG change in atrial flutter
Sawtooth flutter waves
169
ECG change in Wolff-Parkinson-White Syndrome
Delta waves
170
Wolff-Parkinson-White Syndrome
Where the heart has an extra signalling pathway between the atria and ventricles causing tachycardia
171
ECG change in ECG change in acute pericarditis
Saddle-shaped ST segment elevation
172
ECG change in myocardial ischaemia
Q-waves
173
What is a good way to remember ECG changes seen in metabolic acidosis and hyperglycaemia ?
Go, Go long, go wide, go tall
174
What are the ECG signs of metabolic acidosis and hyperglycaemia ?
Absent P waves
Long PR
Wide QRS a
Tall tented T waves
175
What are Kussmual breaths ?
Rapid deep breaths that occur during metabolic acidosis as the patient tries to clear C02 from the body and reverse the acidosis
176
What are the types of cardiomyopathy ?
Dilated, restrictive and hypertonic
177
What are the causes of cardiomyopathy ?
Congenital, idiopathic, vasoconstrictive and infective
178
What is cardiomyopathy ?
Where changes to the heart muscle lead it to become harder to pump blood around the body
179
What would a narrow pulse pressure indicate e.g. 120/100 ?
Aortic stenosis
180
What would a wide pulse pressure, e.g. 150/102 indicate ?
Aortic regurgitation
181
What could a bounding pulse be indicative of ?
Septic shock
182
In what type of shock does bradycardia occur ?
Anaphylactic and cardiogenic
183
What does a tearing/shearing pain in the back usually indicate ?
Aortic dissection
184
What is pleuritic chest pain indicative of ?
Pericarditis - especially if it is made worse by laying back and relieved by leaning forward
185
What is epigastric pain which radiates to the back indicative of ?
Acute pancreatitis
186
What investigation would you conduct in a patient with signs of shock and then abdominal aortic aneurysm
Ultrasound scan
187
Symptoms of hyperthyroid disease
Diarrhoea, weight loss, increased appetite and irritability
188
What is Grave's disease ?
An autoimmune condition in which the body produces TSH receptor stimulating antibodies
189
Typical presentation of Graves
Graves ophthalmopathy, diplopia, eye pain alongside hyperthyroid symptoms
190
What is De Quervain's thyroiditis ?
A viral infection which causes transient thyroiditis
| Can result in both hyper and hypo
191
What is the most common cause of secondary hypoadrenalism ?
Long term corticosteroid usage
192
What can cause Addison's ?
Autoimmune destruction of the adrenal cortex
193
Diagnostic test for someone suspected of Addison's
Synacthen test
194
What is a Synacthen test ?
Synthetic ACTH to see if it can stimulate the adrenal glands
195
Causes of SIADH
Alcohol withdrawal, head injury, pneumonia and small cell lung cancer
196
Substances produced in abundance due to carcinoid syndrome
5-HT, substance P, insulin, ACTH and bradykinin
197
Carcinoid syndrome crisis treatment
Somatostatin analogues then surgery is definitive
198
What are Trousseau and Chvostek's signs indicative of ?
Hypocalcaemia
199
What is Trousseau's sign ?
A wrist flexion when a BP cuff is inflated
200
What is Chvostek's sign ?
Tapping the facial nerve in the parotid gland causing ipsilateral facial muscle twitching
201
Classical signs of hyperparathyroidism
High PTH, Ca and Low P
Pain when pass urine, bone pain and anxiety
Bones, stones, groans and psychiatric moans
202
Which vessel would be the most likely to bleed as a result of a duodenal wall eroding posteriorly ?
Gastroduodenal artery
203
What gastroduodenal artery is the terminal branch of which artery ?
Common hepatic artery
204
Where is pain usually felt in patients with appendicitis ?
Periumbilical region
205
What is angular stomatitis ?
Soreness at the corners of the lips seen in severe cases of coeliac disease
206
What are aphthous ulcers ?
Mouth ulcers, commonly seen in more severe cases
207
What is steatorrhea ?
Classic symptoms of coeliac disease
| Stinking/fatty/loose stools
208
How do PPIs work ?
Inhibit gastric acid secretion by blocking H+/K+ ATPase enzyme
209
Most common cause of a small bowel obstruction
Surgical adhesions
210
Rouleaux formation on a blood film is indicative of what condition ?
Multiple myeloma
211
Most common cause of large bowel obstructions
Malignant tumours
212
What is a complication of strictures from Crohn's disease ?
Small bowel obstruction
213
What is a volvulus ?
