GP 4th Year

Question 1

What side effect needs to be monitored with prolonged use of oral anti-fungals such as fluconizole and terbinafine?

Answer 1

LFTs

Question 2

Name the medication used for resistant obesity and weight loss. Name the side effect caused by this drug.

Answer 2

Orlistat (oral)

Pale stools

Question 3

What medications can be used to treat and prevent osteoporosis?

Answer 3

Bisphosphonates (ex. Alendronic acid)

Vitamin D

Question 4

Side effect to be aware of in bisphosphonates?

Answer 4

Ex. Alendronic acid

Osteonecrosis of the Jaw

Dysphagia/Oesophagitis/GORD

Question 5

Side effect to be aware of in bisphosphonates?

Answer 5

Ex. Alendronic acid

Osteonecrosis of the Jaw

Dysphagia/Oesophagitis/GORD

Question 6

Missed pill rules:

If pills are missed in week 1: _____

If pills are missed in week 2: ____

If pills are missed in week 3: ____

Answer 6

Week 1 : Use emergency contraception if she had UPSI in pill free interval for 1 week

Week 2: no need for emergency contraception

Week 3: Take the last pill that was missed, finish the current pack and start the next pack immediately after.

Question 7

Ellaone works by inhibiting ovulation. It can be taken within ____ days of UPSI.

It is contraindicated in ____ and ____. Breast feeding must be avoided for one week after taking the medication.

Answer 7

5 days

Liver disease and asthma

It can also cause painful periods, mood swings and back pain.

If the patient vomits within 3 hours, she will need to see the doctor again as the pill will not have been absorbed.

Question 8

Which scoring system can be used to measure back pain severity?

Answer 8

Keele Start Back

Question 9

Ipratropium and Tiotropium Bromide are short and long acting _____, used in asthma and COPD.

Answer 9

Anti-Muscurinic

Question 10

What are the causes of vomiting?

Answer 10

Question 11

_____ crystals with _____ birefringence confirm gout and differentiate it from pseudogout, and the fluid should also be sent for gram stain and culture to rule out septic arthritis.

Answer 11

Needle-shaped monosodium urate

Negative

*Remember P for Postive birefringence and Pseudogout*

Question 12

Gout is managed in terms of the acute attack, and then the ongoing management.

____, ____, ____, and ____ may all be used acutely, according to the patient’s co-morbidities. The NSAID indomethacin is traditionally used first-line. For patients with a high risk of gastro-intestinal side effects, past medical history of chronic kidney disease or heart failure, _____ may be used.

Answer 12

NSAIDs

colchicine

steroids

paracetamol

colchicine

Question 13

In the management of Gout, Colchicine can give which side effect?

Answer 13

Diarrhoea (remember 60 yr old man w/ charlotte)

If intolerable to patients, intra articular administration of steroids may be considered.

Question 14

Mnemonic for conservative management of MSK injuries?

Answer 14

PRICED

Protection

Rest

Ice

Compression

Elevation

Drugs (Ibuprofen etc)

Question 15

Adhesive Capsulitis is associated with which other medical conditions?

Answer 15

Diabetes

Thyroid disease

*both risk factors for developing adhesive capsulitis*

Question 16

____ test can be used to test for lateral epicondylitis (i.e Tennis Elbow)

Answer 16

Mill’s Test

Question 17

Passive flexion of the thumb right across the palm is painful in de quervain’s tenosynovitis. This is called ____ test.

Answer 17

Finkelstein’s

Question 18

In a patient with a low B12 and a high MCV which investigations need to be done next?

Answer 18

Anti-Intrinsic Factor antibodies (beware low sensitivity 50-60%)

or

Anti-Gastric parietal cell antibodies (low specificity)

Question 19

Which cancers are predominantly asscoiated with a thrombocytosis?

Answer 19

Lung

Oesophageal and Gastric

Endometrial

Other causes of thrombocytosis :

• Haematological/Clonal thrombocytosis e.g. Primary/Essential Thrombocytosis
• Reactive/secondary thrombocytosis (infection/inflammation/trauma/non-haem malignancy)

Question 20

What dermatological complication is associated with Coeliac disease?

Answer 20

Dematitis Herpetiformis (itchy blistery rash on legs)

Question 21

Complications of coeliac disease:

Answer 21

Dermatitis Herpetiformis ( itchy blistering rash on legs)

Osteoporosis

GI Lymphoma

Question 22

______ can be measured alongside copper to aid the diagnosis of Wilson’s disease.

Answer 22

Caeruloplasmin

Serum copper and caeruloplasmin levels are usually low in patients with Wilson’s disease, however caeruloplasmin may also be normal or elevated in these patients due to to the acute phase response.

As such serum caeruloplasmin alone has a low positive predictive value in patients undergoing evaluation for liver disease. Acute hepatitis in Wilson’s disease can increase caeruloplasmin into the normal range due to the acute phase response. An equivocal test should be followed by analysis of 24hr urine copper. The majority of Wilson’s disease patients are diagnosed between the ages of 5 and 35 years, although it has been diagnosed in younger patients and in those their 70s.

Question 23

_____ genotype, USS and refer hepatologist (fibrosis scoring (FIB4)/fibroscan/liver biopsy) aids in the diagnosis of Haemochromatosis.

Answer 23

HFE

The gene HFE, which contains two missense mutations (C282Y and H63D) was recently identified in patients suffering from haemochromatosis.

• C282Y homozygous (80%)
• H63D (compound heterozygote C282Y/H63D 5%)

Question 24

Haemochromatosis is an _____ condition.

Answer 24

Autosomal recessive

Question 25

Causes of acute confusion?

