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1

What is the dominant cause of B12 deficiency in Western countries?

PA - pernicious anaemia

2

what could an absent radial pulse indicate?

Also may be unequal blood pressure in the upper limbs

20% have aortic regurgitation

associated with renal artery stenosis

Takayasu's arteritis

(large vessel vasculitis)

 

3

Why rehydrate gradually with DKA?

to avoid rapid intracellular osmotic/ sodium shifts that may cause fatal CNS oedema.

Remember: with DKA and polydipsia, rapid fluid shift from intracellular compartments.

4

What is the management of CAP?

low-severity - amoxicillin (or macrolide/ tetracycline if allergic) - 5 day course

 

moderate-high severity - dual antibiotic tx. Amoxicillin (or co-amoxiclav)  and a macrolide.

7-10 day course

 

5

Can you gauge severity of attack by the wheeze?

 

WHY?

NO.

 

Severe attack... very reduced air flow (Silent chest)

6

Cauda Equina - signs and symptoms

  • altered sensation perineal area, bowel/ urine/ sexual dysfunction
  • PR - loss of tone and sensation

7

organism; bacterial tonsilitis

group A beta haemolytic streptococcus

 

'Strep throat'

 

 

8

What is seroconversion?

  • Period of time during which HIV antibodies develop and become detectable.
  •  takes place within a few weeks of initial infection.
  • It is often accompanied by flu-like symptoms including fever, rash, muscle aches and swollen lymph nodes. These symptoms are not a reliable way to identify seroconversion or to diagnose HIV infection.

9

What are typical symptoms of anaemia?

SOB (mainly on exertion)

tiredness

headaches

  • pallor, angina in elderly
  • tachycardia

10

Examples of 2nd generation sulfonylurea drugs (3)

glimepiride

glipizide

glyburide

 

11

Otitis media bugs

haemophilus influenzae

streptococcus pneumoniae

moraxella catarrhalis

 

12

Describe the respiratory tract effect of anticholinergics (eg. ipratropium, tiotropium)

Helps prevent the bronchoconstriction of smooth muscle by inhibiting acetylcholine and the activation of parasympathetic n.s.

** they block the bronchoconstricting effect of the vagus (parasympathetic) nerve stimulation.

13

What are the side effects of B2-adenoceptor agonists?

Tremor, tachycardia,

anxiety, hypokalaemia.

14

What are the tests for Coeliac disease?

Total immunoglobulin A (IgA)

IgA Tissue transglutaminase antibody (shortened to tTG)

+ eat gluten in more than one meal every day for six weeks prior to testing.

GOLD standard; duodenal biopsies with IEL ( increased number of intraepithelial lymphocytes is typical of active celiac disease)

15

Thiazides

moa

side effects

Act on early segment of the distal tubule. Inhibit NaCl reabsorption.

Side effects (due to >> excretion of K+ and H+ ions)

hypokalaemia

metabolic alkalosis

Hyperuricaemia. Increase in uric acid levels may result in gout.

Glucose tolerance; thiazides are contraindicated in patients with non-insulin-dependent diabetes.

16

What is diagnosis of DKA based on?

 

Diabetic ketoacidosis is a serious complication of Type I DM.

Diagnosis based on

diabetes (blood glucose >11 mmol/L)

ketones (urine or blood)

acidosis (pH <7.30 venous blood)

17

What could cause wrist drop?

Radial nerve compression

18

General advice for facial fractures

no nose blowing

no sneezing

knocked out teeth; keep in saline or milk. 1-4 hour window to reimplant.

Bites; Augmentin antibiotic

19

Another name for Broca's aphasia?

Expressive aphasia

20

What is pretibial myxoedema associated with (in 1-5% of cases)

Graves' dermopathies. 

21

When is it appropriate to use montelukast or zafirlukast?

(leukotriene receptor antagonists)

Step 3 or 4 chronic asthma.

Exercise and aspirin-induced asthma. 

Patients with associated rhinitis and/or nasal polyps.

NB. Taken orally OD

22

What could CTS be associated with?

pregnancy

diabetes

hypothyroidism

23

Clavicle management

Broad arm sling and let heal.

24

Buerger's disease

(thomboangiitis obliterans)

Occurs in young men who smoke

 This pain may occur when you use your hands or feet and eases when you stop that activity (claudication), or when you're at rest

Inflammation along a vein just below the skin's surface (due to a blood clot in the vein)

Gangrene

25

Differences between UC and CD

26

Domperidone

D2 antagonist

Similar to metoclopramide but doesn't cross the blood-brain barrier and rarely causes sedation or extrapyramidal effects.

27

What's the most common causes of microlytic anaemia?

Iron deficiency

28

What passes through the optic canal?

optic nerve

ophthalmic artery

ophthalmic vein

29

What is found here?

  • SOLID:
  • lymph nodes, cervical rib
  •  
  • CYSTIC:
  • cystic hygroma (lymphangioma)
  • Pharyngeal pouch
  • Subclavian aneurysm
  •  

30

MOA of propylthiouracil?

works outside of the thyroid gland, preventing conversion of (mostly inactive form) T4 to T3

31

ADH

made in hypothalamus

released via posterior pituitary gland

osmoreceptors in hypothalamus

32

Why would you add a LABA?

If inhaled corticosteroid therapy is insufficient.

33

What is a strong risk factor for ocular involvement in herpes zoster ophthalmicus?

Vesicles on tip of nose = Hutchinson's sign

Can cause anterior uveitis

34

What are some important adverse effects of thiazide diuretics?

The three H's

hypokalaemia

hypocalcaemia

hyponatraemia

GOUT

impaired glucose tolerance

35

Symptoms of bronchiolitis?

coryzal preceeding, dry cough, >> sob.

sometimes wheezing and fine inspiratory crackles

feeding difficulties due to >> sob

999 if: >> resp distress, or oxygen sats <92%

36

Loop diuretic

moa, indications, side effects

Inhibits NaCl reabsorption in the thick ascending loop of Henle

Indications; oedema with heart failure.

effective in patients with << GFR

High doses; endolymph disturbances and deafness.

Adverse : 4 hypos; hypokalaemia (little), hyponatraemia, hypotension, hypovolaemia.

IMP. >>> CALCIUM and >>> MAGNESIUM excretion

37

What are the signs and symptoms of peritonitis?

severe abdominal pain, tenderness and guarding.

(rigidity - invol contraction of abdo muscles)

Worse for movement as the inflammed peritoneum moves.

REBOUND pain (Blumberg sign) as the peritoneum snaps back into place after palpation.

fever, weight loss

 

38

When would you perform a ABG analysis?

When O2 sats are < 92%

39

Name some cystic lumps

  • Branchial cyst
  • Cystic degeneration of tumour
  • Larynogocoele

40

What is the cause of most normocytic anaemias?

ACD

most haemolytic anaemias

 

41

What is the important of lactate in ABG?

by-product of anaerobic respiration. 

Good indicator of poor tissue perfusion.

42

What drugs can interfer with warfarin?

P450 enzyme inhibitors

P450 enzyme inducers (Cause decrease in INR)

- antiepileptics; phenytoin, carbamazepine

barbiturates; phenobarbitone

rifampicin, St John's Wort, griseofulvin

NSAIDs; inbihit platelet function

43

What could blood clotting abnormalities and platelet consumption indicate with a septic px?

development of disseminated intravascular coagulation (DIC); clotting factors and platelets are consumed by clot formation in the peripheral circulation.

44

triple therapy for gastric ulcers

Omeprazole

amoxicillin

Clarithromycin

or

omeprazole

amoxillin

metronidazole

45

Can addison's disease cause hypoglycaemia?

YES

46

What's the general management of COPD (not inhalers part)?

stop smoking

annual influenza vaccination

one-off pneumococcal vaccination

 

47

Severe acute asthma attack.

any one of...

 

PFR?

Resp Rate?

HR?

general observation...

Any one of the following:


Peak flow 33–50% best or predicted


Respiratory rate ≥ 25/min


Heart rate ≥ 110/min


Inability to complete sentences in one breath

48

Ludwig’s angina is a form of severe diffuse cellulitis with bilateral involvement, primarily of the submandibular space.

 It presents with an acute onset and spreads very rapidly meaning early diagnosis and immediate treatment planning is key to saving lives

49

Why do 70% of asthma-related deaths occur at night?

circadian variation in bronchial responsiveness

50

Three rules of fluid replacement

  • Replace blood with blood
  • Replace extracellular fluid depletion with saline
  • REHDRATE with DEXTROSE. NOT FOR RESUSCITATION

51

What drugs would a patient be on, following an MI (hospital inpatient)

antiplatelets, blood pressure, beta blockers, lipid lowering, DVT prevention, pain meds., anti-emetics, GTN

75mg aspirin + 75mg clopidogrel daily

e.g. ramipril (starting dose 2.5mg daily)

 eg. atenolol 25-50mg daily

simvastatin 40mg daily

enoxaparin 40mg SC (after completion of heparin)

morphine sulphate 5-10mg IV

cyclizine,GTN PRN

52

sling for elbow fracture?

Broad arm sling,

and backslab up to the shoulder.

53

Otitis Externa

Otitis externa results from a disturbance of the lipid/acid balance of the ear canal.

It is most usually infectious but may be caused by allergies, irritants or inflammatory conditions (all of which may also underlie bacterial infection).

Infection of the outer ear is usually bacterial (90%) or fungal (10%)[4].  Staphylococcus aureus and/or P. aeruginosa. 

Fungal infection usually follows prolonged treatment with antibiotics, with or without steroids. About 10% of cases are fungal. 90% of fungal infections involve Aspergillus spp. and the rest are Candida spp. 

Herpes zoster (Ramsay Hunt syndrome).

Infection may be localised to an infected hair follicle, causing a furuncle or localised otitis externa (S. aureus is the usual infecting organism).

54

Tests for diabetes

Blood glucose

urine or blood test for ketones

pH (venous fine)

55

Anterior compression/ Open book

Look at SI joint and pubic symphysis

56

What is the treatment of acute asthma?

  • Oxygen (maintain 94-98%). Nebulisers should be driven by oxygen
  • Bronchodilator (Beta 2 agonists) by nebuliser every 15 mins, back to back if needed.
  • Steroids oral or IV and continue for 5 days
  • Consultants; ipratropium bromide neb 0.5mg (4-6 hrly), magnesium, aminophylline

NB> Salbutamol can be given IV if airway compromised.

57

What is FNAC?

Fine Needle Aspiration for Cytology

 

- may be used for neck lumps

58

Ciprofloxacin

Fluoroquinolone group

Effective for many gram -ve bacteria.

Used to treat anthrax - postexposure prophylaxis of inhalational anthrax.

serious adverse effects; tendonitis and tendon rupture.

alters blood glucose, phototoxicity, prolongation of QT interval

Contraindicated; children, adolescents, pregnant and lactating women.

59

Some characteristics of CTS

  • more common in women
  • tingling in hand
  • symptoms often occur at night
  • px may hand hand and arm out of bed for relief
  • associated with.... (3)
  • thenar muscle wasting

60

Why are ACEI drugs good for heart failure?

lower BOTH arterial and venous resistance.

61

What is haemochromatosis?

genetic disorder associated with excessive iron absorption. 

(maybe caused by repeated blood transfusions)

 

62

what could be triggers for hypoglycaemia attacks?

infections; UTI, pneumonia

physiological stressors including cold, status epilepticus.

63

Battle's sign, also mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma.

64

cholecystitis

a stone in the cystic duct

obstructing the GB which leads to infection.

