Medicine Flashcards
(326 cards)
1
Q
What is this rash called? Associated with what disease?
A
Erythema multiform (target lesions)
Herpes Simplex Virus
2
Q
Right ear sensorineural hearing loss. Weber’s test?
A
Lateralises to left ear (normal ear)
3
Q
Mx of haemodynamiccaly unstable PE?
A
Thrombolysis
4
Q
Investigations for pheochromocytoma (2)?
A
Serum metanephrines
Confirmatory test: 24 hour urine metanephrines
5
Q
Normal PT, low aPTT is what pathway and suggests what diseases (3)?
A
Instrinsic pathway
Unfractioned Heperin therapy
DIC
Haemophilia
Note: LMWH is monitored by Xa levels, not aPTT
6
Q
Fever and this rash is what condition and caused by what?
A
Hand foot and mouth disease
Coxsackie A virus
7
Q
COPD. Not managed alone with SABA. What next?
A
LAMA (tiotropium bromide) or LABA (salmeterol)
8
Q
Meds that cause of high prolactin (3)
A
Dopamine antagonists: antipsychotics, metoclopramide
OCP
9
Q
Most common CAP post viral illness?
A
Staph aureus
10
Q
Do you use a T score or a Z score to dx osteoporosis? Cut off?
A
T score (compares to healthy population)
-2.5
11
Q
Ipsilateral decreased pain and temperature sensation
Contralateral loss of pain and temperature sensation
Ataxia
Dysphagia
Hoarseness of voice
A
Lateral medullary syndrome / Wallenberg syndrome / PICA syndrome
(posterior inferior cerebellar artery)
12
Q
Causes of microcytic anaemia (5)
A
TAILS
Thalassaemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemia
13
Q
Example of class III antiarrhythmic
A
Potassium channel blockers
Amiodarone (but also blockers other classes)
14
Q
ABx for moderate CAP?
A
Benzyl penicillin IV and azithromycin PO
15
Q
HBsAg +
HBsAb (Anti-HBsAg) -
HBcAb (Anti-HBcAg) +
IgM Anti-HBc ++
What disease state?
A
Acute HBV infection
16
Q
Differential dx (2)?
A
Impetigo (Staph aureus or GAS infection)
Eczema herpeticum (HSV 1 or 2)
17
Q
Describe image. Diagnosis? Other features associated (4)?
A
Bihilar lymphadenpathy. (May have upper lobe involvement)
Sarcoidosis
African descent, erythema nodosum, lupus pernio (purple lesions of face), non caseating granulomas
18
Q
Describe and dx?
A
Bilateral ground glass radio-opacities, ‘honey combing’
19
Q
Thrombocytopenia + recent illness =?
A
Immune thrombocytopenic purpura (ITP)
20
Q
Cardioselective beta blockers?
A
Bisprolol
Metoprolol XR
Carvedilol
Nebivolol
21
Q
BCR-ABL is associated with which leukaemia?
A
CML
22
Q
Ulnar nerve goes through what canal? (2)
A
Guyon’s canal as it passes through the wrist
Cuboidal as it goes through the elbow
23
Q
South East Asia, high-grade biphasic fever, arthralgia, myalgia, headache, retro-orbital pain, Maculopapular, measles-like exanthem, lymphadenopathy. Dx?
A
Dengue fever
24
Q
HBsAg +
HBsAb (Anti-HBsAg) -
HBcAb (Anti-HBcAg) +
IgM Anti-HBc -
What disease state?
A
Chronic HBV infection
25
What needs to be done for airway in ALS?
Conscious: are they talking?
Unconscious: ensure no obstruction, jaw thrust
26
High calcium
High PTH
Next investigations (2)?
Diff dx (3)?
Next investigations: Phosphate levels and urinary calcium
Diff dx:
Primary hyperparathyroidism (High calcium, high PTH, low phophate, high urinary calcium)
Familial hypocalciuric hypercalcaemia (High calcium, normal-high PTH, low urinary calcium)
Tertiary hyperparathyroidism (High calcium, High PTH, High phosphate as kidneys not working well)
27
Recurrent DVTs, Anticagulation for how long?
Life long
28
What is this and what organism is this associated with?
Kaposi's sarcoma
Human herpesvirus 8 (HHV 8)
29
alpha-1-antitrypsin deficiency pulmonary function tests
Obstructive in young person
FEV1 reduced
FEV/FVC reduced
30
Investigations for DI? (3)
Low urine osmolarity
Water deprivation test (DI will cont to have dilute urine)
Give desmopressin (Central will concentrate urine, nephrogenic will continue to be dilute)
31
Splenomegaly + tear shaped cells on blood smear?
Primary myelofibrosis
32
Reactive arthritis features ?
Can't see, Can't pee, Can't climb a tree
Reiter's syndrome (urethritis, conjunctivitis and arthritis) following a gastro illness.
Typically develops within 4 weeks of initial infection
Asymmetrical oligoarthritis of lower limbs
Keratoderma blennorhagicum
33
Acoustic neuroma clinical features?
(Like Meniere disease but with cranial nerve disturbance)
Unilateral sensorineural hearing loss
Tinnitus
Vertigo
**Unsteady gait**
**Cranial nerve disturbances, such as facial numbness or weakness**
34
Features of Steven-Johnson Syndrome? (3)
Occurs 1-3 weeks post medication exposure
Painful skin sloughing
Positive Nikolsky sign (upper dermis sepeates fom dermis (and creates blister) when shearing force applied)
35
Contraindication for cholchicine?
Myelodysplasia
36
What is this disease? Three other associations?
Measles
3C's: cough, conjuntivitis, Koplick spots
37
SVT mx? (3)
Vagal manoeuvres
Adenosine
Verapramil
38
Systemic disease risk factors for osteoporosis (4 + 1)?
CKD
Hyperparathyroidism
Hyperthyroidism
Premature menopause
+ any disease that requires corticosteroids (RA, SLE)
39
Most common CAP in immunosupressed?
Pneumocystis pneumonia
40
Unstable bradycardia mx?
