Mid / High Qs

Question 1

What is the most common reason total hip replacements need to be revised?

Answer 1

Aseptic loosening of hip replacement

Question 2

Mx of secondary pneumothorax?

Answer 2

> 2cm + 50y+ = Insert chest drain

1-2cm = Aspiration, if this fails chest drain - admit 24hrs

<1cm - O2 + admit for 24hrs

Question 3

When should you thrombolyse in a PE?

Answer 3

When there is haemodynamic instability

Question 4

Hip fracture surgery - when should pts fully weight bear again?

Answer 4

Straight after surgery

Question 5

Describe garden classification of NOFs

Answer 5

The Garden system is one classification system in common use.
Type I: Stable fracture with impaction in valgus
Type II: Complete fracture but undisplaced
Type III: Displaced fracture, usually rotated and angulated, but still has boney contact
Type IV: Complete boney disruption

Question 6

Mx of NOF - Intracapsular / subcaptial ?

Answer 6

Undisplaced = internal fixation (or hemiarthroplastu if unfit)

Displaced = Total hip replacement (or Hemiarthroplasty - if not independent, cognitive impairment / not fit for procedure)

Question 7

Mx of NOF - extracapsular

Answer 7

Extracapsular = subtrochanteric or trochanteric

Stable intertrochanteric = dynamic hip screw
Reverse oblique, transverse or subtrochanteric = intramedullary device

Question 8

What medication should be avoided bowel obstruction? why?

Answer 8

Metoclopramide - has prokinetic properties and can stimulate persistalsis -> can worsen mechanical bowel obstruction and precipitate perforation

Question 9

NSTEMI Mx?

Answer 9

Question 10

Cluster headaches acute mx? prophylaxis?

Answer 10

High flow o2 + Subcut triptans

prophylaxis - Verapamil

Question 11

ACS mx when should you avoid nitrates / use w caution? what should you give when medically mx instead?

Answer 11

PT is hypotensive as it causes widespread vasodilation

Aspirin + Ticagrelor + Fondaparinux

Question 12

What to do in new onset AF presenting w/in 48h? after 48h?

Answer 12

Anticoagulate (heparin) + electrical cardioversion

48h+ - greater risk of clots hence anticoagulate for 3w before cardioversion

Question 13

Mx of acute pericarditis?

Answer 13

Outpatient mx unless 38oC+ Or raised trop

NSAIDs + Colchinie are 1st line

Question 13

Mx of acute pericarditis?

Answer 13

Outpatient mx unless 38oC+ Or raised trop

NSAIDs + Colchinie are 1st line

Question 14

Acute mx of STEMI?

Answer 14

Analgesia
O2
Nitrates
Aspirin + Prasugrel (or clopidogrel if theyre already on a oral anticoagulant)

Question 15

Acute relapse of MS - mx?

Answer 15

High dose oral steroids eg oral methylpred

Question 16

Mx - fragility fracture in woman over 75?

Answer 16

DEXA scan isnt needed to dx osteoporosis - start bisphosphonate therapy

Question 17

What is the treatment of choice in biliary colic?

Answer 17

Elective laparoscopic cholecystectomy

Question 18

Inguinal hernia mx?

Answer 18

Assymptomatic = routine surgical referral

Signs of incarceration / strangulation = urgent surgical referral

Truss = If unfit for surgical referral

Surgery is usually open unless bilateral / recurrent in which case it is laparoscopic

Question 19

Electrolyte abnormality in prolonged diarrhoea?

Answer 19

Met acidosis + hypokalaemia - loss of bicarb excretion from GI tract

Question 20

Constant back pain + worse on movement + fever and anorexia + disc space narrowing on x-ray - dx? most common cause?

Answer 20

Discitis by staph aureus

Question 21

What are the possible side effects of thyroxine therapy?

Answer 21

hyperthyroidism: due to over treatment
reduced bone mineral density -> osteoporosis
worsening of angina
atrial fibrillation

Question 22

Possible interactions w thyroxine therapy and what to do?

Answer 22

Iron + calcium carbonate - reduces absorption of levothyroxine hence give 4 hrs apart

Question 23

What is Phrens sign? what is positive in? how can you test for this?

Answer 23

Lifting scrotal skin from testes reduces pain - seen in epididymoorchitis -> urine void first sample for NAAT

Question 24

What are the causes of normal anion gap met acidosis?

Answer 24

ABCD R Addisons Bicarb loss - eg diarhoea Chloride Drugs R - renal tubular acidosis (High Cl and Low Bicarb)

Question 25

What are the possible paraneoplastic features seen in each of the following lung cancers: Small cell Squamous cell Adenocarcinoma

Answer 25

Small cell - excess ACTH, ADH and Lamert-Eaton syndrome Squamous cell - PTH related protein -> hypercalcemia, hyperthyroidism to ectopic TSH Adenocarcinoma - Gynaecomastia (most common in non-smokers)

Question 26

Vomiting + Fever + Severe abdo pain relieved by leaning forward -> dx?

Answer 26

Acute pancreatitis

Question 27

1st line mx of osteoarthritis?

Answer 27

Osteoarthritis - paracetamol + topical NSAIDs (if knee/hand) first-line

Question 28

Which causes of CKD do not show small kidneys on USS?

Answer 28

CKD due to ADPKD or early stage diabetic nephropathy

Question 29

When giving fibrinolysis to STEMI pts what should you do after?

Answer 29

ECG 60-90 mins post fibrinolysis to check if ST changes have resolved - if not suggests persistent ischaemia hence PCI needs to be considered

Question 30

What are some absolute CI for laparoscopic surgery?

Answer 30

haemodynamic instability/shock raised intracranial pressure acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm) uncorrected coagulopathy

Question 31

Ix for compartment syndrome?

Answer 31

Intracompartmental pressure measurements

Question 32

What drug interaction can increase INR of warfarin pts?

Answer 32

Metronidazole - inhibits warfarin inhibition

Question 32

What drug interaction can increase INR of warfarin pts?

Answer 32

Metronidazole - inhibits warfarin inhibition

Question 33

Mx of RCC?

Answer 33

Less than 7cm = partial nephrectomy More than 7cm = radical nephrectomy

Question 34

testicular bag of worms + on RHS - possible dx?

Answer 34

Right sided varicocele unlikely normally however can be caused by malignancy due to compression of renal vein at nutcracker angle (between AA and SMA)

Question 35

Features of cardiac tamponade?

Answer 35

Raised JVP, persistent hypotension and tachycardia despite fluid resus

Question 36

Common side effect of metoclopramide?

Answer 36

Diarrhoea

Question 37

Suspected PE but delay in imaging - what should you do?

Answer 37

Interim treatment dose apixaban + perform scan when possible

Question 38

Where are metatarsal shaft fractures likely to happen?

Answer 38

2nd metatarsal shaft

Question 39

Mx of mineral bone disease in CKD?

Answer 39

1st = Reduce dietary phosphate 2 = phosphate binders 3 = vit d parathyroidectomy may be needed in some cases

Question 40

What class of analgesics should be avoided in ACS? Why?

Answer 40

NSAIDs - due to interactions w antiplatelets

Question 41

Which drugs can be used for chemical cardioversion and when?

Answer 41

Flecanide - if no structural heart abnormalities Amiodarone - whenever

Question 42

Squaring of thumbs - characteristic of which condition?

Answer 42

Osteoarthritis of the hand

Question 43

Conservatively mx NSTEMI - what should be offered?

Answer 43

NSTEMI (managed conservatively) antiplatelet choice aspirin, plus either: ticagrelor, if not high bleeding risk clopidogrel, if high bleeding risk

Question 44

ECG changes in WPW

Answer 44

short PR interval wide QRS complexes with a slurred upstroke - 'delta wave' left axis deviation if right-sided accessory pathway in the majority of cases, or in a question without qualification, Wolff-Parkinson-White syndrome is associated with left axis deviation right axis deviation if left-sided accessory pathway

Question 45

How can you diagnose gout?

Answer 45

Check serum urate once inflammation has settled down (should remain high)

Question 46

Preferred site for primary PCI?

Answer 46

Radial artery

Question 47

Why does HOCM cause sudden death in young athletes?

Answer 47

Due to VT

Question 48

What are the parts of the modified glasgow scale to calculate severity of pancreatitis?

Answer 48

PANCREAS PaO2 Age Neutrophilia Calcium Renal func Enzymes Albumin Sugar

Question 49

What type of lung cancer can cause a hoarse voice and how?

Answer 49

Pancoast tumours due to suppression of recurrent laryngeal nerve

Question 50

Which drugs can cause SJS?

Answer 50

carbamazepine, lamotrigine, allopurinol, sulfonamide, phenobarbital Phenytoin Salicylates Sertraline Imidazole antifungal agents Nevirapine

Question 51

Which drugs can cause SJS?

Answer 51

carbamazepine, lamotrigine, allopurinol, sulfonamide, phenobarbital Phenytoin Salicylates Sertraline Imidazole antifungal agents Nevirapine

Question 52

Ix of Haemochromatosis?

Answer 52

General public = Transferrin sat > ferritin Family = Genetic testing (HFE mutation)

Question 53

How to distinguish between direct and indirect inguinal hernias?

Answer 53

Try to reduce hernia by pressing on deep inguinal ring (mid point of inguinal ligament) If it stops protruding exit is in deep inguinal ring hence indirect If it still protrudes it is direct

Question 54

MX of osteoporosis if they cant have alendronate due to GI side effects?

Answer 54

Alendronate -> risedronate or etidronate If bisphosphonates arent tolerated then you can provide them with strontium ranelate or raloxifene

Question 55

Mx of sexual epididymoorchittis of unknown organism?

Answer 55

IM ceftriaxone + oral doxy 10-14d

Question 56

Painful shoulder abduction 90-120 degrees - dx? how to distinguish from main differential?

Answer 56

Subacrominal impingement Rotator cuff injuries also present w painful arc but differentiate as these show muscle weakness when compared to opposite arm + pain on palpation (painful arc is also usually first 60 deg)

Question 57

USS of kidneys in chronic diabetic nephropathy?

Answer 57

Bilateral large / normal sized kidneys

Question 58

Parkinsonianism + autonomic features (ED, postural hypotension and atonic bladder) + cerebellar sign - dx?

Answer 58

Multiple system atrophy

Question 59

Mx of antiphospholipid syndrome?

Answer 59

Primary thromboprophylaxis - low dose aspirin Secondary thromboprophylaxis: - Initial VTE - lifelong warfarin INR 2-3 - Recurrent VTE - lifelong warfarin INR 3-4 (if clots whilst on warfarin consider adding aspirin) - Arterial thrombosis - lifelong warfarin INR 2-3

Question 60

Inguinal hernia, pigmented spots on mouth, palms and soles + intussusception @12y - what is likely dx and finding on colonoscopy?

Answer 60

Peutz-Jeghers syndrome - associated w hamartomas

Question 61

Why is hyperphosphataemia in CKD an issue?

Answer 61

Can drag Ca from bones -> osteomalacia treat w bisphosphonates

Question 62

Result of iron studies in haemochromatosis?

Answer 62

Raised transferrin saturation and ferritin, with low TIBC, high serum iron

Question 63

How often is methotrexate taken?

Answer 63

Weekly

Question 64

When anticoagulating for AF - which pts should be offered 2nd line mx and what is this mx?

Answer 64

1st line = DOAC - these are CI if pt has liver / renal dysfunction 2nd line = warfarin

Question 65

Hypoglossal nerve injury - which way does tongue deviate?

Answer 65

Deviates to side of injury

Question 66

What blood test to monitor effect of levothyroxine treatment?

Answer 66

TSH

Question 67

Which fractures are most commonly associated w compartment syndrome?

Answer 67

Supracondylar and tibial shaft fractures

Question 68

Analgesia for NOFs?

Answer 68

Iliofascial nerve block

Question 69

Which wave in ECG is cardioversion syncd to?