Answer 25

Drugs (opiates/ anti-cholinergics/Dopaminergics)

Electrolyte (dehydration, glucose, calcium, sodium), Endocrine (thyroid, adrenal)

Lack of drugs (withdrawal- ETOH/Dx, uncontrolled pain)

Infection (chest, urine, skin, CNS, sepsis etc)

Reduced sensory input (visual/hearing impairment)

Intracranial (stroke, haemorrhage, SOL)

Urinary retention/constipation

M I

Question 26

Mechanism of Action of common antibiotics

Answer 26

Question 27

What is the dose and route of Adrenaline given to adults in anaphylaxis?

Answer 27

0.5mg (500mcg) IM

*0.5 ml in 1/1000*

Question 28

What route is adrenaline given in Cardiac Arrest?

Answer 28

IV

Question 29

Anaphylaxis is a type ___ hypersensitivity reaction.

Answer 29

Type 1

Question 30

What are the 3 core features of an anaphylaxis presentation?

Answer 30

Skin changes: Angiooedema/ Urticaria/ Erythema

Respiratory compromise (often because of larygeal oedema - stridor - involve anaesthetists early)

Hypotension

*remember it’s a rapid onset and history may have allergen exposure*

Question 31

What are the 3 Skin changes in Anaphylaxis?

Answer 31

Urticaria

Angioedema

Erythema

*NB - up to 20% of anaphylactic patients will not have skin changes*

Question 32

3 main allergens that cause anaphylaxis?

Answer 32

Nuts

Insect stings (wasps>bees)

Drugs (antibiotics/anaesthetic agents - remember local anaesthetic)

Question 33

Anaphylaxis Management?

Answer 33

ABCDE (Sats/Oxygen/Cannula etc.)

0.5mg IM Adrenaline (repeat after 5 mins if no improvement)

then

Fluid Challenge (500-1000ml of crystalloid/Hartmann’s - to raise blood pressure)

Chlorphenamine (antihistamine) IM or IV (slow infusion)

*steroids no longer recommended*

• Monitor patient in hospital for 24hrs as up to 20% of patients can have 2nd reaction (biphasic)
• Can measure Mast cell tryptase at baseline and 2hrs later for diagnosis
• Counsel patient on allergy advice and seriousness of situation and discharge with epipen (X2)

Question 34

A helpful mnemonic for remembering the causes of microcytic anaemia is ____ .

Answer 34

TAILS

T – Thalassaemia

A – Anaemia of chronic disease

I – Iron deficiency anaemia

L – Lead poisoning

S – Sideroblastic anaemia

Question 35

The ____ score is used to assess the severity of pancreatitis. It gives a numerical score based on how many of the key criteria are present and can be remmebered with the mnemonic ____.

Answer 35

The Glasgow score is used to assess the severity of pancreatitis. It gives a numerical score based on how many of the key criteria are present:

0 or 1 – mild pancreatitis

2 – moderate pancreatitis

3 or more – severe pancreatitis

The criteria for the Glasgow score can be remembered using the PANCREAS mnemonic (1 point for each answer):

P – Pa02 < 8 KPa

A – Age > 55

N – Neutrophils (WBC > 15)

C – Calcium < 2

R – uRea >16

E – Enzymes (LDH > 600 or AST/ALT >200)

A – Albumin < 32

S – Sugar (Glucose >10)

This patient scores 5 due to age, calcium, enzymes (ALT), albumin and glucose. This indicates severe pancreatitis.

Patients with acute pancreatitis can become very unwell rapidly. They require admission for supportive management. Moderate or severe cases should be considered for management in the high dependency unit (HDU) or intensive care unit (ICU).

Question 36

Causes of Pancreatitis

Answer 36

I GET SMASHED

Question 37

What is courvoisiers law?

Answer 37

Courvoisier’s law states that a palpable gallbladder along with painless jaundice is unlikely to be gallstones. The cause is likely to be cholangiocarcinoma or pancreatic cancer.

Question 38

What is charcots triad?

Answer 38

Fever

RUQ pain

Jaundice

Question 39

Be wary of allopurinol in impaired renal function as it can lead to an accumulation of allopurinol and its metabolites
leading to ______.

Answer 39

Agranulocytosis

Aplastic anaemia

Thrombocytopenia.

Question 40

Acronyms for presenting Chest X-ray:

Answer 40

You must always start by noting the patient details and the time of the x-ray.

The acronym RIPE can be used for the film quality:

Rotation - evaluate the position of the clavicular heads relative to the spinous processes of the vertebrae, if they are not equidistant then there may be an element of rotation.

Inspiration - you can count the visible anterior rib shadows and this should be at least 6 for an adequately inspired film.

Projection & Position - this could be PA or AP projection for a chest x-ray, and could be erect or supine.

Exposure - the vertebrae should be visible behind the cardiac silhouette for adequate exposure.

The acronym ABCDE can be used for the film’s contents:

Airways - comment on the position, whether it is central or deviated laterally

Breathing Fields (lung markings) - look for lung markings all the way to the peripheries of the thorax, any pure black space is likely a pneumothorax.

Cardiac Silhouette - evaluate the heart size for cardiomegaly (>50% of thoracic diameter), and the clarity of the left and right heart borders

Diaphragm - evaluate the clarity of the diaphragmatic borders, their vertical positioning, their positioning relative to each other (right is slightly elevated compared to the left), and the costophrenic angles for the presence of fluid

Everything Else - evaluate the remaining visible structures including ribs, clavicles, retrocardiac region, and any other foreign objects such as pacemakers or surgical clips.

Make sure you finish with a summary and by reiterating the most striking abnormality.