Pacing + ICD
41
Mx of acute RF?
Acute eradication of GAS: oral penicillin V
Long term prophylaxis with benzothine penicillin G
10 years or until 21 years old (whichever is longer)
42
PT is a measure of what factors?
Extrinisc pathway (VII) + common pathway (I, II, V, X)
43
Effect of hypocalcaemia of membrance excitability?
Clinical features? (2)
Increases membrane excitability
Paresthesias, carpopedal spasm,
44
If this is confined to the face and trunk, what disease is this (and differential)?
Rubella (pruritus, tender lymphadenopathy)
Diff dx: measles (no pruritus, cough, coryza prodrome, conjunctivitis, Koplick spots)
45
Bihilar lymphadenopathy and erythema nodosum associated with what?
Sarcoidosis
46
Example of class IV antiarrhythmic
Channel blockers
Cardioselective dihydroridine: verapramil
47
Mx for serotonin syndrome?
Supportive care: IVT, antihypertensives, cooling measures
Chlorpromazine 25mg intravenous
48
What's this visual field called and what causes it?
Left homogenous superior quadrantanopia
Caused by contralateral side temporal stroke
49
Provoked PE. Anticagulation for how long?
Provoked (provoking factor gone) = 3 months therapy
50
Dx and mx?
Seborrhoeic dermatitis
Topical ketoconazole
51
Thyroid cancer associated with MEN-2 gene?
Medullary (calcitonin cells)
52
Starting (and max) dose for metoprolol extended release?
23.75mg (up to 190mg)
53
Manage 'wearing off' effect in Parkinson's Disease?
Decrease dose and more frequent levodopa
Change to modified-released levodopa
54
Reversal of clopidogrel?
Desmopressin
55
Acute management of ACS?
MONA BASH C
Morphine
Oxygen if O2 sats \<90%
Nitrates (expect right ventriclar infarction)
Aspirin
Beta blocker
ACE inhibitor
Statin
Heparin
Clopidogrel
56
Long QT; drug causes (3)
Haloperidol + antipsychotics, macrolides (erthromycin), TCA
57
Aphasia types and which side the stroke is on?
Broca's: Expressive (producing language)
Wernicke's: Receptive (understanding language)
Dominant hemisphere (ie LHS if right handed) MCA stroke
58
Signs of vit B12 deficiency (5)
Decreased vibration sense, decrease proprioception sense, paraesthesias, cerebellar signs (ataxia), delirium
59
Normocytic anaemia blood smear shows bite cells + Heinz bodies. What disease?
Haemolytic anaemia - Glucose-6-phosphate dehydrogenase deficiency
60
Zones of adrenal gland and what they produce.
61
Most common CAP in alcoholics?
Klebsiella pneumoniae
62
Testing for HIV?
HIV antibody immunoassay (ELISA) + p24 antigen (or combinaion antigen/antibody test)
Positive 2-6 weeks post exposue; test at initial presentation and 3 months later
Confirmation: HIV 1/2 differentiation testing or NAAT
63
Mx for Graves disease (2)?
Carbimazole
PTU
64
MEN-2 gene associated with what cancers (2)?
Medullary thyroid cancer (calcitonin) and pheochromocytoma
65
Example of class II antiarrhythmic
Beta blockers
Metoprolol
66
Hodgkin's lymphoma is associated with what cells?
Reed-Sternberg cells
67
Causes of high anion gap metabolic acidosis (6)?
KUSMAL
Ketoacidosis
Uraemia in kidney failure
S (aspirin)
Metformin
Alcohol
Lactic acidosis
68
Mx of sarcoidosis? (2)
50% spontanous remit
Corticosteroids
Infliximab
69
Thrombocytopenia + recent GIT illness + jaundice + renal damage = ?
Haemolytic uremic syndrome (HUS)
70
Intention tremor (worse in terminal stages of movement), not present at rest. Dx?
Cerebellar tremor + slurred speech, nystagmus,
incoordination, wide based gait
71
Which diabetes medication causes euglycamic DKA?
SGL2 inhibitors (-giflozin)
Empagliflozin, dapagliflozin
72
What could this rash be in a child?
Meningococcal meningitis (Neisseria Meningiditis): look for fever, neck stiffness, headache
Henoch-Scholein Purpura: look for recent URTI illness, rash on buttocks, arthalgia + limp, colicky abdominal pain
73
Mx for partial seizures and side effect?
Carbamazepine (hepatotoxicity)
74
What is this condition called and associated with (3)?
Erythema nodosum
SORE SHINS
**Streptococci pharyngitis**
Oral contraceptive pill (OCP)
Rickettsia
Eponymous (Behçet)
Sulfonamides
Hansen's Disease (Leprosy)
**IBD (Crohn's disease)**
Non-Hodgkin's lymphoma
**Sarcoidosis**
75
What needs to be done for circulation in ALS?
Conscious: BP, HR, ECG, ABG, 2x large bore cannulas +/- IVT
Unconscious: Compressions 30:2 with bag and mask, defibrillator
76
aPTT is a measure of what factors?
Instrinsic pathway (VIII, IX, XI, XII) + common pathway (I, II, V, X)
77
Serology to test for Coeliac disease (2)?
Anti-tissue transglutamase antibodies
Anti-gladin antibodies
78
Alcohol cessation medicaiton (3)
Disulfiram (best) Prevents alcohol metabolism. Must NOT have alcohol with this medication (causes aldehyde reaction)
Acamprosate reduces withdrawal symptoms
Naltrexone (less pleasure from alcohol)
79
Tremor: bilateral, action-based, positive family history. Dx, mx?
Essential tremor
Propranolol
80
Extensive red/purple skin lesions over eyes and nasolabial folds, associated with what disease?
Lupus pernio, associated with sarcoidosis
81
Physical exam test for psoriasis?
Auspitz sign (rub of scale and pin point bleeding occurs)
82
Causes of polycythemia?
