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IDDIBIDDI Flashcards

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1
Q

Angina Rx

A
  1. BB or RateCCB (verapamil/diltiazem)
  2. BB and long acting DHP (amlodipine/nifedipine)
  3. ONLY IF AWAITING PCI, add long acting nitrate (ivabradine, nicorandil, ranolazine)
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2
Q

Angina 1st line

A
  1. BB or RateCCB (verapamil/diltiazem)
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3
Q

Angina 2nd line

A

2.BB and long acting DHP (amlodipine/nifedipine)

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4
Q

Angina 3rd line

A
  1. ONLY IF AWAITING PCI, add long acting nitrate (ivabradine, nicorandil, ranolazine)
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5
Q

What Rx for CVA if cannot tolerate clopidogrel?

A

Aspirin + dypiridamole

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6
Q

Thrombectomy AND thrombolysis within how many hours for anterior?

A

6

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7
Q

Within 6 hours can you perform thrombectomy AND thrombolysis for what type of CVA?

A

Anterior

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8
Q

Within how many hours can you perform JUST thrombectomy for anterior CVA?

A

6-24

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9
Q

Within 6-24 hours, for what type of CVA can you perfom JUST thrombectomy?

A

Anterior

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10
Q

Thrombolysis AND thrombectomy, how many hours for POSTERIOR

A

<4.5 (consider)

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11
Q

For what type of CVA can Thrombolysis AND thrombectomy be offered if <4.5 hours?

A

Posterior

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12
Q

When can endarterectomies be done?

A

> 50%

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13
Q

Dizziness and electric shock symptoms post stopping what medication?

A

SSRI

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14
Q

Which do you replace first B12 or folate?

A

B12 first

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15
Q

Can topiramate be given to pregnant ladies?

A

No Teratogenic

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16
Q

Teratogenic migraine Rx

A

Topiramate

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17
Q

Can pregnant ladies receive MMR?

