Medicine Flashcards
(254 cards)
1
Q
What is Idiopathic Pulmonary Fibrosis (IPF)?
A
A chronic lung condition characterized by progressive fibrosis of the interstitium of the lungs
2
Q
What is the typical age range for patients diagnosed with IPF?
A
50-70 years old
3
Q
Is IPF more common in men or women?
A
Twice as common in men
4
Q
List the key features of IPF.
A
- Progressive exertional dyspnea
- Bibasal fine end-inspiratory crepitations
- Dry cough
- Clubbing
- Non-smoker
5
Q
What does spirometry show in IPF patients?
A
Restrictive picture (normal/↓ FEV1, ↓ FVC, ↑ FEV1/FVC)
6
Q
What does a chest X-ray (CXR) show in IPF?
A
Bilateral interstitial shadowing (small, irregular, peripheral opacities – ‘ground-glass’ – late progressing to ‘honeycombing’)
7
Q
What is the investigation of choice for diagnosing IPF?
A
High resolution CT
8
Q
What is the average life expectancy for someone with IPF?
A
Approximately 3-4 years
9
Q
What is the most common inherited bleeding disorder?
A
Von Willebrand’s Disease
10
Q
What inheritance pattern does Von Willebrand’s Disease follow?
A
Autosomal dominant
11
Q
What role does von Willebrand factor play in the body?
A
- Promotes platelet adhesion to damaged endothelium
- Carrier molecule for factor VIII
12
Q
What are the types of Von Willebrand’s Disease?
A
- Type 1: Partial reduction in vWF (80% of patients)
- Type 2: Abnormal form of vWF
- Type 3: Total lack of vWF (autosomal recessive)
13
Q
List common manifestations of Von Willebrand’s Disease.
A
- Epistaxis
- Oral cavity bleeding
- Excessive bleeding from minor wounds
- Excessive post-op bleeding
- Menorrhagia
- Postpartum hemorrhage
14
Q
What is a characteristic feature of autoimmune hepatitis?
A
Condition of unknown etiology commonly seen in young females
15
Q
What are the recognized associations of autoimmune hepatitis?
A
- Other autoimmune disorders
- Hypergammaglobulinemia
- HLA B8, DR3
16
Q
What are the types of autoimmune hepatitis based on circulating antibodies?
A
- Type I: Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)
- Type II: Anti-liver/kidney microsomal type 1 antibodies (LKM1)
- Type III: Soluble liver-kidney antigen
17
Q
What are the features of autoimmune hepatitis?
A
- Signs of chronic liver disease
- Acute hepatitis: fever, jaundice
- Amenorrhea
- Deranged LFTs
- Liver biopsy: Inflammation extending beyond limiting plate
18
Q
What is the first-line treatment for acute heart failure?
A
IV loop diuretics (furosemide, bumetanide)
19
Q
What should be avoided in the treatment of acute heart failure?
A
Routine use of nitrates
20
Q
What is an important management step for patients with respiratory failure in acute heart failure?
A
CPAP
21
Q
What is Mycoplasma pneumoniae associated with?
A
Atypical pneumonia often affecting younger patients
22
Q
What are the complications of Mycoplasma pneumoniae?
A
- Cold agglutinins (IgM)
- Erythema multiforme
- Meningoencephalitis
- Bullous myringitis
- Pericarditis/myocarditis
23
Q
What is the most common inherited cause of kidney disease?
A
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
24
Q
What are the two disease loci identified in ADPKD?
A
- PKD 1
- PKD 2
25
What is the screening investigation for relatives of ADPKD patients?
Abdominal ultrasound
26
What is the first-line treatment for diabetic neuropathy?
Amitriptyline, duloxetine, gabapentin, pregabalin
27
What are common features of Systemic Lupus Erythematosus (SLE)?
* Fatigue
* Fever
* Mouth ulcers
* Lymphadenopathy
28
What is shingles caused by?
Reactivation of the varicella-zoster virus (VZV)
29
What are the key features of shingles?
* Prodromal period
* Burning pain over the affected dermatome
* Vesicular rash
30
What is the first-line treatment for shingles?
Antivirals (e.g., Famciclovir, valaciclovir)
31
What are the key features of osteoarthritis of the knee?
* Age > 50
* Overweight
* Severe pain
* Intermittent swelling
* Limitation of movement
32
What is Polymyalgia Rheumatica (PMR)?
A condition characterized by muscle stiffness and raised inflammatory markers in older people
33
What is the definitive diagnosis for sickle cell anemia?
Hemoglobin electrophoresis
34
What does sickle cell anemia result from?
Synthesis of an abnormal hemoglobin chain termed HbS
35
What are the symptoms of sickle cell anemia?
Symptoms typically develop at 4-6 months when HbSS molecules take over from fetal hemoglobin
36
What causes RBCs to sickle in sickle cell disease?
S molecules polymerise
37
At what pO2 do HbAS patients typically sickle?
2.5 – 4 kPa
38
At what pO2 do HbSS patients typically sickle?
