Medicine passmed

Question 1

Bradycardia (Symptomatic)+shock treatment?

Answer 1

Atropine (IV) 500mcg = 1st line (can also use this for narrow complex tachy if cause due to AF)
- Bradycardia does not normally need treatment BUT if patient is unstable then needs!
- If needs an alternative treatment= Adrenaline/isoprenaline infusion

Question 2

Supraventricular tachycardia(narrow complex) mx?

Answer 2

IV Adenosine

Question 3

REGULAR broad complex tachycardia Mx?

Answer 3

Amiodarone IV: if patient has no adverse features

Question 4

Standard post- MI medication? (after discharge)

Answer 4

4 in total
1) Dual antiplatelet therapy (aspirin+ clopidogrel/ticagrelor/prasugrel)
2) Beta blocker
3) ACE-inhibitor
4) Statin

Question 5

Pericarditis signs?

Answer 5

• Kussmaul’s sign= JVP increases with inspiration
• CXR: pericardial calcification

Question 6

Rheumatic fever presentation?

Answer 6

• Sore throat
• rash
• heart MURMUR
• arthritis (ankles and wrists aching)

Develops after infection with: Strep pyogenes

Mx: Abx- Oral penicillin V, Anti-inflammatories: NSAIDs are 1st line treatment of any complications eg. heart failure.

Question 7

ACS poor prognosis indicator?

Answer 7

Cardiogenic Shock

Question 8

Difference between narrow and broad complexes?

Answer 8

• Narrow: QRS complexes less than 100 ms (milliseconds)
• Broad: QRS complexes more than 100 ms (milliseconds)

Question 9

Mx. for narrow complex tachycardia with no adverse effects?

Answer 9

• Try vagal manoeuvres eg. carotid sinus massage

Question 10

A.F mx if haemodynamically UNSTABLE(if BP is unmeasurable/too low)

Answer 10

Immediate electrical (DC) cardioversion+ followed by thromboprophylaxis

Question 11

‘Provoked PE’ caused post-op/after immobilisation, how long to keep anticoagulation for?

Answer 11

3 Months

Question 12

Massive PE(Pulmonary Embolism)+unstable eg. hypotension?

Answer 12

Thrombolysis

NB: medical mx order:
1) DOAC eg apixaban/rivaroxaban
if neither suitable=
2)Low weight molecular heparin
3) add another DOAC

Question 13

Ulcerative Colitis:

Answer 13

Presence of crypt abscesses, rectal bleeding. tenesmus (feeling to empty bowel but no stool passed)
- inflammatory bowel disease
- on endoscopy: pseudopolyps, loss of haustrations
-association more common: Primary Sclerosing Cholangitis

Question 14

Crohn’s:

Answer 14

non bloody diarrhoea
-mouth to anus skip lesions
-goblet cells
-on endoscopy: skin lesions ‘cobble stone’ appearance

Question 15

Coeliac disease patients should also receive which vaccine?

Answer 15

• Pneumococcal: as can cause hypo-splenism
• in Coeliac disease: bloods= Anti-tissue transglutaminase antibody is very raised.
• Management of coeliac: is a gluten free diet

Question 16

coeliac foods to have and avoid?

Answer 16

-CAN have: gluten free: including rice, potatoes and corn(maize)
- CAN’T have: gluten for eg. rye bread, barley, wheat, couscous

Question 17

Appendicitis:

Answer 17

• Abdominal pain migrated from umbilicus to right iliac fossa within last 12 hours.
• Rovsing’s sign: palpation of left iliac fossa= results in right iliac fossa pain
  -Mx: Appendicectomy

Question 18

What cancer does Pernicious anaemia predispose to?

Answer 18

Gastric cancer

Question 19

Femoral hernias mx?

Answer 19

• Need to be surgically repaired, regardless of symptoms as there is a high risk of strangulation

Question 20

Medication that is a risk factor for c. diff

Answer 20

• PPIs eg. Omeprazole

Question 21

Management for severe flare up of Ulcerative Colitis:

Answer 21

• Admit the patient in hospital and treat with IV corticosteroid

Mx: for long term maintenance and remission: ORAL aminosalicylate

Question 22

Complication of pancreatitis?

Answer 22

Acute Respiratory Distress Syndrome
- Pancreatitis: will have very raised serum Amylase

Question 23

coeliac disease: what Ig should you look at?

Answer 23

Ig A

Question 24

coeliac disease testing and making a diagnosis?