A

NO, only post-natally

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18
Q

How long for IUD to take effect

A

Immediately

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19
Q

How long for POP to take effect

A

2 days

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20
Q

How long for COCP to take effect

A

7 days

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21
Q

How long for implant to take effect

A

7 days

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22
Q

How long for injection contraceptive to take effect

A

7 days

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23
Q

How long for IUS to take effect

A

7 days

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24
Q

Which contraceptives take 7 days to take effect

A

COCP, implant, injection, IUS

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25
Which contraceptive takes 2 days to take effect
POP
26
Which contraceptive is immediate
IUD
27
When can you restart COCP postnatally?
No breastfeeding - 21 days Breastfeeding - 6 weeks
28
A woman has given birth a week ago, can she take COCP
No, 21 days
29
Which drug causes corneal opacities?
Amiodarone
30
Amiodarone does what to your eyes?
Corneal opacities
31
Can a breastfeeding woman take: Lithium
No
32
Can a breastfeeding woman take: Tetracyclines
No
33
Can a breastfeeding woman take: Chloramphenicol
No
34
Can a breastfeeding woman take: Sulfonamides
No
35
Can a breastfeeding woman take: Lithium and benzos
No
36
Can a breastfeeding woman take: Aspirin
No Reyes
37
Can a breastfeeding woman take: Carbimazole
No
38
Can a breastfeeding woman take: Methotrexate
No
39
Can a breastfeeding woman take: Sulfonylureas
No
40
Can a breastfeeding woman take: Amiodarone
No
41
What do you do with a squint?
Refer opthal
42
What effect does smoking cessation have on clozapine?
Rise in levels
43
Fasting glucose >7 in a preggo lady
INSULIN
44
Dominant R wave in V1
WPW TYPE A
45
Features of WPW type A on ECG
Dominant R wave in V1
46
Effect of thiazides on lithium
Lithium toxicity
47
Spasticity in MS Rx
Gabapentin Baclofen
48
2 most common causes of status epilepticus
Hypoxia, hypoglycaemia
49
Poor feeding in an infant, whaddayadoo
Even if losing weight, trial: 1. Gaviscon 2. Omeprazole / ranitidine 3. Paed referral
50
Side effect of nicorandil?
Nicorandil gives you nicks all over the GI tract - ulceration + GIB
51
Baby is born Xray shows fluid in the horizontal fissure and hyperinflation
TTofN
52
Xray sign for transient tachypnoea of newborn
Xray shows fluid in the horizontal fissure and hyperinflation
53
Rx for displaced hip fracture
Hemi / THR
54
Rx for extracapsular hip fracture
DHS
55
How long do you review sertraline in <25yo
ONE week Risk of suicide on starting in young
56
SEVERE eye pain HALOs Reduced vision HAZY cornea Semi-dilated
Acute angle CLOSURE glaucoma
57
Halos Hazy cornea
Acute angle CLOSURE glaucoma
58
Acute angle CLOSURE glaucoma Sx
SEVERE eye pain HALOs Reduced vision HAZY cornea Semi-dilated
59
EYE Acute onset Pain Blurred vision Photophobia Small, FIXED OVAL pupil Ciliary flush
Anterior Uveitis
60
Small, FIXED OVAL pupil Ciliary flush
Anterior Uveitis
61
Anterior Uveitis Sx
Acute onset Pain Blurred vision Photophobia Small, FIXED OVAL pupil Ciliary flush
62
Scleritis Sx
Severe eye pain on movement AI disease
63
Severe eye pain on movement AI disease
Scleritis
64
Rheumatoid eye disease
Keratoconjunctivitis sicca
65
Keratoconjunctivitis sicca
Rheumatoid eye disease
66
Purulent or clear eye discharge
Conjunctivitis
67
Conjunctivitis
Purulent or clear eye discharge
68
What causes subconjunctival haemorrhage
Trauma/coughing
69
Eye disease with trauma/coughing
Subconjunctival haemorrhage
70
Endopthalmitis
AFTER SURGERY Red, painful, decreased vision
71
Eye disorder AFTER SURGERY Red, painful, decreased vision
Endopthalmitis
72
<55 or T2DM First line
ACE or ARB
73
<55 or T2DM 2nd line
ACE or ARB + CCB or thiazide
74
<55 or T2DM 3rd line
ACE or ARB + CCB AND thiazide
75
<55 or T2DM 4th line
<4.5 Spiro >4.5 Beta or alpha blocker
76
>55 or afro 1st line
CCB
77
>55 or afro 2nd line
CCB + ARB/ACEi or thiazidie
78
>55 or afro 3rd line
CCB + ACEi/ARB AND thiazide
79
Anterior MI what artery
LAD
80
Inferior MI what artery
RCA
81
RCA causes what MI
Inferior
82
LAD causes what MI
Anterior
83
What target HbA1c for lifestyle
48
84
What target HbA1c for metformin
48
85
What target HbA1c for hypoglycaemic
53
86
1st line DM
Metformin + SGLT2(if CVD/HF risk)
87
2nd line DM
Add DPP4 or SGLT2
88
3rd line DM
Add another or insulin
89
4th line DM
Switch one for GLP1 if BMI > 35 IE if on 3/4 hypoglycaemics OR insulin and no result consider GLP1 if BMI >35
90
How often cervical cytlology in HIV
Yearly
91
General rule for autosomal dominant
Structural things EXCEPTIONS = gilberts + hyperlipidaemia
92
General rule for autosomal recessive
Metabolic things EXCEPTIONS = ataxias
93
Persistent ST elevation post MI with NO chest pain?
LV aneurysm
94
How does LV aneurysm present
Persistent ST elevation post MI with NO chest pain
95
Rx whooping
Clarithromycin / azithromycin
96
Rx for baby meningitis
ceftriaxone
97
What drug avoid in HOCM?
ACEi
98
Rx for labial adhesions in children
Oestrogen cream
99
What causes falsely elevated HBA1c?
Splenectomy IDA B12/folate deficiency Increased lifespan of RBCs
100
Splenectomy IDA B12/folate deficiency Do what to HBA1c
Falsely elevated
101
Sickle cell G6PD Hereditary spherocytosis B thalassaemia What effects on HBA1c
Falsely LOW
102
What causes falsely low HBA1c?
Sickle cell G6PD Hereditary spherocytosis B thalassaemia
103
Asbestosis / mesothelioma What is notable about death certificate?
NEEDS coroner referral
104
Structural heart disease pharmacological cardioversion
AMIODARONE NOT flecainide
105
DEVELOPMENTAL MILESTONES Quietens to voice Squeaks Turns to parents
3 months
106
DEVELOPMENTAL MILESTONES Double syllables
6 months
107
DEVELOPMENTAL MILESTONES Mama/dada
9 months
108
DEVELOPMENTAL MILESTONES Knows name
12 months
109
DEVELOPMENTAL MILESTONES 2-6 words Understands simple commands
12-15 months
110
DEVELOPMENTAL MILESTONES Combine 2 words Points to body parts
2 years
111
DEVELOPMENTAL MILESTONES 200 words
2.5yrs
112
DEVELOPMENTAL MILESTONES Short sentences What/who Colours 1-10
3 yrs
113
DEVELOPMENTAL MILESTONES Why, when, how
4 yrs
114
Rx for recurrent hiccups
Chlorpromazine
115
Xray signs of rheumatoid
Periarticular erosions Juxta-articular osteoporosis
116
Periarticular erosions Juxta-articular osteoporosis
Xray signs of rheumatoid
117
Alcohol withdrawal
Reduced inhibitory GABA, increased glutamate
118
Reduced inhibitory GABA, increased glutamate
Alcohol withdrawal
119
Rx Ramsay Hunt
Oral acyclovir and prednisolone
120
Most common cause otitis media
H influenza
121
Other (not most common) causes of otitis media
Moraxella Strep
122
Risk factors for SIDS
Sleeping in same bed Prone sleeping Smoking Prematurity Hyperthermia and head covering
123
Sleeping in same bed Prone sleeping Smoking Prematurity Hyperthermia and head covering
Risk factors for SIDS
124
Barlow DDH
Dislocate
125
Ortlani DDH
Relocate
126
DDH investigations
>4.5 months XRAY <4.5 months US
127
Rx DDH <4.5 months
Pavliks BUT MOST SPONTANEOUS STABILISE at 3-6 weeks
128
Pavliks harness BUT MOST SPONTANEOUS STABILISE at 3-6 weeks
Rx DDH <4.5 months
129
When in parvovirus BAD in pregnancy
<20 weeks
130
Section someone in GP What section?
4
131
How do you treat cows milk allergy in a baby?
Extensively hydrolysed formula
132
Extensively hydrolysed formula
Cows milk allergy
133
What audio test is done in schools?
Pure tone audiometry
134
Pure tone audiometry, done when?
Schools
135
Newborn hearing test?
Otoacoustic emission
136
Otoacoustic emission
Newborns
137
Low LH/FSH Low testosterone Anosmia Delayed puberty
Kallman
138
How to treat a cut in an unknown tetanus Hx?
Give booster / immunoglobulin if cant
139
What one off vaccine for hep C patients?
Pneumococcal
140
Obstetric cholestasis, main risk to baby?
Stillbirth
141
Features of a lacunar infarct?
Purely motor or sensory
142
Rx pagets
Bisphosphonates
143
Diclofenac contraindicated with what?
CVA
144
Keratitis from what
KONTACT LENSE
145
Rx raynaulds?
Nifedipine BB cause raynaulds
146
Risk of glandular fever
Splenic rupture
147
Seborrheic dermatitis can randomly cause what? (melassazia fur fur)
Ear ache!
148
Fetal varicella features
Scarring, eye defects, limb defects, microcephaly, LD
149
Scarring, eye defects, limb defects, microcephaly, LD
Fetal varicella features
150
Psoriatic Arthritis, which HLA
B27
151
Which clotting factors are reduced in liver failure?
All apart from 8
152
Which clotting factors are not reduced in liver failure?
8 All others reduced
153
All clotting factors apart from 8 are reduced in what?
Liver failure
154
Normal calcium, phosphate, ALP and PTH
Osteoporosis
155
Osteoporosis biochem
Normal calcium, phosphate, ALP and PTH
156
Osteomalacia biochem
ALP and PTH appropriately high, calcium and phosp low
157
ALP and PTH appropriately high, calcium and phosp low
Osteomalacia biochem
158
Primary HPTHism biochem
PTH high, Ca high, Phosp low, ALP high PTH high cos HPTism, causes high Ca/low phos, ALP high cos PTH stimulates osteo
159
PTH high, Ca high, Phosp low, ALP high
Primary HPTHism biochem
160
CKD biochem, PTH
PTH High, Ca low (cant be absorbed in kidney) Phosphate high (cant be excreted, ALP high IE makes sense that PTH is high and Ca cannot be absorbed, phosp exrected, and ALP is high
161
PTH High, Ca low (cant be absorbed in kidney) Phosphate high (cant be excreted, ALP high
CKD biochem
162
Osteopetrosis biochem
PTH ALP CA and PO4 normal
163
A wee barn has a recurrent sticky eye. What do you do?
Refer if >1 If <1 it is normal Nasolacrimal obstruction
164
Serious cystadenoma
SERIOUSLY COMMON
165
Mucinous cystadenoma explodes and the patient gets a sore tummy
Psuedomyxoma Petronei
166
Gradual blurring after cataract surgery
Posterior capsule opacification
167
Posterior capsule opacification
Gradual blurring after cataract surgery
168
Bilateral sciatica
Cauda equina
169
Dramatic response to steroids
PMR
170
Dry ARMD
Drusen Yellow spots in brusches membrane
171
Drusen Yellow spots in brusches membrane
Dry ARMD
172
Exudative Neovascularisation and leakage of serous fluid and blood
Wet ARMD
173
Wet ARMD
Exudative Neovascularisation and leakage of serous fluid and blood
174
Rx Dry ARMD
Zinc + Vitamins ACE
175
Rx Wet ARMD