65

Compression fracture.

collapse of a vertebra.

Trauma or a weakening of the vertebra (compare with burst fracture). This weakening is seen in patients with osteoporosis 

Wedge deformities, with greater loss of height anteriorly than posteriorly

66

How effective is prophylaxic treatment of AF with warfarin in preventing strokes?

yearly risk of cerebral embolism reduced from 3% to 1%.

 

67

why do you get steatorrhoea with cystic fibrosis?

due to pancreas insufficiency of lipase enzymes; thus fat malabsorption. Maybe diabetes developing too.

68

Where are B12 -Intrinsic Factor complexes absorbed?

terminal ileum

69

Reticulocyte count; what does this indicate?

indication of output of young red cells by the bone marrow.

- raised after haemorrhage or haemolysis

- low if marrow is incapable of normal cell production (e.g. aplastic anaemia)

70

What are the two types of leukaemia?

acute lymphoblastic leukaemia (ALL) - lymphoid cell line

 

myeloid cell line - Acute Myeloid Leukaemia (AML)

71

Angina drug management

First step: Nitrates - reduce preload

Second step: Diltiazem; vasodilator of arteries incl. coronary. Thus reduces afterload. Also < cardiac rate and contractility (reducing oxygen demand)

 

Statins - reduce atherosclerotic plaque risk

Beta-blockers (less popular) if tachycardic.

 

72

What lumps move with swallowing?

SOLID:

Goitre

lymph node

CYSTIC:

Thyroid cyst

73

What are the three main manifestations of alcoholic liver disease?

  • fatty change
  • alcoholic hepatitis
  • alcoholic cirrhosis

74

Examples of 2nd generation sulfonylurea drugs (3)

glimepiride

glipizide

glyburide

 

75

main clinical features of AOM (acute otitis media)

otalgia

fever and deafness

otorrhoea

children; pain often worse at night

 

76

What's a common symptom of a fractured orbit?

Diplopia

due to obstruction of rectus muscles, or suspensory ligament is not fixed.

77

Characteristics of tension headaches

  • mild to moderate (fuzzy head); dull generalized headache
  • bilateral
  • non-pulsatile
  • exert bandlike pressure
  • no nausea

poor response to over the counter analgesia

78

Which HPV types cause 70% of cervical cancers?

types 16 and 18

79

Extragastrointestinal manifestations of IBD

Joint problems

Skin rashes; pyoderma gangrenosum, erythema nodosum

Iritis/ uveitis

Aphthous ulcers.

 

80

What drug can be used for emergency treatment of acute-angle closure glaucoma

pilocarpine

NB. causes miosis

81

What is pramlintide acetate

Analogue of amylin.

Amylin; co-secreted with insulin. It slows gastric emptying and reduces appetite.

Subcutaneous at mealtimes for type I and 2 diabetes. SE; nausea, vomiting, anorexia, headache.

82

Lower motor neurone signs 

  • absence of reflexes
  • muscle fasciculations
  • atrophy of muscles
  • decrease muscular tone

83

Name the two  meglitinides drugs that are short-acting and are useful for patients whose meal schedules vary. 

Repaglinide

Nateglinide

84

What is Oxybutynin?

drug that decreases muscle spasms of the bladder. Can also help with kidney stone symptoms.

(therefore used for an overactive bladder)

85

Diagram of Lung Volumes

86

What are Charcot-Bouchard aneurysms?

Aneurysms in the small penetrating blood vessels of the brain.

They are associated with hypertension.

The common artery involved is the lenticulostriate branch of the middle cerebral artery.

87

QRISK3

Risk of developing a heart attack or stroke if NO previous diagnosis of CHD or stroke/ TIA

88

Macrolides

moa, drugs, indications, side effects

erythromycin, clarithromycin, azithromycin

 

 

89

Mx of type I diabetes

monitor HbA1c every 3-6 months

self-monitoring of blood glucose levels

(5-7mmol/l on waking)

4-7 mmol/l before meals

90

Orbital cellulitis; an emergency and requires intravenous (IV) antibiotics.

In contrast to orbital cellulitis, patients with periorbital cellulitis do not have bulging of the eye (proptosis), limited eye movement (ophthalmoplegia), pain on eye movement, or loss of vision. 

91

What is the risk of thrombolytic tx of ischaemic stroke?

And the incidence?

significant risk of primary intracerebral haemorrhage

1 in 30

92

Signs/ symptoms fractured mandible

pain/ restricted movement

missing teeth, numbness, teeth not meeting properly

Sublingual haematoma; often indicative of fractures.

93

Acute SEVERE asthma signs (any one of)

PEFR value?

Resp rate value?

HR value?

name one observation

PEFR 33-50% predicted

Resp rate >25/min

HR >110bpm

Inability to complete sentences in one breath

94

What does ART stand for (with HIV topic)

and associated problems?

anti-retroviral therapy

  • resistance to drugs
  • side effects, drug intolerance
  • adherence problems from complex regime
  • drug interactions
  • cost

95

Aortic regurgitation

- causes

Blood flows back into the ventricle at start of diastole.

causes; infective endocarditis

rheumatic disease.

Usually asymptomatic until LVF

96

Geneva Score

The Geneva score is an accepted alternative to the Wells’ PE criteria used to risk-stratify patients with concern for PE. 

(both are used for PE)

97

What's the antidote to Heparin overdose?

protamine sulphate

98

Management of AF

cardioversion if < 48 hour onset

Rate and rhythm control

CCB - verapamil or a Beta Blocker

Rate control; amiodarone

anticoagulants to prevent thromboembolism/ stroke

surgical catheter ablation

 

99

What's the most prevalent cause of death for diabetic patients

coronary artery disease

(diabetic px after develop hypertension, dyslipidemia, and a decline in HDL, and a rise in triglyceride levels)

100

peri-orbital cellulitis

painful, unilateral red swollen eyelids

px often systemically unwell

 

101

Which AF drug can cause thyrotoxicosis?

amiodarone

102

Management of Otitis media

analgesia. 80% improve spontaneously. 

>48hrs require antibiotics

103

How does metformin (biguanide drug) work?

 

NB> stop if acidosis suspected due to rare effect of lactic acidosis.

increases insulin receptor affinity in peripheral tissues.

1st line drug for type 2 diabetes. Can be used alone or in combo.

DOES NOT; stimulate insulin secretion, or cause hypoglycaemia, or weight gain.

DIARRHOEA common in 30% of px.

 

104

Symptoms of temporal arteritis

visual loss; blood supply to retina is affected. 

One-sided headache, very tender scalp; tender brushing hair 

Typically new and continuous headache with those over 50 yrs.  Gradual onset (wks-mtns)

Pain in jaw with chewing; jaw claudication

Can cause clots leading to stroke.

  • ESR often raised (>100)

105

 protozoan parasite that causes malaria

Plasmodium falciparum

106

What is Argyll Robertson (AR) pupil and what's the most important cause (and very specific)?

bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light

 

Syphilis

+ diabetic neuropathy

107

What is Zollinger-Ellison syndrome?

108

Some cardinal symptoms of asthma (7)

  • Cough


    Expiratory Wheeze


    Breathlessness


    Chest tightness


    Nocturnal cough (especially children)


    Exercise induced wheeze


    Diurnal variation (worse at night and early morning)

109

Sudden onset headache could be:

meningitis

subarachnoid haemorrhage

migraine

110

What type of headache is common first thing in the morning?

migraine

111

What is Terlipressin?

a vasopressor analogue that acts as a vasoconstrictor to management low blood pressure.

112

What is the TIMI score?

Estimates mortality for patients with unstable angina and non-ST elevation MI.

113

allergic conjunctivitis

bilateral, often related to hay-fever.

Chemosis (oedema of the conjunctiva) is a classic sign.

tx. antihistamines

114

Name some cystic lumps

  • Branchial cyst
  • Cystic degeneration of tumour
  • Larynogocoele

115

What is the Schilling test?

Determine how well the patient is able to absorb vitamin B12 from their intestinal tract.

116

RhA on XR - characteristics

White sclerotic changes - spongy bone looks whiter.

Subluxation of MCP

Wrist/ hand displacement

Thumb - Z deformity

 

117

Which receptors are abundant in the CTZ of the medulla?

D2 dopamine receptors

5HT3 receptors

118

Which part of the orbit do the cranial nerves IV, III, VI pass?

Superior orbital fissure

119

Epworth sleepiness scale

Primarily for obstructive sleep apnoea patients; meaure of excessive daytime sleepiness

120

symptoms of septic shock

  • warm peripherae, bounding pulse with low diastolic pressure, low JVP
  • pyrexia (or hypothermia)
  • history and signs of underlying infection

121

What's this? + info.

Thyroglossal cysts

asymptomatic midline neck mass at or below the level of the hyoid bone, above the thyroid cartilage.

Most often in the midline

They may present in childhood (less than 50%) or, usually as a young adult

Move up when the tongue is protruded & with swallowing- cysts attached to the base of the tongue by the thyroglossal tract

122

What's the difference between hemiparesis and hemiplegia?

Hemiparesis ; unilateral weakness

 

Hemiplegia; complete loss of power on one side

123

What nerve supplies the lateral rectus muscle?

abducens (VI)

long nerve makes it prone to injury. 

124

What's the most common pathogen for bronchiolitis?

Respiratory syncytial virus (RSV)

125

Symptoms of hypovolaemic shock (this includes burns)

  • symptoms of fluid loss, eg. melaena, haematemesis
  • cold peripherae; weak, thready pulse, low JVP
  • skin pallor, dry mucous membranes

126

Foot bones 2

127

What are the main causes of heart failure?

  • CORONARY HEART DISEASE
  • hypertension
  • valvular disease
  • cardiomyopathy

128

Jones fracture is a break between the base and middle part of the fifth metatarsal of the foot.

tx. cast, 6 weeks rest.

129

What are the following acronyms?

TACI

 

LACI

TACI: Total Anterior Circulation Infarction

 

LACI: Lacunar Infarction

130

Guillain-Barre syndrome is "an immune mediated demyelination of the peripheral nervous system often triggered by an infection."

Which one commonly? 

Campylobacter jejuni

131

How does an acoustic neuroma present?

should always be considered in patients with unilateral sensorineural deafness or tinnitus.

NB. otosclerosis causes a conductive deafness, and symptoms are bilateral.

132

which is the steriod given IV for severe asthma?

prednisolone

40–50 mg daily for at least 5 days.

133

meningitis - antibiotic

benzylpenicillin

134

What are Salmeterol and Formoterol examples of?

Long-acting B2 agonists. Half-life 15 hours.

135

what is the screening test for alcohol consumption?

AUDIT

136

ABCD2

Evulate risk of occurence of a stroke in the days following a TIA. 

137

What is the most common cause of subarachnoid haemorrhaging? (SAH)

Intracranial aneurysms (‘berry’ aneurysms): approx 85% of cases.

Conditions associated with berry aneurysms include adult polycystic kidney disease, Ehlers-Danlos syndrome and coarctation of the aorta

138

What the the two groups of antidiabetic drugs?

hypoglycaemic agents

 

antihyperglycaemic agents 

139

Why don't you treat HT immediately following a stroke?

  1. cerebral autoregulation of blood flow is disturbed and therefore risk of hypoperfusion.
  2. Watershed infarction; there can be an extension of the stroke due to reduced blood supply around area of infarction.

NB. continue with regular BP meds if taken previously.