Where a loop of the bowel twists round itself and causes an obstruction. Usually of the large bowel
214
What are Virchow's node ?
(Trosier's sign) Enlargement of the left supraclavicular node commonly associated with gastric cancer
215
First line treatment for mild ulcerative colitis ?
Mesalazine - 5ASA drug group
216
First line treatment for moderate UC
Oral prednisolone
217
First line treatment for severe UC
IV hydrocortisone
218
Causes of macrocytic anaemia ?
Alcohol excess, bone marrow infiltration, B12/Folate deficiency and hypothyroidism
219
Mechanism of macrocytic anaemia ?
Meiosis, cell division and impaired and hence cells are larger than normal
220
Chronic disease is associated with what type of anaemia ?
Chronic disease
221
Most common form of anaemia ?
Iron deficiency
222
First line treatment for the most common form of anaemia ?
Oral iron supplements
223
First line treatment for macrocytic anaemia ?
Folic acid
224
What are Bite cells characteristic of ?
G6PD deficiency
225
What condition risks developing into myeloma/multiple myeloma ?
Monoclonal gammopathy of undetermined significance
226
Which blood cancer can puritus be a symptom of ?
Hodgkin's lymphoma
227
What pneumonia can be used for remembering multiple myeloma ?
```
CRAB
Calcium raised due to bone resorption
Renal impairment
Anaemia
Bone - osteoporosis
```
228
What are Heiz bodies ?
Features of G6PD deficiency
229
What are features of iron deficiency anaemia ?
Abnormally shaped red blood cells
Pale blood cells
Red blood cells of varying sizes
Microcytic RBCs
230
What is Kussmual breathing ?
Deep, laboured breathing that occurs in patients with diabetic ketoacidosis in an attempt to get rid of serum C02
231
What are definitive features of acute liver failure ?
INR greater than 1.5
Onest of less than 26 weeks duration
Mental alteration without pre-existing cirrhosis
No previous liver disease
232
Key presentations of acute pancreatitis
```
Abdominal pain which radiates to the back
Severe pain
Periumbilical bruising (Cullen's sign)
Flank bruising (Grey Turners sign)
```
233
What is Cullen's sign ?
Periumbilical bruising
234
Grey Turner's Sign ?
Flank bruising
235
What is a classic presentation of cancer of the pancreatic head ?
Painless jaundice
Advanced age
Pale stools, dark urine - rules out liver
236
What can benzene exposure be a risk factor for ?
Renal cell carcinoma
237
Gold standard investigation for Wilson's Disease
Liver biopsy
238
What type of inheritance is liver disease secondary to a1-antitrypsin deficiency ?
Autosomal recessive
239
What is first line treatment of hospitalised patients with cholera ?
IV rehydration fluids
240
What type of virus is associated with vomiting and diarrhoea and commonly found in nursing homes and among the elderly ?
Norovirus
241
What virus is likely to be associated with vomiting and diarrhoea among children ?
Rotavirus
242
What is the inheritance pattern for haemochromatosis ?
Autosomal recessive
243
What is the presentation of haemochromatosis ?
Fatigue, ED, arthralgia, bronze skin, DM, CLD and CF
244
What is the cause of haemochromatosis ?
Disorder of iron absorption and metabolism which results in iron accumulation
245
What organism causes a severe form of pneumonia often found in natural/artificial water sources ?
Legionella pneumophila
246
What is legionella pneumophila treated with ?
RIPE antibiotics
247
What separates infection of legionella pneumophila and TB ?
TB has a longer history/presentation
248
What is the immediate treatment in the community for a child with suspected meningococcal septicaemia ?
Benzylpenicillin
249
What AB is used in the hospital setting to treat meningeal infections ?
IV cefotaxime
250
What AB is used to treat children with mild respiratory tract infections ?
Amoxicillin and erythromycin
251
What type of bacteria is Strep.pyogenes ?
A beta-haemolytic gram positive streptococcus
252
What is the first AB given if UTI is suspected in a patient of child bearing age/ability ?
Nitrofurantoin
253
What is the first AB given in UTI if there is no chance of the patient being pregnant ?
Trimethoprim
254
MoA for trimethoprim
Inhibition of folate synthesis
255
Medication used to treat viral encephalitis
Acyclovir
256
Most common viral cause of encephalitis
Herpes simplex virus
257
ABs which inhibit nucleic acid synthesis
Ciprofloxacin
Metronidazole
Rifampicin
Trimethoprim
258
What agar is used to culture mycobacterium tuberculosis ?