Polycythemia vera
Smoking, COPD, CHF, high altitude, or increased EPO production, in renal cell carcinoma
83
Best acute pain meds in renal impairment? (2)
Oxycodone and fentanyl
Avoid morphne and tramadol as renally cleared
84
Diabetes medications contraindicated in ESRF? (2)
Metformin (lactic acidosis)
SGLT-2 inhibitors (-gliflozin) (won't work well and euglycaemic DKA increases). It is renal protective before ESRF
85
Causes of macrocytic anaemia (2)
Vit B 12 deficiency (ie pernicious anaemia), folate
86
Tests for acromegaly (2)
Insulin like growth factor
Oral glucose tolerance test
87
What is this and what disease is it associated with?
Lichenification and adult atopic dermatitis (eczema)
88
Starting (and max) dose for perindopril?
5mg daily (up to 10mg)
89
Unprovoked PE. Anticagulation for how long?
Unprovoked = 3 months therapy + review
90
Investigations for Conn's syndrome (2)
Is it renal artery stenosis/fibromuscular dysplasia or conn's syndrome? Aldosterone:Renin ratio
Confirmation test: Salt supression (give salt, does aldosterone go down) If not -\> Conn's syndrome
91
What is this, what does it represent and what conditions is it prominant?
S4
Hypertrophic ventricle (hitting stiff walls)
Aortic stenosis, chronic HTN
92
What is this disease?
Atopic dermatitis (eczema)
93
Small Cell Lung Cancer associated with what paraneoplastic syndrome? Where is the cancer located?
ACTH (Cushings)
Central location
94
Altered mental state in alcoholic.
Diff dx (4) and mx?
Hepatic encephalopathy (+asterixis: ammonia toxicity in any severe liver disease) - Mx: lactulose
Wernicke's encephalopathy (+oculomotor issues, ataxia: thiamine B1 deficiency in alcoholic specifically)
Mx: IV thiamine
Korsakoff's syndrome (+amnesia and confabulation, hallucinations)
Mx: oral thiamine to prevent progression but irreversible
Alcohol withdrawal (+agitation, alcohol abstinence ie post surgery)
Mx: benzodiazepines
95
Smudge cells are associated with what leukaemia?
CLL
96
Causes of upper lobe DPLD/ILD? (6)
SCHART
Sillicosis
Coal worker's pneumatosis
Histiocytosis
Anklylosing spondylitis
Radiation
Tuberculosis
97
What is this, what does it represent and what conditions is it prominant?
S3
Blood filling a large space in dilated cardiomyopathy
Ischemic dilated cardiomyopathy/ heart failure with reduced ejection fraction
98
ACS; when can you use thrombotic agents (plaminogen activator: tPA)?
Within 30 minutes of presentation
99
3 differential dx for this rash?
Contact dermatitis
Atopic dermatitis
Psoriasis
100
Iron studies for iron deficiency anameia?
Ferritin reduced (expect acute phase reactant)
Transferrin increased
Total iron capacity increased
Transferrin saturation decreased
101
TB investigations:
Tuberculin vs sputum microbiology
Tuberculin skin test assesses previous exposure via vaccine/latent infection
Sputum microbiology for active infection
102
This started on neck and spread to armspits and groin.
What is the disease? What is it caused by?
Scarlett fever
GAS
103
New York classification of HF
I: no symptoms of CHF
II: comfortable at rest
III: only comfortable at rest
IV: symptoms at rest
104
Melanoma biopsy. Breslow depth: 0.5mm. What excision margin does it need?
Beslow depth \<1.0 mm -\> 1cm margin
105
Ventricular tachycardia mx?
Amiodarone
106
Prevention of oesophageal bleeding? (3)
Propanolol
Oesophageal banding
If bleeding will kill before other liver complications (ie Wernicke's encephalopathy) -\> TIPS
107
Vit B12 deficiency associated with what conditions? (3)
Crohn's disease (poor abosprtion)
Pernicious anaemia (no absorption)
Bariatric sugrery (no absorbtion)
108
Plethora, bruising, dizziness. High Hb. Dx, Mx?
Polycythaemia Vera
Venesection
109
Stable but symptomatic 1st and Mobitx Type I mx?
Atropine
110
What is this disease?
Atopic dermatitis (eczema)
111
TB management and adverse effects?
RIPE
Rifampin (CYP inducer, RED bodily fluids)
Isoniazid (Peripheral polyneuropathy (synergistic with B6 deficiency), optic neuritis, hepatotoxic). Give B6 to prevent neuropathy
Pyrazinamide (Hepatotoxic, hyperuricemia + gout, arthralgia)
Ethambutol (Optic neuritis and red/green colour blindness)
112
Effect of hypercalcaemia of membrance excitability?
Clinical features? (4)
Decreases membrane excitability
Moans: abdo pain, pancreatitis
Bones: bone pain
Psych overtones: anxiety, depression, sleep disturbance
Stones: nephrolithiasis
113
Blood smear shows Auer rods?
AML
114
Initial mx of HIV ?
x2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
x1 integrase strand transfer inhibitor (INSTI)
(dolutegravir+abacavir+lamivudine)
Start as soon as diagnosed
115
Dx, mx?
Ankylosing spondylitis
Exercise + NSAID
2nd line is biologicals (-mabs)
116
Mx of asthma (3)
Check technique of current medications
SABAs/short acting beta agonists (salbutamol)
Add low dose-ICS (beclomethasone)
Then add LABA (long acting beta agonists) (always with ICS)
117
Metabolic alkalosis causes (2)?
H+ out of the Head = vomiting
Diuretics
118
What is this called and what disease is it associated with?
Koplick spots
Measles
119
Whats this disease?
Tinea corporis
120
DKA managament?
Fluid replacement++
Potassium supplementation (despite apparent hyperkalaemia)
Low dose IV insulin
Regular monitoring of volume status, serum glucose, serum electrolytes, and acid-base status
121
What is this condition?
Mongolian spots
122
APO managament? (5)
O2
Sit patient forward
IV frusemide
GTN spray
ACE inhibitor
123
Mx for central and nephrogenic DI?
Central: desmopressin
Nephrogenic: thiazide diuretics
124
Rash on web spaces of hands and feet. Dx, Ix?