Answer 69

Electrical cardioversion is synchronised to the R wave - its the biggest

Question 70

T2DM mx of blood glucose post ACS?

Answer 70

Stop diabetes meds + start IV insulin

Question 71

Total hip replacement + pt cant dorsiflex foot - what nerve is damaged?

Answer 71

Sciatic

Question 72

CT head multiple ring enchanced leisons - dx? mx?

Answer 72

Toxoplasmosis - treat w/ Pyrimethamine (+ sulphadiazine if immunocompromised)

Question 73

1st line ix for hip fractures according to NICE?

Answer 73

MRI hip

Question 74

Salicylate poisoning - ABG finding

Answer 74

Resp alkalosis + Metabolic acidosis -> usually met acidosis + raised anion gap

Question 75

Pt w T2DM develops CVD what should be done to their mx?

Answer 75

Add SGLT-2 inhibitor

Question 76

1st line for ix of stable angina?

Answer 76

CT Coronary Angio

Question 77

Mx of salicylate poisoning?

Answer 77

IV sodium bicarb

Question 78

Pt on clopidogrel w/ acid reflux - mx?

Answer 78

Lansoprazole > Omep / esomep - as those drugs decrease efficacy of clopidogrel due to preventing conversion into active form

Question 79

Constipation in IBS - mx?

Answer 79

1st line = bulk forming laxative eg ispaghula husk

Question 80

On examination he has weak hip flexion, weak knee extension, and impaired quadriceps tendon reflex, as well as sensory deficit in the anteromedial aspect of the thigh - which nerve is affected?

Answer 80

Femoral

Question 81

A 42-year-old woman complains of a burning pain of her anterior thigh which worsens on walking. There is a positive tinel sign over the inguinal ligament Which nerve is affected?

Answer 81

Lateral cutaneous nerve of thigh

Question 82

Which drug used in mx of prostate cancer can cause bone pain + bladder obstruction etc

Answer 82

Tumour flare - can be triggered by use of GnRH agonists eg Goserelin

Question 83

ECG change seen in digoxin therapy in a pt w AF?

Question 84

HOCM - inheritance, how likely is a sibling to have it?

Answer 84

AD - 50% risk of passed on to siblings

Question 85

What are the echo findings in HOCM?

Answer 85

Mnemonic - MR SAM ASH - mitral regurgitation (MR) - systolic anterior motion (SAM) of the anterior mitral valve leaflet - asymmetric hypertrophy (ASH)

Question 86

Which drugs need to be avoided in HOCM?

Answer 86

Nitrates ACEi Inotropes

Question 87

What are CIs for statin therapy?

Answer 87

Macrolide - 'thromycins Pregnancy

Question 88

What are the antibodies in adult onset stills disease?

Answer 88

RF and ANA negative (high ferritin and leucocytosis)

Question 89

Indications for steroid use in Sarcoidosis?

Answer 89

patients with chest x-ray stage 2 or 3 disease who are symptomatic. Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment hypercalcaemia eye, heart or neuro involvement

Question 90

Weakness of foot dorsiflexion and foot eversion - which nerve is affected?

Answer 90

Common peroneal nerve palsy

Question 91

How to treat cerebral oedema in brain tumour pts?

Answer 91

Dexamethasone

Question 92

Possible complication of total hip replacement?

Answer 92

Posterior dislocation - internal rotation and shortening of affected leg

Question 93

Secondary prevention of strokes if clopidogrel intolerant?

Answer 93

Aspirin + modified release dipyridamole

Question 94

Pt on long-term steroids - what bone protection should be offered?

Answer 94

Bisphosphonate + vit d + ca - no scan needed if 65+, if under 65 bone scan 1st

Question 95

Blockage of which part of the biliary tree does not cause jaundice?

Answer 95

Cystic duct or gall bladder

Question 96

Imaging of choice for PSC?

Answer 96

ERCP / MRCP

Question 97

Hypercalcaemia - ECG abnormality

Answer 97

Short QT

Question 98

ECG change caused by thiazides and why?

Answer 98

Flattening of t waves due to hypokalaemia

Question 99

Signs of SVCO + Myasthenia gravis - dx?

Answer 99

Thymoma -> causes SVCO and can also cause production of antibodies against acetylcholine receptors

Question 100

Thiazide diuretics - electrolyte abnormalities?

Answer 100

Hypercalcaemia (hypocalcuria), hyponatraemia, hypokalaemia

Question 101

Acute heart failure not responding to treatment - consider what?

Answer 101

CPAP

Question 102

mx of infective exacerbations of COPD? when should additional measures be used?

Answer 102

5 days of pred, add abx if purulent sputum / clinical signs of pneumonia

Question 103

mx of infective exacerbations of COPD? when should additional measures be used?

Answer 103

5 days of pred, add abx if purulent sputum / clinical signs of pneumonia

Question 103

mx of infective exacerbations of COPD? when should additional measures be used?

Answer 103

5 days of pred, add abx if purulent sputum / clinical signs of pneumonia

Question 104

What needs to be corrected prior to bisphosphonate therapy + why?

Answer 104

Ca and vit d deficiencies as this can be worsened by bisphosphonates

Question 105

What should be avoided in severe colitis (in UC) due to risk of perforation, do what instead?

Answer 105

Avoid colonoscopy - do flexible sigmoidoscoppy

Question 106

UC / Crohns - which is associated w gallstones?

Answer 106

Crohns

Question 107

Iron studies in anaemia of chronic disease

Answer 107

Low Fe, Low ferritin, low / normal TIBC

Question 108

Test results in alcoholic ketoacidosis?

Answer 108

Normal / low glucose + met ketoacidosis

Question 109

What is the most sensitive and specific lab finding for liver cirrhosis in CLD?

Answer 109

Reduced platelet count

Question 110

An acute presentation of abdominal pain with peritonism in a patient with known peptic ulcer disease is highly suggestive of ..... - what is the ix required?

Answer 110

gastrointestinal perforation - erect CXR = ix of choice -> if +ve follow w CT

Question 111

Haemochromatosis - inheritance?

Answer 111

AR

Question 112

Mild elevation in ferritn + Abnormal LFTs + Obese = ?

Answer 112

NAFLD

Question 113

Test of exocrine func in chronic pancreatitis?

Answer 113

Faecal elastase

Question 114

Ix of choice pancreatic ca?

Answer 114

High res CT

Question 115

Sudden onset abdo pain + AF + big meal - dx?

Answer 115

Mesenteric ischaemia

Question 116

initial ix when suspecting mesenteric ischaemia?

Answer 116

ABG/ VBG - check for raised lactate CT angio abdo + pelvis + contrast is needed definitively

Question 117

Upper GI endoscopy, stop what medication and when?

Answer 117

Stop PPIs 2w before to identify any pathology

Question 118

What part of GI tract normally has diverticula?

Answer 118

Sigmoid colon - outpouchings

Question 119

Liver sign in RHF?

Answer 119

Firm smooth enlarged tender and pulsatile liver edge

Question 120

AI liver disease - mx?

Answer 120

Steroids +- other immunosuppression (eg azathiprine) Liver transplant?

Question 121

Biopsy of which part of small intestine in coeliac is required?

Answer 121

Jejunem / duodenum

Question 122

How should you mx diverticulitis flares?

Answer 122

Oral abx at home - if no improvement in 72h admit for IV ceftriaxone + metronidazole

Question 123

Biliary colic - what are the LFTs and inflammatory markers like?

Answer 123

Normal

Question 124

Oesophageal varicies - prophylaxis of bleeding?

Answer 124

Non-cardioselective BB eg propanolol

Question 125

What the features of mild, moderate, severe and life-threatening C. diff?

Answer 125

Question 126

Which anal fissures are concerning?

Answer 126

Lateral ones - should normally be in posterior midline

Question 127

Mx of hepatic encephalopathy?

Answer 127

Lactulose - increased excretion of ammonia Prophylaxis w rifamixin - adjust gut flora to decrease ammonia production

Question 128

AXR w signs of small bowel obstruction + air in biliary tree - what is possible dx?

Answer 128

Gallstone ileus - gallstone enters ileocaecal valve

Question 129

What should be given before endoscopy in pts w variceal haemorrhage?

Answer 129

Terlipressin + prophylactic abx

Question 130

Why should folate be replaced after B12 in deficiency?

Answer 130

Folate replacement prior to B12 can precipitate subacute combined degeneration of the spinal cord.

Question 131

What class of drug is terlipressin?

Answer 131

Vasopressin analogue

Question 132

ix findings in PBC? mx?

Answer 132

Ix: - Raised ALP + GGT - Raised AMA titre >1:40 Mx: 1st - ursodeoxycholic acid - slows disease and improves sx Pruritis - cholestyramine Fat soluble vitamins Liver transplant if >100 bilirubin

Question 133

What is the most common cause of large bowel obstruction?

Answer 133

Colon cancer

Question 134

When checking if there is any anastamotic leaks following bowel surgery what ix is used and why?

Answer 134

Gastrograffin enema > barium - less toxic than barium if it leaks into abdo cavity

Question 135

Imaging of choice for PE if renal impairment?

Answer 135

V/Q scan

Question 136

ECG - II, III and aVF ST elevation - what vessel is affected? what is a possible complication?

Answer 136

Supplies right coronary artery -> supplies AV node so can cause arrhythmias inc bradycardia and AV block

Question 137

Which type of MI is more likely to cause RBBB?

Answer 137

LAD - as blocks below level of AV node

Question 138

What should not be given alongside verapamil, why?

Answer 138

BB due to risk of complete heart block / bradycardia -> death

Question 139

What causes U waves on ECG? an example of a medication that can cause this?

Answer 139

caused by hypokalaemia (also see prolonged PR interval 1st degree heart block) - can be caused by thiazide

Question 140

What is the most specific ECG finding in acute pericarditis?

Answer 140

PR depression secondary to atrial injury

Question 141

How long before elective surgery is warfarin stopped?

Answer 141

5d - aim to get INR below 1.5 Usually resumed on evening of surgery / next day if hemostasis is adequate

Question 142

mid-late diastolic murmur - describes what?

Answer 142

mitral stenosis - most commonly cause by rheumatic fever

Question 143

How should orthostatic hypotension be mx?

Answer 143

education and lifestyle measures such as adequate hydration and salt intake discontinuation of vasoactive drugs e.g. nitrates, antihypertensives, neuroleptic agents or dopaminergic drugs if symptoms persist, consider compression garments, fludrocortisone, midodrine, counter-pressure manoeuvres, and head-up tilt sleeping

Question 144

What should be offered to pts on symptomatic stable angina that require addition of another drug already on CCB but CI against BB?

Answer 144

long-acting nitrate, ivabradine, nicorandil or ranolazine

Question 145

What are some side effects of thiazide like diuretics?

Answer 145

Dehydration Postural hypotension Gout Impaired glucose tolerance Impotence

Question 146

What is pulsus paradoxus?

Answer 146

Large drop in BP upon inspiration seen in cardiac tamponade

Question 147

What are the reversible causes of cardiac arrest ?

Answer 147

4H + 4T Hypoxia Hypovolaemia Hyper/po - kalaemia, hypoglyc, hypocalc Hypothermia Thrombosis (coronary or pulmonary) Tension pneumothorax Tamponade Toxins

Question 148

What electrical activity is likely to be seen in tension pneumothorax?

Answer 148

Pulseless electrical activity

Question 149

What should be done in CPR if suspecting PE?

Answer 149

Prove thrombolytic drugs eg alteplase and continue CPR for 60-90 mins

Question 150

Early diastolic murmur - high pitched and blowing in character describes what murmur?

Answer 150

Aortic regurg

Question 151

Which drugs need to be used with caution in pts w statins and why?

Answer 151

Erythro / clarithromycin - inhibits p450 leading to raised levels of statin in the body -> increased risk of rhabdomyolysis EVEN GREATER RISK IN CKD PTS

Question 152

What should you do in AF pt if ChadVasc is below threshold to treat?