140

Syphilis - antibiotic

Benzylpenicillin

or

Doxycycline

141

Asthma affects boys or girls the most?


Asthma affects men or women the most?

BOYS

 

WOMEN

142

What's this? And info

BCC is a non-melanoma skin cancer, and is the most common type (> 80%) of all skin cancer.

BCC are sometimes referred to as ‘rodent ulcers’.

Common on areas that are exposed to the sun, such as your face, head, neck and ears

143

What is the GRACE score?

A scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality

144

Symptoms of hypoglycaemia

confusion, sweating, fatigue and feeling dizzy.

maybe pale, weak, blurred vision, tachycardia, unconsciousness

 

 

145

What is cor pulmonale?

Pulmonary heart disease.

Occurs in 25% of patients with COPD.

Caused by pulmonary hypertension causing enlargement of the right ventricle.

146

usually bilateral. 

Refer to orthopaedics ; other injuries likely.

147

Some signs and symptoms of infective endocarditis

splinter haemorrhages

Janeway lesions

Osler's nodes

dental hygiene

 

148

How does a ruptured ovarian cyst present?

a sharp unilateral pain immediately following intercourse or strenuous exercise.

(other DDs; ovarian, or adnexal torsion - this is tender on bimanual exam)

149

What lumps move with swallowing?

SOLID:

Goitre

lymph node

CYSTIC:

Thyroid cyst

150

Dacryoadenitis

  • Swelling of the outer portion of the upper lid, with possible redness and tenderness
  • Pain in the area of swelling
  • Excess tearing or discharge
  • Swelling of lymph nodes in front of the ear

Common causes include mumps, Epstein-Barr virus, staphylococcus, and gonococcus.

 

 

151

Acute asthma attack

Salbutamol nebs

add ipratropium bromide if not working well.

Give steroids (orally, IM, IV) 

152

What is tenesmus?

Sensation of needing to defaecate although the rectum is empty.

 

(could be rectal inflammation of tumour)

153

What is bioavailability?

Bioavailability :

A subcategory of absorption and is the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs.

By definition, when a medication is administered intravenously, its bioavailability is 100%.

154

dentritic ulcer - not common

presents as red eye with FB sensation.

seen with fluoroscein , caused by herpes-simplex virus

155

Diagnositic symptoms of DKA?

polydipsia

weight loss

dehydration

+ Kussmaul breathing

156

What is pharmacokinetics?

Pharmacokinetics is the study of how an organism affects a drug. 

Absorption is part of pharmacokinetics.

IV - max bioavailability.

157

Dermatome to the thumb

158

elbow fracture - what will you find on x-ray?

The sail sign.

Never a posterior fat pad unless there is a fracture.

159

Name for rectal bleeding

haematochezia

160

Acute-angle closure glaucoma

acutely painful red eye. 

Px usually > 60, other symptoms; headache, nausea, blurred vision and haloes around lights.

161

When is Percutaneous Nephrostomy indicated?

In all cases of upper urinary tract obstruction causing hydronephrosis. 

(need to depressurize the system before stone removal)

Ix: USS- identifies presence of hydronephrosis and can assess the kidneys, CT scan for stones - renal colic.

162

Stroke tx whilst awaiting CT scan results

Px NBM

Nasogastric tube, IV fluids

Oxygen mask, monitor cardiac rhythm (digoxin if needed)

Possibly catheter to monitor output

Aspirin 75mg

Statins (low dose) even if lipid levels normal

TED (thromboembolic disease) stockings 

 

163

Obese px; type I or type II diabetes more likely?

type II

164

What is a common cause of asthma in childen under 10?

respiratory infection (viral or bacterial)

165

166

Examination fo asthma (things to look for)

  • Abilty to speak
  • PEFR is vital to assess severity of attack. Work out % of predicted peak flow.
  • Rountine obs
  • ABCDE approach; A - airway. Can the patient talk?

B - breathing - inspection

C - circulation  HR, BP, pulsus paradoxus

E - any rash/ hives to suggest allergic reaction. Exhaustion

167

What is the main causal organism of Bronchiolitis?

RSV

168

What stimulates EPO?

hypoxia and anaemia

 

169

What is pulmonary consolidation?

Possible causes?

Alveolar space that contains liquid (could be oedema, blood, pus)

Pulmonary oedema

inflammation

pneumonia

pulmonary haemorrhaging

170

Foot bones 4

171

Where do B Lymphocytes mature?

 

T- lymphocytes?

mainly in the bone marrow 

 

Thymus

172

Dermatome to little finger?

173

What is a big danger of px with long-standing diabetes and neuropathy?

MI or abdominal conditions such as infection or pancreatitis may be painless. Maybe osteomyelitis in the feet.. 

174

what class of drug can cause rhabdomyolysis?

statins

175

What would you use for impacted stool?

Glycerol suppository

Glycerol suppositories stimulate the rectum because glycerol is mildly irritant.

May need to be repeated. Digital assistance needed.

176

What changes occur with chronic asthma?

>> goblet cells (increase mucus).

thickening of basement membrane.

Smooth muscle hyperplasia and hypertrophy.

 

177

Some possible red flags for neck lumps

Dark colour suggestive of malignant melanoma,

ulceration,

skin fixation,

bleeding, or

hard texture

178

What is pseudomembranous colitis?

Also called antibiotic-associated colitis or C. difficile colitis, is inflammation of the colon associated with an overgrowth Clostridium difficile.

 This overgrowth of C. difficile is most often related to recent antibiotic use.

179

Headache; red flags

  • new onset or changes in headache in px over 50 years old
  • thunderclap
  • focal neurological symptoms
  • abnormal neurological examination
  • headache that changes with posture
  • wakes up px during night
  • worse for valsalva manoeuvre
  • thrombosis risks
  • jaw claudication
  • neck stiffness with fever
  • new onset with cancer/ HIV px

180

Signs of aortic regurgitation

collapsing pulse

investiations; echocardiography

 

 

181

Immediate Stroke/ TIA management

  • CT scan to rule out haemorrhagic cause
  • thrombolysis (3 hr window from onset of symptoms?)
  • antiplatelet therapy

 

182

What can cause sudden loss of vision?

retinal detachment

central retinal artery occlusion

vitreous detachment/ haemorrhage

+ full neurological examination for cv event

183

Upper motor neurone lesion, upper....

face sparing.

184

pericarditis ECG changes (findings in first two weeks)

saddleback ST elevation and PR depression throughout most of the leads.

RECIPROCAL deviation in lead aVR

185

Wells score

Risk calculator for patients AT RISK of developing DVT

186

How does PCP present? - pneumocystis carinii (jirovecii) pneumonia

  • non-productive cough
  • fever
  • dyspnoea

- subacute, symptoms last 3-4 weeks.

CXR normal in 90% of cases.

187

NYHA

188

If self help tips don't help a child with nocturnal enuresis, what's the next step?

enuresis alarm for children under 7 years

desmopressin for children over age 7.

189

Type I defined

autoimmune condition causing destruction of the pancreatic B cells resulting in absolute insulin deficiency.

(70-90% of cells must be destroyed before symptoms)

190

What diuretic group could be used to help with reducing the incidence of renal stones?

thiazide diuretics because they cause hypercalcaemia (i.e. hypocalciuria)

191

Small bony nodules (osteophytes) at the DIP and PIP joints are characteristic of what?

OA

DIP - Herberden's nodes

PIP - Bouchard's nodes

192

HIV is caused by what type of virus?

blood-borne RNA retrovirus

  • intercourse, drug use
  • maternal-child transmission
  • transfusion of blood products

193

Life-threatening asthma - possible signs (10), only one needed

PEFR <33% of predicted best

Sats <92%

PaO2 <8kPa, normal PaCO2 (4.6-6kPa)

Silent chest, cyanosis

arrthymia

altered mental state/ exhaustion

hypotension

194

Upper motor neurone signs

Increase in muscular tone (spasticity)

Increase in reflexes (hyperflexia)

++ Babinski sign

 

195

Which type of leukaemia has a peak age of onset of four years?

ALL - acute lymphoblastic leukaemia

 

70-80% cure rate for children.

196

Tender points for knee - ottawa

other factors

> 55 yrs

can't weight bear

can't flex 90 o

197

What would you include in an assessment of asthma?

  • known triggers/ allergies
  • family history
  • medication
  • presenting symptoms
  • post history of astham management
  • Anything to suggest INFECTION?
  • Normal PEFR (if known)
  • other medical complaints

198

Fluid challenge and central venous cannula/ measurement of CVP; what's that about?

If CVP doesn't rise or rises transiently and then falls, then px is 'underfilled'.

199

which hormones, which layer of the adrenal gland?

200

Dermatome to Inner Forearm

201

Dermatome to middle finger

202

Dermatome to medial malleolus

203

Which shoulder dislocation is most common?

Anterior - 95%

 

Usually caused by a direct blow to, or fall on, an outstretched arm.

The patient typically holds his/her arm externally rotated and slightly abducted.

204

Which group of drugs are indicated for unusual organisms such as Mycoplasma pneumoniae and Legionnaire's disease?

Macrolides

205

Testing the median nerve

NB. Thumb opposition; C8, T1 nerve roots

  • test; altered sensation over thumb, index, middle fingers
  • any thenar eminence wasting?
  • hand palm up on flat surface. Px moves thumb vertically against resistance (abductor pollicis brevis)
  • opponens pollicis; try and pull thumb and ring finger apart

206

207

What is the relationship of breast cancer and HRT?

There is a very small risk of breast cancer and this is related to duration of taking HRT, and declines after stopping HRT. 

After 5 years the risk is the same as a woman who has never taken HRT.

208

Cellulitis - antibiotic

Flucloxacillin

- clarithromycin for penicillin allergy

209

What is Kussmaul breathing?

Deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.

210

Felty's syndrome (important)

Rare autoimmune disease

Splenomegaly

neutropenia

RhA

211

What are the risk factors for coronary artery disease? (7)

hypertension

diabetes mellitus

obesity

FH

Hyperlipidaemia

smoking

alcohol

212

What are typical signs and symptoms of acute leukaemia?

  1. Bone marrow failure symptoms; anemia, leukopenia, thrombocytopenia. Therefore; SOB, fatigue, bacterial infections, bleeding, bruises. Possibly DIC.
  2. Systemic; malaise, weight loss, sweats are common

213

osteoma

more in males, unilateral.

often at junction of bony and cartilaginous ear canal.

214

EM tx of hypoglycaemia

50ml of glucose 50% if IV access available.

otherwise 1 mg glucagon

(as PAs 10% glucose IV okay)

non-emergency; dextrose, then more complex carbohydrates.

215

What's the story?

Zollinger–Ellison syndrome (ZES) is a disease in which tumors cause the stomach to produce too much acid, resulting in peptic ulcers.

Symptoms include abdominal pain and diarrhea.

The syndrome is caused by a neuroendocrine tumor that secretes a gastrin. The tumor causes excessive production of gastric acid.

216

What are the features of well-controlled asthma?

minimal symptoms at day and night

minimal need for reliever medication

no exacerbations

no limitation of physical activity

normal lung function PEFR >80% predicted/ best

217

What pneumonia can gentamicin treat?

Life-threatening Gram -ve infections, eg. pseudomonas aeruginosa

218

Hamstring injury management

crutches and refer to fracture clinic

219

Causes of anaemia; inherited

  • defects of haemoglobin; sickle cell , thalassaemia
  • defects of red cell metabolism; pyruvate kinase deficiency
  • defects of red cell membrane; hereditary spherocytosis
  • red cell aplasia/ aplastic anaemia

220

What is Hirschsprung's disease?