Lowenstein-Jensen
259
What agar is used to culture anaerobic bacteria such as fusobacteria ?
Blood agar
260
What agar is used to culture campylobacter jejuni
Charcoal agar
261
What agar is used to culture aerobic bacteria ?
Chocolate agar
262
Give an example of an aerobic bacteria ?
Step.pneumonia
263
What agar is used to culture gram -ve bacilli ?
MacConkey
264
Examples of non-lactose fermenting aerobic bacilli with negative oxidase tests ?
Proteus
Salmonella
Shigella
265
Give an example of a non-lactose fermenting aerobic bacillus that gives a positive oxidase test
Pseudomonas
266
Most common cause of infective endocarditis in IVDUs ?
S.aureus
267
Most common cause of infective endocarditis after mouth/oral surgery
Strep.viridans
268
Most common bacteria to colonise prosthetic valves
Staph. epidermis
269
What are Lancefield A bacteria associated with and name a bacterial cause ?
Strep.pyogenes - strep throat/ scarlet fever
270
What are Lancefield B bacteria associated with and name a bacterial cause ?
Strep.agalactiae - can cause neonatal meningitis
271
Test to distinguish between staph and strep
Catalase
Staph = +ve
Step = -ve
272
What bacteria can a coagulase test differentiate between ?
S.aureus (+ve) and S.epidermidis (-ve)
273
COPD grade 1
Breathless with strenuous exercise
274
COPD grade 2
Short of breath when hurrying or walking up hill
275
COPD grade 3
Short of breath when walking on flat or slower than people of the same age
276
COPD grade 4
Stops for breath after walking 100m on flat
277
COPD grade 5
Too breathless to leave house
278
First line for suspected lung cancer ?
CXR
279
Investigation for staging lung cancer ?
CT chest
280
Post 2 weeks of hospitalisation for pneumonia what does a stony dull percussion at the right lung base and an CXR finding of blunting of the right costophrenic angle with homogenous opacity of the lower zone of the right lung suggest ?
Parapneumonic pleural effusion
281
What AB is associated with Wegner's granulomatosis (GPA) ?
C-ANCA
282
What ABs are associated with RA ?
Anti-CCP (most specific)
| Anti-rheumatoid factor
283
What AB is seen in SLE ?
Anti-DsDNA
284
What are oxygen and C02 levels in T2RF
High C02, Low Oxygen
285
What are 02 and C02 levels in T1RF
Low 02, normal C02
286
What does atelectasis mean ?
Lung collapse
287
What is Bronchiectasis ?
Permanent dilation of the airways due to chronic lung disease or infection
288
What does a FEV1/FVC of <0.7 indicate ?
Obstructive disease
289
Name 2 restrictive lung conditions ?
Fibrosis and sarcoidosis
290
What kind of condition is silicosis ?
Occupational lung disorder
291
Causes of bronchiectasis ?
Bronchogenic carcinoma, CF, immotile ciliary syndrome and pneumonia
292
First line COPD management
Smoking cessation and vaccination (influenza and pneumococcal)
293
Second line COPD
SABA + SAMA
294
COPD 3rd Line management of steroid responsive asthmatic
LABA + inhaled corticosteroid (Beclometasone)
295
COPD 3rd line management of steroid non-responsive/asthmatic
Add LABA + LAMA
296
4th line COPD
Oral theophylline
| Long term oxygen therapy
297
2nd line in asthmatic patient already prescribed salbutamol
Beclometasone
298
What are NICE guidelines for Beclometasone therapy ?
Use SABA three times or more a week
Have asthma symptoms 3 times a week or more
Are woken at night by symptoms one weekly or more
299
What is a side effect of rifampicin ?
Orange or red urine
300
Investigation for sarcoidosis ?
Tissue biopsy
301
What is a T1 hypersensitivity reaction ?
IgE mediated quick onset after exposure (allergic)
302
What is a T2 hypersensitivity reaction ?
Cytotoxic/antibody-mediated (cytotoxic)
303
What is a T3 hypersensitivity reaction ?
Immune complex/IgG/IgM mediated (immune complex deposition)
304
What is a T4 hypersensitivity reaction ?
Delayed or cell mediated
305
Give an example of a T1 hypersensitivity reaction ?
Bee sting, latex, penicillin
306
Give an example of a T2 hypersensitivity reaction ?
Hemolytic reactions, Goodpasture syndrome
307
Give an example of a T3 hypersensitivity reaction ?
SLE
308
Give an example of a T4 hypersensitivity reaction ?