Answer 152

Do a transthoracic echo to rule out to exclude valvular heart disease

Question 153

Which anti-HTN can cause hypocalcaemia?

Answer 153

Loop diuretics eg furesomide

Question 154

Widespread joint hypermobility + MR - dx?

Answer 154

Collagen disorder eg marfans , ehlers-danlos

Question 155

What are some causes of postural hypotension - how is this defined?

Answer 155

Causes - Hypovolaemia - Autonomic dysfunction: diabetes, Parkinson's - Drugs: diuretics, antihypertensives, L-dopa, phenothiazines, antidepressants, sedatives - Alcohol Postural hypotension = >20mmhg drop

Question 156

What drugs should be avoided in AS due to the theoretical risk of hypotension?

Answer 156

Nitrates

Question 157

Broad complex tachycardia - what medication is CI?

Answer 157

This is VT - Verapamil is CI due to risk of haemodynamic deterioration, VF and cardiac arrest

Question 158

VF / pulseless VT - mx?

Answer 158

1 shock as soon as identified followed by 2 mins of CPR If arrest is witnessed in monitored pt - up to 3 stacked shocks v 1 before CPR

Question 159

1st line mx of trigeminal neuralgia?

Answer 159

Carbamzepine

Question 160

Mx of medication overuse headaches?

Answer 160

Simple analgesia + triptans can be stopped abruptly Opioids should be weaned gradually

Question 161

What should you do if a pt w pneumothorax has persistent air leak or recurrent episodes?

Answer 161

Consider referral for VATS (video-assisted thoracopscopic surgery) to allow for mechanical/chemical pleurodesis +/- bullectomy

Question 162

1st line ix for osteoporotic vertebral fractures?

Answer 162

X-ray Spine -> if theres a compression fracture may need a CT spine

Question 163

Ca + breathlessness of exertion + upper lobe findings on CXR?

Answer 163

Radiation pneumonitis - causing upper zone fibrosis

Question 164

how can you have a definitive diagnosis of medication overuse headaches?

Answer 164

Symptoms must resolve (or revert back to their original pattern) within 2 months of stopping the causative medication.

Question 165

Effect of clarithromycin + warfarin together?

Answer 165

Increased effect of warfarin due to inhibition of P450 system leading to decreased break down

Question 166

Gene mutation associated w hereditary non-polyposis colorectal carcinoma?

Answer 166

MSH2/MLH1 gene mutations

Question 167

Rib fracture what to do if not controlled with normal analgesia? when might you consider further mx?

Answer 167

Nerve blocks If conservative measures dont work after 12w consider surgical fixation or in the case of flail chest

Question 168

What are the different rotator cuff muscles and what are their functions?

Answer 168

Question 169

Effect of barbiturates and antiepileptics on warfarin?

Answer 169

P450 inducers - reduces concentration

Question 170

Which is a mroe common cause of colorectal ca - HNPCC or FAP?what other ca does this increase risk of?

Answer 170

HNPCC -> endometrial

Question 171

Diverticular sx + vaginal passage of faeces or flatus - dx?

Answer 171

Colovaginal fistula

Question 172

Difference between diverticulosis and diverticulitis in presentation?

Answer 172

If symptomatic probs -itis

Question 173

1st line osteoarthritis?

Answer 173

Paracetamol and NSAIDs - topical NSAIDs only if hand or knee

Question 174

Tension pneumo mx - what size cannula and where?

Answer 174

14G cannula in 5th ICS MCL

Question 175

Use of vibrating tools can cause what condition in the hands?

Answer 175

Raynauds

Question 176

What foods should pts taking warfarin avoid?

Answer 176

Foods high in vit K - broccoli, spinach, kale and sprouts

Question 177

What increases risk of chest infections in rib fractures?

Answer 177

Inadequate ventilation

Question 178

Mx of acute confusional state?

Answer 178

Treating the underlying cause and environmental modification not working then haloperidol sometimes used - if parkinsonianism use atypical eg ozapines

Question 179

What should you do for AF + TIA?

Answer 179

Start anti coagulation asap once haemmorhage is excluded - probs a DOAC

Question 180

Cavitating upper lobe pneumonia in diabetic + alcoholic?

Answer 180

Kleb pneumoniae

Question 181

Chronic steroid use + insidious development of anterior hip pain + stiffness - what should you be most worried about? what is the ix?

Answer 181

Avascular necrosis - MRI hip

Question 182

On auscultation of the chest, what can you hear in the following conditions: Asbestosis and Bronchiectasis

Answer 182

Asbestosis - inspiratory crackles Bronchiectasis - coarse crackles and high-pitched inspiratory squeaks

Question 183

How do you manage different types of seizures in men and women?

Answer 183

Question 184

What are the clinical findings in ank spond?

Answer 184

Reduced: - Chest expansion - Lateral flexion - Foward flexion

Question 185

What should anticoagulant of choice be in a pt w/ AF who has a stroke / TIA?

Answer 185

Warfarin / direct thrombin / factor Xa inhibitor

Question 186

What conditions do the following x-ray findings suggest: - periarticular erosions and bone resorption - Erosions with overhanging edges ('rat-bite' erosions) - joint effusion - loss of joint space, osteophytes, and subchondral sclerosis - Widened, bulky physeal plates and irregularity

Answer 186

- periarticular erosions and bone resorption = Psoriatic arthritis (pencil in cup) - Erosions with overhanging edges ('rat-bite' erosions) = Gout - joint effusion = septic arthritis - loss of joint space, osteophytes, and subchondral sclerosis = Osteoarthritis - Widened, bulky physeal plates and irregularity = Osteopaenia

Question 187

Ix for aki of unknown origin?

Answer 187

Renal tract US

Question 188

What to do if considering SAH, CT is negative?

Answer 188

If CT was done w/in 6h -> consider another dx no need fro LP If CT was done after 6h -> Do an LP 12h after onset of sx (done to check for xanthochromia - product of RBC breakdown)

Question 189

How is ADPKD screened for?

Answer 189

US abdomen

Question 190

What drug can reduce progression of ADPKD?

Answer 190

Tolvaptan

Question 191

What vit d replacement should be offered to those with CKD - why?

Answer 191

Alfacalcidiol - doesnt require activation in kidneys

Question 192

Which Ig is found quicker in infection IgM or IgG?

Answer 192

IgM then IgG

Question 193

How can you distinguish between amoebic and pyogenic liver abscesses?

Answer 193

Both have similar US appearances - homogenous hypoechoic round leisons Amoebic - associated w travellers diarrhoea Pyogenic - Associated w hepatobiliary / pancreatic disease

Question 194

What needs to be monitored in pts w HSP?

Answer 194

BP and Urinalysis - check for progressive renal involvement

Question 195

Reddening and thickening of nipple and areola - possible dx? mx?

Answer 195

Pagets disease of breast - suggestive of breast ca hence requires urgent referral to breast clinic for punch biopsy, mammography and US breast

Question 196

How to distinguish between pagets disease of breast and nipple eczema? mx?

Answer 196

Nipple - starts areola and goes to nipple Pagets - starts nipple and goes to areola mx = Emollients (mild), Corticosteroids (mod), Tacrolimus (refractory)

Question 197

How much monitoring is recommened in T1DM? when is more frequent monitoring of blood glucose suggested?

Answer 197

recommend testing at least 4 times a day, including before each meal and before bed (5-7 in morning and 4-7 at other times = target levels) more frequent monitoring is recommended if frequency of hypoglycaemic episodes increases; during periods of illness; before, during and after sport; when planning pregnancy, during pregnancy and while breastfeeding

Question 198

Epilepsy + learning disability + bilateral flank masses w/ haematuria - overall dx? cause of flank masses?

Answer 198

Tuberous sclerosis - masses are angiomyolipomas

Question 199

Mx of hypothyroidism in pregnancy?

Answer 199

Maternal free t4 needs to be in upper 1/3rd to avoid foetal hypothyroidism 1st trimester - propylthiouracil > carbimazole - due to reduced risk of congenital abnormalites 2nd trimester+ = carbimazole - less risk of severe hepatic injury

Question 200

When may renal replacement therapies such as haemodialysis be offered in mx of AKI?

Answer 200

When pt is not responding to medical mx of complications eg hyperkalemia, pulmonary oedema, acidosis or uraemia

Question 201

how is a thyrotoxic storm treated?

Answer 201

BB, anti-thyroid drugs + steroids

Question 202

When can stage 1 and 2 CKD be diagnosed?

Answer 202

If GFR is within the correct ranges + markers of kidney disease including proteinuria, haematuria, electrolyte abnormalities or structural abnormalities detected

Question 203

All patients with a CD4 count lower than 200/mm3 should receive what mx of HIV?

Answer 203

very active ART + PCP prophylaxis (co-trimoxazole)

Question 204

Abx for MRSA???

Answer 204

Vancomycin

Question 205

Assymptomatic bacteria in catheterised pts - to treat or not to treat?

Answer 205

dont traet

Question 206

How can you confirm dx of post-streptococcal glomerulonephritis?

Answer 206

Anti-streptolysin O titre

Question 207

What thyroid disease can smoking cause?

Answer 207

graves - (hyperthyroid)

Question 208

Mx of paediatric inguinal hernias?

Answer 208

- Urgent referral if <1y due to increased risk of strangulation - Older can be considered for elective repair - Neonates and premature may be kept overnight due to increased risk of post op apnoea

Question 209

3rd trimester UTI - what to use?

Answer 209

Amox / cefalexin for 7d

Question 210

What defines the resolution of DKA? what if no resolution of ketonaemia + acidosis in 24h?

Answer 210

DKA resolution is defined as: pH >7.3 and blood ketones < 0.6 mmol/L and bicarbonate > 15.0mmol/L review by senior endocrinologist

Question 211

When to send MSU in women w UTI?

Answer 211

Have symptoms that are persistent or do not resolve with antibiotic treatment. Have recurrent UTI (2 episodes in 6 months or 3 in 12 months). Have a urinary catheter in situ or have recently been catheterised. Have risk factors for resistance or complicated UTI such as abnormalities of the genitourinary tract, renal impairment, residence in a long-term care facility, hospitalisation for more than 7 days in the last 6 months, recent travel to a country with increased resistance or previous resistant UTI. Have atypical symptoms. Have visible or non-visible (on urine dipstick) haematuria. Pregnant Age more than 65 years old.

Question 212

Mx of testicular torsion surgery?

Answer 212

Definitive is emergency exploratory surgery + bilateral orchidopexy If surgery is delayed 6h+ / prep is being made for it - can do emergency manual de-torsin (anti clockwise rotation) - buy more time for surgery

Question 213

What should be done to steroid dose during illness + why?

Answer 213

Double the dose - due to risk of adrenal crisis

Question 214

When is surgical mx of hiatus hernia required?

Answer 214

If it is a paraoesophageal hernia or signs of complication eg UGI haemorrhage / necrosis

Question 215

How long to wait after prostatitis to measure PSA levels?

Answer 215

1 month

Question 216

Obstructive urinary calculi + signs of infection -> mx?

Answer 216

Urgent surgical renal decompression + IV Abx due to risk of sepsis

Question 217

Anal fistula dx - what to do now?

Answer 217

MRI pelvis - to characterise its course -> surgery may be needed in emergencies if pt is v unwell

Question 218

Missing dialysis - effect on K+, what is a sign of this happening severly on ECG?

Answer 218

Can increase K+ Severe hyperkalaemia -> Sinusoidal wave pattern

Question 219

T2DM dx in assymptomatic pts?

Answer 219

Need 2 positive results

Question 220

What conditions can lead to higher-than-expected and lower-than-expected levels of HbA1c?

Answer 220

Higher - increase RBC lifespan: - Vit b12 / folate deficiency - IDA - Splenectomy Lower - reduced RBC lifespan: - Sickle cell - G6PD deficiency - Hereditary spherocytosis - Haemodialysis

Question 221

What are the possible extra renal manifestations of ADPKD?