A birth defect in which nerves are missing from parts of the intestine.

The most prominent symptom is constipation.

Other symptoms may include vomiting, abdominal pain, diarrhea, and slow growth.

 Symptoms usually become apparent in the first two months of life.

The disorder may occur by itself or in association with other genetic disorders such as Down syndrome.

221

What three factors can influence eGFR?

eating red meat

muscle mass (amputees, body-builders)

pregnancy

222

What are the symptoms of acute asthma?

  • Feels like they can't breathe
  • not enough air to cough
  • Can be gradual or rapid onset
  • anxiety
  • Feel unable to breathe out
  • (cough)
  • Wheezing
  • tight chest/ shortness of breath

223

Peptic ulcers location

stomach

upper part of duodenum

 

224

Wrist drop; which nerve extends the wrist?

radial nerve 

225

CHA2DS2-VASc

Risk of ischaemic stroke in px

with AF

without

anticoagulation therapy.

226

Management of chronic gout

Allopurinol is first-line.

(xanthine-oxidase inhibitor)

227

What's the management for mild, persistent asthma?

Corticosteroid inhaler - preventer

Short acting B2 agonist as and when required.

228

Clinical features of HCC 

Ache in right hypochrondrial area

tender nodular liver on palpation

rapid onset with cirrhosis px

weight loss, anorexia, fever

 

229

what drug would you give for acute renal colic?

Diclofenac IM (recommended by NICE)

230

 an injury to the spine in which the vertebral body is severely compressed.

- severe trauma, such as a motor vehicle accident or a fall from a height.

231

What's the main marker for near fatal asthma? (2)

Raised PaCO2

Requiring mechanical ventilation with increased inflation pressures.

232

Common AIDS-defining illnesses in the West

  • Pneumocystis jirovecii
  • oesophageal candidiasis
  • tuberculosis
  • herpes simplex/ zoster - repeated infections
  • + others

ALONG WITH; systemic features weight loss, persistent fever or persistent diarrhoea. 

 

233

Thrombolysis; remember that...

lots of exclusion criteria!!!

Including:

  • seizures
  • px on warfarin
  • previous stroke within three month
  • BP  >110 diastolic, > 185 systolic
  • hypoglycaemic/ hyperglycaemic

234

What is flucloxacillin indicated for?

infections caused by penicillinase-producing penicillin-resistant staphylocci.

i.e. most hospital-acquired staphlococcal infections.

235

Signs/ symptoms of fractured zygomatic arch

swelling/ bruising - periorbital

pain, numbness, diplopia, reduced eye movements

altered pupillary reflexes, facial flattening/ symmetry

- look at jaw from behind and put fingers on zygomatic arches. Compare for differences.

236

What's this?

koilonychia

 

Associated with hypochromic anaemia, especially iron-deficiency anaemia

237

Nerve involved with CTS?

median

238

What are the first line drugs for type 2 diabetes?

metformin

sulfonylureas

meglitinides

 

239

Typically symptoms of intestinal obstruction

  • abdominal colic
  • vomiting
  • constipation WITHOUT the passing of wind
  • distension
  • increased bowel sounds
  • Marked tenderness

240

What must never be missed and could cause avascular necrosis?

septal haematoma

(swelling from the medial side of a fractured nose)

241

tx of rhabdomyolysis

Rapid IV fluid rehydration (saline)

properly perfuse the kidneys and limit damage to the kidneys due to myoglobin. 

242

POUND mneumonic

  • Pulsatile
  • 4-72 hOurs duration
  • Unilateral
  • Nausea or vomiting
  • Disabling intensity

243

Management of Otitis media

analgesia. 80% improve spontaneously. 

>48hrs require antibiotics

amoxiciliin/ clarithromycin

 

244

What is a fibroadenoma?

A fibroadenoma is mostly seen in women aged <30 years of age.

They are discrete, non-tender, highly mobile lumps.

245

Pancreatitis

stones in the common bile duct or the ampulla of Vater causing obstruction and cholangitis and pancreatitis.

 

246

When is a CT scan URGENT following a stroke?

  • if 3 hour window to start thrombolytics
  • evidence of head injury
  • severe headache at the time of onset of weakness
  • GCS score deteriorating
  • prior anticoagulation treatment

247

Neisseria Gonorrhoea - antibiotic

Ceftriaxone

248

symptoms of Addison's disease (adrenal insufficiency)

- aldosterone

- corticol

249

What are the clinical features of a PE?

  • sudden and unexplained dyspnoea. This maybe the only symptom, especially in the elderly.
  • IMP> pleuritic chest pain and haemoptyosis are present only when infarction has occured. PE can be silent!

250

What causes hot potato voice and tender, swollen lymph nodes?

A progressively severe sore throat on one side, odynophagia, usually are the earliest symptoms.

As the abscess develops, persistent pain in the peritonsillar area, fever, a general sense of feeling unwell, headache and a distortion of vowels informally known as "hot potato voice" may appear. Neck pain associated with tender, swollen lymph nodes, referred ear pain and foul breath are also common. 

PTA should be specifically considered if there is limited ability to open the mouth (trismus).

251

Are px with carotid artery stenosis at risk of embolic stroke?

+ exclusions?

Yes, especially if stenosis 70-99% (very high risk). Also: is px well enough to receive tx?

Carotid stenosis diagnosis; doppler

Exclusions?

haemorrhagic strokes - TACI or POCI 

 

252

Important things that affect vit D absorption (except for the obvious)

  • age
  • absorption is in first part of SI, therefore digestive disorders
  • condition of the Kidneys

253

Dermatome to dorsum of foot

254

Metoclopramide

moa, indications, side effects

D2 antagonist

Also has prokinetic effect on the gut, and increases the absorption of many drugs.

255

256

What is the TIMI score?

Estimates mortality for patients with unstable angina and non-ST elevation MI.

257

What's the advantages of LMWH over normal heparin?

Can be given SC (heparin is injected)

Has a long duration of action (heparin is short)

lower risk of Heparin-induced thrombocytopenia (HIT), and reduced risk of osteoporosis

Routine monitoring isn't required (Heparin requires APTT - activated partial thromboplastin time)

standard tx for DVT and acute coronary syndromes

258

How does heparin work?

Heparins generally act by activating antithrombin III

259

Define acute leukaemia

Clonal haematopoietic stem cell/ progenitor disorder characterized by the rapid accumulation of immature progenitor cells (blasts) and impaired normal marrow function.

260

CAP - antibiotic

amoxicillin

or doxycycline/ clarithromycin

261

foot bones 1

262

What causes the airways to become constricted?

  • constriction of the smooth muscle in the bronchioles
  • inflammed/ thickened epithelium
  • mucous production blocking the airways

263

RhA diagnostic criteria

morning stiffness >> 60 mins

stiffness after rest

>> six weeks duration

DIP joints spared

Volar subluxation

Swan neck/ boutonniere, guttering between bones

RhA attacks connective tissue (therefore tendinous sheaths); fingers stay in flexion/ extension

264

Commonest cause of mesothelioma?

+ symptoms

asbestos esposure

  • persistent chest wall pain
  • pleural effusion

265

Some key points of motor neuron disease; what's the worse type and what's the most common?

Progressive bulbar palsy - worse. Affects tongue, muscles of mastication, facial muscles, brainstem motor nuclei. Nasty one. 

 

Amyotrophic lateral sclerosis ; 50% of patients. Mixture of LMN and UMN signs in legs.

 

 

266

symptoms of cardiogenic shock

  • chest pain, palpitations, history of IHD, AF
  • Cold sweaty peripherae; weak pulse, JVP raised, tachycardia
  • pulmonary oedema

267

Exostoses

broad based and bilateral.

wax can collect behind.

cold water swimmers; inflammatory response to extremes of temperature.

 

268

What is the age group for AML (acute myeloid leukaemia)?

more common with increasing age, with peak age onset of 70 years.

269

What is the management of type II Diabetes?

Patient education: reduce risk factors - 

smoking, sedentary life style, hypertension, dyslipidaemia, and obesity.

Discuss dietary advice. Encourage exercise.

HbA1c testing until glucose levels stabilised.

Drug tx: standard-release metformin. Consider dual therapy if ineffective, or triple therapy.

BP: Aim for 140/80 and below

 

270

What is the most common cause of intestinal obstruction in patients aged 5 months to 3 years?

intussusception

Symptoms: paroxysmal (10-20 mins) of colicky abdominal pain

Child may appear well between paroxysms.

Early vomiting.

late sign: bloody 'redcurrant' stools.

 

271

What's the common cause of this?

cirrhosis,

the consequences of portal hypertension.

Commonly these bleed.

lower 1/3 of the oesophagus

272

Dermatome to Upper inner arm

273

Acute gout management

Lifestyle advice

NSAIDs at maximum dose as early as possible and continue for 1-2 days after attack finished.

(give PPI for protection)

Cholchicine

274

Name opportunistic HIV infections

  • PCP - pneumocystis jirovecii
  • cytomegalovirus (CMV) in late-stage infection (CD4 <50) - main problem progressive retinitis (85%)
  • toxoplasmosis - protozoa infection. Causes encephalitis (80%) in late HIV
  • Kaposi's sarcoma (herpes virus 8)
  • + others 

275

Where is erythropoietin produced?

peritubular complex of the kidneys (90%), and Liver

 

276

What could cefuroxime and clarithromycin possibly treat?

CAP

+ may need vasopressor drugs to produce peripheral vasoconstriction if px adequately filled (CVP monitoring). Renal output would be poor.

277

Name some macrolides (3)

erythromycin,, azithromycin and clarithromycin. 

 

bacteriostatic

278

MOA of carbimazole

Carbimazole is a pro-drug; it is converted to the active form, methimazole.

Methimazole prevents thyroid peroxidase enzyme from coupling and iodinating the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4 (thyroxine).

Rashes/ pruritus are common.

Serious side effect; bones marrow suppression.

279

When is the best time to measure troponin levels?

12 hours after event - most severe pain (peak time)

280

What are the symptoms of hypovolaemia?

  • pallor
  • orthostatic hypotension
  • tachycardia
  • absence of JVP at 45 degrees
  • dry mucous membranes
  • absent axillary sweat
  • decreaed skin turgor
  • oliguria
  • organ failure

281

Which patients are at risk of developing HCC (hepatocellular carcinoma)?

Carriers of HBV and HCV

cirrhosis patients

282

What do D cells (pancreas) produce?

somatostatin

283

tx drug for hypocalcaemia?

calcium gluconate 10% by slow IV.

Repeat as necessary or follow with infusion of calcium gluconate 10% infusion - 40 ml (9 mmol)/24 hours.

284

Addison's disease

autoimmunal destruction of adrenal tissue.

Can present as an 'adrenal crisis'

Largest cause of adrenal insufficiency in the west.

285

B lymphocytes; which type of immunity?

humoral or antibody-mediated immunity

 

The mature B cells that manufacture immunoglobulin are called plasma cells.

286

How do thiazide diuretics work?

Inhibit Na reabsorption at the distal convoluted tubule (DCT).

Have a roe in the tx of mild heart failure, although loops are better for reducing overload.

Examples: bendroflumethiazide and indapamide

287

otomycosis

288

 

infectious esophagitis.

 

Common cause?

Candida albicans

HIV/ cancer patients

289

What is the criteria for possible Dementia with Lewy Bodies?