5 – 6 kPa
39
What complications do sickle cells cause?
Fragility, hemolysis, blocking small blood vessels, and causing infarction
40
What is the definitive diagnosis for sickle cell disease?
Hemoglobin electrophoresis
41
What is recurrent priapism?
Painful prolonged erection of the penis
42
What defines traveller’s diarrhea?
At least 3 loose to watery stools in 24 hours with or without abdominal cramps, fever, nausea, vomiting, or blood in the stool
43
What is the most common cause of traveller’s diarrhea?
Escherichia coli
44
What describes acute food poisoning?
Sudden onset of nausea, vomiting, and diarrhea after ingestion of a toxin
45
Which bacteria typically cause acute food poisoning?
* Staphylococcus aureus
* Bacillus cereus
* Clostridium perfringens
46
What is the incubation period for Staphylococcus aureus and Bacillus cereus?
1-6 hours
47
What is the typical presentation of Escherichia coli in gastroenteritis?
Watery stools, abdominal cramps, nausea
48
What symptoms are associated with cholera?
Profuse, watery diarrhea and severe dehydration
49
What are the key symptoms of Shigella infection?
Bloody diarrhea, vomiting, abdominal pain
50
What is the incubation period for Shigella and Campylobacter?
48-72 hours
51
What are the symptoms of tuberculosis?
Fever, night sweats, anorexia, weight loss
52
What are the symptoms of pulmonary embolism?
Pleuritic chest pain, tachycardia, tachypnea
53
What is the typical history associated with aspergilloma?
Past history of tuberculosis
54
What is gout?
A form of inflammatory arthritis
55
What is the typical duration of acute gout episodes?
Lasting several days
56
What is the main feature of gout?
* Pain
* Swelling
* Erythema
57
What uric acid level supports a diagnosis of gout?
≥ 360 umol/L
58
What does synovial fluid analysis reveal in gout?
Needle shaped negatively birefringent monosodium urate crystals
59
What is the first line management for acute gout?
NSAIDs or colchicine
60
What is the first line urate-lowering therapy for gout?
Allopurinol
61
What lifestyle modifications are recommended for gout?
* Reduce alcohol intake
* Lose weight if obese
* Avoid high purine foods
62
What does ROME stand for in arterial blood gas interpretation?
Respiratory = Opposite, Metabolic = Equal
63
What is the first line treatment for chronic plaque psoriasis?
Potent corticosteroid + vitamin D analogue
64
What is hyperhidrosis?
Excessive production of sweat
65
What is the first line management for hyperhidrosis?
Topical aluminium chloride preparations
66
What is urinary incontinence (UI)?
A common problem affecting 4-5% of the population
67
What are the risk factors for urinary incontinence?
* Advancing age
* Previous pregnancy and childbirth
* High BMI
* Hysterectomy
* Family history
68
What are the types of urinary incontinence?
* Overactive bladder (OAB)/ Urge incontinence
* Stress incontinence
* Mixed incontinence
* Overflow incontinence
* Functional incontinence
69
What is the initial investigation for urinary incontinence?
Bladder diaries
70
What is the management approach for urge incontinence?
Bladder retraining, antimuscarinics, pelvic floor muscle training, surgical options
## Footnote
Antimuscarinics include Oxybutynin and Tolterodine.
71
What are the first-line medications for urge incontinence?
Antimuscarinics: Oxybutynin, Tolterodine, Darifenacin
## Footnote
Mirabegron may be used in frail elderly patients.
72
What is the recommended duration for pelvic floor muscle training?
At least 3 months, with contractions performed 3 times per day
## Footnote
Minimum of 8 contractions each session.
73
What is the first-line treatment for chronic heart failure?
An ACE inhibitor and a beta blocker
## Footnote
One drug should be started at a time.
74
Which medications are considered second-line for chronic heart failure?
Aldosterone antagonists: Spironolactone, Eplerenone
## Footnote
Potassium levels should be monitored due to the risk of hyperkalemia.
75
What are the criteria for using Ivabradine in heart failure management?
Sinus rhythm > 75/min and LVEF < 35%
## Footnote
LVEF stands for Left Ventricular Ejection Fraction.
76
What is the main feature of temporal arteritis?
Vasculitis affecting medium and large-sized vessels
## Footnote
Also known as giant cell arteritis (GCA).
77
What is the first-line treatment for temporal arteritis?
High-dose prednisolone
## Footnote
Treatment should start promptly upon suspicion.
78
What are the common symptoms of sarcoidosis?
Dyspnea, non-productive cough, malaise, weight loss
## Footnote
Acute features include erythema nodosum and bilateral hilar lymphadenopathy.
79
What antibodies are associated with limited cutaneous systemic sclerosis?
Anti-centromere antibodies
## Footnote
CREST syndrome is a subtype of limited cutaneous systemic sclerosis.
80
What are the key features of Bell's palsy?
Acute unilateral facial nerve paralysis, post-auricular pain, altered taste
## Footnote
More common in pregnant women.
81
What is the typical treatment for Bell's palsy?