Anti VEGF or laser photocoagulation (has a risk of acute visual loss)
176
ASA 1
Healthy non smoker
177
ASA 2
Mild disease
178
ASA 3
Severe disease
179
ASA 4
Severe disease, but constant threat to life
180
ASA 5
Moribund, expected not to live without operation
181
ASA 6
Brain dead
182
What is Fomepizole for?
Fomepizole For antiFreeze
183
Rx antifreeze
Fomepizole
184
Disproportionate microcytosis
B thalassaemia trait
185
When is jaundice in neonates pathological
First 24hrs After 2 weeks
186
When is jaundice in neonates normal
2-14 days
187
Causes of jaundice >2weeks neonates
Breast milk, biliary atresia, UTI, galactosaemia, hypothyroidism, prematurity, CMV, toxoplasmosis
188
Breast milk, biliary atresia, UTI, galactosaemia, hypothyroidism, prematurity, CMV, toxoplasmosis
Causes of jaundice >2weeks neonates
189
Rx phaeo and what is importants
PHenoxybenzamine ALWAYS A blockade before Beta
190
OLDBEN VOICE EYES
OBEY LOCALISE DRAW AWAY BEND EXTEND NONE ELEGANT CONFUSED INAPPROPRIATE OBSCURE VOICELESS SPONTANEOUS EAR PIERCING NOISE YOUCH EYES SHUT
191
OLDBEN
OBEY LOCALISE DRAW AWAY BEND EXTEND NONE
192
VOICE
ELEGANT CONFUSED INNAPPROPRIATE OBSCURE NOISES VOICELESS
193
EYES
EYES SHUT YEOUCH EAR PIERCING SPONTANEOUS
194
Monitor fibroadenomas if
<3cm
195
Peutz jeghers what is it
AD MultiPle PolyPs Pigmented lesions on hands and feet
196
AD MultiPle PolyPs Pigmented lesions on hands and feet
Peuts-jeghers
197
18yo hasn't had Men ACWY do ya give it
YEA
198
What are the rules with live vaccines?
>4 weeks apart
199
Turners heart disease
Bicuspid aortic valve
200
Brushfields spots
Downs syndrome
201
When can you start POP and COCP after birth?
POP immediately COCP 6 weeks
202
Sudden onset sensorineural deafness, whaddayado
ENT urgent
203
Statins? Pregnancy?
Contraindicated
204
Croup caused by, and Rx
Parainfluenza Steroids
205
Parainfluenza Steroids
Croup
206
Key SE of carbimazole?
Agranulocytosis
207
Features Patau Tri 13
Polydactyly, cleft Palate, small PeePing eyes
208
Polydactyly, cleft Palate, small PeePing eyes Tri 13
Patau
209
Edwards Tri 18
Ed the rocker likes low basses Rockerbottom feet, low set ears, overlapping fingers [for playing guitar]
210
Rockerbottom feet, low set ears, overlapping fingers [for playing guitar]
Edwards Ed the rocker likes low basses Tri 18
211
Fragile X
XTRA LARGE head, ears, testicles, face takes a LONG time to learn - LD
212
XTRA LARGE head, ears, testicles, face takes a LONG time to learn - LD
Fragile X
213
Noonan
Noo noo vacuUM Short, pectus excavatUM, pulmonary stenosis (ie hoover) Clears away the cobwebbed neck
214
Short, pectus excavatUM, pulmonary stenosis (ie hoover) Clears away the cobwebbed neck
Noonan
215
Pierre robin
Palate-robin Cleft palate, tiny mouth like a robin
216
Prader willi
Fat Hungry Floppy
217
Fat Hungry Floppy
Prader-willi
218
Williams
Think of will Happy, friendly extrovert, short stature, LD, aortic stenosis
219
Happy, friendly extrovert, short stature, LD, aortic stenosis
Williams
220
Cri du chat
CrI - Eyes far apart Loud cry Hard to feed This cri-du-chat is hard to feed!
221
Eyes far apart Loud cry Hard to feed
Cri-du-chat
222
1st stage of puberty in girls
Breast development
223
Bow legs, when do they get better?
Bow legs Better By 4
224
Whooping cough
RSV
225
RSV
Bronchiolitis
226
All breech babies get what
US scan
227
FEVER then red rash
Roseola HHV6
228
Fever, head+trunk then rest of body macular to papular to vesicular
Chickenpox VCZ
229
Measles features
Koplik spots mucosa Rash BEHIND ears Conjunctivtis, fever
230
Rash BEHIND ears Conjunctivtis, fever
Measles
231
How many days off for measles?
4 days from rash onset
232
Unilateral parotitis then b/l FEVER
Mumps
233
Mumps features
Unilateral parotitis then b/l FEVER
234
How many days off for mumps
5 days since gland onset
235
Rubella features
RUBELLA RS Rubella Starts on the face Lymphadenopathy
236
Rash starting on face -> elsewhere LNs
Rubella
237
How many days off school rubella?
5 days since rash onset
238
Slapped cheek Red arms
YOU SLAP WITH YOUR ARM Parvovirus B19/erythema infectiosum
239
Parvovirus B19/erythema infectiosum features
Cheek + arms rash
240
Strawberry tongue, rash spares the mouth,
GASSY Scarlet Kiss gassy scarlet and give her a strawberry Group A strep
241
Scarlet fever features, GAS
Strawberry tongue, rash spares the mouth
242
How many days off school for scarlet?
24hrs onset of ABx Penicillin V
243
HAND FOOT N MOUTH
COX Coxsackie A16 Vesicles in HFM
244
When can you go to school with hand foot and mouth
No time off
245
When can you go to school after whooping? And what Rx eh?
2 days after ABX Azithromycin Clari
246
What reduces absorption of levothyroxine?
Iron
247
Keratocanthoma. Whaddyado
Refer to derm as could be SCC
248
Low B6 and high B6 can cause what?
Peripheral neuropathy
249
How many rescue breaths in paediatrics?
5 Most likely hypoxic cardiac arrest
250
Anti TPO are seen in hashimotos, what else?
Graves interestingly
251
Rouleaux
MM
252
Blepharitis and conjunctivitis 1st + 2nd
Clean eyes ABx if failure
253
Vincristine SE
Peripheral neuropathy
254
What do you need to monitor when giving magnesium sulfate
RR Reflexes
255
What is the TT380
Not a plane Its a copper IUD
256
Distinguish between hashimotos and de quervains subacute thyroiditis OE
Tender in de quervains
257
AST:ALT in alcohol
2:1
258
AST:ALT in paracetamol
1:1
259
SE of cyclophosphamide
Pee in cycles TCC, haemorrhagic cystitis
260
SE of bleomycin
Bliff Lung fibrosis
261
SE of Doxorubicin
dOxO CardiOmyopathy
262
SE of 5FU
FU sneezy itchy mess Mucositis Dermatitis
263
SE of cytarabine
cytArAbine Ataxia
264
SE of vincristine
Crystals in your poop n legs Paralytic ileus Peripheral neuropathy
265
SE of Cisplatin
Cis men can pee or hear
266
Rx PPROM
ABx Steroids
267
Pregnancy dates 8-12 weeks
Booking and bloods
268
Pregnancy dates 10-13+6
First scan
269
Pregnancy dates 11-13+6
Downs nuchal thickness
270
Pregnancy dates 16
Clinic, results
271
Pregnancy dates 25
SFH, clinic
272
Pregnancy dates 28
BP check Anti D
273
Pregnancy dates 31
Routine care clinic
274
Pregnancy dates 34
Second Anti D
275
Pregnancy dates 38
Routine Preg planning
276
Pregnancy dates 40
Options for prolonged preg
277
Pregnancy dates 41
Induction
278
Pregnancy dates Anti D
28 34
279
SE of aminosalicylates
Agranulocytosis
280
Cluster headache Rx
Verapamil
281
Young, Sx of peripheral neuropathy Ass with raynaulds
Buergers
282
How long can copper coil be used for EMERGENCY contraception?
5 days
283
Perthes disease, dont treat until what age?
6 yrs
284
What biomarker for medullary thyroid carcinoma?
Calcitonin
285
B12 or folate first
B before F
286
Bronchiolitis onset?
<1yo RSV Supportive
287
Imposter syndrome
Capgras
288
Belief one is dead
Cotard
289
Someone high ranking loves you
De Clarembauld
290
Everyone is one person
Fregoli
291
Not tested in neonatal prick test?
Galactosaemia YEAHAHA
292
Size of kidneys in diabetic nephropathy
BIG
293
Duputryns caused by what antiepileptic
Phenytoin
294
Rx rosacae
Mod: ivermectin Severe ie pustular: ivermectin and doxy
295
When does PDA close
First FEW BREATHS
296
How to close a PDA
Indomethacin/ibuprofen
297
How to keep a PDA open
Prostaglandins
298
Amster grid testing, Looking at wavy lines What is it for?
Dry ARMD
299
11+6 check your dicks
Warts
300
16+18 get the cervical vaccine/screen
Cervical cancer
301
CRAZY MASSIVE SPLEEN What lymphoma
CML
302
Someone gets bad eye pain after mydriatic drops
Acute angle CLOSURE glaucoma
303
Fat boi, groin knee thigh pain
Slipped femoral epiphysis
304
Tumour in the anal verge
AP
305
Tumour in the rectum
Anterior resection
306
Tumour in the sigmoid
High anterior resection
307
Contraception NEEDED after pregnancy
21 days (NB POP instant, COCP contraindicated for 6 weeks)
308
Claudication like pain legs, back pain Better with rest
Lumbar canal stenosis
309
If you have an allergy to sulfsalazine, what else can you not take?
Aspirin SALICYLATES
310
Dont what after a hip replacement
Cross ya legs
311
Big interaction with statins
Macrolides, eg clarithromycin
312
Pemphigus vulgaris also affects
VULVA Mucosal surfaces
313
Most common cause of newborn jaundice
Rhesus incompatibility
314
Aspirin is ingested Suicide attempt Timeframe for charcoal
<1hr
315
Most common complication of meningitis
Sensorineural hearing loss
316
Bridging vein affected Crescent shaped CTH
Subdural
317
Soft, systolic, symptomless, short, Sitting->Standing
Innocent murmur
318
Metabolic acidosis with increased ketones but LOW glucose?
Alcoholic ketoacidosis
319
Common cancer after transplantation
SCC
320
Lateral rectus controlled by what nerve
CN6
321
Superioroblique controlled by
CN4
322
Diltiazem causes what toxicity
DIGOXIN
323
Samters triad
Aspirin sensitivity, nasal polyps, asthma
324
Shaken baby syndrome features
Subdural Retinal haemorrhages Encephalopathy
325
Subdural Retinal haemorrhages Encephalopathy
Shaken baby syndrome
326
Active crohns disease rash?
Erythema nodosum
327
1st line paediatric migraine
Ibuprofen <12
328
AAA screening
Single US at 65
329
Fever pain scoring
FEVER Purulent Attend rapidly <3days Inflamed tonsils No cough 0-1 no Abx 2-3 delayed ABx 4-5 ABx
330
FEVER Purulent Attend rapidly <3days Inflamed tonsils No cough What are the Rx thresholds
0-1 no Abx 2-3 delayed ABx 4-5 ABx
331
1st line to maintain remission in crohns
Azathioprine
332
SE depoprovera
Reduced BMD
333
Provoked vs unprovoked
3 vs 6
334
TIA Rx
DAPT
335
How to monitor haemochromatosis
Ferritin TF sat
336
Initial Rx RhA
DMARD Bridging corticosteroid
337
One eye cant adduct and the other gets nystagmus
INO Lesion in the MLF
338
Pain on longitudinal compression of the thumb
Scaphoid fracture
339
NSTEMI Mx
Aspirin (+fondaparinux if no PCI immediately)
340
NSTEMI Mx GRACE score explanation?
<3% - ticagreol >3% - PCI in 72hrs, UFH, Prasugrel OR ticagrelor
341
NSTEMI Mx Grace <3%
Ticagrelor no PCI
342
NSTEMI Mx Grace >3%
>3% - PCI in 72hrs, UFH, Prasugrel OR ticagrelor
343
If a patient has an NSTEMI and is on anticoagulation, what happens to the antiplatelet?
Swap ticagrelor/prasugrel for clopidogrel
344
STEMI Mx
Aspirin 300mg Is PCI possible in 120mins? YES-> prasugrel, UFH, glp2b/3a NO-> fibrinolysis + antithrombin + ticagrelor after procedure
345
STEMI Mx PCI not possible in 120mins
NO-> fibrinolysis + antithrombin + ticagrelor after procedure
346
STEMI Mx PCI possible in 120mins
YES-> prasugrel, UFH, glp2b/3a
347
STEMI If high bleeding risk what antiplatelet is recommended?
Clopidogrel