(lewy bodies; in brainstem and neocortex)

Definitely dementia

and then 2 out of 3 of the following:

  • Fluctuating attention and concentration.
  • Recurrent well-formed visual hallucinations.
  • Spontaneous Parkinsonism.

290

What is a secondary pneumothorax?

one that presents with a background history of lung disease that could predispose the patient to developing pneumothoraces, such as COPD. 

291

PPPP

stop bleeding

Pressure

Posture

Patient - time

Pray

292

What is a pharyneal pouch?

diverticulum of the mucosa of the pharynx.

Dysphagia, and sense of a lump in the throat

Trapped food:

Regurgitation, reappearance of ingested food in the mouth

Cough, due to food regurgitated into the airway

Halitosis, smelly breath, as stagnant food is digested by microorganisms

Infection

293

What is the signifance of a lack of consensual pupillary response?

  • problem with motor connection
  • could be; oculomotor nerve or Edinger-Westphal nucleus

294

Management of Benign prostatic hypertrophy

alpha-adrenergic blockers; prazosin

alpha adrenoceptor antagonists; tamsulosin

or finasteride (inhibitor of testosterone, reduces prostatic hypertrophy)

TURP: TransUrethral Resection of the Prostate.

295

What's the difference between intrinsic and extrinsic asthma?

Intrinsic; childhood and adolescent onset, atopic and and driven by allergen exposure. 

Extrinsic; late-onset with adults,often following viral URTI.

296

Central upper abdominal radiating through to the back and partially relieved by sitting forwards is...

pancreatitis

297

What's the common cause of esophageal varices?

cirrhosis and consequences of portal hypertension

298

Heparin and LMWH can both cause what electrolyte disturbance?

hyperkalaemia

299

Eye conditions not to miss

  • acute-angle closure glaucoma
  • peri-orbital cellulitis
  • giant cell arteritis
  • keratitis
  • uveitis

300

Types of wrist fracture

Smith's - surgery

Colle's (often due to FOOSH). Tx in A & E

301

How does airflow inflammation seen in asthma lead to airflow obstruction?

mast cell degranulation releases histamine, prostaglandins, and leukotrienes.

This causes; vasodilatation and increased vascular permability causing mucosal oedema.

Increase in bronchial secretions.

Smooth muscle contraction, causing bronchospasm.

302

Dermatome to knee

303

What is achalasia?

 

What is a dange of this?

  1. Oesophageal aperistalsis
  2. Impaired relaxation of the lower oesophageal sphincter.

Progressive overflow of secretions and food, esp. at night and can cause aspiratory pneumonia.

304

What conditions can cause upper motor neurone symptoms?

  • stroke
  • MS
  • traumatic brain injury
  • cerebral palsy

305

Diagnositic symptoms of DKA?

polydipsia

weight loss

dehydration

+ Kussmaul breathing

306

THREE pathogenetic process in asthma. Name them.

  1. bronchoconstriction
  2. swelling (and therefore narrowing of lumen) of epithelium
  3. hypersecretion of mucus (therefore << lumen)

307

Some possible red flags for neck lumps

Dark colour suggestive of malignant melanoma,

ulceration,

skin fixation,

bleeding, or

hard texture

308

Giant cell arteritis

painless visual loss, px usually >60.

Scalp tenderness, jaw claudication, headache.

Blindness if not prompt treatment.

refer.

309

What is Todd's paralysis?

A focal appendage transient weakness after a seizure. 

It usually subsides completely within 48 hours.

Todd's paresis may also affect speech, eye position (gaze), or vision.

NB> important to differentiate from ischaemic stroke because seizure is an exclusion criteria for thrombolysis.

310

orthostatic hypotension values

20 mmHg drop of systolic pressure

20 beats per minute increase in HR

(remember two min delay between position changes)

311

What's the most common psychiatric problem with Parkinson's disease?

Depression

312

What is the cause of most URTI?

common cold virus

313

Mx of acute asthma attack key points

Give oxygen to maintain 94-98% sats

Salbutamol, back to back if needed. Oxygen driven if needed.

Oral prednisolone 45-50mg for five days.

Combine ipratropium with salbutamol if poor response.

Consultant; magnesium/ aminophylline

314

Cholangitis

stone obstructing the common bile duct

causing intrahepatic and extrahepatic biliary obstruction.

315

What is a big danger of late response asthma?

  • Increased airway resistance leads to air trapping in alveoli and hyperinflation of the lungs

 

  • If airway inflammation is not treated or does

not resolve, these reactions may lead to
irreversible lung damage

316

Stress fracture - metatarsals

Can occur from running or significant walking

can be hairline fracture with no displacement.

 

tx. review 7-10 days. analgesia and << activity. Possibly x-ray.

317

When should a woman stop the COC pill if having an operation?

4 weeks prior

318

When to use Equinus cast

Ruptured achilles tendon

319

Signs of scaphoid fracture?

  • tenderness at anatomical snuff box.
  • pain when pressing thumb proximally

 

IMP. Danger of avascular necrosis

320

What's the function of cholecystokinin?

stimulates pancreatic secretions when food enters the duodenum, and stimulates bile release from gall bladder.

Cholecystokinin is synthesized and secreted by cells in the duodenum.

321

What is metaplasia?

the transformation of one type of tissue into another

322

Does inflammation in the bronchioles during asthma result in increase in mucus production?

YES - hypersecretion of mucus from bronchial epithelium..

323

What is vancomycin used for?

 

+ what happens if >> infusion rate?

MRSA (rem. staphlococcus) - given orally.

Adminstered parenterally to treat systemic infections.

>>> infusion rate = hypotension, erythematous rash on face/ upper body "red man syndrome"

324

What happens to RBC after 120 days?

removed by macrophages of reticuloendothelial system

325

T Waves

 

Three abnormal types

Upright in all leads except aVR and V1

 

  • Flattened T waves (hyperkalaemia)
  • Inverted T waves
  • Hyperacute T waves

326

drainage of aqueous humour

Formed in the anterior portion of the ciliary process in the posterior chamber of the eye.

 

Drains into the scleral venous sinus (Schlemm's canal)

Blockage = glaucoma

327

Takayasu's disease (rare)

 

Takayasu arteritis is a rare, systemic, inflammatory large-vessel vasculitis of unknown etiology; affects women of childbearing age.

Gradual stenosis of arteries dues to inflammatory attacks.

  • Pain with use of an arm or leg (called “claudication”),
  • high BP

distinguish between narrowing due to vasculitis  and due to atherosclerosis 

Diagnosis; angiogram (X-ray with dye), CT angiography

Tx: steroids, immune suppresants

328

Ticarcillin and be combined with clavulanate to treat......

pseudomonas aeruginosa

 

(ticarcillin is an antipseudomonal penicillin)

329

What is HONK?

hyperosmolar non-ketotic coma

induced by prolonged hyperglycaemia and dehydration and hypernatraemia.

* require careful management with fluid replacement and small doses of insulin to restore euvolaemia and euglycaemia.

330

Signs and symptoms of acute life-threatening asthma

(any ONE of the following)

Peak flow < 33% best or predicted
Arterial oxygen saturation (Sp02) < 92%
Partial arterial pressure of oxygen (PaO2) < 8 kPa
Normal partial arterial pressure of carbon dioxide (PaCo2) (4.6–6.0 kPa)
Silent chest
Cyanosis
Poor respiratory effort
Arrhythmia
Exhaustion
Altered conscious level

hypotension

331

What is Ramsay Hunt Syndrome?

Ramsay Hunt syndrome; varicella-zoster virus (chickenpox) becomes reactivated in the geniculate ganglion of the VIIth cranial nerve (facial nerve) causing facial paralysis, loss of taste, vestibulocochlear dysfunction and pain. 

As a general rule, shingles is a disease of sensory nerves but Ramsay Hunt syndrome is distinctive in that there is a motor component. 

332

Endocarditis - antibiotic

Gentamicin and Penicillin G

333

What are some common symptoms of URI?

fever

dysuria

urinary frequency

suprapubic pain

334

Dementia with Lewy bodies; what symptoms?

Parkinsonian symptoms

visual hallucinations

fluctuations in symptoms

prone to fainting or funny turns

335

Physiology of heart failure

Insufficient cardiac output unable to perfuse tissues. Adaptive changes; increases in heart rate and force, increases in renal volume and increase blood pressure.

Heart unable to compensate and physiological changes further decrease cardiac output.

336

What is diagnosis of DKA based on?

 

Diabetic ketoacidosis is a serious complication of Type I DM.

Diagnosis based on

diabetes (blood glucose >11 mmol/L)

ketones (urine or blood)

acidosis (pH <7.30 venous blood)

337

Epigastric pain that is not tender on palpation and has autonomic symptoms could be....

MI

338

Most common cause of aortic stenosis and physiological effect

senile calcification

Heart has to work harder to push blood through the stenotic valve.

>> Volume load = hypertrophy + myocardial dysfunction, arrhythmias, heart failure.

339

Weber's test - where is the fork placed?

 

middle of forehead

 

 

340

Characteristics of cluster headaches

severe, unilateral, retro-orbital

clustered over time

variable duration (10-60 mins)

autonomic symptoms; tearing, red eye, nasal congestion.

attacks often at night

much more commen in MEN (9:1)

 

341

Which part of the GI tract is Crohn's disease?

anywhere

(abdominal cramping + diarrhoea)

342

What is the most common cause of dementia?

Alzheimer's

343

If usual meds are ineffective for acute asthma attack, what is worth trying?

magnesium sulphate

2g over 20 minutes via 200ml saline (mark saline bag with time)

344

Referred pain (diagram)

345

Which type of cells does HIV virus infect?

CD4-bearing T lymphocytes and monocytes/ macrophages

 

346

What is Kussmaul breathing?

Deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.

347

Aspirin, stroke, no CT scan results. What's the story?

No evidence that starting aspirin before CT findings are known adversely affects prognosis. 

348

What is a big danger of px with long-standing diabetes and neuropathy?

MI or abdominal conditions such as infection or pancreatitis may be painless. Maybe osteomyelitis in the feet.. 

349

How can you check for suspected csf discharge from nose or ear?

Test for glucose

350

When would I refer a patient to ICU?

  • Failing to respond to therapy, worsening PEFR, worsening hypoxia, development of hypercapnia, exhaustion/ feeble respiration, confusion, respiratory arrest.
  • requiring ventilatory support

 

351

When?

Meniscus tear

352

Salbutamol and Terbutaline are examples of?

short-acting B2-agonists, and have a biological half-life of 2-3 hours.

353

Treatment, presentation and organism of malignant otitis externa

tympanic membrane normal

Pseudomonas aeruginosa infection which becomes invasive and erodes the temporal bone.

(diabetics are risk group)

>> Offensive discharge, chronic, pain, headaches

abx: ciprofloxacin

(amoxicillin for otitis media)

Flucloxacillin if uncomplicated otitis externa + signs of systemic infection

354

355

What is the gold standard investigation for endometriosis?

 

laparoscopy

(combine with biopsy)

356

Dermatome to Toes 4 and 5; lateral malleolus

357

What is Von Willebrand disease?

 is the most common hereditary blood-clotting disorder

It arises from a deficiency of von Willebrand factor (vWF), a protein that is required for platelet adhesion.

 

358

Diagnostic values of diabetes mellitus - fasting and non-fasting

fasting: 7 mmol/l and above

 

random glucose 11.1 mmol/l and above.

 

If patient is asymptomatic then must be tested again.

359

Salient points of Wilson's disease

A combination of liver and neurological disease.