Prednisolone within 72 hours of onset
## Footnote
Antivirals may be added for severe cases.
82
What are the clinical features of aortic stenosis?
Chest pain, dyspnea, syncope, ejection systolic murmur
## Footnote
Murmur radiates to the carotids and decreases with Valsalva maneuver.
83
What is the most common cause of aortic stenosis in patients over 65?
Degenerative calcification
## Footnote
Bicuspid aortic valve is common in younger patients.
84
What is the hallmark rash of Lyme disease?
Erythema migrans, a 'bulls-eye' rash
## Footnote
Typically appears 1-4 weeks after a tick bite.
85
What is the first-line test for suspected Lyme disease?
Enzyme-linked immunosorbent assay (ELISA)
## Footnote
If negative, repeat ELISA after 4-6 weeks.
86
What should be done for suspected bacterial meningitis in a pre-hospital setting?
Administer IM benzylpenicillin if meningococcal disease is suspected
## Footnote
This should not delay transit to the hospital.
87
What investigations should be performed in suspected bacterial meningitis?
FBC, U&E, CRP, glucose, lactate, clotting profile
## Footnote
If lumbar puncture is performed, test CSF for glucose, protein, and cultures.
88
What are the signs that indicate severe sepsis or rapidly evolving rash?
Sepsis or rapidly evolving rash, severe respiratory or cardiac compromise, significant bleeding risk, signs of raised intracranial pressure, focal neurological signs, papilledema, continuous or uncontrolled seizures, GCS ≤ 12
## Footnote
GCS refers to the Glasgow Coma Scale, a neurological scale that aims to provide a reliable, objective way of recording the conscious state of a person.
89
What investigations should be performed if a lumbar puncture (LP) has been performed?
CSF should be tested for:
* Glucose
* Protein
* Microscopy and culture
* Lactate
* Meningococcal and pneumococcal PCR
* Enteroviral, herpes simplex and varicella-zoster PCR
* Consider investigation for TB meningitis
## Footnote
These tests help in diagnosing various types of meningitis and other CNS infections.
90
What is the initial empirical therapy for patients aged < 3 months with suspected bacterial meningitis?
IV cefotaxime + amoxicillin (or ampicillin)
## Footnote
This combination is used to cover a broad range of potential pathogens.
91
What is the management strategy for patients with signs of raised ICP?
IV access for bloods and blood cultures, LP if cannot be done within 1st hour, IV antibiotics, IV dexamethasone, CT scan not normally indicated, critical care input, secure airway + high flow oxygen, IV fluid resuscitation
## Footnote
Management may vary based on the severity and specific circumstances of the patient's condition.
92
What are the common causes of primary hypothyroidism?
Hashimoto’s thyroiditis, subacute thyroiditis, Riedel thyroiditis, drug therapy (lithium, amiodarone, anti-thyroid: carbimazole), dietary iodine deficiency
## Footnote
Hashimoto's thyroiditis is the most common cause and is an autoimmune condition.
93
What are the key features of acute pericarditis?
Pleuritic chest pain relieved by sitting forwards, non-productive cough, dyspnea, flu-like symptoms, pericardial rub
## Footnote
Symptoms may mimic those of myocardial infarction but differ in nature and response to position.
94
Which ECG changes are most specific for pericarditis?
PR depression
## Footnote
This is considered the most specific ECG marker for pericarditis.
95
What is the first-line treatment for acute idiopathic or viral pericarditis?
NSAIDs + Colchicine
## Footnote
This treatment is aimed at reducing inflammation and managing pain.
96
What defines the diagnosis of trigeminal neuralgia according to the International Headache Society?
A unilateral disorder characterized by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve
## Footnote
Pain is often triggered by light touch and can remit for variable periods.
97
What are the red flag symptoms for trigeminal neuralgia?
Sensory changes, deafness or other ear problems, history of skin or oral lesions, pain only in the ophthalmic division, optic neuritis, family history of multiple sclerosis, age of onset < 40
## Footnote
These symptoms may suggest an underlying serious condition requiring further investigation.
98
What is the management for patients with dyspepsia suspected of having cancer?
Urgent referral for endoscopy within 2 weeks for patients with dysphagia, upper abdominal mass consistent with stomach cancer, and patients > 55 y/o with weight loss and other symptoms
## Footnote
Early detection of gastrointestinal cancers can significantly improve prognosis.
99
What tests are used for the initial diagnosis of H. pylori infection?
Carbon-13 urea breath test, stool Helicobacter antigen test, laboratory-based serology
## Footnote
These tests help in confirming the presence of H. pylori, which is linked to peptic ulcers.
100
What is the first-line treatment regimen for H. pylori in patients without penicillin allergy?
PPI + amoxicillin + clarithromycin/metronidazole for 7 days
## Footnote
This combination targets the bacteria effectively and helps in reducing gastric acid.
101
What are the key features for diagnosing Irritable Bowel Syndrome (IBS)?