Chronic graft rejection
309
What is Goodpasture's syndrome ?
ABs specific to a type of collagen in the glomerular basement membrane
Leading to inflammation and destruction of the basement membrane leading to pulmonary haemorrhage adn kidney failure
310
What are the differentials of Goodpasture's syndrome ?
Idiopathic pulmonary hemosiderosis, RA and SLE
311
Rupture of which vessel is associated with subarachnoid haemorrhage ?
Berry-aneurysm
312
Rupture of which vessel is associated with an extradural haemorrhage ?
Middle meningeal artery
313
Rupture of which vessel is associated with an subdural haemorrhage ?
The bridging veins
314
Severe, sudden-onset occipital headache with associated vomiting, photophobia, and neck stiffness. Her past medical history includes refractory hypertension. A CT head is reported to show hyper-attenuated areas in the basal cisterns. What is the most likely diagnosis?
Subarachnoid
315
What type of haemorrhage is most commonly associated with elderly/alcoholics or those on anti coagulation or platelet therapy ?
Subdural haemorrhage
316
Hx more chronic - headache/ fluctuating consciousness/ cognitive decline. CT head: sickle-shaped/crescent shaped haematoma
Subdural haemorrhage
317
Typically caused by trauma to the temple and a tear in the middle meningeal artery. Hx of brief loss of consciousness, followed by lucid period before rapid deterioration with headache, vomiting, confusion, focal neurology. CT head: Lens-shaped/ Lentiform/ Bi-convex haematoma
Extradural
318
Cardinal triad of Parkinson's Disease
Bradykinesia, rigidity and tremor
319
Epidemiology for cluster headache
Male, smoking 30-50yo, circadian periodicity (tend to happen at the same time each day)
320
Acute management of cluster headache
High flow 100% oxygen + SC sumatriptan
321
Preventative management of cluster headache
Verapamil
322
A 14-year-old girl, Anna, presents to A&E. Her mum says she has had a ‘seizure’ approximately an hour ago. Her mum, who witnessed the incident, says Anna told her she felt ‘weird’ whilst they were watching TV together. Anna then appeared to stare into the distance and was unresponsive to her mum’s voice, whilst picking at her clothes and chewing. Afterwards, Anna was ‘confused’. What is the most likely diagnosis?
Temporal lobe seizure
323
A 19-year-old man presents to A&E with a fever, headache, vomiting, photophobia, and drowsiness. On examination, neck stiffness and a positive Kernig’s sign are elicited. Given the patient’s reduced GCS and as a highly proficient FY1, you order a CT head to rule any intracranial pathology / raised ICP before conducting a lumbar puncture. You send both blood and CSF samples to be cultured. After 24 hrs of successful empirical treatment, the lab reports the results of the CSF gram stain: Gram positive diplococci seen. Given the most likely diagnosis and the histopathology, which pathogen is most likely responsible for his symptoms?
Streptococcus Pneumoniae
324
A 75-year-old woman presents to A&E with new-onset right arm and lower facial weakness. On examination, power in the right upper limb is reduced. Power in the left upper limb and both lower limbs is not substantially affected. Of note, she also has impaired language comprehension, although she is speaking fluently. Which vessel is most likely to be affected?
Left middle cerebral artery
325
Rupture of which vessel is locked in syndrome associated with ?
Basilar artery
326
Rupture of which vessel would cause right sided hemiparesis, sensory loss, lower extremity affected > upper ( upper>lower in middle cerebral artery)
Left anterior cerebral artery
327
Rupture of which vessel would cause left sided hemiparesis, sensory loss lower extremity > upper
Right anterior cerebral artery
328
Rupture of which vessel would cause left sided hemiparesis, sensory loss upper > lower
Right middle cerebral artery
329
Initial treatment in a patient with a suspected TIA
Aspirin 300mg daily
330
Treatment once TIA/ischemic Stroke confirmed
Aspirin 300mg + clopidogrel
331
Second line anti-thrombotic therapy
Clopidogrel + Dipyridamole
332
How does cauda equina syndrome present ?
Begins at L1/2 (where the spinal cord terminates)
| LMN signs only
333
LMN signs of CES
```
Lower back pain
Decreased limb power and reflex
Sphincter disturbances
Impotence
Saddle paraesthesia
```
334
How does Brown Syndrome ?
Lateral hemisection of the spinal cord) features ipsilateral weakness below the lesion, ipsilateral loss of proprioception + vibration, contralateral loss of pain + temperature
335
Conus medullaris syndrome
Similar to cauda equina but with UMN features