Answer 221

Hepatic cysts which manifest as hepatomegaly Diverticulosis Intracranial aneurysms Ovarian cysts

Question 222

What are the possible extra renal manifestations of ADPKD?

Answer 222

Hepatic cysts which manifest as hepatomegaly Diverticulosis Intracranial aneurysms Ovarian cysts

Question 223

Menstrual issues in hyper / hypothyroid?

Answer 223

Hyperthyroid = oligomennorhoea / amennorhoea Hypothyroid = menorrhagia

Question 224

Brainstem stroke vessels and their presenting sx: - Anterior cerebral artery - Anterior inferior cerebellar artery - Basilar artery - Posterior cerebral artery - Posterior inferior cerebellar artery

Answer 224

Question 225

What is a good induction anasthesia in someone who is hemodynamically unstable?

Answer 225

Ketamine

Question 226

Which people should be referred via suspected ca pathway for breast ca?

Answer 226

aged 30 and over and have an unexplained breast lump with or without pain or - routine referral if below this age aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer in people: with skin changes that suggest breast cancer or aged 30 and over with an unexplained lump in the axilla

Question 227

Possible electrolyte abnormality w infusing large amounts of NaCl?

Answer 227

Hyperchloraemic acidosis - use hartmanns instead

Question 228

Traumatic injury + LOC + Lucid interval -> what dx? what feature may you see?

Answer 228

Extradural haematoma Cushings reflex - HTN and bradycardia

Question 229

Shoulder dislocation - when is anteroir more common and when is posterior more associated? how does it present on examination?

Answer 229

anterior = FOOSH - locked in external rotation posterior = seizures / electric shock - locked in internal rotation

Question 230

Which manoeuvre to open airway is preferred if concerned about C-spine injury?

Answer 230

Jaw thrust > Head tilt / chin lift

Question 231

What type of myopathy can corticosteroids cause?

Answer 231

Proximal myopathy

Question 232

Mx of raised ICP?

Answer 232

Ix and tx underlying cause 1. Raise head of bed to 30deg 2. IV mannitol 3. controlled hyperventilation-> reduced co2 -> vasoconstriction of cerebral arteries -> reduced ICP (caution in ischaemia)

Question 233

Suspected visual loss in temporal arteritis - mx?

Answer 233

IV methylpred

Question 234

What are some possible complications following SAH?

Answer 234

Re-bleeding normally 1st 12hrs Hydrocephalus Vasospasm - causes stroke like sx Hyponatraemia - secondary to SiADH Seizures

Question 235

Causes of unilateral and bilateral hydronephrosis?

Answer 235

Unilateral = PACT - Pelvic-ureteric obstruction (congenital or acquired) - Aberrant renal vessels - Calculi - Tumours of renal pelvis Bilateral = SUPER - Stenosis of the urethra - Urethral valve - Prostatic enlargement - Extensive bladder tumour - Retro-peritoneal fibrosis

Question 236

Mx of hydronephrosis?

Answer 236

Remove obstruction and drainage of urine Acute upper urinary tract obstruction = nephrostomy tube Chronic upper urinary tract obstruction = ureteric stent or pyeloplasty

Question 237

All men w/ ED should have what levels checked?

Answer 237

Morning free testosteroen

Question 238

What is normal anion gap?

Answer 238

8-14

Question 239

Mx of small bowel obstruction?

Answer 239

Drip + Suck - NG tub insertion + IV fluids w/ extra K+

Question 240

Swelling at DIP joints - what sign is this, what condition?

Answer 240

Herberdens nodes - features of osteoarthritis

Question 241

Radiotherapy after wide-local excision / masectomy in breast ca mx?

Answer 241

- Whole breast radiation is recommended in wide local excision - Radiotherapy in only T3 and T4 tumours or 4+ positive axillary nodes in those w/ masectomy

Question 242

initial mx of limb threatening ischaemia?

Answer 242

IV analgesia + heparin + vascular review

Question 243

What should happen to pts own insulin when mx of DKA?

Answer 243

Stop short acting insulin Continue long acting insulin

Question 244

Mx of primary hyperaldosteronism?

Answer 244

Mx w spironolactone

Question 245

Osteomyelitis ix of choice?

Answer 245

MRI

Question 246

What is a common cause of bilateral carpal tunnel syndrome?

Answer 246

RA

Question 247

When to add insulin in mx of HHS?

Answer 247

Only if glucose level stops falling just giving iv fluids otherwise there is a risk of central pontine myelinolysis consider vte

Question 248

Complete heart block following a MI - what vessel?

Answer 248

Right coronary artery

Question 249

What is the definition of AKI?

Answer 249

Detect acute kidney injury, in line with the (p)RIFLE, AKIN or KDIGO definitions, by using any of the following criteria: * a rise in serum creatinine of 26 micromol/litre or greater within 48 hours * a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days * a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than

Question 250

Mx of ileus?

Answer 250

NBM -> can progress to small sips of clear fluids NG tube if vomiting IV fluids to maintain normovolaemia TPN - needed for prolonged / severe cases

Question 251

What are the indications for a CT head within 1 hour and what are the indications for CT head within 8 hours

Answer 251

Question 252

Insulin dependent diabetic - when should they check blood glucose re driving?

Answer 252

Check before driving and every 2 hrs whilst driving

Question 253

Raised which hormone is increased risk of pseudogout?

Answer 253

PTH - hyperparathyroidism

Question 254

Renal colic - contrast or non-contrast KUB?

Answer 254

non-contrast KUB

Question 255

mechanism of action of tamsulosin?

Answer 255

a-1 antagonist

Question 256

What are the red flag sx and signs that suggest a serious underlying cause for trigeminal neuralgia?

Answer 256

Sensory changes Deafness or other ear problems History of skin or oral lesions that could spread perineurally Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally Optic neuritis A family history of multiple sclerosis Age of onset before 40 years

Question 257

What cause of n+v should the following medications be used for? Ondansetron Haloperidol Prochlorperazine Metoclopramide

Answer 257

Ondansetron for chemotherapy-induced nausea Haloperidol for intracranial causes (raised ICP, direct effect of tumour) Prochlorperazine for vestibular causes Metoclopramide for gastrointestinal causes

Question 258

Pt on steroids - has surgery what do you need to do and why?

Answer 258

The patient needs steroid cover with hydrocortisone or dexamethasone before and after major surgery to prevent adrenal crisis

Question 259

Describe the different epilepsy localising features in terms of lobe affected?

Answer 259

Question 260

What is the mx of neuropathic pain?

Answer 260

first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin- if the first-line drug treatment does not work try one of the other 3 drugs

Question 261

What are the causes of postural hypotension w/ compensatory tachycardia -what doesn't have compensatory tachy?

Answer 261

The '4Ds' can be useful in remembering causes of postural hypotension with compensatory tachycardia. - Deconditioning. - Dysfunctional heart: aortic stenosis. - Dehydration: disease (acute illness, adrenal insufficiency), dialysis, drugs (diuretics, narcotics). - Drugs: anti-anginals, anti-parkinsonian medications (levodopa), antidepressants, antipsychotics, anti–benign prostatic hyperplasia drugs (tamsulosin) Autonomic failure eg in parkinsons

Question 262

Why do you get long QT syndrome?

Answer 262

Usually due to loss of function / blockage of K+ channel

Question 263

What is the new definition of a TIA?

Answer 263

New 'tissue-based' definition is now used: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction

Question 264

Which pts should be offered urate lowering therapies (allopurinol / febuxostat) in mx of gout?

Answer 264

Those w 2 or more attacks per year, tophi, renal disease, uric acid renal stones and if on cytotoxic / diuretics When prescribing this colchicine should be co-prescribed for 1st 6m (otherwise NSAIDs)

Question 265

Which pts should be offered urate lowering therapies (allopurinol / febuxostat) in mx of gout?

Answer 265

Those w 2 or more attacks per year, tophi, renal disease, uric acid renal stones and if on cytotoxic / diuretics When prescribing this colchicine should be co-prescribed for 1st 6m (otherwise NSAIDs)

Question 266

What is the most common type of thyroid cancer, most likely complication of this type and prognosis?

Answer 266

Papillary Spreads to cervical lymph nodes Excellent prognosis

Question 267

Mx of HAP?

Answer 267

Within 5 days of admission: co-amoxiclav or cefuroxime More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

Question 268

What is CK like normally in Rhabdomyolysis?

Answer 268

10,000+

Question 269

Stroke + AF = mx?

Answer 269

Start anticoag w DOAC or Warfarin

Question 270

Best ix to identify C spine fractures?

Answer 270

CT Spine

Question 271

Needle biopsy: nuclei that are enlarged, hyperchromatic and pleomorphic - suggests what ca?

Answer 271

Carcinoma

Question 272

OAB mx?

Answer 272

Oxybutinin - antimuscarinic

Question 273

Incidental AF found what to do?

Answer 273

CHADVASC then decide if you need anticoagulation

Question 274

Nose bleed - mx?

Answer 274

cautery -> minor bleeding + accessible site = cautery, anterior pack used for profuse bleeding w/ sites difficult to localise

Question 275

MSM + Procitis + Lymphadenopathy - possible dx?

Answer 275

Lymphogranuloma venereum

Question 276

Cord compression due to spinal mets + too frail for surgery possible mx?

Answer 276

External beam radiotherapy

Question 277

what type of peptic ulcer is relieved by eating and worse on rest?

Answer 277

duodenal

Question 278

Acute gout but NSAIDs are ruled out in CKD stage 4 what should you use?

Answer 278

Oral pred

Question 279

Down and out eye - which nerve palsy, what if there's pupil dilation?

Answer 279

3rd nerve - if dilation it is surgical 3rd nerve

Question 280

What to do if severe hyperkalaemia in context of AKI?

Answer 280

Immediate discussion w/ crit care / nephrology to consider renal replacement therapies

Question 281

Myasthenia gravis antibodies?

Answer 281

Anti-ACHr

Question 282

How can you diagnose IgA nephropathy definitively?

Answer 282

Renal biopsy - shows diffuse mesangial IgA deposition

Question 283

What are the main causes of non-gonococcal urethritis?

Answer 283

1 = Chlamydia trachomatis If negative for chlamydia -> mycoplasma genitalium

Question 284

Mx of subclinical hypothyroidism - raised TSH but normal T3/4?

Answer 284

If TSH >10 consider offering levothyroxine if levels remain like this at 2 occasions 3m apart if TSH 5.5-10 depends on age - 65> - measurements are true 2x 3m apart + sx -> consider supplementation - older people (particularly 80+) - watch and wait - Assymptomatic - observe and repeat in 6m

Question 285

What common drugs can cause SJS?

Answer 285

Antibiotics such as penicillin, amoxicillin, erythromycin, ciprofloxin and sulfonamides Anticonvulsants such as Lamotrigine, phenobarbital, valproic acid, phenytoin and carbamazepine NSAIDs- Pain relievers such as acetaminophen, ibuprofen, naproxen sodium and allopurinol Antifungals such as ketoconazole, itraconazole and fluconazole Antivirals such as abacavir

Question 286

What is Lights criteria for exudative v transudative pleural effusion and when should it be applied?

Answer 286

Applied when pleural fluid protein is 25-35 Criteria that suggest exudative is: - pleural fluid protein divided by serum protein >0.5 (more than 1/2) - pleural fluid LDH divided by serum LDH >0.6 (more than 60%) - pleural fluid LDH more than two-thirds the upper limits of normal serum LDH - more than 150

Question 287

What is the max metformin can be titrated up to - when does this need to be done?

Answer 287

Increase to 500mg TDS (3x daily) - before initiating SGLT-2 inhibitors

Question 288

What bacteria does this describe: - Gram -ve rod - Non-lactose fermenting - Oxidase +ve

Answer 288

Pseudomonas eurginosa

Question 288

What bacteria does this describe: - Gram -ve rod - Non-lactose fermenting - Oxidase +ve

Answer 288

Pseudomonas eurginosa

Question 289

What blood pressure reading in clinic is the criteria for immediate tx?