Abdominal pain AND/OR bloating AND/OR change in bowel habit
## Footnote
Positive diagnosis requires abdominal pain relieved by defecation or associated with altered bowel frequency.
102
What red flag features may indicate a more serious condition in patients with IBS?
Rectal bleeding, unexplained/unintentional weight loss, family history of bowel or ovarian cancer, onset after 60 y/o
## Footnote
These features warrant further investigation to rule out serious pathology.
103
What are the diagnostic criteria for Type 2 Diabetes Mellitus using plasma glucose?
Fasting glucose ≥ 7.0 mmol/l, random glucose ≥ 11.1 mmol/l (or after 75g OGTT)
## Footnote
Diagnosis must be confirmed on two separate occasions in asymptomatic patients.
104
What lifestyle changes are recommended for managing Type 2 Diabetes Mellitus?
High fibre diet, low glycemic index carbohydrates, low-fat dairy products, oily fish, control of saturated fats, target weight loss of 5-10%
## Footnote
These changes play a crucial role in managing blood glucose levels.
105
What is the first-line drug therapy for Type 2 Diabetes Mellitus?
Metformin
## Footnote
Metformin is preferred for its efficacy in lowering blood sugar levels and favorable safety profile.
106
What factors indicate the need for SGLT-2 inhibitors in Type 2 Diabetes Mellitus management?
High risk of developing CVD (QRISK ≥ 10%), established CVD, CHF
## Footnote
SGLT-2 inhibitors are beneficial in patients with cardiovascular risks.
107
What are the NICE criteria for using SGLT-2 inhibitors?
SGLT-2 inhibitors may be used if the patient has:
* High risk of developing CVD (QRISK ≥ 10%)
* Established CVD
* CHF
## Footnote
Metformin should be established and titrated up before introducing the SGLT-2 inhibitor.
108
When should further drug therapy be considered for HbA1c?
Further treatment is indicated if HbA1c rises to 58 mmol/mol (7.5%)
109
What are the options for 2nd line therapy in diabetes management?
Dual therapy options include:
* Metformin + DPP-4 inhibitor
* Metformin + pioglitazone
* Metformin + sulfonylurea
* Metformin + SGLT-2 inhibitor
110
What are the options for 3rd line therapy in diabetes management?
Options include:
* Metformin + DPP-4 inhibitor + sulfonylurea
* Metformin + pioglitazone + sulfonylurea
* Metformin + (pioglitazone/sulfonylurea/DPP-4 inhibitor) + SGLT-2
* Insulin-based treatment
111
What criteria must be met to consider GLP-1 mimetics in diabetes management?
Criteria include:
* BMI ≥ 35 with specific medical problems associated with obesity
* BMI < 35 where insulin therapy has significant implications
## Footnote
Only continue if there is a reduction of ≥ 11 mmol/mol (1.0%) in HbA1c and a weight loss of ≥ 3% of initial body weight in 6 months.
112
What are the classifications of blood product transfusion complications?
Transfusion complications may be classified into:
* Immunological
* Infective
* Transfusion-related acute lung injury (TRALI)
* Transfusion-associated circulatory overload (TACO)
* Other (e.g., hyperkalemia, iron overload, clotting)
113
What are the features and management of non-hemolytic febrile reactions?
Features: Fever, chills
Management: Slow or stop transfusion, administer paracetamol, monitor
114
What is the cause and management of anaphylaxis during a transfusion?
Cause: Patients with IgA deficiency who have anti-IgA antibodies
Management: Stop transfusion, administer IM adrenaline, provide ABC support (oxygen, fluids)
115
What are the characteristics of sick euthyroid syndrome?
Sick euthyroid syndrome is characterized by:
* Low T3/T4
* Normal TSH
* Changes are reversible upon recovery from systemic illness
116
How is obesity classified using BMI?
Classification of obesity based on BMI:
* Underweight: < 18.49
* Normal: 18.5 – 25
* Overweight: 25 – 30
* Obese class 1: 30 – 35
* Obese class 2: 35 – 40
* Obese class 3: > 40
117
What is the management approach for obesity?
Management consists of a stepwise approach:
* Conservative: Diet, exercise
* Medical: Orlistat, Liraglutide
* Surgical
118
What is Marfan's syndrome and its genetic cause?
Marfan's syndrome is an autosomal dominant connective tissue disorder caused by a defect in the FBN1 gene on chromosome 15.
119
What are the features of Marfan's syndrome?
Features include:
* Tall stature
* High arched palate
* Arachnodactyly
* Pectus excavatum
* Scoliosis of > 20 degrees
* Aortic dilatation
* Mitral valve prolapse
* Upwards lens dislocation
120
What are the components of alcoholic liver disease?
Alcoholic liver disease includes:
* Alcoholic fatty liver disease
* Alcoholic hepatitis
* Cirrhosis
121
What are common symptoms of Guillain-Barre syndrome?
Symptoms include:
* Progressive, symmetrical weakness of limbs
* Ascending weakness
* Diminished reflexes
* Normal sensation
122
What is the main feature of a common peroneal nerve lesion?