348
Do you do PCI if pt presents after 12 hours?
Consider
349
Herceptin What main SE?
Cardiotoxicity
350
Stress incontinence treatment
Duloxetine
351
1st line Rx for scalp psoriasis
Potent corticosteroid EG Clobetasol propionate 0.05%: Dermovate Diflorasone diacetate 0.05%: Fluocinonide 0.1%: Halobetasol propionate 0.05%: Betamethasone valerate 0.1%: (Betnovate) Betamethasone dipropionate 0.05%: (Diprosone)
352
What is a curlings ulcer?
Stress ulcer after burns (GI)
353
Stellwag sign
Reduced blinking
354
Reduced blinking sign
Stellwag
355
IM influenza vaccine, what type of vaccine?
Inactivated
356
Intranasal influenza vaccine, what type of vaccine?
Live attenuated
357
Which coronary artery, complete HB?
RCA Inferior
358
Antiemetic of choice for brain mets?
Cyclizine
359
HER2 drug
Trastuzumab
360
Trastuzumab
HER2
361
Eye disease and RhA
Keratoconjunctivitis sicca
362
Urinary 5HIAA
Carcinoid
363
Cerazette desonorgestrel MOA
Inhibits ovulation
364
Gottrons papules (hands) Heliotrope rash
Dermatomyositis
365
Absolute contraindications to thrombolysis
Hx ICH Seizure IC neoplasm Stroke or TBI in last 3 months LP within 7 days GI haemorrhage in last 3 weeks Hx of varices Active bleeding Uncontrolled HTN >200/120
366
Hx ICH Seizure IC neoplasm Stroke or TBI in last 3 months LP within 7 days GI haemorrhage in last 3 weeks Hx of varices Active bleeding Uncontrolled HTN >200/120
Absolute contraindications to thrombolysis
367
Spared in MND
Eyes
368
Purple, pruritic, papular, Polygonal rash on extensor surfaces Oral involvement
Lichen Planus
369
Lichen Planus
Purple, pruritic, papular, Polygonal rash on extensor surfaces Oral involvement
370
How long stop COCP for before surgery
4 weeks
371
Rx broad complex tachycardia
Amiodarone
372
Neonatal blood spot, when?
5-9 days of age
373
Causes torsades de points
Hypokalaemia SSRIs (mainly citalopram)
374
Which SSRI causes torsades de points?
Citalopram
375
Non invasive prenatal testing for what
Increased nuchal thickness
376
FEV1:FVC in restrictive
>70
377
FVC in restrictive
378
Diactylitis What arthritis
Psoriatic
379
Replacement of normal bone with spongy bone. Hyperaemia of cochlear and membrane Schwartz sign = prominent vascularity
Otosclerosis
380
What is otosclerosis
Replacement of normal bone with spongy bone. Hyperaemia of cochlear and membrane Schwartz sign = prominent vascularity
381
Schwartz sign
prominent vascularity in ear
382
Thiazides cause what electrolyte abnormality
Hypocalcaemia
383
Classification UC
Mild <4 Mod 4-6 Severe >6
384
Rx mild mod severe UC
Mild <4 - rectal salicylates Mod 4-6 - rectal and oral Severe >6 - steroids
385
Rx mild UC
Mild <4 - rectal salicylates Mod 4-6 - rectal and oral Severe >6 - steroids
386
Rx mod UC
Mild <4 - rectal salicylates Mod 4-6 - rectal and oral Severe >6 - steroids
387
Rx severe UC
Mild <4 - rectal salicylates Mod 4-6 - rectal and oral Severe >6 - steroids
388
Target cells Siderotic granulated acanthocytes Pappenheimer Howell-jolly bodies
Hyposplenism
389
Tear drop poikilocytes
Myelofibrosis
390
Contraception in menopause whens it needed?
<50 24 months >50 12 months
391
Why does seminoma have better prognosis than teratoma?
Responds to radiotherapy
392
Prognosis, whats better seminoma vs teratoma?
Seminoma - responds better to radiotherapy
393
BV Rx
5 days metronidazole
394
Ear more prominent and ear infection
SHIT THIS IS MASTOIDITIS ADMIT EM FOR IVABx
395
ST depression, raised R waves, tented T waves
Do posterior ECG ?Posterior MI
396
Can pregnant ladies have pertussis vaccine?
Yes but ONLY 16-32 weeks
397
BL acoustic neuromas Which type of neurofibromatosis
Type 2 Bilateral Ya got 2 ears
398
Serum progesterone for ovulation, when?
7 days before the expected period
399
When progesterone for POF
Day 21
400
Rx of HUS
Supportive
401
Bradyarrythmia and no shock
Pacing
402
Bradyarrythmia and shock
500mcgs atropine
403
Pregnant lady with varicella, what do you do?
Check immunity If doubts - blood test If no immunity and exposed - aciclovir at 7-14 days post exposure Rx needed: ORAL acyclovir if >20 weeks If under - consider
404
Tiny white papules on eyelids
Milia Often seen in newborns and disappears Can be seen in adults
405
Rx milia
None in babies Adults - retinoids or cryotherapy/curettage
406
Avoid which acne Rx in pregnancy
Adapaline
407
Argyll Robertson
ARRRRRR Pirate Squinting eye Pupils constricted Syphilis
408
What electrolyte abnormality can cause cataracts?
Hypocalcaemia
409
Organophosphate poisoning DUMBELS
Diaphoresis/defecation Urinary incontinence Miosis Bradycardia Emesis Lacrimation Salivation
410
How to tell between epi/scleritis
Scleritis more painful Phenylephrine eye drops, scleritis no change, epi blanches
411
What heart defect in downs
AV septal defect
412
BL hypodensities in the temporal lobes
HSV encephalitis
413
Pain over radial styloid on forced flexion/abduction of the thumb Finklestein positive
De Quervains tenosynovitis
414
De Quervains tenosynovitis
Pain over radial styloid on forced flexion/abduction of the thumb Finklestein positive
415
What is the point of irradiated blood products?
Avoid transfusion related graft vs host disease
416
1st line hyperhidrosis
Aluminium chloride
417
Isoniazid SE
PerIpheral Neuropathy Izzagots peripheral neuropathy
418
Red flags back pain
<20 >50 Hx malignancy Night pain Trauma Systemic features
419
<20 >50 Hx malignancy Night pain Trauma Systemic features
Red flags back pain
420
Offer statins if what?
T1DM and: >40 DM >10yrs Nephropathy Obesity/HTN
421
Dual antiplatelets for how long post MI?
12 months
422
Sodium valproate + raised amylase?
Pancreatitis induced by sodium valproate
423
Acrocyanosis, what is it?
Blue fingers/tips Normal in babies
424
Pt being induced Increased in end tidal CO2 Flexion of muscles Rhabdomyolysis Mottling of skin Genetic disorder
Malignant hyperthermia
425
When do you use cyclical HRT first?
Always UNLESS Tried for 1yr 1 year since LMP 2 yrs cince LMP if premature menopause (pre 40yo)
426
Scaphoid pole fracture treatment
Fixation every time
427
Which is the only contraceptive to cause weight gain?
Progesterone injection
428
>40 urinary sodium Reduced urinary osmolality Normal urea:creatinine ratios Poor response to fluid challenge Brown granular casts
ATN
429
Features of ATN
>40 urinary sodium Reduced urinary osmolality Normal urea:creatinine ratios Poor response to fluid challenge Brown granular casts
430
Most common extra-intestinal manifestation of IBD
Arthritis
431
Pathophysiology of cholesteatomas
Result from chronic ear infections / glue ear
432
When do you restart COCP after emergency contraception with levonorgestrel?
Immediately
433
Total dose for syringe driver?
Total in a day / 2
434
Can nitrofurantoin be used in CKD?
NOT CKD 3 Needs to be concentrated in urine to work therefore likely to fail if CKD 3
435
Hand preference when is it normal?
After 1 year If before - abnormal - refer to paeds
436
TFTS: Graves
TSH: low T4: high
437
TSH: low T4: high
Graves
438
TFTS: Primary hypothyroidism
TSH: high T4: low
439
TSH: high T4: low
TFTS: Primary hypothyroidism
440
TFTS: Secondary hypothyroidism
TSH: low T4: low
441
TSH: low T4: low
TFTS: Secondary hypothyroidism
442
TFTS: Sick euthyroid
TSH: low/Normal T4: low (predominance for T3) No symptoms
443
TSH: low/Normal T4: low (predominance for T3) No symptoms
TFTS: Sick euthyroid
444
TFTS: Subclinical
TSH: high T4: normal
445
TSH: high T4: normal
TFTS: Subclinical OR poor compliance
446
TFTS: Poor compliance
TSH: high T4: Normal
447
TFTs: Steroid Rx
TSH: low T4: Normal
448
TSH: low T4: Normal
TFTs: Steroid Rx
449
Most common cause nephrotic syndrome in young adults / children
Minimal change disease
450
SE cabergoline
Pulmonary fibrosis
451
What vitamin should breastfeeding women take?
Vit D
452
White PV discharge in babies up to 3 months
Normal
453
Peripheral artery disease, what drugs should they be on?
Clopidogrel Atorvastatin
454
Rx scarlet fever
Penicillin V (phenoxymethylpenicillin)
455
Contact with rat urine Farmers Fever, viral type symptoms Later renal/liver failure Subconjunctival haemorrhages
Leptospirosis
456
Most important factor for liver transplant
Arterial pH <7.3
457
Otitis externa Rx
Corticosteroid and aminoglycoside drop
458
Hordeola Externam
Stye
459
Homonymous hemianopia How do you work out the lesion
PITS Parietal inferior Temporal superior
460
PITS Parietal inferior Temporal superior
Homonymous hemianopia How do you work out the lesion
461
BROCA lesion location
Frontal (near mouth)
462
Wernickes
Temporal lobe (near ear)
463
What is given before fibroid surgery
GnRH analogues Levoproline
464
When does progesterone peak?
Luteal phase
465
AST:ALT 2:1
Alcohol
466
What sort of line is TPN given through
Subclavian
467
COCP MISSED PILLS 1x pill missed
Take 2 pills in one day No contraception needed
468
COCP MISSED PILLS 2x missed in week one
Take an extra missed pill (2/day) Barrier for 7 days Consider emergency contraception if had sex
469
COCP MISSED PILLS 2x missed in week two
Take an extra missed pill (2/day) Barrier for 7 days No emergency needed
470
COCP MISSED PILLS 2x missed in week 3
Take an extra missed pill (2/day) Barrier for 7 days Omit the pill free interval
471
What to monitor in haemochromatosis
TF sat Ferritin
472
Severe Cdif Rx
Oral vanc and IV metronidazole
473
ER +ve Rx
Postmenopausal - anastrozole Premenopausal - tamoxifen
474
DRUG MONITORING ACE
U+Es
475
DRUG MONITORING Amiodarone
TFTs LFTs
476
DRUG MONITORING Methotrexate
FBC LFT U+Es
477
DRUG MONITORING Azathioprine
FBC LFT
478
DRUG MONITORING Lithium
Levels TFTs U+Es
479
DRUG MONITORING Sodium Valproate
LFTs
480
DRUG MONITORING Glitazones/thiazolidinediones Pioglitazone
LFTs
481
Hypokalaemia ECG signs
U have no T but a long PR and QT U waves Absent T waves Long PR ST depression Long QT
482
U have no T but a long PR and QT U waves Absent T waves Long PR ST depression Long QT
Hypokalaemia ECG signs
483
If has vasomotor but doesn't want HRT
Fluoxetine
484
Referral for BRCA gene testing
FHx <40 B/L breast Ca Male Ovarian Ca Jewish ancestry Sarcoma <45 Glioma/childhood adrenal carcinoma Multiple cancers at young age 2x breast Ca on dads side
485
FHx <40 B/L breast Ca Male Ovarian Ca Jewish ancestry Sarcoma <45 Glioma/childhood adrenal carcinoma Multiple cancers at young age 2x breast Ca on dads side
Referral for BRCA gene testing
486
Rx and Mx bleeding in pregnancy
Anti D Kleihaur (works out the amount of fetal cells in maternal circulation and whether more anti D is needed)