Onset 10-25 typically.

neurological : basal ganglia degeneration, speech, behavioural, psychiatric problems.

Rem: Kayser-Fleischer rings and blue nails.

360

Emphysema and Lung volumes - what's the story

 Emphysema, functional respiratory capacity  is increased, because the lungs are more compliant. Total lung capacity also increases, largely as a result of increased functional residual capacity.

361

White-Eyed Blowout

Greenstick fracture of the orbital floor or medial orbital wall resulting in ischemic entrapment of an extraocular muscle.

• Typically children

Minimal external signs of trauma mask the severity of the orbital injury.

Commonly due to sports injuries.

362

What is the test for H. pylori?

Urea breath test

363

Asthma classification figures

  • moderate: 50-75% PEF, no other symptoms

 

  • acute severe 33-50% PEF, Resp >25, Heart rate >110. Can't complete breaths in one sentence

 

  • life-threatening <33%  O2Sats <92%

 

364

What's this? + info.

Thyroglossal cysts

asymptomatic midline neck mass at or below the level of the hyoid bone, above the thyroid cartilage.

Most often in the midline

They may present in childhood (less than 50%) or, usually as a young adult

Move up when the tongue is protruded & with swallowing- cysts attached to the base of the tongue by the thyroglossal tract

365

Toes - x-ray or not?

If associated wound present, or injury is with the great toe.

366

Mx of bronchiolitis?

Supportive; humidified oxygen if <92%

nasogastric if unable to drink/ feed

suction if needed.

367

Investigations for acute leukaemia

FBC; anaemia and thrombocytopenia, << WBCs (or normal , or raised). If raised then cells are mainly primitive white cells (blasts).

Coagulation profile; prolonged clotting times

Blood cultures; infection risk

CXR; mediastinal mass on ALL of T-cell lineage.

+ others 

GOLD standards to differentiate ALL from AML; bone marrow aspirations, trephine biopsy.

368

What are the values of CRB-65?

(essential assessment of pneumonia in the community)

Confusion (abbreviated mental test scote <= 8/10)

Resp Rate >= 30/min

BP systolic <=90 and/or diastolic <=60mmHg

Aged <=65

 

(NB urea > 7 mmol/l)

369

370

Lung volumes diagram

371

Tests for diabetes

Blood glucose

urine or blood test for ketones

pH (venous fine)

372

373

Addison's signs

374

Mallory-Weiss tears

- when?

 

 alcoholic ‘dry heaves’, retching, severe coughing.

 tears at the oesophagogastric junction by a sudden increase in intra-abdominal pressure

375

Beta blockers and asthma?

Don't do it!

(bronchospasm potential)

 

376

What factors cause cause a hypoglycaemic attack?

Too high a dose of medication (insulin or hypo causing tablets)

Delayed meals

Exercise

Alcohol

377

UTI - antibiotic

nitrofurantoin

trimethoprim

378

Prophylactic tx for angina

Aspirin + Clopidogrel (anti-platelet)

Dabigatran - doesn't need monitoring. Fixed dose. MOA: direct thrombin inhibitor.

Problem: no antidote if bleeding occurs.

379

Px advise for type II diabetes to reduce risk?

lose weight

stop smoking

- these are additional risk factors for hypertension and CV disease, both common in type II diabetes.

380

RIFLE

International consensus classification for AKI.

 

381

CRB-65/ CURB-65

predicting mortality rate for pneumonia

382

Tx for DKA

 

(Sickness and vomiting, abdominal pain, muscular weakness)

500ml then another 500ml then another 500ml (saline).  MUST ensure patient is rehydrated before giving insulin. 0.1units per kilo per hour.  

As sugar moves into cells (insulin taking effect) potassium follows therefore px becomes hypokalaemic. Normal potassium 3.5 to 5. 

Watch urine output to check hydration. 

 

Red flag; peds until 22-23 yr old. Can die from cerebral oedema; therefore don’t give insulin until properly hydrated.  

383

aminoglycerides

injection only

narrow therapeutic index

Renal excretion + nephrotoxic

ototoxicity (VIIIth cranial nerve)

384

After HCC, which is the second most common cancer of the liver?

secondary metastatic tumours.

Particularly from:

GI tract (via portal blood supply)

Breast

Bronchus

385

What is a pannus?

hypertrophied synovium,

containing inflammatory cells that release collagenolytic enzymes

causing loss of bone and cartilage (chronic RhA)

386

sudden foot inversion can cause....

avulsion fracture of the base of the 5th metatarsal.

(tightening of peroneus brevis tendon)

tx. support bandage if can weight-bear

backslab is unable to weight-bear

387

Chlamydia - antibiotic

Azithromycin

388

What's the function of the choroid?

Dark pigmentation to prevent internal light reflection, supplies blood to the retina

389

What is the ankle-brachial pressure index (ABPI)

 

The ratio of the blood pressure at the ankle to the blood pressure in the upper arm.

Lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease (PAD)

Unreliable with calcification of arteries (e.g. diabetes)

390

What is an inherent problem with Sulfonylurea drugs?

Since they increase insulin secretion, can lead to hypoglycaemic episode if px skips or delays meals. 

Alcohol increases hypoglycaemic effect.

391

What's the MOA of benzodiazepines?

Enhances the effect of gamma-aminobutric acid,

GABA is the main inhibitory neurotransmitter.

 

392

What is the most common cause of visible haematuria? (glomerular origin)

Immunoglobulin (IgA) nephropathy; often preceded by a non-specific upper resp tract infection.

393

What can cause miosis?

 

NB> latency of pupillary responses increases with age

Light

opiates/ opioids

anti-hypertension medication

394

hypocalaemia affects the muscle and nerve cells; what are the symptoms?

paraesthesia (usually fingers, toes and around mouth), tetany

carpopedal spasm (rem Trousseau's sign ), muscle cramps 

seizures

prolonged QT interval

laryngospasm, bronchospasm

395

What could a unilateral nasal polyp be a red flag sign for?

nasopharyngeal cancer and therefore warrant an urgent referral to ENT.

bilateral nasal polyps require non-urgent referral and topical corticosteroid therapy is first-line management. 

396

How is HIV infection diagnosed?

Detection of anti-HIV antibodies by ELISA (enyme-linked immunosorbent assay).

397

What is different about the management of children with acute asthma?

  • Life-threatening if O2 Sata below 94%
  • use spacers
  • can add ipratropium to Salbutamol neb

 

398

Weber fractures

399

What type of cancer is endometrial, and who gets it?

adenocarcinoma (oestrogen-dependent)

(remember that cervical cancer is squamous cell carcinoma)

90% of cases are women over 50.

Risk factor: prolonged exposure to unopposed oestrogen.

400

What is the most common serious lower respiratory tract infection in < 1yr old babies?

bronchiolitis

symptoms:

coryzal precede

dry cough, > breathlessness,

wheezing, fine inspiratory crackles (not always present)

401

What do u waves signify?

hypokalaemia

402

Kussmaul breathing is a deep sighing pattern to decrease COlevels and is commonly seen with....

Diabetic ketoacidosis

403

What symptoms could indicate a median nerve pathology?

the thumb and lateral two and a half fingers affected (numbness)

wasting of thenar eminence

weakness of thumb abduction

404

High BP two weeks after stroke. Which meds?

ACE inhibitors (perindopril - take at bedtime because can become dizzy)

thiazide diuretics

405

Name some triggers of asthma (8)

  • Gastro-oesophageal reflex esp at night
  • viral infections
  • cold
  • exercise
  • pollen
  • certain chemicals
  • animal dander
  • house mite dust

 

406

What and where and how?

melanoma - cutaneous malignant melanoma is a cancer of the pigment cells of the skin

common backs (men), legs (women)

Usual skin type suspects. Sunbeds and sudden intense sun exposure BAD. 

 

407

What's the primary care first line tx of endometriosis?

NSAIDS and/or paracetomal for symptomatic relief

COC or progestogens can be tried.

 

408

Risk factors for CVD?

hypertension

hyperlipidaemia

diabetes mellitus

obesity

family history

smoking

409

What is the gold standard investigation for suspected urolithiasis?

CT KUB

Non-contrast computerised tomography of the kidneys, ureters and bladder.

410

which antithyroid drugs can cause aplastic anaemia or agranulocytosis?

Carbimazole

propylthiouracil

411

What is the GRACE score?

A scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality

412

What is the anatomical signifiance of the central artery of the retina?

It runs WITHIN the optic nerve.

It's an end artery, a branch of the ophthalmic artery.

413

Which part of the GI tract is ulcerative colitis?

colon and rectum only

 

(abdominal cramping + diarrhoea)

414

What does the reticuloendothelial system consist of?

  • Kupffer cells, alveolar macrophages, mesangial cells, microglial, macrophages
  • macrophages in ; bone marrow, spleen, lymph nodes, skin

415

Possible antibiotics for meningitis

Cefolaxime

Benzylpenicillin

Chloramphenicol

416

definitive tx of acute leukaemia and side effects?

cytotoxic drugs

  • hair loss, nausea & vomiting, sore mouth, bone marrow failure.
  • severe infection

 

radiotherapy, & some cases; stem cell transplantation. Destroy stem cells and reinfuse.

417

Common antibiotics for UTIs?

Nitrofurantoin

Trimethoprim - CAUTION with PREGNANCY. Need to take Folic acid. NOT first choice.

 

418

What are the clinical symptoms of asthma? ()

  1. Wheezing attacks
  2. episodic shortness of breath
  3. symptoms usually worse at night
  4. cough - nocturnal and often in children
  5. Diurnal variations in PEFR
  6. Revesible; 15% improvement if FEVafter using a bronchodilator.

419

Why avoid amoxicilin with tonsillitis?

in case causative organism is Epstein-Barr virus (glandular fever); rash

420

What is respiratory acidosis?

Acidosis due to an inability of the lungs to excrete COadequately.

 

421

Anatomy

422

What can cause mydriasis?

anticholinergic drugs

MDMA

cocaine

amphetamines

some hallucinogens

423

What's the problem with taking nitrates for angina?

Headaches

Reflex tachycardia (prevented by taking beta blockers)

Tolerance to nitrates can occur.

424

Why is asthma worse at night?

  • Impaired mucoclilary clearance during sleep.
  • Possible increase exposure to allergens (house dust mite in bedding).
  • Diurnal fluatuations in corticosteroids, catecholamines.

425

Le Fort Fractures

426

Name the two  meglitinides drugs that are short-acting and are useful for patients whose meal schedules vary. 

Repaglinide

Nateglinide

427

What is an inherent problem with Sulfonylurea drugs?

Since they increase insulin secretion, can lead to hypoglycaemic episode if px skips or delays meals. 

Alcohol increases hypoglycaemic effect.

428

Which drugs are used to treat hyperthyroidism?

Carbimazole

Propylthiouracil

 

Propranolol (for symptoms of anxiety, palpitations, tremor, heat intolerance)

 

429

laxative - lactulose

function and indications

increase bulk by retaining water.

Takes 48 hrs to act and must be given regularly.

430

Apart from conserving water via >> reabsorption, what else does ADH do?

<< sweat in glands

>> arteriole constriction, therefore BP rises

431

What are typical symptoms of guillain-barre syndrome?

progressive weakness of all four limbs that starts in the lower extremities.

Tends to affect proximal muscles earlier than the distal ones.

Sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs. 

432

Common cause of metatarsal fractures?

stress fractures; don't need trauma history

433

Which bone is boxer's fracture?