The most characteristic feature is foot drop.
123
What are the components of the CHA2DS2-VASc scoring system?
CHA2DS2-VASc is used to determine the need for anticoagulation in AF based on:
* Congestive heart failure
* Hypertension
* Age
* Diabetes
* Stroke
* Vascular disease
* Sex category
124
What ECG features are associated with hypokalemia?
ECG features include:
* U waves
* Small or absent T waves
* Prolonged PR interval
* ST depression
125
What is the management for severe hypokalemia?
Management includes IV replacement (3 x 1L 0.9% NaCl + 40mmol KCl)
126
What is the management for Addison's disease?
Management includes:
* Hydrocortisone for cortisol replacement
* Fludrocortisone for aldosterone replacement
* Doubling glucocorticoid dose during intercurrent illness
127
What are the first-line treatments for acute migraine?
First-line treatments include:
* PO triptan + NSAID
* PO triptan + paracetamol
* Nasal triptan for 12-17 year-olds
128
What is the Ranson criteria used for?
To assess the severity of acute pancreatitis
## Footnote
The Ranson criteria includes various clinical and laboratory parameters to predict mortality.
129
What are common ECG features of hypokalemia?
* U waves
* Small or absent T waves/T wave flattening
* Prolonged PR interval
* ST depression
## Footnote
Hypokalemia can predispose patients to digoxin toxicity, especially if on diuretics.
130
What is cataplexy?
A sudden and transient loss of muscular tone caused by strong emotion
## Footnote
It is commonly seen in patients with narcolepsy.
131
What disease is caused by Hemophilus ducreyi?
Chancroid
## Footnote
It presents with painful genital ulcers and unilateral inguinal lymph node enlargement.
132
What is the classic presentation of primary biliary cholangitis?
Itching in a middle-aged woman
## Footnote
It is a chronic liver disorder commonly associated with Sjogren’s syndrome.
133
What are the immunological markers for primary biliary cholangitis?
* Anti-mitochondrial antibodies (AMA) M2 subtype in 98% of patients
* Smooth muscle antibodies in 30% of patients
* Raised serum IgM
## Footnote
AMA is highly specific for this condition.
134
What is a common cause of atypical pneumonia?
Mycoplasma pneumoniae
## Footnote
It often affects younger patients and is associated with erythema multiforme.
135
What is the first-line management for essential tremor?
Propranolol
## Footnote
Primidone may also be used in some cases.
136
How is cerebral perfusion pressure (CPP) calculated?
CPP = Mean arterial pressure (MAP) – Intracranial pressure (ICP)
## Footnote
A rise in ICP can lead to a fall in CPP, resulting in cerebral ischemia.
137
What are the features of Henoch-Schonlein purpura (HSP)?
* Palpable purpuric rash over buttocks and extensor surfaces
* Abdominal pain
* Polyarthritis
## Footnote
HSP is an IgA mediated small vessel vasculitis often seen in children.
138
What is Section 2 of the Mental Health Act?
Admission for assessment for up to 28 days, not renewable
## Footnote
Requires an application by an Approved Mental Health Professional and two doctors.
139
What is the initial treatment for active tuberculosis?
* Rifampicin
* Isoniazid
* Pyrazinamide
* Ethambutol
## Footnote
This is part of the initial phase treatment lasting the first 2 months.
140
What characterizes alcoholic ketoacidosis?
A non-diabetic form of ketoacidosis occurring in malnourished alcoholics
## Footnote
It presents with metabolic acidosis and normal or low glucose concentration.
141
What are the features of anaphylaxis?
* Sudden onset of symptoms
* Airway problems (throat swelling)
* Breathing problems (wheeze, dyspnea)
* Circulation problems (hypotension, tachycardia)
## Footnote
Skin changes like generalized pruritus and rash are also common.
142
What is the first-line acute management for supraventricular tachycardia (SVT)?
* Vagal maneuvers
* Intravenous adenosine
## Footnote
Adenosine is given as a rapid IV bolus, increasing the dose if necessary.
143
What does the Glasgow Coma Scale (GCS) assess?
The level of consciousness in a patient
## Footnote
It evaluates eye opening, verbal response, and motor response.
144
What distinguishes obstructive lung disease from restrictive lung disease in pulmonary function tests?
Obstructive: FEV1 significantly reduced, FVC reduced or normal
Restrictive: FEV1 and FVC both reduced, FEV1% normal or increased
## Footnote
Common obstructive diseases include asthma and COPD; restrictive diseases include pulmonary fibrosis.
145
What is the main management for Clostridioides difficile infection?
1st line: PO vancomycin for 10 days
## Footnote
Other options include fidaxomicin and metronidazole for recurrent cases.
146
What is the classic triad of infectious mononucleosis?
* Sore throat
* Pyrexia
* Lymphadenopathy
## Footnote
It is caused by the Epstein-Barr virus (EBV).
147
What is the management for major bleeding in a patient on warfarin?