Scabies
Skin scraping for microscopy
125
Severe headache, N/V and eye redness, halos
around lights, unilateral reduced visual acuity. Dx, Ix?
Acute glaucoma
Acetazolamide
126
What is this rash called and how long will it take to form?
Differntial dx in children? (2)
Morbilliform drug reaction after 14 days post exposure
Measles (cough, coryza prodrome, conjunctivitis, Koplick spots)
Rubella (tender lymphadenopathy)
127
What's this condition?
Cherry haemangioma
128
ECG bradycardia with irregular rhythm?
HB 2 Mobitz type 1
129
Signs of previous STEMI (2)
T wave inversion (weeks), Q waves (forever)
130
What disease is this and other features (3)?
Chickenpox (Varicella Zoster Virus)
Pruritis
Mild fever
Scalp, mouth involvement
Self limiting 8 days
131
Side effects of glucocorticoids (CORTICOSTEROIDS)
C: Cushing syndrome
O: osteoporosis
R: retarded growth
T: thin skin
I: immunosuppressive
C: cataracts
O: oedema
S: suppresses HPA axis
T: thin gastric mucosa
E: emotional (psychosis)
R: rise in BP
O: overweight
I: increased hair
D: diabetes
S: striae
132
Mutation in JAK2 leads to what disease?
Polycythaemia vera
133
Tx for TB (and side effects) (4)
RIPE
Rifampin (red body fluids)
Isoniazid (Peripheral polyneuropathy (synergistic with B6 deficiency), optic neuritis, hepatotoxic)
Pyrazinamide (hyperuraemia + GOUT)
Ethambutol (Optic neuritis and red/green colour blindness)
134
What does CT show? Risk factors?
Subdural haematoma: bleeding into space between dura mater and arachoid layer
Trauma
135
Med mx for hyperprolactinaemia?
Dopamine agonist (cabergoline)
136
Miscarriages, chest pain, headaches, thrombocytosis (platelets++), increased megakaryocytes on bone marrow biopsy
Essential Thrombocytosis
137
Child with high-grade fever which lasts for \> 5 days (paracetamol doesnt help), red conjunctiva, cervical lymphadenopathy.
Dx and Mx
Kawasaki's disease
High dose aspirin (usually contraindicated due to Reye’s syndrome)
138
Causes of a normal anion gap metabolic acidosis? (2)
Loss of bicarb
Bicarb out the Bum (diarrhoea)
Bicarb loss in Renal Tubular Acidosis
139
Starting (and max) dose for bisprolol?
1.25mg daily (up to 10mg)
140
Steps on counselling smoking cessation?
Ask: quantity, dependence (smoking after waking up), what methods have they tried before
Advise: Personalised reasons for quitiing
Assess: Willingness to quit
Assist: refer to QUIT line, nicotine patches/gum, medical therapy (varenicline = nicotine agonist, bupropion = antidepressant)
Arrange: follow up review
141
ACS; What complications after days-weeks (5)
Ventricular wall rupture
Papillary muscle rupture + mitrale regurg
Atrial thromboembolism
Dressler's syndrome/Pericarditis
Congestive heart failure
142
Name the dermatomes
S1 lateral foot!
143
Mx of SBP?
Ceftriaxone
144
Lateral STEMI leads and vessel?
I, aVL, V5, V6, Left circumflex
145
Above knee DVT. Anticagulation for how long?
Provoked (provoking factor gone) = 3 months therapy
Unprovoked = 3 months therapy + review
146
Flushed face (plethora) is present in what disease?
Polycythaemia vera
Polycythemia in COPD, chronic CHF, smoking, alcohol
147
, repeat ABGWhat needs to be done for disability in ALS?
Conscious: blood glucose, GCS, pupils, check for 4Hs and 4Ts (temperature, aucultation and trachea placement, ECG, urine toxins, ABG, CXR, CTPA)
148
What's this called?
Port Wine stain
149
Risk factor for Hodgkin's lymphoma?
EBV (Human herpes virus 4)
150
HBsAB (Ani-HBsAg) positive means what?
We won! Either cleared infection or immunised
151
Asymmetrical resting tremor, enhanced with distraction. Dx?
Parkinsonian tremor
152
What is Alteplase?
thrombolytic plasminogen activator (fibrinolytic therapy - bust-a-clot)
153
SPB prophylaxis (4)?
Fix the ascites:
Salt restriciton
Diuretic (esp. spironolactone)
Paracentesis
Consider Bactrim
154
Below knee DVT. Anticagulation for how long?
Provoked (provoking factor gone) = 6 weeks therapy
Unprovoked = 3 months therapy + review
155
Investigations for Graves (2)?
TRAbs (Anti-TSH receptor AB)
Anti-TPO
156
Avoid what medication as 2nd line in diabetes?
Gliclazide (Sulfonylureas)
Risk of severe hypoglycaemia, weight gain
157
Most common leukaemia of children?
ALL
158
Classes of antiarrhythmics
Some Block Potassium Channels
Class I Sodium channel blockers
Class II Beta blockers
Class III Potassium blockers
Class IV Calcium channel blockers
159
What is this disease?
Diabetic retinopathy
160
Medical mx of delirium?
Oral anti-psychotic (riseperidone)
Then IM
Never benzodiazepines (unless alcohol withdrawl)
161
Whats this disease and how to tx?
Impedigo
Amoxycillin
162
Neurological claudication/spinal stenosis.
What are the symptoms?
What makes it worse/better?
Bilateral pain in buttocks and thighs
Occasional paraesthesias in legs
Worse pain when back is extended (standing)
Less pain bending forwards (ie walking uphill)
163
Reversibility of FEV/FVC ?
12% _and_ more than 200 mL in adults
164
Tx for acne (2 + 1 females)?
Retinoids (avoid in pregnancy)
Topical benzoyl peroxide
OCP
165
What's this visual field called and what causes it?
Left homogenous inferior quadrantanopia
Caused by contralateral side parietal stroke
166
Clinical features (1) and lab finding (1) of Conn's syndrome?