Answer 289

180/120<

Question 290

Medial epicondylitis - what aggrevates pain and what might this accompany?

Answer 290

pain is aggravated by wrist flexion and pronation symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement

Question 291

What form of encephalitis typically shows bilateral temporal lobe changes on CT? how do different causes of encephalitis varus?

Answer 291

this is textbook HSV encephalitis Cryptococcus - weeks not days and CMV (CD <50) encephalitis occur in immunocompromised (HIV) pts

Question 292

Painful 3rd nerve palsy + dilated eye suggests what?

Answer 292

Posterior communicating artery aneurysm - dilation suggests compressive leison

Question 293

Diabetic foot ulcer + raised temp + raised HR -> suggests what? how to dx?

Answer 293

These are signs of systemic illness - suggestive of osteomyelitis Dx is done using MRI - requires 6w of fluxcox

Question 294

Which viruses are most likely to cause meningitis in adults?

Answer 294

Enterovirsuses eg coxsackie, echovirus

Question 295

Breast Ca - post surgery adjuvant therapy choices if hormone +ve?

Answer 295

If post-menopausal - aromatase inhibitors eg anastrozole If pre/peri-menopausal - tamoxifen (can increase risk of endometrial, VTE and menopausal sx)

Question 296

Signs of hydrocephalus?

Answer 296

Wet weird wobbly

Question 297

Signs of venous sinus thrombosis?

Answer 297

Risk factors for thrombosis, headache, reduced consciousness, vomiting

Question 298

contralateral homonymous hemianopia with macular sparing and visual agnosia - what vessel

Answer 298

Posterior cerebral artery

Question 299

What are the signs seen in lateral medullar syndrome?

Answer 299

cerebellar signs, contralateral sensory loss & ipsilateral Horner's

Question 300

Mx of VT - what drug is CI?

Answer 300

Verapamil

Question 301

Pt w/ gonorrhoea - what can be offered if they refuse IM ceftriaxone?

Answer 301

Oral cefixime + oral azithromycin

Question 302

Ejection systolic murmur - worse on inspiration (downs) -dx?

Answer 302

ASD

Question 303

Spinal cord trauma + low BP + normal HR - suggests what? mx?

Answer 303

Neurogenic shock - low BP due to reduced sympathetic tone / increase parasympathetic tone + cannot produce tachycardia response Will need vasopressers

Question 304

Which lung ca can cause SiADH, ACTH rise and lambert eaton?

Answer 304

Small cell

Question 305

Which lung ca can cause increased release of PTH-rp?

Answer 305

Squamous cell

Question 306

Which lung ca can cause gynaecomastia?

Answer 306

Adenocarcinoma

Question 307

What is a common complication of intraventricular haemorrhage? how can this be distinguished from expansion of hematomas?

Answer 307

Hydrocephalus - this is way more common and doesn't cause midline shift Treat w external ventricular drain

Question 308

What electrolyte abnormality can Trimethoprim cause?

Answer 308

Trimethoprim -> tubular dysfunction -> HYPERKALAEMIA

Question 309

Effect of Ca on QT interval?

Answer 309

Rising calcium shortens QT interval

Question 310

In trauma - when fluid is draining from ear / nose - how can you check if its CSF?

Answer 310

Check glucose - present in CSF not in mucus Beta-2-transferrin is gold standard xanthachromia takes 12h to present

Question 311

UTIs and breastfeeding - which abx is safe and which isn't?

Answer 311

Both nitrofurantoin and trimethoprim are present in breast milk Trimethoprim - isnt harmful for short term use Nitrofurantoin - can cause haemolysis in G6PD infants

Question 312

In diagnosing PSC - when may you prefer to use ERCP over MRCP?

Answer 312

ERCP is more invasive so generally avoided unless - MRCP is unsuitable eg metal implants

Question 313

Differences and similarites between churg strauss and Granulomatosis w/ polyangiitis?

Answer 313

Similarities: - Vasculitis - Sinusitis - Dyspnoea Churg: - Asthma - pANCA - Eosinophilia Granulomatosis w/ polyangiitis (wegners): - Renal failure - cANCA - Epitaxis / haemoptysis

Question 314

What causes TLCO to be lower?

Answer 314

pulmonary fibrosis pneumonia pulmonary emboli pulmonary oedema emphysema anaemia low cardiac output

Question 315

What causes TLCO to be raised

Answer 315

asthma pulmonary haemorrhage (Wegener's, Goodpasture's) left-to-right cardiac shunts polycythaemia hyperkinetic states male gender, exercise

Question 316

What are the most common causes of endocarditis?

Answer 316

Staph aureus - acute and IVDU - most common overall Staph epidermis - most common 2m following valve replacement Staph bovis - colorectal ca Staph viridans - developing countries HACEK - culture negative causes

Question 317

Strongest RF for anal cancer?

Answer 317

HPV Increasing age, smoking, HIV and multiple anal sex partners = other RFs

Question 318

What worsens lateral epicondylitis pain?

Answer 318

Opposite of medial epicondylitis - resisted wrist extension and elbow extension/supination This is tennis elbow

Question 319

Thoracic kyphosis causes what type of lung disease?

Answer 319

Restrictive - raised FEV1/FVC ratio Can cause reduced TLCO (measure of gas transfer from lung to alveoli) - chest wall deformeties affect how much alveoli can expand KCO (measure of gas exchange efficiency) = TLCO / alveolar SA -> in this case alveolar SA would be reduced thus increasing KCO

Question 320

What is the intervention of choice in pts w malignant distal obstructive jaundice due to unresectable pancreatic carcinoma?

Answer 320

Biiliary stenting

Question 321

Signs of infants w/ hydrocephalus?

Answer 321

Increased head circumfrence + bulging fontanelle + sunsetting of eyes (impaired upward gaze)

Question 322

MoA of fondaparinux?

Answer 322

Activates antithrombin III - similar to LMWH

Question 323

bupropion - moa?

Answer 323

a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist CI in pregnancy, epilepsy (reduces seizure threshold) and breast feeding - Eating disorder = relative CI

Question 324

What is pellagra - how does it present?

Answer 324

B3 (niacin) deficiency - presents w/ DDDD: Dermatitis Diarrhoea Dementia / delusion Leads to DEATH

Question 325

What is BeriBeri - how does it present / get categorised?

Answer 325

B1 (thiamine) deficiency, split into wet and dry beriberi Wet beriberi (presenting with tachypnoea, dyspnoea and pedal oedema) Dry beriberi (presenting with pain, paresthesia and confusion). -> Wernicke–Korsakoff syndrome is a subtype of dry beriberi

Question 326

CMT disease inheritance pattern?

Answer 326

CMT1 + 2 = AD CMT3 = AD / AR CMT4 = AR

Question 327

What are the ottowa rules for ankle injuries?

Answer 327

An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings: * Bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular) * Bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia) * Inability to walk four weight bearing steps immediately after the injury and in the emergency department

Question 328

What are the definitions of malnutrition?

Answer 328

BMI <18.5 BMI <20 + 5% unintentional weight loss in 3-6m 10% unintentional weight loss in 3-6m

Question 329

Why might crohns cause intermittent jaundice?

Answer 329

Bile salts absorbed in terminal ileum -> if absorption is impaired due to crohns -> development of gallstones which can go into CBD and cause jaundice

Question 330

What is mirizzi syndrome?

Answer 330

When gallstones compress bile duct directly -> one rare time cholecystitis presents w jaundice

Question 331

What organ is most likely to be enlarged in ADPKD and why?

Answer 331

Hepatomegaly due to hepatic cysts

Question 332

Do pts who have had catheter ablation for AF need long term anticoagulation?

Answer 332

Yes if their CHAD VASC score says so (>1 indicates this) If score is 0, then 2 months of anticoagulation needed only

Question 333

CKD + Urinary A:CR >30mg/mol - what mx is required?

Answer 333

Need to be started on ACEi / ARB

Question 334

What is an alternative to long-term anticoagulation medication in pts w AF?

Answer 334

Left atrial appendage closure surgery

Question 335

Pt w intracranial bleed -> becomes unresponsive - what ix is needed and why?

Answer 335

CT head needed to rule out hydrocephalus

Question 336

How can you distinguish between CT heads of extra and subdural hematoma? which is this?

Answer 336

Extradural = Lemon - within suture lines cause life gives you (extra) lemons Subdural = Banana - The banana is (sub) under the skin to eat

Question 337

What do different ABPI results mean?

Answer 337

0.3 - critical limb ischaemia <0.5 = severe arterial disease - PAD 0.5-0.8 = suggests presence of arterial disease or mixed arterial/venous disease - PAD or mixed PAD and PVD 0.8-1.3 = no evidence of significant arterial disease >1.3 = suggests presence of arterial calcification, such as in some people with diabetes, RA, systemic vasculitis, atherosclerotic disease and advanced chronic renal failure.

Question 338

What needs to be co-administered w/ Izonisaid to prevent peripheral neuropathy?

Answer 338

Pyoxidine - Vit B6

Question 339

When can you drive again following TIA?

Answer 339

When sx free for 1m no need to tell DVLA

Question 340

Difference between low pressure and high pressure chronic urinary retention?

Answer 340

High pressure retention: - impaired renal function and bilateral hydronephrosis - typically due to bladder outflow obstruction Low pressure retention: - normal renal function and no hydronephrosis

Question 341

When should darboetin be given to pts w CKD?

Answer 341

If they develop anaemia secondary to CKD

Question 342

Should pts w/ CKD be on statins?

Answer 342

Yes - lipid-lowering therapy with a statin is also recommended for all patients with CKD <60 for the primary or secondary prevention of cardiovascular disease

Question 343

What GFR means metformin is CI?

Answer 343

GFR <45 use w/ caution GFR <30 stop using

Question 343

Black and HTN w/ T2DM - 1st line?

Answer 343

ARBs - '-artans'

Question 344

How can you distinguish between drug induced and idiopathic parkinsons?

Answer 344

Drug induced = bilateral sx Idiopathic = unilateral

Question 345

Goserelin - MoA?

Answer 345

GnRH AGONIST -> -ve feedback to anterior pituitary

Question 346

Side effects of B-blockers?

Answer 346

Bronchospasm Cold peripheries Fatigue Sleep disturbances + nightmares ED

Question 347

What drugs are the most common cause of drug-induced angioedema?

Answer 347

ACEi

Question 348

Bromocriptine - galactorrhoea - does it cause it?

Answer 348

Galactorrhoea - no bro, no homo - its used to treat it

Question 349

What monitoring is needed on statins?

Answer 349

LFTs at baseline, 3m and 12m Fasting lipid profline can also be checked during monitoring to assess response to mx

Question 350

What is the criteria for diagnosing RF?

Answer 350

Joints (migrating polyarthritis). Obvious, the heart would be involved (carditis, pancarditis, pericarditis). N (Subcutaneous Nodules). E (Erythema marginatum). S (Sydenham's chorea).

Question 351

Surgery + diabetes - what to do if a pt has poorly controlled diabetes ? who else should do this?

Answer 351

Usually require variable rate insulin infusion - if more than one meal is to be missed patients with poor glycaemic control - risk of renal injury (e.g. low eGFR, contrast being used)

Question 352

Green-blue colour + chronic wound infection +offensive smell (esp in immunocompromised) - what organism?

Answer 352

Pseudomonas

Question 353

What type of visual loss is associated w macular degeneration?

Answer 353

Central field loss

Question 354

RFs for macular degeneration?

Answer 354

Older age - 75+ Smoking FHx Same as increased risk of ischaemic CVD

Question 355

RFs for macular degeneration?

Answer 355

Older age - 75+ Smoking FHx Same as increased risk of ischaemic CVD

Question 356

What type of hearing loss in Menieres?

Answer 356

Unilateral sensorineural

Question 357

Oral pred + dendritic corneal ulcer -> likely dx and mx?