Answer 24

• needs a REintroduction of gluten for at least 6 weeks before further testing otherwise the tests will come back negative even if patient has coeliac disease.
• Gold standard for diagnosis: Endoscopic intestinal biopsy
• 1st line test: Tissue transglutaminase antibodies

Question 25

Hypercalcaemia ECG finding:

Answer 25

- Shortening of QT interval

Question 26

painful Diabetic neuropathy 1st line mx: (in the feet) for pain-

Answer 26

- Duloxetine; is a SNRI= enhances pain suppression - Other 1st line med: Pregabalin, Gabapentin, Amytriptiline

Question 27

Medication that can be a cause of nephrogenic diabetes insipidus?

Answer 27

Lithium

Question 28

Medication that can be a cause of SIADH:

Answer 28

Fluoxetine

Question 29

Aortic dissection presenting signs:

Answer 29

- Weak/absent pulse (either carotid, brachial or femoral) - Variation in arm blood pressure

Question 30

Mx. of heart failure with a reduced ejection fraction?

Answer 30

- In addition to: ACE-i, beta blocker, furosemide, also add 2nd line) Spironolactone(mineralocorticoid receptor antagonist), NB; contraindication to spironolactone is hyperkalaemia 3rd line) Digoxin and Ivabradine add

Question 31

Prescribing anticoagulants post-surgery:

Answer 31

- For a PE: Prescribe DOAC for 3 months only if the PE is provoked (ie. after surgery), if is not provoked= prescribe for 6 months. DOACs are offered 1st line over LWMH (low weight molecular heparin) - 1st line= Thrombolysis

Question 32

Mx. of a single episode of paroxysmal atrial fibrillation:

Answer 32

Even if it is provoked= need to give anticoagulation: therefore give Apixaban. 2nd line) use Warfarin

Question 33

What drug can cause Heinz Body anaemia?

Answer 33

- Sulphasalazine - Can cause increased reticulocytes - Presents with: SOB, dizziness, tiredness

Question 34

Investigation to be able to differentiate between: IBS and IBD (Irritable Bowel Syndrome and Inflammatory Bowel Disease)=

Answer 34

Faecal calprotectin test . - Colonoscopy is also correct, but this is a more invasive procedure therefore faecal calprotectin is preferred first line.

Question 35

Pregnant woman who smoke: management?

Answer 35

- Nicotine patch is good! - Buproprion and varenicline are contraindicated in pregnancy

Question 36

Meningococcal Septicaemia in children? mx.

Answer 36

- IV fluids and Abx - NB Do NOT give dexamethasone

Question 37

Asthma diagnosis investigation in children?

Answer 37

- Peak Flow - Spirometry and Bronchodilator reversibility: an increase of more than 12% is considired positive= to give salbutamol. (FeNO is not used in children like it is used in adults)

Question 38

what is a strange common feature in appendicitis in children?

Answer 38

- Anorexia / losing appetite and not eating

Question 39

Pathogen causing: Eczema Herpeticum?

Answer 39

- Herpes Simplex Virus - the way the rash can present: painful pruritic rash, with punched out lesions (monomorphic) - Mx: is potentially life threatening= therefore admit children for IV Aciclovir

Question 40

Patients (children) with active HSP(henoch schloein purpura) need what investigations?

Answer 40

-Need to monitor BP and urinalysis (especially in children without renal involvement) - HSP is a type of vasculitis - Around 1/3rd of patients have a relapse

Question 41

Paeds BLS: life support 1st line before starting chest compressions?

Answer 41

- Give 5 rescue breaths

Question 42

Asthma management in children?

Answer 42

- 1) SABA 2) SABA+ ICS 3) SABA+ICS+ LTRA(Monteluklast)- if less than 5, after this stage refer to a paeds asthma specialist 4) SABA+ICS+LABA (instead of LTRA) 5)then MART etc.

Question 43

Classical presentation of HSP? (same as in children)

Answer 43

- Abdo pain - arthritis - haematuria - purpuric rash over buttocks and extensor surface of arms and legs - often follows a URTI and is most common in children. - NB: need to monitor BP and Urine dipstick

Question 44

Mx. of congenital inguinal hernias?

Answer 44

- Need to immediately refer for Paeds surgery: as there is a high rate of complications

Question 45

What medication does Eczema Herpeticum require?

Answer 45

Antivirals eg. Aciclovir

Question 46

Mx. of Testicular Torsion?

Answer 46

- Urgent BILATERAL orchidopexy (surgery involves fixing both testes to prevent torsion of the other testes)- treatment is with surgical exploration