487
N+V and red eye
Acute angle closure glaucoma
488
Traveller with orchitis Rx
Cef IM and 10-14 doxy
489
Perthes onset
4-8yo
490
What is erysipelas
Infection of the upper dermis Commonly caused by strep pyogenes
491
What often precedes orbital cellulitis
Ethmoidal sinus infection (thin membrane)
492
Domperidone doesnt what
Cross BBB
493
Near immediate rejection of transplant?
ABO/HLA incompatibility
494
6months+ and rejection of the transplant?
T cell mediated
495
Statins + macrolides cause what?
Rhabdomyolysis
496
Rhabdomyolysis is caused by what drug combination?
Statins + macrolides
497
HHV7 Viral infection precedes
Pityriasis rosea
498
Pityriasis rosea cause
HHV7
499
What cancer is associated with coeliacs
Enteropathy associated T cell lymphoma
500
Cervical smear when?
25-49 3 yearly 50-64 5 yearly
501
Hydroxychloroquine serious side effect
Retinopathy
502
Well demarcated waxy atrophic patches on the anterior shin
Necrobiosis lipoidica Associated with DM
503
Late sign in cauda equina
Urinary incontinence
504
CONTACEPTIVE MOA COC
Inhibits ovulation
505
CONTACEPTIVE MOA Desogestrel
Inhibits ovulation
506
CONTACEPTIVE MOA Implantable
Inhibits ovulation
507
CONTACEPTIVE MOA IUS
Decreases endometrial proliferation
508
CONTACEPTIVE MOA IUD
Sperm motility and survival
509
CONTACEPTIVE MOA POP
Thickens cervical mucous
510
Thickens cervical mucous
POP
511
Decreases sperm motility and survival
IUD
512
Prevents endometrial proliferation
IUS
513
Inhibits ovulation
COCP Desogestrel Implantable
514
Drugs causing erythema nodosum Hint: Painful Coloured Skin
Penicillins COCP Sulfonamides
515
Erythema nodosum causes SORE SHINS
Strep OCP Rickettsia Eponymous Behcets Sulfonamides Hansens disease (leprosy) IBD NHL Sarcoid
516
Rx glandular fever
Self limiting
517
Myopic
Small pupils OPIUM
518
Mydriatic
Those pupils are actually huge
519
Second line Rx BV
Topical clindamycin 1st line metronidazole
520
BV cause
Gardenella vaginalis
521
ANTIPLATELET SUMMARY ACS
DAPT 1 year, aspirin lifelong
522
ANTIPLATELET SUMMARY TIA/STROKE/PAD
Clopidogrel lifelong
523
Acute limb ischaemia Rx
IV unfractionated heparin
524
Ovarian cyst, <5cm <35
Repeat US in 8 / 12 / 52 weeks
525
Ovarian cyst, PM
Refer gynae
526
Drug Rx PTSD
Venlafaxine / SSRI
527
Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine
Drugs causing tinnitus
528
Drugs causing tinnitus
Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine
529
SSRIs in pregnancy?
Try to avoid
530
What is telogen effluvium
Hair loss in response to stress
531
Low BP, increased JVP, muffled heart sounds
Becks triad Seen in tamponade
532
Becks triad Seen in tamponade
Low BP, increased JVP, muffled heart sounds
533
Seen in priests, swelling of knee
Infrapatellar bursitis
534
AF < 48 hours and systemically well
Admit for electrical cardioversion
535
AF >48 hours
TOE vs 3 weeks anticoagulation and cardioversion, with anticoagulation for 4 weeks after (ADD AMIODARONE/SOTALOL IF HIGH CHANCE FAILURE)
536
Cushings triad
Bradycardia Wide pulse pressure/HTN Irregular breathing
537
Bradycardia Wide pulse pressure/HTN Irregular breathing
Cushings triad
538
Promotes hyperuricaemia by increasing uric acid absorption in the proximal tubule
Furosemide Can cause gout
539
VareNICline MOA Aids smoking cessation
Partial nicotinic agonist
540
Buproprion MOA Aids smoking cessation
NA and dopamine reuptake inhibitor and nicotinic antagonist
541
Cannot have IUS if what
Fibroids
542
HPV+ve after 2x HPV and NORMAL cytology
Colposcopy
543
Anastrozole causes
Osteoporosis
544
Consider what if HF not responding to to diuresis
CPAP
545
Highly contagious conjunctivitis
Adenovirus
546
Staph aureus food poisoning is what
Rapid onset
547
What is secondary amenorrhoea
Pelvic problems
548
Plasma paracetamol levels <4 hours are what
Not reliable
549
After how long before plasma paracetamol levels can be done
4 hours post ingestion
550
COPD severity levels FEV1
Mild >80 Mod 50-80 Severe 30-50 Very severe <30
551
Carbemazepine cyp inducer or inhibitor
Induces
552
How many tear degrees?
4 1 - mucosa 2 - muscle 3 - anal complex 4 - anal epithelium
553
Triptan and SSRI
NONONONONON NOOOOOOO
554
How to tell between capilliary haemangioma and port wine stain
Capilliary haemangiomas get bigger then resolve
555
Which part of the bone do osteosarcomas occur
Metaphysis
556
Does transdermal HRT increase VTE risk
No
557
How many total doses of tetanus
5
558
Omeprazole and clopidogrel, what happens
Reduced effectiveness
559
Prolactinoma causes PPPPPP
Pregnancy Prolactinoma Prochlorperazine, metoclopramide, domperidone Physiological PCOS Primary hypothyroidism
560
How long does methotrexate need to be stopped for before trying to conceive? And who?
6 months Both male and female
561
Kawasaki Rx
High dose aspirin (even though aspirin normally contraindicated)
562
How to tell between viral labyrinthitis and vestibular neuronitis?
Viral labyrinthitis - hearing loss and dizziness Vestibular neuronitis - dizziness
563
Isoniazid and rifampicin, inhibit or induce cyp?
Isoniazid inhibits Rifampicin Raises
564
Actinic keratosis Rx
5FU
565
Atorvastatin primary vs secondary prevention doses
Prim - 20mg Sec - 80mg
566
HBSAg
Acute or chonic disease
567
AntiHBS
Immunity
568
HBeAg
Infectivity
569
AntiHBc
Prev or current infection depending on M vs G
570
Most common cause meningitis in neonates
GBS
571
Fever, rash, arthritis, raised eosinophils
AIN
572
Thrombopheblitis of saphenous
US doppler, even before D DIMER or if Wells negative
573
Opiate of choice for neuropathic pain
Tramadol
574
Problem with bupropion
Reduces seizure threshold
575
Imagery of choice for achilles rupture
US
576
Colorectal screening, which ages
FIT 2yrly 60-74 England 50-74 in Scotland
577
Corticosteroids in dark skin
Causes depigmentation
578
Pseudopolyps IBD
UC
579
Oral rotavirus, what type of vaccine
Oral Live attenuated Given at 2 months + 3 months
580
Oral rotavirus, when cant it be given
1st dose after 15 weeks, second dose after 24 weeks - increased risk of intussiception
581
Achilles tendonitis Rx
Rest >7 days - physio
582
Drug induced lupus antibody
Antihistone
583
Antihistone antibody
Drug induced lupus antibody
584
Akylosing spondylitis AAAAAA
Apical fibosis Anterior uveitis Aortic regurg Amyloidosis Achilles tendonitis AV node block
585
Apical fibosis Anterior uveitis Aortic regurg Amyloidosis Achilles tendonitis AV node block
Ankylosing spondylitis
586
Sebacious cyst needs
Needs surgery to fully cut out otherwise comes back with a VENGEANCE
587
Should you give metoclopramide in BO?
NEVER Worsens and can cause perforation
588
What increases BNP?
LVH Ischaemia Tachycardia COPD GFR reduced RV overload Sepsis DM Age >70 Cirrhosis
589
LVH Ischaemia Tachycardia COPD GFR reduced RV overload Sepsis DM Age >70 Cirrhosis
Increases BNP
590
What reduces BNP
Obesity Diuretics ACEi BBlockers ARB Aldosterone antagonists
591
Obesity Diuretics ACEi BBlockers ARB Aldosterone antagonists
Reduce BNP
592
OA Xray findings
LESS Loss of joint space Erosions Subchondral sclerosis Subchondral cysts
593
LESS Loss of joint space Erosions Subchondral sclerosis Subchondral cysts
OA Xray findings
594
On examination, there is a full range of movement of the knee. There is sharp pain on palpation over the lateral epicondyle of the femur, particularly with the knee at 30 degrees of flexion.
Iliotibial band syndrome
595
alternation of QRS complex amplitude between beats
Electrical alternans Cardiac tamponade
596
alternation of QRS complex amplitude between beats
Electrical alternans Cardiac tamponade
597
form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis
Weber's syndrome
598
form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis
Weber's syndrome
599
This presents with ipsilateral facial pain and temperature loss. Along with contralateral limb/ torso pain, ataxia and nystagmus.
Lateral medullary syndrome, wallenburgs
600
Facial paralysis and deafness are common findings on the same side as the infarction. This is accompanied by contralateral weakness.
Lateral pontine syndrome. This is a stroke affecting the pons meaning the cranial nerve nuclei arising from the pons are affected here.
601
Facial paralysis and deafness are common findings on the same side as the infarction. This is accompanied by contralateral weakness.
Lateral pontine syndrome. This is a stroke affecting the pons meaning the cranial nerve nuclei arising from the pons are affected here.
602
Dermatophyte nail infections Rx
Oral terbinafine
603
Gliptin MOA
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
604
When is the peak incidence of seizures following alcohol withdrawal?
Alcohol withdrawal symptoms: 6-12 hours seizures: 36 hours delirium tremens: 72 hours
605
Gingival hyperplasia drugs
Gingival hyperplasia: phenytoin, ciclosporin, calcium channel blockers and AML
606
Classic triad of sensorineural deafness, eye abnormalities and congenital heart disease. Caused by what infection?
Rubella - congenital rubella syndrome
607
Triad of congenital rubella syndrome
classic triad of sensorineural deafness, eye abnormalities and congenital heart disease
608
Triad of congenital rubella syndrome
classic triad of sensorineural deafness, eye abnormalities and congenital heart disease
609
Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level
Non-seminomatous testicular cancer
610
A 71-year-old woman is diagnosed with polymyalgia rheumatica. She is started on prednisolone 15mg od. What is the most appropriate approach to bone protection?
Bone protection for patients who are going to take long-term steroids should start immediately
611
A 38-year-old woman presents with a litany of symptoms that have been ongoing for the past four months. These include weight gain, which particularly bothers her around the abdomen, with troubling purplish stretch marks, thin skin and easy bruising. She has been noticing increased swelling in her ankles and poor mood. In the diagnostic work-up, a range of laboratory tests is taken. What is the expected electrolyte abnormality in this patient?
hypokalaemic metabolic alkalosis This patient has Cushing's syndrome, a disease characterised by cortisol excess. Most commonly, it is related to exogenous glucocorticoid therapy but may also stem from autonomous overproduction by the adrenal glands or increased production of adrenocorticotrophic hormone. Cortisol at high levels can simulate the effects of aldosterone. There is increased sodium and subsequently water retention and increased potassium excretion, resulting in hypokalaemia. Bicarbonate resorption is increased in the tubules with potassium depletion causing metabolic alkalosis. Due to the potassium excretion, there is a hypokalaemic metabolic alkalosis