Hypotension
Hypokalaemia
167
Acoustic neuroma hearing tests?
Sensorineural hearing loss
Rinnes test AC\>BC (normal but may be reduced bilaterally)
Weber's test latersalises to normal ear
168
Melanoma biopsy. Breslow depth: 1.3mm. What excision margin does it need?
Beslow depth 1-2 mm -\> 1-2cm margin
169
Causes of lower lobe DPLD/ILD? (6)
RASIO
Rheumatoid arthritis
Aspestosis
Scleroderma
Idiopathic pulmonary fibrosis
Other (meds): methotrexate, chemotherapy, nitrofurantoin (ABx for UTIs), amiodarone
170
What's this? Tx?
Ventricular tachycardia
Unstable: electrical cardiovert
Stable: amiodarone
171
Cholesteatoma hearing tests?
Rinne's test BC \> AC in affected ear (abnormal)
Weber's test lateralises to diseased ear (abnormal)
172
Older lady, new onset pain in shoulders, hips and neck, morning stiffness. Weight loss, night sweats. Dx, Ix, Mx?
Polymyalgia rheumatica
ESR ++
Ensure no giant cell arteritis (jaw claudication, severe headache, visual symptoms, scalp tenderness or malaise)
Prednisolone
173
HBcAB (Anti-HBcAg) + means what?
C means Contact, we have had expoure either currently or in the past
174
Triad of Wernicke's encepahlopathy and mx?
Opthalmoplegia
Ataxia
Confusion
IV thiamine
175
ACS; when can you go to cath lab for PCI?
Within 60 minutes from presentation
176
Central diabetes insipitus. What will the investigations show (2) and what is a cause?
Water deprivation test shows (continued) low urine osmolarity. Give desmopressin and urine osmolarity increases++
Caused by craniopharyngioma
177
Melanoma biopsy. Breslow depth: 3mm. What excision margin does it need?
Beslow depth 2-4mm -\> 2cm margin
Consider SLNB
178
Asthma not controlled by SABA + ICS. What's next?
ICS+LABA (Symbicort; budesonide and formoterol)
179
Mx of pheochomocytoma?
Phenoxybenzamine (alpha blocker)
180
Grey, frothy and malodorous, oily dirrhoea?
Coeliac's disease
Anti-tissue transglutaminase antibodies
Anti-gladin antibodies
181
New onset rash (+buttocks), recent URTI illness in child. What is the disease? What other features should you look out for?
Henoch-Schonlein Purpura
Arthritis and a limp
Abdominal pain
Nephritic syndrome
182
Limited scleroderma diagnostic test?
Anti-centromere antibodies
183
Treating nausea and vomiting in Parkinson's disease?
Domperidone
Avoid metoclopramide (dopamine antagonist)
184
Melanoma biopsy. Breslow depth: 5mm. What excision margin does it need?
Beslow depth \>4mm -\> 2cm margin
185
Preserved EF Heart failure (diastolic HF), what drug improves mortality?
Low dose spironolactone
186
Widened sacro-iliac joints on pelvic x-ray. Dx?
Ankylosing spondylitis
187
Mx for COPD (6)
Smoking cessation
Pulmonary rehab
Short acting beta agonsists
Long acting muscurinic antagonists (tiopropium bromide) AND/OR Long acting beta agonist (salmeterol)
If exacerbations still: ICS+ LABA
(Consider O2 if sat \<88%)
188
Investigation for Hashimoto's thyroiditis?
Anti-TPO
189
Side effect of diuretics (2)?
AKI
Gout
190
Floaters, flahsng lights, descending curtain of vision loss. Dx? Mx?
Retinal deattachment
Emegency opthalmoloical referral + repair
191
Conductive hearing loss
Foul smelling ear discharge
Persistent otitis media
Otalgia
Vertigo
Facial weakness
Dx? Ix? Mx? Complications?
Cholesteatoma
CT of temporal bones looking for invasion
Surgery
Destructon of ossicles, intracranial invasion, facial nerve paralysis
192
Non modifable risk factors for osteoporosis? (3)
Women
Post menopausal
Family history
193
Starting (and max) dose for irbesartan?
75mg (up to 300mg daily)
194
A 72 year old woman with a background of ischaemic heart disease and chronic kidney disease is admitted for a right total hip replacement. She is commenced on an unfractionated heparin infusion for VTE prophylaxis. Five days after surgery you notice that her left lower limb is tender and swollen and her platelet count is 70 (baseline 210). Dx and Mx?
Heparin Induced Thrombocytopenia Syndrome (HITS)
Cease heparin and change to non heparin (fondaparinux)
195
Post ACS mx (6)
Statins, aspirin, beta blocker, ACE inhibitor, dual antiplatelet (1 year)
196
Provoking factors for PE and DVT? (6)
Major surgery
Hospitalisation with immobilisation
Oestrogen therapy
Pregnancy
Postpartum period
Malignancy
197
Hypercalcaemia + low PTH.
Investigations (2)?
Diff dx (3)?
Worried about PTHrP from tumours, bone mets for malignancy and granulomatous diseases (sarcoidosis, TB)
Investigation with PTHrP levels + 1,25 vit D levels
Tumour secreting PTHrP (SCC of lung, renal carcinoma): High PTHrP
Sarcoidosis, TB: High 1,25 vit D
Mets: consider whole body bone scan
198
COPD: next management after SABA?
LAMA (tiopropium bromide)
199
What's this disease?
Psoriasis
200
Haemolytic anaemia bloods (4)
Normocytic anaemia
Decreased haptoglobin
Increased LDH
Increased bilirubin
201
Band forms are associated with what leukaemia?
CML
202
Most common CAP in COPD
Haemophilus influenzae
203
Examination findings for psoriasis (Skin + 2 others)?
Erythermaous well demarced patch on extensor surfaces with overlying silvery plaque
Nail pitting
Onycholysis (nail bed seperation)
204
Positive Purified Protein Derivative TB test, next step and mx?
Is it latent or active? CXR and sputum culture
Latent -\> Isoniazid
Active -\> RIPE
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
205
What is this skin condition?