Answer 357

herpes simplex keratitits treated w topical aciclovir

Question 358

What cause of conductive hearing loss is associated w chronic smelly ear discharge and recurrent glue ear?

Answer 358

Cholesteatoma

Question 359

What causes chalky patch on tympanic membrane upon otoscopy? what type of hearing loss is this?

Answer 359

Tympanosclerosis - conductive hearing loss

Question 360

What does abnormal fluorescin staining showing linear branching corneal ulcer suggest?

Answer 360

Herpes simplex keratitits - presents w painful red eye w/ photophobia and epiphora (excessive tearing)

Question 361

How does spider naevi differ from teleangtasia?

Answer 361

Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge

Question 362

What side is the language centre in right-handed and left-handed people?

Answer 362

Left side for 95-99% of right handed people Left side for 70% of left-handed people

Question 363

When should BB be stopped in acute heart failure?

Answer 363

Only stopped if: - HR <50bpm - 2nd / 3rd degree AV block - Shock

Question 363

When should BB be stopped in acute heart failure?

Answer 363

Only stopped if: - HR <50bpm - 2nd / 3rd degree AV block - Shock

Question 364

Suspected GCA, pt is started on prednisolone but biopsy is clear - what is the mx?

Answer 364

Continue pred - regardless of biopsy result as complication is blindness and GCA has skip leisons which can show normal biopsy (ideally biopsy in 1st 7d of steroid mx)

Question 365

How can cholera present?

Answer 365

Dehydration + Hypoglycaemia

Question 366

What to do for pts on warfarin going to have emergency surgery?

Answer 366

If surgery can wait for 6-8 hours - give 5 mg vitamin K IV If surgery can't wait - 25-50 units/kg four-factor prothrombin complex

Question 367

How much insulin is there in 1ml?

Answer 367

100 units

Question 368

How can you differentiate between seizures and vasovagal syncope?

Answer 368

Syncopal episodes are associated with a rapid recovery and short post-ictal period. Seizures are associated with a far greater post-ictal period

Question 369

What is subacute combined degeneration of spinal cord cause by and what are its features?

Answer 369

Caused by B12 deficiency Causes these features + peripheral parasthesia

Question 370

What are the key indications for NIV?

Answer 370

Question 371

What are the initial ix in acute limb threatening ischaemia?

Answer 371

Initial investigations should include a handheld arterial Doppler examination. If Doppler signals are present, an ankle-brachial pressure index (ABI) should also be obtained.

Question 372

Wilsons or Haemochromatosis? What causes cranial DI

Answer 372

Haeochromatosis

Question 373

HOCM heart sounds?

Answer 373

S4 + mid-diastolic murmur (no radiation to carotids)

Question 374

If a pt w/ parkinsons cant take levodopa - what can they take instead?

Answer 374

They can be given a dopamine agonist patch as rescue medication to prevent acute dystonia co-careldopa -> can be given orally

Question 375

What are the RFs for asystole in bradycardia - how should these be mx?

Answer 375

complete heart block with broad complex QRS recent asystole Mobitz type II AV block ventricular pause > 3 seconds They need transvenous pacing

Question 376

What is the key parameter to monitor in HHS? how is this measured?

Answer 376

Serum osmolality - 2xna+glucose+urea Will be more than 320

Question 377

Secondary prevention in TIA?

Answer 377

1st line clopidogrel 2nd line aspirin + dipyridamole

Question 378

What are some RFs for gallstones that arent the 4Fs?

Answer 378

DM Crohns Rapid weight loss Drugs - fibrates, COCP

Question 379

How much stenosis of internal carotid is required to be reffer for carotid endarterctomy?

Answer 379

>70% + suffered stroke / TIA in carotid territory and not severely disabled

Question 380

Why should B12 levels be checked and corrected before adjusting folate levels?

Answer 380

Can cause subacute degeneration of the spinal cord -> Loss of proprioception + vibration + muscle weakness + hyperreflexia (Spinocerebellar, lateral corticospinal and dorsal columns)

Question 381

What are some x ray changes seen in avascular necrosis ?

Answer 381

Flattening, subchondral fractures and smaller size of bone Remember MRI is ix of choice

Question 382

How can SAH cause hyponatraemia?

Answer 382

due to SiADH

Question 383

Mx of HSV in pregnancy - w/in 6w of delivery?

Answer 383

mother to take 400mg aciclovir til delivery + elective c-section recommended

Question 384

How can vasopasm be prevented after SAH?

Answer 384

21d course of Nimodipine

Question 385

How can aneurysms causing SAH be treated?

Answer 385

Coiling by interventional neuroradiologist

Question 386

If symptomatic AV type 2 block - what is mx?

Answer 386

Surveilance If symptomatic - can stop CCBs and BB -> then if still problematic pacemakers

Question 387

what is the 1st line mx of parkinsons?

Answer 387

If the motor symptoms are affecting the patient's quality of life: levodopa If the motor symptoms are not affecting the patient's quality of life: dopamine agonist (non-ergot derived), levodopa or monoamine oxidase B (MAO‑B) inhibitor

Question 388

What should be given alonside insulin kit to diabetics?

Answer 388

Glucagon kit +- glucose

Question 389

What is Felty syndrome? how can you distinguish between this and methotrexate use?

Answer 389

Both cause neutropaenia however no splenomegaly in methotrexate use Felty syndrome occurs in RA and causes splenomegaly hence the hypersplenism -> increased RBC breakdown

Question 390

What imaging is required in RA pts pre surgery and why?

Answer 390

AP + lateral C-spine radiographs - atlantoaxial subluxation is a complication of RA -> cervical cord compression hence this needs to be checked for and if present -> wear C-spine collar + ensure neck isnt hyperextended on intubation

Question 391

Ischaemic stroke - 6h+ after sx + limited infarct core on CT -> mx?

Answer 391

Thrombectomy

Question 392

What is the most common organism found in bronchiectasis?

Answer 392

H influenzae

Question 393

In status epilepticus what needs to be checked before thinking about other causes?

Answer 393

Hypoxia and hypoglycaemia

Question 394

What is whipples triad of Insulinoma? Which type of MEN1 does this occur w?

Answer 394

1. Hypoglycaemia w/ fasting / exercise 2. Reversal of sx w/ glucose 3. Recorded low BM at time of sx MEN1 -PPP - parathyroid adenoma, pituitary tumour + pancreatic tumour

Question 395

Ix? Mx of insulinoma?

Answer 395

Ix = Supervised prolonged fasting (upto 72h) + CT pancreas Surgery - if not suitable diazoxide + somatostatin

Question 396

Which pts in tachycardia require immediate DC (synchronised) cardioversion?

Answer 396

Unstable pts defined as the following signs: - shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness - syncope - myocardial ischaemia - heart failure

Question 397

What causes the following changes to S2: - Loud S2 - Soft S2 - Widely split S2 - Fixed split S2 - Reverse split S2

Answer 397

Question 398

What blood test abnormalities can be caused by TPN?

Answer 398

LFT derangement

Question 399

What is the bone profile like in osteogenesis imperfecta?

Answer 399

All normal! Ca, PTH, ALP and PO4- all normal

Question 400

What is the mx of angina?

Answer 400

Aspirin and statin for all patients unless contraindicated Sublingual glyceryl trinitrate for angina attacks First-line: beta-blocker or calcium channel blocker (rate-limiting if on its own eg diltiazem / verapamil) Second-line: increase dose of first-line drug or add another drug from the same class Third-line: add one of these drugs: long-acting nitrate, ivabradine, nicorandil, ranolazine Refer for PCI or CABG if still symptomatic after three drugs

Question 401

What are the typical signs of acute interstitial nephritis? what can cause this?

Answer 401

The patient presents with typical symptoms of acute interstitial nephritis: fever and rash. Eosinophilia would likely be found on blood tests. HTN and mild impairment can also be seen Medications including penicillin, rifampicin, NSAIDs, allopurinol and furosemide have been linked with acute interstitial nephritis

Question 402

Increased SOB + Fever following stroke - likely dx? which part is likely affected?

Answer 402

Aspiration pneumonia - more likely in right lung

Question 403

Blood stained discharge + no palpable lump + younger pt - likely dx?

Answer 403

Intraductal papilloma

Question 404

What initial ix can be useful in identifying contributing factors to post op ileus?

Answer 404

U+Es - can often be triggered by underlying electrolyte abnormalities (K, Mg, PO4-)

Question 405

Statins should be stopped when patients are on what type of abx?

Answer 405

Macrolides - Clarithromycin, erythromycin etc

Question 406

Partial anterior circulation infarcts - 2 of the following:

Answer 406

unilateral hemiparesis and/or hemisensory loss of the face, arm & leg homonymous hemianopia higher cognitive dysfunction e.g. dysphasia

Question 407

Differences between Brocas and Wernickes Aphasia -> What part of the brain is affected

Answer 407

Broca = FRONTAL LOBE - front of brain, near mouth hence used for language production Wernickes = TEMPORAL LOBE - back of brain, near back of brain more thinking hence language comprehension

Question 408

What to do if effective removal of milk hasnt improved sx of lactational mastitis after 12-24h ?

Answer 408

Oral fluclox 10-14d If untreated becomes breast abscess -> needs I+D

Question 409

Post-exposure prophylaxis for HIV - what and how long for?

Answer 409

4w of oral ART

Question 410

Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis likely dx in an MSM?

Answer 410

Lymphogranuloma venerum

Question 411

What is the general course of LGV?

Answer 411

LGV is a sexually transmitted infection caused by a type of bacteria called chlamydia The first sign of LGV is a small blister or sore on the genitals or anus that may not hurt or itch and may go away quickly The second sign of LGV is swollen and painful glands in the groin area, usually on one side but sometimes on both The third sign of LGV is inflammation and bleeding from the rectum (the end of the bowel), especially if you have sex with men or have HIV

Question 412

What is the most common cause of nephrotic syndrome in adults?

Answer 412

Membranous nephropathy

Question 413

Renal biopsy shows: thickened basement membrane Silver staining shows: subendothelial spikes What is likely dx?

Answer 413

Membranous nephropathy

Question 414

What abx is used for prophylaxis against infective exacerbations of COPD + what things need to be done before this can be done?

Answer 414

Azithromycin Pt must: - Not smoke + Optimised treatments and still have exacerbations - CT thorax (exclude bronchiectasis) + sputum culture (exclude TB) - LFT + ECG - exclude QT prolongation as macrolides can prolong it

Question 415

What does raised T3 + T4 but normal fT3 + fT4 suggest?

Answer 415

Increased amounts of thyroid binding globulin - seen normally in pregnancy (dont be tricked by minor weight gain and fatigue)

Question 416

Can you give fluclox in pregnancy if not whats the alternative?

Answer 416

Yes - Erythromycin if allergic (for cellulitis) Outside of pregnancy its doxycycline 2nd line

Question 417

Indwelling catheter -> Osteomyelitis - likely organism?

Answer 417

Staph aureus

Question 418

NSAIDs + AKI - are they okay to continue?

Answer 418

No - except aspirin at cardio dose

Question 418

NSAIDs + AKI - are they okay to continue?

Answer 418

No - except aspirin at cardio dose

Question 419

What is Hedingers syndrome?

Answer 419

Carcinoid heart disease - Pulmonary stenosis in a pt w/ carcinoid tumour

Question 420

Which drugs are safe to continue in AKI?

Answer 420

Paracetamol Warfarin Statins Clopidogrel BB Aspirin @ 75mg

Question 421

Broad complex tachycardia - likely dx? what drug should be avoided as it can percipitate severe hypotension, VF or cardiac arrest?

Answer 421

VT Avoid verapamil!!

Question 422

How can you distinguish between carotid and aortic dissection?

Answer 422

Both can cause neurological deficits (often Horners) however carotid doesnt cause marked chest pain

Question 423

What anti-HTNsive is CI in renovascular disease?

Answer 423

ACEi - OPPOSITE OF CKD!!

Question 424

Can amylase levels be raise in small bowel obstruction?