* Stop warfarin
* IV vitamin K 5mg
* Prothrombin complex concentrate
## Footnote
Fresh frozen plasma (FFP) is an alternative but takes time to prepare.
148
What should be considered in case of intracranial hemorrhage?
Prothrombin complex concentrate
## Footnote
This is due to the risk of significant bleeding associated with intracranial hemorrhage.
149
What is the management for INR levels between 5.0 and 8.0 with no bleeding?
Withhold 1 or 2 doses of warfarin and reduce subsequent maintenance dose
## Footnote
This is to prevent further increases in INR.
150
What is the management for INR levels between 5.0 and 8.0 with minor bleeding?
Stop warfarin and administer IV vitamin K 1 – 3mg
## Footnote
Restart warfarin when INR < 5.0.
151
What is the management for INR levels greater than 8.0 with no bleeding?
Stop warfarin and give vitamin K 1 – 5 mg PO
## Footnote
Repeat dose of vitamin K if INR still too high after 24 hours.
152
What are the commonest causes of an anterior mediastinum mass?
4Ts:
* Teratoma
* Terrible lymphadenopathy
* Thymic mass
* Thyroid mass
## Footnote
These four conditions encompass the majority of anterior mediastinal masses.
153
What is the standard management for patients following a myocardial infarction (MI)?
Dual antiplatelet therapy (aspirin + 2nd antiplatelet), ACE inhibitor, Beta-blocker, Statin
## Footnote
This combination helps in reducing the risk of future cardiovascular events.
154
What should be initiated within 3-14 days of an MI in patients with symptoms of heart failure and LV systolic dysfunction?
Aldosterone antagonist (eplerenone)
## Footnote
This treatment should preferably begin after ACE inhibitor therapy.
155
Which organism is classically associated with pneumonia in alcoholics?
Klebsiella pneumoniae
## Footnote
This bacterium is commonly found in patients with a history of alcohol use.
156
What is the commonest cause of community-acquired pneumonia (CAP)?
Streptococcus pneumoniae
## Footnote
This organism is frequently responsible for CAP cases.
157
What should be done for patients allergic to aspirin regarding sulfasalazine?
Patients may also react to sulfasalazine
## Footnote
Caution is advised as cross-reactivity can occur.
158
What is the commonest cause of sporadic encephalitis?
Herpes simplex encephalitis (HSE)
## Footnote
HSE typically presents with a prodrome of fever, headache, and malaise.
159
What should be considered during CPR if a pulmonary embolism (PE) is suspected?
Thrombolytic drugs (alteplase)
## Footnote
This is a critical intervention for suspected PE during resuscitation.
160
What are the secondary prevention options for stroke?
Clopidogrel, Aspirin + MR dipyridamole lifelong, MR dipyridamole lifelong
## Footnote
The choice depends on patient tolerance and contraindications.
161
What is the driving restriction duration after successful catheter ablation for arrhythmia?
2 days off driving
## Footnote
This is a precautionary measure post-procedure.
162
What is the driving restriction duration after angioplasty?
1 week
## Footnote
Patients should be advised on this timeline for safety.
163
What are the first-line antibiotics for acute prostatitis?
Quinolone antibiotics (ciprofloxacin 500mg BD or ofloxacin 200mg BD)
## Footnote
Trimethoprim is an alternative if quinolones cannot be taken.
164
What distinguishes bullous pemphigoid from pemphigus vulgaris?
No mucosal involvement in bullous pemphigoid; mucosal involvement in pemphigus vulgaris
## Footnote
This is crucial for diagnosis.
165
What are common features of anorexia?
Reduced BMI, bradycardia, hypotension, hypokalemia, low FSH/LH/estrogen/testosterone, low T3
## Footnote
Growth hormone, glucose, cortisol, and cholesterol are typically raised.
166
True or False: The use of steroids in sepsis is recommended.
False
## Footnote
Steroids are not recommended in the management of sepsis.
167
What is sick euthyroid syndrome characterized by?
Low T3/T4 and normal TSH with acute illness
## Footnote
This condition reflects thyroid function during illness.
168
What should be done for all patients with peripheral vascular disease (PVD)?
Take clopidogrel and atorvastatin
## Footnote
This is essential for secondary prevention.
169
What is the maximum recommended alcohol intake for men and women per week?
14 units
## Footnote
It is advisable to spread this intake over 3 days or more.
170
What condition is associated with infrapatellar bursitis?
Kneeling
## Footnote
Commonly seen in occupations such as clergy.
171
What is acute chest syndrome a complication of?
Sickle-cell disease
## Footnote
Symptoms include dyspnea, chest pain, cough, and hypoxia.
172
Why is ECG required at baseline for patients on antipsychotic medications?
To monitor for potential cardiac side effects
## Footnote
This is important for patient safety.
173
What are common complications of seborrheic dermatitis?
Otitis externa and blepharitis
## Footnote
These conditions can arise due to skin inflammation.
174
What is the commonest cause of hepatocellular carcinoma worldwide?
Hepatitis B
## Footnote
In Europe, Hepatitis C is more common.