Suborrheic keratosis
206
Most common CAP?
Strep. Pneumoniae
207
Investigation for Cushing's (2+1+1)
_Is it a high cortisol issue (Cushing's syndrome)?_
**Low dose dexamethosone supression test** _good as outpatient_ (give dexamethosone (cortisol), check early morning serum cortisol levels -\> if elevated, it is cushings.
+ either (confirmation)
**24 urinary cortisol** (best but _needs to be inpatient_)
OR **midnight salivary cortisol**
_Is it ACTH depndent?_
**Serum ACTH level** (if high, it is pituitary or exogenous)
_If ACTH depndent; is it pituitary or lung?_
**High dose dexamethosone supression test** (give loads of dexamethosone, pituitary will be supressed, lung actopic ACTH won't be)
208
Normal Rinne's test?
Air conduction \> bone conduction
209
Non-small cell lung cancer types and paraneoplastic syndromes? (3)
Adenocarcinoma = peripherally located, no syndrome
SCC = PTHrP (hypercalcaemia)
Carcinoid tumour = serotonin syndrome
210
Symptoms of Gastroperesis?
Nausea, vomiting, early satiety, upper abdominal pain, and bloating
Acute on chronic course
211
Abrupt onset of severe eye pain, redness, blurry vision/vision loss, headache, nausea, halos around lights, fixed mid-dilated pupil, conjunctival redness, corneal edema.
Dx? Ix? Mx?
Acute Angle Closure Glaucoma
Gonioscopy (slit lamp)
Emergent Opthalmology referral
Eye drops: Beta blocker (e.g., timolol) or α2 agonist (e.g., apraclonidine)
Systemic: acetazolamide
212
When to needle thoracocentesis in (non tension) pneumothorax?
Primary pneumothorax (no significant smoking history or evidence of underlying lung disease), size \>2cm and/or breathless
Secondary pneumothorax (significant smoking history or evidence of underlying lung disease), size 1-2cm
If \<1cm: high flow oxygen and observation for 24 hours
If \>2cm or breathless: chest drain
213
Which type of PUD is likely to cause haematemesis?
Gastroduodenal artery
214
Tumour marker for papillary and follicular thyroid cancer?
Thyroglobulin
215
Clinical signs of :
Ignore half of their body
Dressing apraxia
Visual-spartial neglect
Non dominant (RHS if right handed) hemisphere Parietal MCA stroke
216
What's this skin condition?
Acinic/Solar keratosis, premalignant for SCC
217
This rash is present on the extensor surfaces or buttocks.
What is this called and what disease it is associated with?
Dermatitis herpetitformis (herpetiform vesicles/like herpes)
Coeliac disease
218
What needs to be done for breathing in ALS?
Conscious: O2 sats probe, 15L non rebreather mask
Unconscious: Ear to mouth, check breaths and chest rising
219
What disease are these associated with?
Herpes Simplex Virus
| (Erythema multiforme/target lesions)
220
Bilateral symmetrical progressive weakness, sensory loss, and areflexia.
Diagnosis?
Guillain-Barre Syndrome (GBS)
Preceding diarrhoeal illness (e.g. Campylobacter jejuni infection)
Bilateral facial paralysis
Progressive weakness
221
Features of CXR?
Dx?
Complication?
Bilateral hazy opacities, loweer lobe predominance
Pleural plaques
Asbestosis
Mesothelioma
222
Best test for hereditary spherocytosis?
Osmolarity frgility test
223
Dx? Mx?
Basal cell carcinoma
Moh's surgery as on aesthetic spot
Alternatives: cryotherapy, laser blation, 5-Fluorouracil
224
What is this rash and what is is caused by?
Erythema infecioseum, Parovirus B19 (+arthritis)
225
ACS cintraindication to fibrinolytics?
Significant hypertension
226
What is this called and what disease?
Herald patch in Pityriasis rosea
227
4H's and 4T's ALS?
Hypoxia, hypovolaemia, hypo/hyperkalamaemia, hypo/hypoerthermia, hypoglycaemia
Thromboembolism, tension pneumothorax, cardiac temponade, toxins
228
Starting (and max) dose for nebivolol?
1.25mg (up to 10mg) daily
229
Unstable tachycardia Mx?
Synchronised cardioversion
230
Deficiency in ADAM TS13 is what disease?
Thrombotic thrombocytogenic purpura (TTP)
231
Symmetrical weakness
Symmetrical loss of proprioception and vibration sense
Unsteady wide-based gait
Subacute combined degeneration of the spinal cord (secondary to vitamin B12 deficiency)
232
Low PT, normal aPTT is what pathway and suggests what diseases? (3)
Extrinsic pathway
Warfarin use
Vit K deficiency
FVII deficiency
233
Most common HAP?
Pseudomonas pneumonia
234
What is this disease?
Retinal vein occlusion
235
What could this disease be (5)?
Roseola infantum (HHV6) - high fever, fever ceases then rash on trunk
Rubella - puritus
Measles - widepsread non-pruritic rash, cough, conjunctivitis, Koplick
Scarlet fever - rash on face, pits, groin
Erythema infeciosum
Chicken pox- veicles, pruritus
236
Thrombocytopenia + fever + jaundice + neuro sx + renal damage = ?
thrombotic thrombocytopenic purpura (TTP)
237
HBsAg -
HBsAb (Anti-HBsAg) +
HBcAb (Anti-HBcAg) +
What disease state?
Resolved HBV infection
HBsAg - (not currently infected)
HBsAb (Anti-HBsAg) + (we won!)
HBcAb (Anti-HBcAg) + (has had contact)
238
Right ear conductive hearing loss. Weber's test?
Lateralises to right ear (diseased ear)
239
When can you give atleplase (thrombolytic therapy/plasminogen activator) in ischemic stroke?
4.5 hours from symptom onset, from when they went to sleep or last seen normal
240
Investigation for hypercalcaemia (2)?
Check corrected with albumin.