612
A 59-year-old man is diagnosed with Parkinson's disease after being referred with a tremor and bradykinesia. His symptoms are now affecting his ability to work as an accountant and are having a general impact on the quality of his life. What treatment is he most likely to be offered initially?
Levodopa should be offered for patients with newly diagnosed Parkinson's who have motor symptoms affecting their quality of life
613
614
Eye drops causes brown pigmentation
Latanoprost and brown pigmentation= Latina-prost
615
Thyroid storm treatment
In thyroid storm with IV beta-blockers are a important first-line treatment Beta B4 alpha
616
What is the most significant risk of prescribing an oestrogen-only preparation rather than a combined oestrogen-progestogen preparation?
Endometrial cancer
617
Electrolyte abnormality Cushing
Cushing's syndrome - hypokalaemic metabolic alkalosis
618
What is the most common cause of childhood hypothyroidism in the United Kingdom?
Autoimmune thyroiditis
619
How long stop COCP before surgery?
Advise women to stop taking their COCP/HRT 4 weeks before surgery
620
Anterior uveitis Rx
Anterior uveitis is most likely to be treated with a steroid + cycloplegic (mydriatic) drops
621
MRI shows: Normal alignment and segmentation. There is a small left para-central L4/5 disc prolapse causing compression of the transiting L5 nerve root. There is no compression of the cauda equina with CSF visible around all nerve roots. All other discs are normal and there are no bony abnormalities visible. What do you do?
The duration of symptoms is less than 4 weeks and conservative management has not been attempted yet so this should be the first-line management at this point in time. This comprises a trial of NSAIDs and physiotherapy. Approximately 90% of cases of sciatica settle within 3 months with conservative management and it is rare to actually need a referral to specialist services.
622
Rx salmonella
Cipro
623
Folic acid, diabetes
She should be taking folic acid 5mg once a day 3 months before conception to 12 weeks of pregnancy. Women with diabetes are considered at high risk of conceiving a child with neural tube defects
624
P450 Induce SCARS
Smoking Chronic alcohol AED (except Sodium valproate) Rifampacin St Johns Wort
625
Inhibit p450 ASSzoles
Inhibit ASSzoles ABx (exc Rifampicin) Sodium Valproate SSRIs omeprazole, ketoconazole, fluconazole
626
Colchicine SE
Diarrhoea
627
Down's syndrome HCG, PAPP-A, nuchal translucency
Memory technique: In Down's the papa leaves (the others are high)
628
SCREENING for polycystic kidneys
US
629
630
Which contraceptives are unaffected by epilepsy drugs?
Examples of contraceptives that are unaffected by EIDs are: Copper intrauterine device Progesterone injection (Depo-provera) Mirena intrauterine system
631
Bladder cancer, which antidiabetic is contraindicated?
Pioglitazone
632
Rx chlamidya in pregnancy
Azithromycin, erythromycin or amoxicillin may be used to treat Chlamydia in pregnancy
633
Which one contraceptive does the Faculty of Sexual and Reproductive Healthcare (FSRH) recommend should be discontinued after the age of 50 year
Injectible progesterone
634
Nsaids and lithium, what about em?
Lithium toxicity can be precipitated by NSAIDs
635
Methotrexate Sulfasalazine Leflunomide Penicillamine and gold Infliximab Rheum side effects Clue = same letter
Methotrexate: Myelosuppression Sulfasalazine: Sperm low Leflunomide: Liver, Lung disease Penicillamine and Gold: Proteinuria Infliximab: Infection TB
636
Length of time for depressive episode
Over 2 weeks
637
What are glucose levels in Addison's?
Often see hypoglycaemia
638
Which ligament is most commonly sprained in inversion injuries of the ankle?
The anterior talofibular ligament is the most commonly sprained ligament in inversion injuries of the ankle
639
Which ligament is most commonly sprained in inversion injuries of the ankle?
The anterior talofibular ligament is the most commonly sprained ligament in inversion injuries of the ankle
640
Ventricular tachycardia - what drug is contraindicated
Ventricular tachycardia - verapamil is contraindicated
641
1st line frozen shoulder
Physio
642
Which side are congenital inguinal hernias more common on?
RIGHT
643
Huntingtin gene, what chromosome?
Huntington's disease is due to a defect in the huntingtin gene on chromosome 4
644
CKD bones
Osteoporosis
645
Boxers fracture
5th metacarpal
646
Abx of choice for otitis externa
1. cipro 2. fluclox/taz
647
ABx and POP
no interactions, continue as normal
648
MI drugs
DABS have dabs after an MI DuApTs - Asp / ticag ACE Bblocker Statin
649
Rose spots
Salmonella
650
more than 35 years old and smoking more than 15 cigarettes/day migraine with aura history of thromboembolic disease or thrombogenic mutation history of stroke or ischaemic heart disease breast feeding < 6 weeks post-partum uncontrolled hypertension current breast cancer major surgery with prolonged immobilisation positive antiphospholipid antibodies (e.g. in SLE)
Examples of UKMEC 4
651
Down and out
3rd nerve palsy
652
653
When should nocturnal enuresis stop?
Children under the age of 5 years who have nocturnal enuresis can be managed with reassurance and advice
654
Polycystic kidney heart disease
MVP Mitral regurg
655
C peptide levels T1DM
C-peptide levels are typically low in patients with T1DM
656
Urea breath test - how long after ABx
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
657
When do you check LFTs statins
2014 NICE guidelines recommend checking LFTs at baseline, 3 months and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range
658
Urea breath test - how long after PPI
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
659
Gastroschisis vs exomphalos
Whereas gastroschisis tends to be a stand alone bowel condition, exomphalos is associated with cardiac and kidney diseases
660
4 features of TOF
TOF is a result of anterior malalignment of the aorticopulmonary septum. The four characteristic features are: ventricular septal defect (VSD) right ventricular hypertrophy right ventricular outflow tract obstruction, pulmonary stenosis overriding aorta
661
662
Chocolate ovarian cyst
Endometriotic cyst
663
What electrolyte abnormality predisposes to digoxin toxicity
Hypokalaemia predisposes patients to digoxin toxicity
664
Wernicke's encephalopathy quadiad
Confusion, gait ataxia, nystagmus + ophthalmoplegia are features of Wernicke's encephalopathy
665
DVLA RULES HTN
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
666
Angioplasty DVLA rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
667
ACS driving rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
668
Catheter ablation driving rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
669
ACS driving rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
670
Angina driving rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
671
ICD driving rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
672
Heart transplant driving rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
673
Heart transplant driving rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
674
AAA driving rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
675
Catheter ablation driving rules
Specific rules hypertension can drive unless treatment causes unacceptable side effects, no need to notify DVLA if Group 2 Entitlement the disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more angioplasty (elective) - 1 week off driving CABG - 4 weeks off driving acute coronary syndrome- 4 weeks off driving 1 week if successfully treated by angioplasty angina - driving must cease if symptoms occur at rest/at the wheel pacemaker insertion - 1 week off driving implantable cardioverter-defibrillator (ICD) if implanted for sustained ventricular arrhythmia: cease driving for 6 months if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers successful catheter ablation for an arrhythmia- 2 days off driving aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted subject to annual review. an aortic diameter of 6.5 cm or more disqualifies patients from driving heart transplant: do not drive for 6 weeks, no need to notify DVLA
676
Secondary causes of bile acid malabsorption
Secondary causes are often seen in patients with ileal disease, such as with Crohn's. Other secondary causes include: cholecystectomy coeliac disease small intestinal bacterial overgrowth
677
Test for bile acid malabsorption
SeHCat test
678
What is bile acid malabsorption
Bile-acid malabsorption is a cause of chronic diarrhoea. This may be primary, due to excessive production of bile acid, or secondary to an underlying gastrointestinal disorder causing reduced bile acid absorption. It can lead to steatorrhoea and vitamin A, D, E, K malabsorption. Secondary - coeliac, cholecystectomy, SBBovergrowth
679
Treatment of bile acid malabsorption
Management bile acid sequestrants e.g. cholestyramine
680
M rule of PBC
Primary biliary cholangitis - the M rule IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females
681
Bilateral red swelling of the nasal septum - what do you do? RX? SEQUELAE?
Urgent ENT referral Features may be precipitated by relatively minor trauma the sensation of nasal obstruction is the most common symptom pain and rhinorrhoea are also seen on examination, classically a bilateral, red swelling arising from the nasal septum this may be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm Management surgical drainage intravenous antibiotics If untreated irreversible septal necrosis may develop within 3-4 days. This is thought to be due to pressure-related ischaemia of the cartilage resulting in necrosis. This may result in a 'saddle-nose' deformity
682
Investigation of choice for acromegaly
In the investigation of acromegaly, if a patient is shown to have raised IGF-1 levels, an oral glucose tolerance test (OGTT) with serial GH measurements is suggested to confirm the diagnosis
683
SBP cell count
>250
684
Epilepsy breast feeding
All drugs safe except barbiturates
685
Developmental milestones 3/6/9/12 HRCC 15/18/2/3/4 WSRTH
3, 6, 9, 12: Head → Roll → Crawl → Cruise. 15, 18, 2, 3, 4: Walk → Squat → Run → Trike → Hop.