175
What can precipitate lithium toxicity?
NSAIDs, thiazide diuretics, ACEi, ARB, metronidazole
## Footnote
These medications can increase lithium levels.
176
What is the only effective treatment for degenerative cervical myelopathy?
Cervical decompressive surgery
## Footnote
This procedure alleviates spinal cord compression.
177
What should be given in case of beta-blocker overdose presenting with bradycardia?
Atropine
## Footnote
This helps to counteract the bradycardic effects.
178
What can capnography detect?
Accidental esophageal intubation
## Footnote
This is a valuable tool in emergency settings.
179
What is the first-line antibiotic for campylobacter infection?
Clarithromycin
## Footnote
This antibiotic is indicated for severe cases.
180
What are the side effects associated with SSRIs?
Hyponatremia
## Footnote
This can occur due to inappropriate secretion of antidiuretic hormone (SIADH).
181
What fetal abnormalities can lithium cause?
Cardiac abnormalities, tremor
## Footnote
This highlights the teratogenic potential of lithium.
182
What should be done if one COCP pill is missed?
Take the last pill ASAP, no further action needed
## Footnote
This is the recommended immediate response.
183
What may be one of the earliest symptoms of aspirin overdose?
Tinnitus
## Footnote
This symptom can help in early identification of overdose.
184
What is the timeframe for diagnosing chronic fatigue syndrome?
Symptoms should be present for 3 months
## Footnote
This duration is necessary for diagnosis.
185
When should anticoagulation for atrial fibrillation start after a TIA?
Immediately once imaging has excluded hemorrhage
## Footnote
Timely intervention is crucial in preventing further strokes.
186
When should anticoagulation for atrial fibrillation start after an acute stroke?
After 2 weeks
## Footnote
This is to ensure patient safety post-stroke.
187
When should COCP or HRT be stopped before surgery?
4 weeks before surgery
## Footnote
This reduces the risk of thromboembolic events.
188
What should be trialed in infants with GORD who do not respond to initial treatments?
PPI
## Footnote
This is considered if there are feeding difficulties or faltering growth.
189
What is the dosing schedule for Depo Provera injectable contraceptive?
Every 12 weeks (3 months)
## Footnote
Contraindicated in patients with breast cancer.
190
What are some ototoxic medicines?
Gentamicin, Quinine, Furosemide, Aspirin, some chemotherapy agents
## Footnote
These drugs can cause hearing loss.
191
What are the side effects of quinine?
Tinnitus, sweating, low platelets, increased sweating
## Footnote
These effects can vary in severity.
192
What is bow legs in a child under 3 years old considered?
A normal variant
## Footnote
Usually resolves by age 4.
193
What condition is pioglitazone contraindicated in?
Heart failure
## Footnote
This medication can cause fluid retention.
194
What condition should be suspected with metabolic ketoacidosis and normal or low glucose?
Alcohol use
## Footnote
This metabolic state is often seen in chronic alcoholics.
195
What is the standard for diagnosing and screening HIV?
Combination tests (HIV p24 antigen and HIV antibody)
## Footnote
These tests enhance accuracy.
196
What should women take during the first 12 weeks of pregnancy?
Folic acid 400mcg
## Footnote
This is important for fetal neural tube development.
197
What should pregnant women avoid in multivitamins?
Vitamin A (retinol)
## Footnote
It is teratogenic in high doses.
198
What condition is suggested by fasciculations?
Motor neuron disease
## Footnote
This symptom is characteristic of this disease.
199
What is a key feature of motor neuron disease regarding eye movements?
Typically spared
## Footnote
This helps differentiate it from other neurological disorders.
200
What type of inhibitor is aspirin?
Non-reversible COX 1 and 2 inhibitor
## Footnote
This mechanism is crucial for its antiplatelet effects.
201
What should be avoided when prescribing methotrexate?
Trimethoprim or co-trimoxazole concurrently
## Footnote
This increases the risk of marrow aplasia.
202
What is the management for methotrexate toxicity?
Folinic acid
## Footnote
This helps to mitigate the effects of toxicity.
203
What is the SSRI of choice post-MI?
Sertraline
## Footnote
This medication is preferred for its safety profile.
204
What should be done for women on COCP who present with migraines + aura?
Stop the COCP and start POP
## Footnote
This is to reduce the risk of stroke.
205
What is the risk for a child under 3 months with a fever > 38.0?
High risk of serious illness
## Footnote
Such cases require urgent assessment.
206
What condition is indicated by fluctuating confusion or consciousness?
Subdural hematoma
## Footnote
This can occur due to head trauma.
207
What is the most common cause of death following a myocardial infarction?
Ventricular fibrillation
## Footnote
This arrhythmia can lead to sudden cardiac death.
208
What should be done for pneumonia cases after clinical resolution?
Repeat CXR at 6 weeks
## Footnote
This ensures consolidation has resolved.
209
What is contraindicated in patients with Parkinsonism?
Metoclopramide
## Footnote
This medication can exacerbate symptoms.