PTH
Normal or low PTH -\> malignancy
High PTH -\> hyperparathyroidism
241
What indicates a current HBV infection? How to determine acute or chronic?
HBsAg + (current infection)
HBcAb (Anti-HBcAg) + (has had contact)
Determine with IgM HBcAb (Anti-HBcAg)
242
Meniere disease symptoms
Middle-age
Recurrent attacks of vertigo,
Progressive sensorineural hearing loss
Nausea, vomiting
Tinnitus
Aural fullness
243
Mechanism of action of SGL2 inhibitors (-giflozin; empagliflozin, dapagliflozin). Adverse effects (2)?
Inhibits resorption of urinary glucose.
Euglycaemic DKA, UTIs
244
Asthma not controlled by SABA alone. What's next?
Low dose ICS (beclomethosone)
245
Example of class I antiarrhythmic
Sodium channel blocker
Lignocaine
246
Mx for acinic keratosis (2)?
Cryotherapy
5-fluorouracil (5-FU)
247
ACS; What complications within 48 hours (4)
Heart blocks
Ventricular tachycardia
Sudden cardiac death
Acute LVHF (pulmonary oedema, cardiac death)
248
Mx of thyrotoxic phase of sub acute thyroditis?
Beta blocker
NO ANTITHYROID DRUG
249
Vestibular neuritis features?
Younger people
Acute onset
Vertigo
No hearing loss
250
What is this and it is associated with what disease?
Kolionychia + iron defieicny anaemia
251
Telangiectasia of lips is associated with?
Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
252
CT shows what and risk factors?
Extradural (epidural) haematoma: bleeding in between dura mater and skull, bi-convex (bleeding on outside and inside of skull)
Trauma related (blow to head); rupture of middle meningeal artery
253
On metformin already. Which 2nd line diabetes medication would not cause you to gain weight?
SGLT2 inhibitors (-giflozin)
Empagliflozin, dapagliflozin
254
Test's for Coeliac disease?
Anti-tissue transglutaminase antibodies
Anti-gladin antibodies
Confirm with endoscopy and biopsy of duodenum
255
Pattern of inheritance of haemophilia?
X-linked recessive; means a male patient will only inherit it from his mothers side.
Father will NOT pass to his son but may pass gene to daughter (who will become carrier).
256
Philadelphia chromosome (t22:9) associated with which leukaemia?
CML
257
AV nipping in what disease?
hypertensive retinopathy
258
What is this disease?
Retinal artery occlusion
259
Biggest cause of preserved ejection fraction/diastolic failure ?
Others (2)
LV hypertrophy from HTN
Aortic stenosis
Constrictve hypertrophy (sacroidosis, amyloidosis, haemochromotosis)
260
CA 125 is associated with which cancer?
Ovarian cancer
261
New name for wegener's granulomatosis?
Granulomatosis with polyangiitis
262
HBsAg positive means what?
Currently infected
| (If negative may have cleared in past)
263
Torsades de pointes mx?
Magnesium
264
HBsAg -
HBsAb (Anti-HBsAg) +
HBcAb (Anti-HBcAg) -
What disease state?
Vaccinated against HBV
265
Unilateral eye pain and redness with this on fluorescein staining. Dx?
Herpes simplex keratitis
266
How to give adrenaline in anaphylaxis, where, how much?
1:1000 0.5mL, midlateral thigh
267
Investigation for Addison's (2)
Is it low cortisol? Early morning salivary cortisol
Is the deficiency in pituitary or adrenal? ACTH stimulating test (if pituitary, then cortisol will decrease)
268
Reversal agent for benzodiazepines?
Flumenazil
But **not in emergency setting/overdose**. Needs intubation.
269
Tx for SIADH?
Fluid restrict
270
What is this condition?
Infantile haemangioma
271
Best diabetes medication for CHF?
SGL2 inhibitors (-giflozin)
Empagliflozin, dapagliflozin
Cardiac protective
272
Test for ascites and diff dx?
SAAG serum-ascitic albumin gradient
([albumin]serum – [albumin]ascitic fluid)
High gradient \>11g/L -\> transudate, theres more protein in blood (Liver ascites, right CHF)
Low gradient \<11g/L -\> Exudative (malignancy, SBP, nephrotic syndrome)
273
Contraindications in AF + WPW (4)
Adenosine
beta blocker, calcium channel blocker, digoxin
274
Urine and serum (osmolarity and sodium) in SIADH?
Urine high osmolarity
Urine high sodium
Serum low osmolarity
Serum low sodium
275
Long QT; Electrolyte disturbances (1)
Hypokalaemia
276
Reversal agent for opioids?
Naloxone
277
Indigestion (dyspepsia), mild epigastic pain radiating to left shoulder, occuring immediately after meals, weight loss, melena. Dx, Ix, Mx?
Chronic gastric peptic ulcer
Bets test: Endoscopy and biopsy (gastric ulcers have higher risk of malignancy)
H. Pylori rapid urease breath test
Triple therapy to eradicate H Pylori: PPI + amoxycillin + clarithromycin
Rescope (+/- biopsy) gastric ulcers in 6 weeks to ensure eradication as higher risk of malignancy
278
Complication in infective endocarditis from IVDU?
Pulmonary emboli (due to septic emboli from tricuspid valve)
279
Modifiable risk factors for osteoprosis (4)?
Smoking
Alcohol use
Low BMI and malnutrition
Sedentary
280
Inferior STEMI leads and vessel
II, III, aVF; right coronary
281
What's this? Mx?
Supraventricular tachycardia (\>150 beats per minute, narrow complex)
Vagal manoeurves
Adenosine
Verapramil
282
Acute GI bleed mx (4)
Endoscopy
Fluid resuscitation + blood transfusion
Terlipressin
Octreotide
283
Sub-Saharan Africa, fever, jaundice, thrombocytopenia, renal dysfunction. Dx, Ix?
Malaria
Thick and thin blood films
284
Starting (and max) dose for valsartan?
40mg (up to 160mg) daily
285
2/5 for all movements on the right side and 5/5 for the left side.
There is loss of vibration and proprioception on the right limbs.