686
Developmental milestones 3/6/9/12 HRCC 15/18/2/3/4 WSRTH
3, 6, 9, 12: Head → Roll → Crawl → Cruise. 15, 18, 2, 3, 4: Walk → Squat → Run → Trike → Hop.
687
3/6/9/12 HRCC 15/18/2/3/4 WSRTH
3, 6, 9, 12: Head → Roll → Crawl → Cruise. 15, 18, 2, 3, 4: Walk → Squat → Run → Trike → Hop.
688
3/6/9/12 HRCC 15/18/2/3/4 WSRTH
3, 6, 9, 12: Head → Roll → Crawl → Cruise. 15, 18, 2, 3, 4: Walk → Squat → Run → Trike → Hop.
689
Parkland formula, burn fluid formula
Volume of fluid = total body surface area of the burn % x weight (Kg) x 4ml
690
What is refractory anaphylaxis and how is it treated?
Adrenaline infusion Refractory anaphylaxis is defined as respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline
691
Allergic conjunctivitis management
first-line: topical or systemic antihistamines second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate
692
Red orange PEE and TB what med
Rifampicin
693
HF, a drug is given to a patient and their psoriasis worsens. What drug?
Beta blockers
694
Antiemetic of choice in migraine
Metoclopramide Slows transit of gastric contents
695
When do you treat stage one hypertension?
ABPM/HBPM >= 135/85 mmHg (i.e. stage 1 hypertension) treat if < 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater in 2019, NICE made a further recommendation, suggesting that we should 'consider antihypertensive drug treatment in addition to lifestyle advice for adults aged under 60 with stage 1 hypertension and an estimated 10-year risk below 10%. '. This seems to be due to evidence that QRISK may underestimate the lifetime probability of developing cardiovascular disease
696
When do you treat stage one hypertension?
ABPM/HBPM >= 135/85 mmHg (i.e. stage 1 hypertension) treat if < 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater in 2019, NICE made a further recommendation, suggesting that we should 'consider antihypertensive drug treatment in addition to lifestyle advice for adults aged under 60 with stage 1 hypertension and an estimated 10-year risk below 10%. '. This seems to be due to evidence that QRISK may underestimate the lifetime probability of developing cardiovascular disease
697
Gout is can be caused by what loop diuretic?
Furosemide
698
A 45-year-old man undergoes a renal transplant from a deceased donor due to renal failure. The on-call doctor is asked to review the patient 2 hours after the procedure. His observations show temperature of 40ºC, heart rate 114/min, respiratory rate 23/min, saturations of 97% in room air, blood pressure of 81/62mmHg. Considering the most likely diagnosis, what is the appropriate management for this patient?
No treatment is possible for hyperacute transplant rejection - the graft must be removed
699
Management of bilateral adrenal hyperplasia
Spiro Not adrenalectomy as it is bilateral
700
What do all these drugs have in common? drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
Worsen psoriasis drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
701
Which drugs worsen psoriasis
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
702
A 32-year-old man attends eye casualty following an eye injury to his right eye whilst playing squash. On examination of the right eye, there is blood in the anterior chamber, proptosis, a stiff eyelid, and a relative afferent pupillary defect. A diagnosis of orbital compartment syndrome is suspected. What is the most appropriate management?
Immediate canthotomy
703
Azathioprine and allopurinol, what happens?
Neutropenic sepsis if coprescribed
704
How long do symptoms need to be present for before diagnosing chronic fatigue syndrome
Chronic fatigue syndrome: the symptoms should be present for 3 months before making a diagnosis
705
The ECG performed on scene by the paramedics shows ST depression in V1-V3 with tall, broad R waves and upright T waves
Posterior MI
706
Stroke/Tia NO atrial fibrillation. Clopidogrel not tolerated. What Rx?
Aspirin instead
707
Hypercalcaemia ECG findings
Short qt
708
Normal anion gap metabolic acidosis
Normal anion gap ( = hyperchloraemic metabolic acidosis) gastrointestinal bicarbonate loss: prolonged diarrhoea: may also result in hypokalaemia ureterosigmoidostomy fistula renal tubular acidosis drugs: e.g. acetazolamide ammonium chloride injection Addison's disease
709
Normal anion gap ( = hyperchloraemic metabolic acidosis) gastrointestinal bicarbonate loss: prolonged diarrhoea: may also result in hypokalaemia ureterosigmoidostomy fistula renal tubular acidosis drugs: e.g. acetazolamide ammonium chloride injection Addison's disease
Normal anion gap metabolic acidosis
710
lactate: shock sepsis hypoxia ketones: diabetic ketoacidosis alcohol urate: renal failure acid poisoning: salicylates, methanol
Raised anion gap metabolic acidosis
711
Raised anion gap metabolic acidosis
Raised anion gap lactate: shock sepsis hypoxia ketones: diabetic ketoacidosis alcohol urate: renal failure acid poisoning: salicylates, methanol
712
Lactic acidosis type B
Metformin related
713
Cyst at the nail bed
Mxyoid cyst
714
Sensory loss over anterior thigh Weak hip flexion, knee extension and hip adduction Reduced knee reflex Positive femoral stretch test
L3 nerve root compression
715
Sensory loss anterior aspect of knee and medial malleolus Weak knee extension and hip adduction Reduced knee reflex Positive femoral stretch test
L4 nerve root compression
716
Sensory loss dorsum of foot Weakness in foot and big toe dorsiflexion Reflexes intact Positive sciatic nerve stretch test
L5 nerve root compression
717
Sensory loss posterolateral aspect of leg and lateral aspect of foot Weakness in plantar flexion of foot Reduced ankle reflex Positive sciatic nerve stretch test
S1 nerve root compression
718
Benzo MoA
Benzodiazepines enhance the effect of GABA, the main inhibitory neurotransmitter
719
Acute epiglottitis is caused by Haemophilus influenzae type
type B
720
Erythema chronicum migrans
lyme disease
721
Lyme disease rash
Erythema chronicum migrans
722
How to differentiate between IgA and post-strep glomerulonephritis IE recent cough and then haematuria
IgA - INstant Post-strep - haematuria 2 weeks later
723
724
Communicating hydroceles are common in newborn males, what do you do?
Communicating hydroceles are common in newborn males and often resolve spontaneously
725
Treatment for capillary haemangioma
Propranolol is the treatment of choice in capillary haemangiomas requiring intervention
726
When to offer ECV for breech
36 weeks nulliparous 37 weeks multiparity
727
Marfan's painless visual loss
Lens dislocation
728
BRCA2 associated with what male cancer
Prostate
729
AAA <3cm
No Action
730
AAA 3-4.4cm
12 monthly scans
731
AAA 4.5-5.4
3 monthly scan
732
AAA >5.5cm
2w referral for probable intervention
733
Impaired glucose tolerance definition
Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
734
A 38-year-old woman and her partner come to the GP surgery after failing to conceive their first child. After what period of time of regular sexual intercourse should you begin to investigate?
6 months if over 35
735
CKD diagnosis for stages 1 + 2 hinges on what?
Chronic kidney disease is only diagnosed in this situation if supporting tests such as urinalysis or renal ultrasound are abnormal
736
Clindamycin + clarithromycin can both cause C dif, but which is more associated with it?
C-Dif, ClinDamycin
737
Which raises INR, P450 inhibition or induction?
A raised INR is a result of inhibited liver enzymes
738
When can copper IUD be inserted for emergency contraception?
The copper intrauterine device can be inserted for emergency contraception within 5 days after the first unprotected sexual intercourse in a cycle, or within 5 days of the earliest estimated date of ovulation, whichever is later
739
Staggered doses of paracetamol, what do you do?
Immediate NAC
740
1st line threadworms
MEBENDAZOLE
741
Chest drain for secondary pneumothorax if what?
The correct answer for a secondary pneumothorax which is >2cm and/or the patient is breathless is a chest drain.
742
ABx in acute pancreatitis yes or na?
Antibiotics should not be offered routinely to patients with acute pancreatitis
743
Fatty liver on US, what test next?
Enhanced liver fibrosis blood test
744
benign condition most commonly seen in women. It is one of the differentials of a dilated pupil. Overview unilateral in 80% of cases dilated pupil once the pupil has constricted it remains small for an abnormally long time slowly reactive to accommodation but very poorly (if at all) to light Often absent knee reflex
Holmes adie
745
Flexural psoriasis Rx
Mild-mod corticosteroid NO VIT D ANALOGUE - THIS IS ONLY FOR EXTENSOR
746
747
Drug induced lupus causes
Most common causes procainamide hydralazine Less common causes isoniazid minocycline phenytoin
748
Most common causes procainamide hydralazine Less common causes isoniazid minocycline phenytoin
Drug induced lupus causes
749
Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago
no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity
750
Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago
if tetanus prone wound: reinforcing dose of vaccine high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin
751
If vaccination history is incomplete or unknown
reinforcing dose of vaccine, regardless of the wound severity for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin
752
What number of years is key to working out tetanus management with cuts?
10 years <10 - nil needed >10 - booster +/- immunoglobulin dependent on severity Unknown - booster and immunoglobulin
753
1st line legionella
Macrolides
754
Effect of rheumatoid factor negativity on rheumatoid arthritis
Less severe if RF -ve
755
Bacterial conjunctivitis treatment IF PREGNANT
topical fusidic acid
756
Anion gap equation
Na+K minus cl + bicarbonate
757
Anion gap raised if
>14
758
A 29-year-old man presents with a rash on his trunk. Around two weeks ago he describes developing a patch of 'eczema' on his torso the size of 50 pence piece. Around a week later a number of smaller, red patches started to appear as well
The earlier lesion represents a classical herald patch. This image demonstrates the 'fir tree' appearance often seen in patients with pityriasis rosea.
759
Light's Criteria
Light's Criteria for exudative effusion requires one of more of the following: Pleural fluid protein / Serum protein >0.5 Pleural fluid LDH / Serum LDH >0.6 Pleural fluid LDH > 2/3 * Serum LDH upper limit of normal Glucose is not used in Light's Criteria.