210
What is erythema multiforme a known complication of?
Carbamazepine use
## Footnote
This skin condition can arise as an adverse effect.
211
What is the most common organism causing exacerbations of COPD?
H. influenza
## Footnote
This bacterium frequently contributes to acute exacerbations.
212
What is the distinction between inguinal and femoral hernias?
Inguinal hernia: superior and medial to pubic tubercle; Femoral hernia: inferolateral to pubic tubercle
## Footnote
This anatomical knowledge is vital for diagnosis.
213
What does myxedema coma present with?
Confusion + hypothermia
## Footnote
This is a medical emergency requiring immediate intervention.
214
What effect does phenylephrine have on conjunctival and episcleral vessels?
Phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels
215
What is a painful condition associated with scleritis?
Scleritis is a painful condition
216
What are the ocular manifestations of rheumatoid arthritis?
* Keratoconjunctivitis sicca (commonest)
* Episcleritis
* Scleritis
* Corneal ulceration
* Keratitis
217
What are the symptoms of necrotizing enterocolitis?
* Feeding intolerance
* Abdominal distension
* Bloody stools
218
Where is an inguinal hernia located?
Superior and medial to the pubic tubercle
219
Where is a femoral hernia located?
Inferolateral to the pubic tubercle
220
What are the key features of myxedema coma?
* Confusion
* Hypothermia
221
What medical interventions are required for myxedema coma?
* IV thyroid replacement
* IVF
* IV corticosteroids
* Electrolyte imbalance management
222
When is azithromycin prophylaxis recommended?
In COPD patients who meet certain criteria and who continue to have exacerbations
223
What are the symptoms of Paget’s disease of the bone?
* Frontal bossing
* Bowing of the legs
224
How is Paget’s disease of the bone treated?
With bisphosphonates (alendronate, risedronate, zoledronate)
225
What is a protective factor for endometrial cancer?
Combined oral contraceptive pill (COCP)
226
What condition is caused by radial nerve palsy?
Saturday night palsy
227
What medications should be avoided in breastfeeding?
* Aspirin
* Amiodarone
* Lithium
* Benzodiazepines
* Carbimazole
* Methotrexate
* Sulfonylureas
* Clozapine
* Antibiotics (ciprofloxacin, tetracycline, chloramphenicol, sulphonamides)
228
What appearance does chorioretinitis have on fundoscopy?
Pizza pie appearance (mixture of red and white retinal lesions)
229
What is a common symptom of psoriatic arthritis?
Dactylitis (sausage finger)
230
What stimulant can be used in newborns to aid weaning off a ventilator?
Caffeine
231
Which antiepileptic medication has the smallest effect on the developing fetus?
* Lamotrigine
* Carbamazepine
* Levetiracetam
232
What may be required during pregnancy for women with epilepsy prescribed lamotrigine?
A dose increase
233
Is breastfeeding considered safe for mothers taking antiepileptics?
Yes, generally safe
234
What life-threatening side effects are associated with clozapine?
Agranulocytosis/neutropenia
235
What should be monitored in patients taking clozapine?
Full blood count (FBC)
236
What is a key side effect of mirtazapine at lower doses?
Sedation and increased appetite
237
How does caput succedaneum present?
Crosses the suture line and resolves within days
238
How does cephalohematoma present?
Does not cross the suture line and resolves within months
239
What is the treatment for impetigo if hydrogen peroxide is not suitable?
Topical fusidic acid
240
What is a clinical sign of a scaphoid fracture?
Persisting pain in the anatomical snuffbox
241
When is jaundice in the first 24 hours post delivery considered pathological?
Always pathological
242
What medication may be used as 'rescue therapy' for neuropathic pain exacerbation?
Tramadol
243
What should be checked before treating ulcerative colitis with azathioprine?
Thiopurine methyltransferase deficiency (TPMT)
244
What happens to clotting factors in liver failure?
All are low except for factor VIII which is supra-normal
245
What is the treatment for Ramsay Hunt syndrome?
Oral aciclovir + prednisolone
246
What is the treatment for chlamydia?
Doxycycline for 7 days; if pregnant, use azithromycin, erythromycin, or amoxicillin
247
Which medications are known to cause cholestasis?
* Sulphonylureas (gliclazide)
* Co-amoxiclav
* Erythromycin
* COCP
248
When must methotrexate be stopped before conception?
At least 6 months before conception in both men and women
249
What neurotransmitter balance changes occur during alcohol withdrawal?
Decreased inhibitory GABA and increased NMDA glutamate transmission
250
What are the components of Beck's triad in cardiac tamponade?
* Falling BP
* Raised JVP
* Muffled heart sound
251
What is the first line investigation for suspected clinically localized prostate cancer?
Multiparametric MRI
252
What are the first line treatments for spasticity in multiple sclerosis?
* Baclofen
* Gabapentin
253
Which organism commonly causes LRTI in cystic fibrosis patients?
Pseudomonas aeruginosa
254
How long should children be excluded from school after mumps onset?
5 days from the onset of swollen glands