There is deviation of the tongue to the left with mild atrophy.
Left medial medullary infarct (anterior spinal artery)
286
ABx for uncomplicated cystitis
Trimethoprim 3 days
287
ABx for mild CAP?
Amoxicillin and doxycycline
288
Prophylaxis of tumour lysis syndrome?
Allopurinol
289
Renal involvement, history of asthma, dyspnoea + petechieal rash? Dx and what bloods?
Churg-Strauss disease (Eosinophilic granulomatosis with polyangiitis)
pANCA
Eosinophilia
290
Features of APO on CXR?
ABCDE
Alveolar oedema
Kerley B lines and bats wing hilar shadowing
Cardiomegaly
Diversion of upper lobes
Effusions
291
Amiodarone adverse effects? (7)
BITCH
Bradycardia/Blue man
**Interstitial Lung Disease**
**Thyroid** (hyper and hypo) (due to excess iodine in amIODarone)
Corneal (ocular)/Cutaneous (skin)
**Hepatic**/Hypotension when IV (due to solvents)
292
Target BP for diabetics?
140/90
130/80 if they have diabetes + proteinuria.
293
Cannon 'a' wave dx?
Complete heart block
a wave is contraction of atrium. Cannon a signifies contraction of the atrium against a closed tricuspid valve ie in complete heart block
294
Dominant 'a' wave dx?
Pulmonary stenosis and tricuspid stenosis
295
Janeway's nodes location on hand. Painful or not painful?
Janeway's nodes are painless and on palmar surface of hands
296
Osler's nodes location on hand. Painful or not painful?
Osler's nodes are painful and on dorsum of hands
297
Where does frusemide work?
Ascending loop of Henle
298
Where do thiazides work?
Distal tubule
299
Where does spirinolactone work?
Collecting ducts
300
Tx of cluster headaches? (3)
High flow oxygen, subcut sumatriptan and for prophylaxis verapamil (get CG before)
301
Man comes in with lower limb weakness. Likely vascular territory affected?
ACA (lower limbs \>\> upper limbs)
302
Mx of ascites?
Spironolactone
303
Older person with meningitis. Empirical ABx?
Ceftriaxone + dexamethosone + listeria cover (benzylpenicillin)
304
Most common cause of death after a MI in 24 hours?
Ventricular fibrillation
305
How to determine severity of pneumonia?
CURB-65
**Confusion** (disorientation, impaired consciousness)
**Urea** \> 7 mmol/L (20 mg/dL)
**Respiratory rate** ≥ 30/min
**Blood pressure**: systolic BP ≤ 90 mm Hg or diastolic BP ≤ 60 mm Hg
Age ≥ **65** years
CURB-65 score ≤ 1: The patient may be treated as an outpatient.
CURB-65 score ≥ 2: Hospitalization is indicated.
CURB-65 score ≥ 3: ICU-care should be considered.
306
Mx of Crohn's disease?
Acute: corticosteroids
Maintainence: Azathioprine
Stop smoking
307
Mx of UC?
5-ASA drugs
308
Painful rash. Dx and Mx?
Hepes zoster (Shingles) caused by VZV/HHV3
Oral acyclovir
309
Triad in Meniere's disease?
Vertigo, tinnitus and hearing loss (sensorineural)
310
Dx of LBBB or RBBB?
Widened QRS complex.
V1 downwards R wave = LBBB
V1 upwards R wave = RBBB
311
ECG changes in hyokalaemia?
In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT
U waves
Sine T wa=ve
Flattened T waves
312
When to refer a burn? (6)
all deep dermal and full-thickness burns.
superficial dermal burns of more than 10% TBSA in adults, or more than 5% TBSA in children
superficial dermal burns involving the face, hands, feet, perineum, genitalia
any inhalation injury
any electrical or chemical burn injury
circumforencial burns or deep torso burns need escharotomy
313
Fluids for burns?
Parkland formula
total body surface area of the burn % x weight (Kg) x4
314
Assessing total body surface aea of burns?
Wallace's Rule of Nines:
head + neck = 9%
each arm = 9%
each anterior part of leg = 9%
each posterior part of leg = 9%
anterior chest = 9%
posterior chest = 9%
anterior abdomen = 9%
posterior abdomen = 9%
315
Budd-Chiari syndrome is associated with what clinical features (3)?
Clot in the portal vein
Sudden onset abdominal pain, ascites, and tender hepatomegaly
316
Carcinoid syndrome features?
Abdominal pain, diarrhoea and flushing
317
What's this? Mx?
Keratoacanthoma. Rapidly growing, resemble SCC but is benign.
Surgical excision.
318
Loss of right lower limb motor. What stroke?
Left lucunae pure motor stroke
319
Left horner's syndrome, horseness of voice, dysphagia, loss of temp and pain over left face. Loss of pain and temp over right arm and leg. Ataxia. Dx?
Left lateral medullary/PICA/Wallenberg syndrome
320
Most common type of thyroid cancer?
Papillary cancer (is popular)
321
Proximal muscle weakness, dysphagia, rash over upper eye lids and this rash. Dx? Ix?
Dermatomyositis, raised CK
322
Mx of paracetamol overdose?
If within 4 hours -\> activated charcoal
If within 8 hours, get 4 hour paracetamol level to see if NAC is needed
If unknown or \>8 hours, give NAC
323
Mx of Bell Palsy?
\<72 hours onset of symptoms -\> prednisolone
\>72 hours -\> do nothing, 85% spontaneously remit in 3 weeks
324
Red flags for headache?
Severe unrelenting headache
Thunderclap
Focal neuro deficit
Seizures
Impaired consciousness
Signs of raised ICP: LOC, vomiting, bradycardia, worse in mornings, worse when lying down
Signs of meningism: neck rigidity, photophobia, fever
Eye pain
325
Acute onset vertigo in otherwise healthy person with recent URTI.
No hearing loss, no tinnitus.
Vestibular neuritis
326
Gradual onset sensorineural hearing loss, tinnitus, dizziness.
Potential for cranial nerve involvement.
Acoustic neuroma