760
Cipro and epilepsy?
Ciprofloxacin lowers the seizure threshold
761
Check what else with rhabdo
Calcium and phosphate
762
Panic disorder RX
SSRIs are the most commonly used drug treatment in panic disorder
763
Reduced fetal movements, no heartbeat on doppler, >28 weeks
If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Doppler then an immediate ultrasound should be offered
764
Secondary dysmenorrhoea management
All patients with secondary dysmenorrhoea need to be referred to gynaecology for investigation
765
1ST LINE RX for regular broad complex tachycardias without adverse features
IV amiodarone is the first-line treatment for regular broad complex tachycardias without adverse features
766
Staggered paracetamol overdose definition
staggered overdose is defined as taking paracetamol over more than a 1 hour period
767
Bradycardia and shock Rx
Patients with bradycardia and signs of shock require 500micrograms of atropine (repeated up to max 3mg) Atropine 500mcg IV is the first-line treatment in this situation. If the patient does not respond, then up to 3mg of atropine can be given. If this fails as well, transcutaneous pacing can be considered.
768
Contraception after vasectomy?
Vasectomy isn't an immediate form of contraception; semen analysis must be performed and azoospermia confirmed before used as contraception
769
When can COCP be started after emergency contraception?
Hormonal contraception can be started immediately after using levonorgestrel (Levonelle) for emergency contraception
770
Most APPROPRIATE Ix in pt with bronchiectasis stable obs with creps and SOB
Sputum culture
771
Otitis externa with itchy ear and patient well
Topical antibiotic and steroid drops, not antifungal
772
A 39 year old woman presents with a 6 month history of amenorrhoea. She has schizophrenia. She denies sexual intercourse over the past 2 years and reports some episodes of lactation. Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are within normal limits, prolactin is 1125 (normal range < 500).
Adverse reaction to antipsychotics
773
A 14 year old boy presents with a one month history of bilateral nasal blockage, sneezing and a clear bilateral nasal discharge. The family have recently purchased a cat.
Itranasal beclometasone
774
A 28 year old man presents with a 1 day history of right-sided low back pain. On examination, he has a straight leg raise of 55° on the right side and 85° on the left side, with a bilateral negative sciatic stretch test. There is no bony tenderness and no neurological signs of note.
Self management advice > analgesia
775
Cardiac toxicity, which MAB?
Trastuzumab (Herceptin) - cardiac toxicity is common
776
Cholestasis with DM drug
Gliclazide (Sulphonylureas may cause cholestasis)
777
Contraindication to triptan
Cardiovascular disease is a contraindication to triptan use
778
Rx MND
Riluzole
779
Anti Phospholipase A2 antibodies may be positive ● Mainstay of management - ACEi/ARB - reduce proteinuria ● Most common cause of nephrotic syndrome in adults
Membranous nephropathy
780
Renal disease ● Causes: HIV, Heroin use, Alports ● High rate of recurrence
FSGS
781
Management IPF
Management: Nintedanib, pirfenidone.
782
CFs: Parkinsonism plus autonomic dysfunction, manifesting as ○ Falls due to postural hypotension ○ Impotence ○ Loss of bladder control/retention
MSA
783
● Autosomal dominant disorder ● CFs: Sudden cardiac death, syncope. More common in Asian ethnicities. ● ECG: Convex ST elevation in V1-3 followed by T wave inversion, RBBB. ○ ST changes increase with flecainide/ajmaline provocation
- Brugada syndrome
784
● CFs: Mononeuritis multiplex, livedo reticularis ● Invx: Commonly Hep B positive, p-ANCA
Polyarteritis nodosa
785
Anti-Mi-2, anti-SRP
Dermatomyositis
786
cANCA (PR3)
Granulomatosis with polyangiitis: cANCA (PR3)
787
pANCA (MPO)
Eosinophilic granulomatosis with polyangiitis: pANCA (MPO)
788
Anti-U1 ribonucleoprotein
Sharp’s syndrome (MCTD): Anti-U1 ribonucleoprotein
789
Anti-centromere antibodies
Limited cutaneous systemic sclerosis: Anti-centromere antibodies
790
Anti-SCL-70 antibodies
Diffuse cutaneous systemic sclerosis: Anti-SCL-70 antibodies
791
Mutation on Chr 17: o Café au lait spots o Axillary freckling o Peripheral neurofibromas o Phaeochromocytoma
NF1
792
Antithyroid Rx in pregnancy
PTU
793
Primary open-angle glaucoma: management Increases uveoscleral outflow Once daily administration Adverse effects include brown pigmentation of the iris, increased eyelash length
Prostaglandin analogues (e.g. latanoprost)
794
Primary open-angle glaucoma: management Reduces aqueous production Should be avoided in asthmatics and patients with heart block
Beta-blockers (e.g. timolol, betaxolol)
794
Primary open-angle glaucoma: management Reduces aqueous production and increases outflow Avoid if taking MAOI or tricyclic antidepressants Adverse effects include hyperaemia
Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)
795
Primary open-angle glaucoma: management Reduces aqueous production Systemic absorption may cause sulphonamide-like reactions
Carbonic anhydrase inhibitors (e.g. Dorzolamide)
796
Primary open-angle glaucoma: management Increases uveoscleral outflow Adverse effects included a constricted pupil, headache and blurred vision
Miotics (e.g. pilocarpine, a muscarinic receptor agonist)
796
Primary open-angle glaucoma: management 1st line Rx
NICE guidelines offer 360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg NICE 360° SLT can delay the need for eye drops and can reduce but does not remove the chance they will be needed at all a second 360° SLT procedure may be needed at a later date prostaglandin analogue (PGA) eyedrops should be used next-line NICE the next line of treatments includes: beta-blocker eye drops carbonic anhydrase inhibitor eye drops sympathomimetic eye drops surgery in the form of a trabeculectomy may be considered in refractory cases.
797
most common precipitating factors of DKA
infection, missed insulin doses and myocardial infarction.
798
Key points glucose > 11 mmol/l or known diabetes mellitus pH < 7.3 bicarbonate < 15 mmol/l ketones > 3 mmol/l or urine ketones ++ on dipstick
Diagnostic criteria for DKA
799
an intravenous infusion should be started at 0.1 unit/kg/hour once blood glucose is < 14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in addition to the 0.9% sodium chloride regime
DKA
800
Lead poisoning Rx
Dimercaprol, calcium edetate
801
Cyanide poisoning Rx
Hydroxocobalamin; also combination of amyl nitrite, sodium nitrite, and sodium thiosulfate
802
Pulmonary fibrosis, which parkinsons drug
cabergoline, dopamine agonist
803
Most common UK hepatitis
hepatitis C most common cause in Europe
804
Sleep disturbance, what HF medication?
Betablockers
805
how to tell cystic hygroma vs branchial cyst
Branchial - older patients, after cough cystic hygroma - babies
806
AEIOU dialysis indications
Acidosis (<7.1) Electrolyte abnormalities (K>6.5) Ingestion Overload Uraemia (pericarditis/encephalopathy)
807
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1 if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception* if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1 if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception* if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
808
COCP missed pills week 1 ?emergency contraception ?what to do
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
809
COCP missed pills week 2 ?emergency contraception ?what to do
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
810
COCP missed pills week 3 ?emergency contraception ?what to do
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
811
POP (apart from deso=cerazette) what is the timeframe that matters?
>3 hours Contraception only established after 48hr pills
812
What is the timeframe that matters for missed cerazette?
12 hours
813
electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia acute myocardial infarction myocarditis hypothermia subarachnoid haemorrhage
Long QT causes, predisposes to torsades
814
How to differentiate POAG and PCAG
OPEN - insideous, painless CLOSED - Sudden, Painful POAG may present insidiously and for this reason is often detected during routine optometry appointments. Features may include peripheral visual field loss - nasal scotomas progressing to 'tunnel vision' decreased visual acuity optic disc cupping
815
Anti HBC AND ANTI HBS
Immune due to natural infection If there's surface antigen: current infection If there's core antibody (anti-HBc): previous or current infection If there's surface antibody (anti-HBs): immunisation or infection So, remember that the vaccine only has the surface antigen (therefore you can only make anti-surface antibody). From there it's easy.
816
core antibody (anti-HBc)
If there's core antibody (anti-HBc): previous or current infection
817
infection may cause marked right iliac fossa pain mimicking appendicitis
campylobacter
818
Treating mild-to-moderate ulcerative colitis proctitis
topical (rectal) aminosalicylate: for distal colitis rectal mesalazine has been shown to be superior to rectal steroids and oral aminosalicylates if remission is not achieved within 4 weeks, add an oral aminosalicylate if remission still not achieved add topical or oral corticosteroid
819
Treating mild-to-moderate ulcerative colitis proctosigmoiditis and left-sided ulcerative colitis
topical (rectal) aminosalicylate if remission is not achieved within 4 weeks, add a high-dose oral aminosalicylate OR switch to a high-dose oral aminosalicylate and a topical corticosteroid if remission still not achieved stop topical treatments and offer an oral aminosalicylate and an oral corticosteroid
820
Treating mild-to-moderate ulcerative colitis extensive disease
topical (rectal) aminosalicylate and a high-dose oral aminosalicylate: if remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid
821
Treating Severe ulcerative colitis
should be treated in hospital IV steroids are usually given first-line IV ciclosporin may be used if steroids are contraindicated if after 72 hours there has been no improvement, consider adding IV ciclosporin to IV corticosteroids or consider surgery
822
Cervical cancer screening: if smear inadequate
Cervical cancer screening: if smear inadequate then repeat in 3 months
823

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