5th metacaral

434

Otitis media bugs

haemophilus influenzae

streptococcus pneumoniae

moraxella catarrhalis

if viral then short-lived and self-limiting.

435

Definition of premature ovarian failure

Onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years.

Common cause - idiopathic

436

What are the QRS complexed like with LBBB?

WIDE

Sometimes W-shaped complex in V1

Sometimes M pattern in V4-V6

 

437

What's the 1st line tx for one secondary pneumothorax?

1-2cm ; aspirate

 

>2cm; chest drain

438

What the the two groups of antidiabetic drugs?

hypoglycaemic agents

 

antihyperglycaemic agents 

439

What does a collapsing pulse indicate?

severe aortic regurgitation

440

management of corneal abrasion

remove FB with damp cotton bud/ bevel of needle (with slit lamp)

antibiotic ointment

review 2-3 if not improving.

441

Acute asthma treatment; what O2 levels should be maintained?

What should be continued after discharge?

 

94-98%

 

40-50mg prednisolone for 5 days minimum.

442

Deformities of the finger in RhA

(diagram)

443

which extraoccular muscle attaches nasally?

Inferior Oblique

444

Foot bones 3

445

What is the gold standard investigation for bladder cancer?

 cystoscopy.

All patient with symptoms suggestive of bladder cancer.

 

 

446

what is a cardinal feature of bronchitis?

a productive cough.

(usually self resolving and viral)

- an infection of the main airways (bronchi)

Chronic bronchitis features in COPD

447

What does raised PSA indicate?

Prostate cancer/ benign hypertrophy

other examination; PR, biopsy

448

What can cause erythema nodosum?

(NB. not just on the skins)

IBD,

infections; TB, streptococci, brucellosis

malignancy/ lymphoma

drugs; penicillins, sulphonamides, COC pill

pregnancy

449

Immediate management of acute leukaemia

  • often very ill px vulnerable to infections and/or bleeding.
  • IV antibiotics
  • platelets and fresh frozen plasma for bleeding
  • blood transfusion for anaemia

* even if fever is caused by disease and not infection, treat with antibiotics because  b.

450

How does metformin (biguanide drug) work?

 

NB> stop if acidosis suspected due to rare effect of lactic acidosis.

increases insulin receptor affinity in peripheral tissues.

1st line drug for type 2 diabetes. Can be used alone or in combo.

DOES NOT; stimulate insulin secretion, or cause hypoglycaemia, or weight gain.

DIARRHOEA common in 30% of px.

 

451

Coronary arteries territories

452

Primary tx/ mx of osteoporosis

Calcium and vit D in diet

bisphosphonate; alendronate on the basis of cost.

 

453

What is a Salter-Harris Fracture?

A fracture that involves the epiphyseal plate.

454

The hallux dorsiflexes, and the other toes fan out; this is Babinski's sign; 

damage to the central nervous system.

Stimulate from heel upwards. 

455

Name some lower motor neurone conditions

Guillain-Barre syndrome

C. botulism

polio

cauda equina syndrome

amyotrophic lateral sclerosis

456

What neurological signs are associated with B12 deficiency?

  • tingling in the feet (more than the hands)
  • difficulty in gait, visual or psychiatric disorders
  • pregnancy >> neural tube defects

457

What is a haematoma block?

Analgesic technique used to allow painless manipulation of fractures while avoiding the need for full anesthesia.

This procedure is normally only appropriate for fractures of the radius and ulna.

458

what are the local effects of inhaled steroids?

Oral thrush

Sore mouth

Hoarse voice

459

What specific signs are there with intussusception?

Recurrant stools

Dance's sign - absence of bowel in the right lower quadrant.

palpable 'sausage-shaped' mass in the right upper quadrant.

460

T-lymphocytes; which type of immunity?

Cell-mediated immunity 

461

What is found here?

  • SOLID:
  • lymph nodes, cervical rib
  •  
  • CYSTIC:
  • cystic hygroma (lymphangioma)
  • Pharyngeal pouch
  • Subclavian aneurysm
  •  

462

SEs of Hydroxychloroquine

(malaria treatment)

GI effects: The most common adverse effects are a mild nausea and occasional stomach cramps with mild diarrhea.

The most serious adverse effects affect the eye.

 

463

What drugs treat TB? (mycobacterium tuberculosis)

Rifampicin (prevents RNA transcription). Resistance develops quickly, therefore needs to be combined with other drugs; isoniazid

464

Where is the most common site of osteomyelitis in children?

Long bone - metaphysis because it is a highly vascular area (contains growth plate)

Found between the epiphysis and diaphysis 

For adults, osteomyelitis is more common in the epiphysis

465

what are common causes of hypocalcaemia?

hypoparathyroidism (frequently following surgery)

vitamin D deficiency or abnormal metabolism, chronic kidney disease and hypomagnesaemia

466

Which lung cells secrete surfactant?

pneumocytes type II

467

468

Key symptoms : endometriosis

chronic pelvic pain, dysmenorrhoea

deep dyspareunia

pelvic examination: < organ mobility and tenderness on palpation.

 

(rem: laparoscopy is gold standard investigation)

469

What is diabetes insipidus?

Impaired water resorption by the kidneys due to lack of ADH secretion by the posterior pituituary

or reduced sensitivity of the kidneys to the action of ADH.

470

HAS-BLED score

Assess the bleeding risk of patient with AF,

to support clinical decision regarding antithrombotic therapy.

471

Why must LABAs be taken with steroids?

>> risk of death. Mechanism unknown.

Suggested that LABAs reduce the sensitivity of B2-receptors, making short-acting B2-agonists less effective during an acute attack.

472

What lifestyle advise would you give a woman who is considering HRT?

Stop smoking

lose weight

limit alcohol

 

473

AOM

474

managment for sprains

Ice 20 mins every two hours. elevate << swelling.

Increase in pain 48 hours after injury. Takes 6-8 weeks to heal.

475

What are sulfonylureas and meglitinides examples of?

hypoglycaemic drugs

476

What lab investigations could be performed for acute asthma attack?

  • Sats - maintain between 94-98%
  • ABG if SpO2 <92%
  • CXR is NOT routinely recommended unless; suspected infection, pneumothorax, life-threatening asthma, failure to respond to tx.

 

477

MCQ - important facts about Metformin

MOA, adverse effects, contraindications

Mechanism of action

  • increases insulin sensitivity
  • decreases hepatic gluconeogenesis
  • may also reduce gastrointestinal absorption of carbohydrates


Adverse effects 

gastrointestinal upsets are common (nausea, anorexia, diarrhoea), intolerable in 20%

lactic acidosis* with severe liver disease or renal failure (rare but important to know for exams)


Contraindications**

chronic kidney disease: NICE recommend that the dose should be reviewed if the creatinine is > 130 µmol/l (or eGFR < 45 ml/min) and stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min)

metformin may cause lactic acidosis if taken during a period where there is tissue hypoxia. Examples include a recent myocardial infarction, sepsis, acute kidney injury and severe dehydration, iodine-containing x-ray contrast media: there is an increasing risk of provoking renal impairment due to contrast nephropathy; metformin should be discontinued on the day of the procedure and for 48 hours thereafter


**metformin is now sometimes used in pregnancy, for example in women with polycystic ovarian syndrome

478

It transmits the infraorbital artery and vein, and the infraorbital nerve, a branch of the maxillary nerve

Can be palpated during an examination.

479

Which conditions do you find Mallory bodies?

Alcoholic liver disease

WIlson's disease

PBC (primary biliary cirrhosis)

480

Why rehydrate gradually with DKA?

to avoid rapid intracellular osmotic/ sodium shifts that may cause fatal CNS oedema.

Remember: with DKA and polydipsia, rapid fluid shift from intracellular compartments.

481

NYHA

I : No limitation of physical activity.

II: Slight limitation of physical activity. Comfortable at rest. Some SoB, fatigue, palpitations with ordinary physical activities.

III: Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.

IV: Unable to carry out physical activites.  Symptoms of heart failure at rest.

482

Why does gastroesophageal reflux disease (GORD) trigger an asthma attack?

If the stomach acid reaches into the throat or airways the
irritation and inflammation can trigger an asthma attack.

 

Often worse at night when lying down.

483

Cockcroft-Gault equation

is often used as a method of estimating GFR 

from knowledge of serum creatinine, age and weight:

The calculation is unreliable if the patient has unstable renal function, is very obese, or is oedematous.

484

With asthma, what should the O2 Sats percentage be maintained at?

between 94-98%

485

What is the pathophysiology of asthma? (3)

Bronchospasm

mucosal oedema

mucus hypersecretion

- causing airway obstruction

486

Which inhaled steroids can be given for asthma?

Beclometasone

Budesonide

Fluticasone (more potent, and given at half dose compared to the above)

NB. Budesonide is a dry powder inhaler.

487

Bronchiolitis; when to call 999?

Looks unwell, cyanosis

severe respiratory distress (e.g. grunting, marked chest recession)

RR over 70 breaths/ minute

oxygen sats <92% on air.

Consider if; resp rate over 60.

difficulty breastfeeding/ inadequate fluid intake.

488

Why perform a blood film?

 red blood cell abnormalities eg. sickle cell anemia and spherocytosis

Look for parasites; malaria, Filariasis

489

Reasons to do a lumbar puncture

  • investigating bacterial meningitis
  •  

490

What is dalteparin?

low molecular weight heparin (LMWH)

491

Definition of Asthma

Disease characterized by recurrent attacks of breathlessness and wheezing, which varies in frequency from person to person.

492

Causes of purpura

(pathophysiology)

Platelet disorders (thrombocytopenic purpura)

 

Vascular disorders (nonthrombocytopenic purpura)

Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged

Hypertensive states

Vasculitis, as in the case of Henoch–Schönlein purpura

Coagulation disorders

Disseminated intravascular coagulation (DIC)

Scurvy (vitamin C deficiency) - defect in collagen synthesis results in weakened capillary walls and cells

Meningococcemia

Cocaine use with concomitant use of the one-time chemotherapy drug and now veterinary deworming agent levamisole can cause purpura of the ears, face, trunk, or extremities. Levamisole is purportedly a common cutting agent.

493

When would you use a collar and Cuff sling?

  • gravity assist
  • eg. impacted head of humerus (refer if impacted head)

494

What is CHA₂DS₂-VASc Score?

Risk for stroke for AF patients

 

helps determine the 1 year risk of a thromboembolic event in a non-anticoagulated patient with non-valvular AF.

495

What is glipizide?

 

SE: weight gain

Can be combined with metformin for better control. 

Sulfonylurea drug; increases the secretion of insulin and secondarily decreases the secretion of glucagon. 

'hypoglycaemic drug'

496

Immediate management of chest pain - cardiac type

A & E setting

  • High flow oxygen
  • opioids and anti-emetics IV (morphine + cyclizine)
  • 300mg aspirin + 300mg clopidogrel

 

497

What is bacterial vaginosis?

•Commonest cause of vaginal discharge (often recurrent)

•Overgrowth of commensals - anaerobes, mycoplasmas & Gardnerella vaginalis

•NOT sexually transmitted though may exacerbate

METRONIDAZOLE

498

In the case of ischaemic stroke, what is the window for treatment?

3 hours from onset of symptoms.

(this includes getting a CT scan!)

499

bilateral - basilar skull fracture

Bilateral hemorrhage occurs when damage at the time of a facial fracture tears the meninges and causes the venous sinuses to bleed into the arachnoid villi and the cranial sinuses

500

Characteristics of essential/ benign/ idiopathic tremor.