Answer 424

Yes - so be aware of this as a differential in pts w/ RFs for this

Question 424

Mx of fibroadenomas?

Answer 424

Only needed if >3cm - surgical excision is the response

Question 425

What drugs can cause PROXIMAL MYOPATHY?

Answer 425

PREDNISOLONE - corticosteroids

Question 426

Bone pain + Low Ca, Low PO4-, High ALP and PTH - likely dx?

Answer 426

Osteomalacia -> low vit d -> needed for GI absorption of ca and po4- -> raised PTH -> increased bone resorption hence raised ALP

Question 427

What is ostetis fibrosa cystica found in and what are the bone profile results?

Answer 427

Late primary hyperparathyroidism hence Raised PTH -> Raised Ca, ALP + Low PO4-

Question 428

Mx of severe cellulitis?

Answer 428

Only say the C word if its a SEVERE situation Cellulitis Mx = Co-amox / Cefuroxime / Clindamycin / Ceftriaxone (4 Letters in the C word 4 C drugs)

Question 429

Effects of thiazides upon glucose control?

Answer 429

Worsens it

Question 430

Seizures features and lobes involved?

Answer 430

Frontal = motor eg jacksonian march, hand/leg + post ictal weakness Parietal = Parasthesia (sensory) Occipital = Floaters / flashes (visual) Temporal = everything else - aura, w or w/out impaired conciousness + automatisms

Question 431

What is Todds paresis?

Answer 431

Post ictal weakness in a pt w/ focal seizure

Question 432

how does orlistat work?

Answer 432

Orlistat works by inhibiting gastric and pancreatic lipase to reduce the digestion of fat

Question 433

What drug acting on the kidneys can cause ototoxicity?

Answer 433

Loop diuretics eg Furosemide

Question 434

Thyroid scintigraphy scan in subacute dequervains thyroiditis - shows what?

Answer 434

Decreased Iodine uptake

Question 435

What is torsades de points? mx?

Answer 435

VT w/ long QT -> can become VF and hence lead to death IV mag sulf

Question 436

How to measure QT interval?

Answer 436

QT interval: Time between the start of the Q wave and the end of the T wave

Question 437

What dose of statins should patients be on?

Answer 437

Primary prevention (T1DM, CKD <60, Qrisk >10) of CVD = 20mg of atorvastatin -> can increase dose if non-HDL doesnt reduce by 40%or more Secondary prevention of CVD = 80mg of atorvastatin

Question 438

Most common type of breast ca?

Answer 438

Invasive ductal carcinoma (no special type) is the most common type of breast cancer

Question 439

What is the likely dx and tx? A 54-year-old man presents with a persistent tremor. On examination there is 6-8 Hz tremor of the arms which is worse when his arms are outstretched. His father suffered from a similar complaint.

Answer 439

Essential tremor - made better by alcohol and propanolol (sometimes primidone)

Question 440

RFs for avascular necrosis?

Answer 440

Long term steroids Alcohol excess Chemo Trauma

Question 441

Which nerve is commonly injured in posterior hip dislocations?

Answer 441

Sciatic - loss of sensation in sciatic nerve distrubution + foot drop (as sciatic nerve supplies common peroneal) Femoral - can also be injured loss of sensation in the anterior and medial aspects of the thigh and leg, as well as weakness in hip flexion and knee extension

Question 442

Which nerve is commonly injured in posterior hip dislocations?

Answer 442

Sciatic - loss of sensation in sciatic nerve distrubution + foot drop (as sciatic nerve supplies common peroneal) Femoral - can also be injured loss of sensation in the anterior and medial aspects of the thigh and leg, as well as weakness in hip flexion and knee extension

Question 443

Which nerve is commonly injured in posterior hip dislocations?

Answer 443

Sciatic - loss of sensation in sciatic nerve distrubution + foot drop (as sciatic nerve supplies common peroneal) Femoral - can also be injured loss of sensation in the anterior and medial aspects of the thigh and leg, as well as weakness in hip flexion and knee extension

Question 443

Which nerve is commonly injured in posterior hip dislocations?

Answer 443

Sciatic - loss of sensation in sciatic nerve distrubution + foot drop (as sciatic nerve supplies common peroneal) Femoral - can also be injured loss of sensation in the anterior and medial aspects of the thigh and leg, as well as weakness in hip flexion and knee extension

Question 444

What changes are seen in septic shock (interms of BP and Hr etc)

Answer 444

reduced SVR increased HR normal/increased cardiac output decreased blood pressure

Question 445

What changes are seen in cardiogenic shock (interms of BP and Hr etc)

Answer 445

increased SVR (vasoconstriction in response to low BP) increased HR (sympathetic response) decreased cardiac output decreased blood pressure

Question 446

Malignancy + raised CK - might suggest what condition? how might this present?

Answer 446

Polymyiositis - might present w/ proximal muscle weakness + tenderness

Question 447

Headache that is worse when standing up and better lying down suggests what? name a cause? associated w?

Answer 447

Low ICP headache - can be caused by spontaneous intracranial hypotension Connective tissue disorders eg marfans

Question 448

A 38-year-old woman presents with fever, malaise and jaundice. On examination she has moderate hepatomegaly. Laboratory analysis confirms a positive anti-smooth muscle antibody and anti-nuclear antibody. likely dx?

Answer 448

AI hep

Question 449

How is cellulitis diagnosed?

Answer 449

Clinically

Question 450

Which ca is increased risk in a pt w/ hashimotos thyroiditis?

Answer 450

MALToma

Question 451

Metastatic ca - effect upon adrenal gland?

Answer 451

Adrenal disorder - it can cause addisons (hyponatraemia, hyperkalaemia, hypotension etc)

Question 452

Roughened red papules over the knuckles described what seen in what condition?

Answer 452

Grottons papules seen in Dermatomyositis - refer urgently to rheum

Question 453

Vomiting + Addisons - how should mediactions be changed?

Answer 453

Take IM hydrocortisone until vomiting stops

Question 454

Which valvular abnormality is associated w ADPKD?

Answer 454

Mitral valve prolapse

Question 455

Which anti-epileptic causes peripheral neuropathy?

Answer 455

Phenytoin

Question 456

What type of shock will cause warm peripheries?

Answer 456

Neurogenic, septic, and anaphylactic shock (together are all distributive shock) will cause warm peripheries, with the others causing cool peripheries

Question 457

What are some local complications of gonnorhea infection?

Answer 457

male- urethral strictures, epididymitis and salpingitis (hence may lead to infertility) female - PID and Bartholin's abscesses

Question 458

What are the 3 main presentations of basilar artery strokes?

Answer 458

Locked-in syndrome: - An acute decreased GCS and advanced motor symptoms. - Insidious, gradual deterioration in GCS and motor symptoms with a subsequent sudden advanced decrease in GCS and motor symptoms. - A 'herald hemiparesis' with associated headache and vision changes prior to the onset of permanent symptoms of motor loss.

Question 459

Ix of suspected spinal abscess?

Answer 459

MRI whole spine as there may be skip leisons

Question 460

What anasthetic agent: Reverses action of midazolam

Answer 460

Flumazenil

Question 461

What anasthetic agent: Is hepatotoxic

Answer 461

Halothane

Question 462

What anasthetic agent: Has antiemetic properties

Answer 462

Propofol

Question 463

Prolonged incubation period + foreign travel + non-bloody diarrhoea - organism?

Answer 463

Giardasis -> can get lactose intolerance and malabsorption w it

Question 464

A 48-year-old male presents with a 8 week history of epistaxis and nasal stuffiness. On examination there is evidence of nasal crusting. A chest x-ray demonstrates multiple cavitary lesions Likely dx? antibody?

Answer 464

Wegners granulomatosis (granulomatosis w/ polyangiitis) cANCA

Question 465

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller →

Answer 465

Dengue

Question 466

Which drug can reduce awareness of hypoglycaemic sx and thus increase risk of hypoglycaemia?

Answer 466

BB

Question 467

How long after abx use does drug induced interstitial nephritis occur and is it common?

Answer 467

4-7d after abx exposure and it is still relatively rare

Question 468

Hypermigmented + thickened waxy skin + brown discolouration (lipodermatosclerosis) + little pain ulcer = what type of ulcer?

Answer 468

Venous

Question 469

Oxybutinin - can cause constipation or nah?

Answer 469

Yes

Question 470

Increasing number of floaters in one eye, what is likely dx?

Answer 470

Retinal detachment

Question 471

What is the most likely cause of developing fever in early post-op period + reduced O2 sats esp in a pt w/ abdo surgery + has pain?

Answer 471

Bibasal atelectasis

Question 472

Most important prognostic factor in melanomas?

Answer 472

Breslow depth / thickness

Question 473

hat is the purpose of cricoid pressure during anasthesia?

Answer 473

Prevent passage of gastric content into the airway

Question 474

When is vestibular neuroniits more ikely thna BPPV and Vestibular migraine?

Answer 474

When its an isolated incident

Question 475

Wasting of muscles instrins hand muscle? where is leison

Answer 475

T1

Question 476

Painful eye w/ loss of acuity in primary care mx?

Answer 476

Needs urgent opthal assessment

Question 477

Graves antibody?

Answer 477

Anti-TSH

Question 478

What should be prescribed to all people w/ PBC?

Answer 478

Ursodeoxycholic acid

Question 479

Multiple fractures followed by early onset (within 24 hours) of hypoxia, dyspnea, and tachypnea are the most frequent findings. Neurologic manifestations range from the development of an acute confusional state and altered level of consciousness to seizures and focal deficits and usually follow respiratory symptoms. A petechial rash is the last component to appear and only appears in about a third of cases - What does this describe a case of?

Answer 479

Fat embolism syndrome

Question 480

A 51 year old woman presents to her GP with 6 months of dry mouth and gritty eyes. She has had vitiligo for the last 10 years. Both parotid glands are mildly enlarged. What is the likely dx?

Answer 480

Sjogrens syndrome

Question 481

Above what level do spinal cord lesions have to be in order to cause autonomic dysreflexia?

Answer 481

Above T6

Question 482

Describe the COPD mx

Answer 482

Question 483

What is the CXR finding in PE?

Answer 483

Usually normal however if theres going to be anything it would be a wedge-shaped opacification of the lung -> might also see pleural effusion

Question 484

What should pts w/ frequent infective exacerbations of COPD be offered to have at home?

Answer 484

Home supply of predniolone and abx

Question 485

What blood results suggests atopic features in COPD?

Answer 485

High esinophil count

Question 486

What are the features of anterior cord syndrome?

Answer 486

This is a specific cord lesion affecting the anterior 2/3 of the cord. - complete motor paralysis below the level of the lesion - loss of pain/temperature sensation - intact proprioception/vibration sensation.

Question 487

Which pts should be offered annual influenza vaccinations and 5 yearly pneumococcal?

Answer 487

CKD or Hyposplenism

Question 488

What are the features of acetabular labral tear?

Answer 488

Hip/groin pain Snapping sensation around hip Occasionally may involve sensation of locking Usually involved w/ trauma or degenerative change in older adults

Question 489

Primary hypogonadism + High LH, FSH and Low Testosterone - likely dx?

Answer 489

Klinefelters syndrome - XXY Usually taller than average, infertile and small firm tested + gynaecomastia + increased risk of breast ca

Question 490

Mx of Bells palsy?

Answer 490

Oral pred w/in 72 hr + eye care F/U - Refer to ENT if no improvement in 3w - If long standing weakness (months) may need referral to plastics

Question 491

Mx of human and animal bites?

Answer 491

Abx - Co-amoxiclav or if allergic doxycyc + metronid If skin is broken and blood is drawn OR if in high risk area (hands, feet, face, genitals, skin overlying cartilaginous structures or an area of poor circulation)

Question 492

An x-ray spine shows vertebral wedge compression fractures and focal sclerotic bony lesions Suggests what

Answer 492

Metastatic prostate ca

Question 493

What are the most common tumours causing bone mets in order? What are the most common sites of bony mets?