  • cause unknown
  • symmetrical (Parkinson's is asymmetric)
  • happens on movement or postural (due to sustained muscular tone). EG. Rattling of a teacup. 
  • DOESN'T HAPPEN AT REST (unlike PARKINSON'S)

501

What's the most common cause of macrolytic anaemias?

B12 or folate deficiency

502

503

What are the EM physiological side effects of type I diabetes causing hypoglycaemia? (3) 

>>> sugar in blood, none in cells.

Breakdown of fats and proteins; ketones and acidosis

leads to dehydration, Potassium loss and acidosis.

Dehydration because water follows excretion of sugar (osmotic diuresis)

504

Symptoms of hypoglycaemia

confusion, sweating, fatigue and feeling dizzy.

maybe pale, weak, blurred vision, tachycardia, unconsciousness

 

 

505

What's a cause of loud borborygmi? 

(movement of fluid and gas)

small-bowel obstruction/ dysmotility if associated with colicky discomfort.

506

what could be triggers for hypoglycaemia attacks?

infections; UTI, pneumonia

physiological stressors including cold, status epilepticus.

507

What is a common cause of melaena.

NB> melaena is due to an upper GI bleed

peptic ulceration

508

Scaphoid fracture management

Cast if suspected (scaphoid backslab)

Refer to review clinic in 10-12 days

 

509

hyphaema

Hyphaema

refer.

510

What is the mx of erythema nodosum?

(inflammation of subcutaneous fat)

usually resolves within 6 weeks, lesions heal without scarring. Therefore no active treatment.

 

511

It's not just histamine that creates an inflammatory response in the airways; what else?

Prostaglandins

Adenosine

Bradykinin

Major basic protein

Leukotrienes

Prostaglandins

512

Parotid tail lump - Solid

What other solid lumps are there?

  • lymph node
  • tumours
  • vagal schwannoma

513

Where does pain radiate with acute cholecystitis?

from right hypochondrial region to shoulder/ interscapular region.

514

RhA nodules characteristics

Made from fibroblasts.

Pinky colour.

Blood supply on the outside only; can become necrotic.

Locations; extensor surfaces of elbows, forearms and hands

515

Why do you get chest tightness with asthma?

It is difficult to expire, and so air gets trapped in the lungs leading to chest. tightness.

This increase in air also increases resistance, resulting in difficulty breathing.

 

516

Common causes of acute mitral regurgitation

infective endocarditis

ruptured chordae tendineae

ischaemic papillary muscle rupture

517

What is the ROME III criteria?

Criteria for diagnosing IBS

Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with two or more of the following:

  • Improvement with defecation
  • Onset associated with a change in frequency of stool
  • Onset associated with a change in appearance of stool.

518

Relationship of aldosterone and spironolactone

Aldosterone raises BP by stimulating Na+ absorption.

Spironolactone competitively blocks the binding of aldersterone.

* weak diuretic *

SE: severe hyperkalaemia, especially in px with renal impairment.

Indications: Liver disease with ascites, severe heart failure, Conn's syndrome

519

Parotid tail lump - Solid

What other solid lumps are there?

  • lymph node
  • tumours
  • vagal schwannoma

520

DUKE Criteria

Used to establish the diagnosis of endocarditis

521

What age is typical for pyloric stenosis, and what's the cut off age?

2-8 weeks, rare above 6 months

522

Common causes of hypotension (6)

  • sepsis
  • acidosis
  • medications
  • nitrates (GTN)
  • CCBs
  • many anaesthetic agents

523

What drug is used for first line treatment of peripheral arterial disease?

Clopidogrel 

524

C. diff - antibiotic

metronidazole

or vancomycin (glycopeptide) . Nephrotoxic

525

Symptoms of SAH?

occipital headache, thunderclap

nausea and vomiting

meningism (photophobia, neck stiffness)

coma/ seizures/ death

 

526

Two main types of conjunctiva based anatomically

  • palpebral conjunctiva lines the lids
  • bulbar conjunctiva is over the eyeball

527

What's the difference between primary and secondary nocturnal enuresis?

primary; child has never been continence.

secondary; child has been dry for at least 6 months before.

528

ACNE - antibiotic

doxycycline - tetracyclines

if not responding; erythromycin

529

Symptoms of meningitis

  • high temperature of 38C or more
  • headache
  • blotchy rash that doesn't fade when a glass is rolled over - septicaemia (
  • often not present)
  • stiff neck
  • photophobia, drowsiness, seizures, confusion,
  • aching muscles & joints, 
  • cold hands & feet, tachypnoea

530

What % of px presenting to hospital with strokes, fulfill criteria for thrombolytic tx, and what is the drug?

2%

 

Actilyse; recombinant tissue plasminogen activator alteplase

531

Rhonchi

Continuous low pitched, rattling lung sounds that often resemble snoring.

Obstruction or secretions in larger airways.

Chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis.

Rhonchi usually clear after coughing. 

532

A Colle's fracture is a fracture of the distal radius. Which nerve is commonly affected?

median nerve

- affects thumb abduction

 

533

What happens to Functional Residual Capacity with emphysema?

Increased because

REDUCED elastic recoil, and therefore less resistance to the elastic recoil of the chest.

534

What is the most common cause of macrocytosis? (large RBC) 

Alcohol

(Hb level is usuallly normal)

Also.. RBC are usually circular

 

535

What is glipizide?

 

SE: weight gain

Can be combined with metformin for better control. 

Sulfonylurea drug; increases the secretion of insulin and secondarily decreases the secretion of glucagon. 

'hypoglycaemic drug'

536

Indications for senna; stimulant laxative

+ side effect

Increase mobility by stimulating the myenteric plexus.

mobility maybe damaged due to drug use.

Side effect: abdominal cramps

* don't use for impacted feces *

537

What is FNAC?

Fine Needle Aspiration for Cytology

 

- may be used for neck lumps

538

What is the most common cause of hypotension?

+ what drugs commonly cause hypotension

hypovolaemia

>>> diuretics

alpha/ beta blockers

539

What are the symptoms of hypervolaemia? overfilling

  • jugular venous distension
  • S3 gallop
  • dyspnoea
  • ascites
  • pulmonary oedema
  • pleural effusions
  • peripheral oedema
  • hypertension

540

Acromegaly

Excess GH.

In more than 95% of cases the excess production is due to a benign tumor, known as a pituitary adenoma.

541

A good drug for gram +ve bacteria?

erythromycin

(macrolide)

because they accumulate 100 x of the drug.

542

Characteristics of migraines

 

  • often unilateral. Recurrent
  • usually pulsatile
  • builds up over minutes to hours
  • occurs with or with aura
  • associations include; nausea & vomiting, photophobia, sound sensitivity, family history
  • exacerbation with physical activity
  • triggers; cheese, chocolate, etc.

NB. neurological exam should be negative

543

What is the definitive examination for a PE?

CT pulmonary angiogram (CTPA)  computed tomography using a contrast dye to obtain an image of the pulmonary arteries. 

544

EM tx of hypoglycaemia

50ml of glucose 50% if IV access available.

otherwise 1 mg glucagon

(as PAs 10% glucose IV okay)

non-emergency; dextrose, then more complex carbohydrates.

545

Pathophysiology of pleural effusion due to LVF

back up of fluids increases pulmonary pressure resulting in pulmonary oedema in the alveoli, fluid in the interstitial fluid, and finally into the pleural cavity.

546

Cockcroft-Gault Equation

The most common formula for determining creatinine clearance, ; creatinine clearance may over-estimate GFR by 10-20%, but still remains the standard for drug dosing adjustments.

Less accurate in weight extremes (underweight and particularly overweight/obesity). 

547

Tx for DKA

 

(Sickness and vomiting, abdominal pain, muscular weakness)

500ml then another 500ml then another 500ml (saline).  MUST ensure patient is rehydrated before giving insulin. 0.1units per kilo per hour.  

As sugar moves into cells (insulin taking effect) potassium follows therefore px becomes hypokalaemic. Normal potassium 3.5 to 5. 

Watch urine output to check hydration. 

 

Red flag; peds until 22-23 yr old. Can die from cerebral oedema; therefore don’t give insulin until properly hydrated.  

548

Risk factors for endometrial cancer

unopposed oestrogen

therefore:

nulliparous women, anovulatory cycles.

Obesity (very important - 50% of endometrial cancers related to >> weight).

tamoxifen.

REDUCED with COC pill. 

549

What are sulfonylureas and meglitinides examples of?

hypoglycaemic drugs

550

Conjunctivitis characteristics

  • red, watery eye, often bilateral.
  • VA is usually normal.
  • bacterial or viral

 

Infectious, topical treatment,

 

NB> check for FB, abrasion before diagnosing conjunctivitis

551

What factors cause cause a hypoglycaemic attack?

Too high a dose of medication (insulin or hypo causing tablets)

Delayed meals

Exercise

Alcohol

552

Suspected subarachnoid haemorrhage headache diagnosis 

CT scan (reliability 90% only)

If CT negative, LP > 12 hours following onset of symptoms.

LP: uniform RBC in bottles suggests SAH

Presence of bilirubin suggests bleed (and not trauma)

553

What are the EM physiological side effects of NO insulin causing hypoglycaemia? (3) 

>>> sugar in blood, none in cells.

Breakdown of fats and proteins; ketones and acidosis

leads to dehydration, Potassium loss and acidosis.

Dehydration because water follows excretion of sugar (osmotic diuresis)

554

Dermatome to Toes 1-3

555

What are the acquired causes of anaemia?

  • Reduced RBC production: deficiencies; iron, B12, folate, marrow replacement or aplasia
  • Increased RBC destruction (haemolytic anaemia)
  • Systemic illness; ACD (anaemia of chronic disease), renal failure,

556

Can you get anaemia with SLE?

Yes; autoimmune haemolytic anaemia

557

What is Proctitis?

Proctitis is an inflammation of the lining of the rectum.

Proctitis can cause rectal pain and the continuous sensation that you need to have a bowel movement

558

What is xanthochromia?

Yellow discoloration indicating the presence of bilirubin in the CSF

differentiate in vivo hemorrhage from a traumatic LP

559

Rinne test

560

Coeliac disease and gluten... what's the story?

gluten > villous atrophy > malabsorption

 

  • Familial component 
  • T Cell mediated autoimmune inflammation of the small bowel.

561

How could retinal detachment present?

New onset of floaters

New onset of flashes (flashing lights in vision)

Sudden onset, painless, usually progressive visual field loss

[dark curtain or shadow which starts in the periphery)

 

Peripheral curtain over vision + spider webs + flashing lights in vision think retinal detachment

 

562

What is the most common type of breast cancer?

 

Invasive ductal carcinoma

To complicate matters further this has recently been renamed 'No Special Type (NST)'

563

Vertical shearing

564

What is Boerhaave syndrome?

10% of esophageal perforations which occur due to vomiting. 

full-thickness tear in the esophageal wall

high morbidity and mortality and is fatal without treatment

565

566

What is the Mx of a bite with suspected rabies?

And what is the potential complication?

immunoglobulin + vaccination

acute encephalitis

rem hydrophobia: water-provoking muscle spasms

hypersalivation

567

What's the first line tx of a clinically suspected TIA?2

immediately 300mg aspirin - loading dose

immediate referal. UNLESS; patient has bleeding disorder or taking anticoagulant.

ABCD2 ; no longer recommended by NICE, performs poorly.

 

568

569

what is the Truelove and Witts' severity index?

assesses the severity of ulcerative colitis in adults

(if needing hospital admisstion)

570