Answer 493

Prostate Breast Lung Spine Pelvis Ribs Skull Long bones

Question 494

Describe ALS pathways

Answer 494

Question 495

What drug can induce neutrophilia?

Answer 495

Corticosteroids eg prednisolone

Question 496

What organism is most likely to cause chest infections in CF?

Answer 496

Pseudomonas

Question 497

What are the features of Wernickes encephalopathy + Korsakoffs syndrome?

Answer 497

Noa(H) was feeling too hot after drinking so he needed the AC on

Question 498

Baby bilous vomiting + double bubble on xr -> ??

Answer 498

Intestinal / duodenal atresia

Question 499

Absent corneal reflex - what nerve?

Answer 499

CN V1

Question 500

A 68-year-old man, while talking to his wife, starts staring into space. He seems unresponsive to what his wife is saying to him, and he is also smacking his lips multiple times. After 1 minute, he stops and acts normally again, but denies any of this happened when his wife questions him. What type of seizure?

Answer 500

Focal impaired awareness

Question 501

What is the most common cause of brown-green nipple discharge?

Answer 501

Duct ectasia - may also be associated w small lump right under nipple

Question 502

Acute HF mx?

Answer 502

All pts - IV loop diuretics O2 - maintain sats 94-94 Vasodilators (nitrates) - if severe HTN, MI or regurg (A or M) - CI if hypotensive If resp failure - CPAP If hypotensive: - Ionotropes (dobutamine) - LV dysfunction + versible cardiogenic shock - Vasopressor (NE) - if insufficient response to above or evidence of end organ hypoperfusion - Mechanical circulatory asistence also can be considered

Question 503

Asthma - reversibility testing results?

Answer 503

in adults, a positive test is indicated by an improvement in FEV1 of 12% or more and increase in volume of 200 ml or more in children, a positive test is indicated by an improvement in FEV1 of 12% or more

Question 504

A CT chest, abdomen, and pelvis shows mural thickening of the colon and the presence of pericolic fat stranding in the sigmoid colon - suggests what dx?

Answer 504

Diverticulitis - esp since ct findings are limited to the sigmoid colon

Question 505

EEG in absence seizures?

Answer 505

3 Hz spike and wave

Question 506

When should ACEi be stopped in CKD pts?

Answer 506

A potassium above 6mmol/L should prompt cessation of ACE inhibitors in a patient with CKD (once other agents that promote hyperkalemia have been stopped)

Question 507

Mx of rhabdomyolysis?

Answer 507

IV fluids

Question 508

Maturity-onset diabetes of the young (MODY) - inheritance?

Answer 508

AD

Question 509

Which abx used to treat UTIs CANNOT be given alongside methotrexate?

Answer 509

Trimethoprim

Question 510

When should triptans be avoided in the Mx of cluster headaches ?

Answer 510

In pts w/ CAD as it has the potential to cause coronary vasospasm

Question 511

What is a parapneumic effusion

Answer 511

Any effusion caused by pneumonia or lung abscess

Question 512

What are the signs and sx of myxedema coma? How can this be mx?

Answer 512

confusion, bradycardia, hypothermia and profoundly hypothyroid Mx = IV thyroid replacement + IV hydrocortisone (as giving thyroid replacement in a adrenal deficient person can perciptiate adrenal crisis so this needs to be given until this can be excluded)

Question 513

In a patient with hypercalciuria and renal stones, calcium excretion and stone formation - how can this be decreased?

Answer 513

Thiazide diuretics

Question 514

Raised CK in a person w/ recent initiation of Statins?

Answer 514

Rhabdomyolysis

Question 515

What are some drugs that impair wound healing?

Answer 515

Non steroidal anti inflammatory drugs Steroids Immunosupressive agents Anti neoplastic drugs

Question 516

What are some complication of acromegaly?

Answer 516

HTN Diabetes >10% Cardiomyopathy Colorectal Ca

Question 517

Sx of claudication in femoral and iliac vessels?

Answer 517

Femoral = more calf pain Iliac = more buttock pain

Question 518

A wide-based gait with loss of heel to toe walking is called an ..... gait

Answer 518

Ataxic

Question 519

What are some causes of cerebellar injury?

Answer 519

P - Posterior fossa tumour A - Alcohol S - Multiple sclerosis T - Trauma R - Rare causes I - Inherited (e.g. Friedreich's ataxia) E - Epilepsy treatments S - Stroke Pastries

Question 520

When is S3 normal? what are some pathalogical causes?

Answer 520

Caused by diastolic filling of ventricles - normal if <30y can be upto 50y in women LVF (eg dilated cardiomyopathy), Constrictive pericarditis and mitral regurg

Question 521

How remember difference between Galeazzi and Monteggia fractures?

Answer 521

MUgGeR Montegia = Ulnar Galaeazii = Radius MonteggiA = M is A (proximal fracture w/ dislocation) GalaeazZi = G is Z (distal fracture w/ dislocation)

Question 522

Which patients need v urgent (48h) access Xray to assess for bone sarcoma?

Answer 522

Children and young people with unexplained bone swelling or pain

Question 523

What is given to replace thiamine?

Answer 523

Pabrinex

Question 524

Which anti-HTN meds are CI in pregnancy and why?

Answer 524

ACEi due to causing foetal abnormalities and renal failure

Question 525

What is power like in limb girdles in polymyalgia rheumatica? CK?

Answer 525

There is no true weakness of limb girdles in polymyalgia rheumatica on examination. Any weakness of muscles is due to myalgia (pain inhibition) Normal CK

Question 525

What is power like in limb girdles in polymyalgia rheumatica? CK?

Answer 525

There is no true weakness of limb girdles in polymyalgia rheumatica on examination. Any weakness of muscles is due to myalgia (pain inhibition) Normal CK

Question 526

How much water, k, na, cl and glucose is needed for maintence fluids of adults?

Answer 526

25-30 ml/kg/day of water # approximately 1 mmol/kg/day of potassium, sodium and chloride approximately 50-100 g/day of glucose to limit starvation ketosis

Question 527

Describe the mx of different amounts of splenic trauma:

Answer 527

Conservative: - Small subcapsular haematoma - Minimal intra abdominal blood - No hilar disruption Laparotomy w/ conservation: - Increased amounts of intraabdominal blood - Moderate haemodynamic compromise - Tears or lacerations affecting <50% Resection: - Hilar injuries - Major haemorrhage - Major associated injuries

Question 528

COPD o2 sats target?

Answer 528

88-92% + Do an ABG If ABG doesnt show signs of hypercapnia -> then aim for 94-98%

Question 529

Which type of hip dislocation is more common? how does this appear?

Answer 529

Posteerior hip dislocation - leg is internally rotated and appears shorter than the other one

Question 530

Direct v indirect inguinal hernia - how to tell the diffrence?

Answer 530

Indirect = No reappearance during coughing when covering the deep inguinal ring Direct = Reappearance during coughing when covering the deep inguinal ring

Question 531

What are some possible complications of radical prostatectomy?

Answer 531

Late/ longterm complications = ED, incontinence and urethral stenosis

Question 532

Warfarin - bleeding test results?

Answer 532

PT - Long APTT - normal

Question 533

Which abx for Leigionella?

Answer 533

Macrolides - clarithromycin

Question 534

Pt presenting to GP w/in 7d of TIA -> mx?

Answer 534

300mg aspirin immediately (and be referred for specialist review within 24h)

Question 535

Breathing problems in a pt w clear chest should warrant consideration of what dx?

Answer 535

PE

Question 536

What are the features of INO (Internuclear ophthalmoplegia)? Causes?

Answer 536

impaired adduction of the eye on the same side as the lesion horizontal nystagmus of the abducting eye on the contralateral side Causes = MS and Vascular diseas

Question 537

What is plasma and urine osmolality like in DI?

Answer 537

HIGH plasma osmolality in DI LOW urine osmolality in DI

Question 538

U+E before and after ACEi - what is accepted and when should it be stopped?

Answer 538

Rise in creatinine and potassium may be expected after starting ACE inhibitors Acceptable changes are: - Increase in serum creatinine, up to 30% from baseline - Increase in potassium up to 5.5 mmol/l.

Question 539

What is the initial mx of open fractures?

Answer 539

Immediate wound debridement and application of spanning external fixation device

Question 540

UTI in pregnancy - what should you do after treatment?

Answer 540

Test of cure MSU

Question 541

Gold standard ix for intracrainal venous thrombosis? mx?

Answer 541

Non-contrast CT head LMWH acutely then warfarin generally long term

Question 542

'empty delta sign' seen on venography

Answer 542

Saggital sinus thrombosis - headache, diplopia, bilateral papilloedema

Question 543

Management of atelectasis?

Answer 543

Chest physiotherapy with mobilisation and breathing exercise

Question 544

Difference between HF-pEF and HF-rEF?

Answer 544

HFpEF = diastolic (heart filling issue) eg HOCM, restrictive cardiomyopathy, cardiac tamponade and constrictive pericarditis HFrEF = IHD, Dilated cardiomyopathy, Myocarditis and Arrhythmias

Question 545

affected eye is unable to look down as easily, therefore causing vertical diplopia, worst on looking down (whilst reading) - which nerve palsy?

Answer 545

Trochlear

Question 546

What features are usually spared in MND?

Answer 546

doesn't affect external ocular muscles no cerebellar signs abdominal reflexes are usually preserved and sphincter dysfunction if present is a late feature

Question 547

How can local anasthetic toxicity be treated?

Answer 547

w/ 20% lipid emulsion

Question 548

Which abx can cause trosardes du pointes?

Answer 548

Macrolides eg erythromycin

Question 549

Proximal muscle weakness + raised CK + no rash - whatis dx?

Answer 549

Polymyositis - treated w/ corticosteroids and / or immunosuppressants such as methotrexate

Question 550

PCP treatment abx?

Answer 550

Co trimoxazole

Question 551

patient is noted to have persistent ST elevation 4 weeks after sustaining a myocardial infarction. Examination reveals bibasal crackles and the presence of a third and fourth heart sound = what dx? mx?

Answer 551

Left ventricular aneurysm - anticoagulation due to risk od stroke

Question 552

Occurs around 1-2 weeks afterwards. Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). what dx? mx?

Answer 552

Left ventricular free wall rupture - Urgent pericardiocentesis and thoracotomy are required

Question 553

What does ECG show for posterior MI?

Answer 553

Tall R waves in lead V1-3

Question 554

Why might a person w/ mycoplasma pneumoniae present w/ tiredness?

Answer 554

AIHA - causing anaemia raised LDH and raised unconjugaed bilirubin

Question 555

What can cause a isolated fever in a pt 24h after surgery?

Answer 555

Physiological reaction to operation

Question 556

A 40-year-old woman complains of a permanent 'funny-bone' sensation in her right elbow. This is accompanied by tingling in the little and ring finger. Her symptoms are worse when the elbow is bent for prolonged periods. What is the most likely diagnosis?

Answer 556

Cubital tunnel syndrome

Question 557

Seminomas or tetromas which have a better prognosis?

Answer 557

Seminomas

Question 558

What are the features of adhesive capsulitis?

Answer 558

Active and passive movement is painful / affected External rotation is more affected than internal rotation and abduction

Question 558

What are the features of adhesive capsulitis?

Answer 558

Active and passive movement is painful / affected External rotation is more affected than internal rotation and abduction

Question 559

Brain bleed w/ fluctuating levels of conciousness / confusion?

Answer 559

Subdural haematoma

Question 560

in AS when is Aortic valve replacement required?

Answer 560

If assymptomatic the valvular gradient >40mmHg and features such as LV systolic dysfunction If symptomatic replace

Question 561

What can make the ejetion systolic murmur in aortic stenosis quieter?

Answer 561

Left ventricular systolic dysfunction - due to decreased flow rate

Question 562

DCM and HOCM what causes S3 and what causes S4?

Answer 562

S3 - 3 so DCM S4 - 4 so HOCM

Question 563

Marfans inheritance?

Answer 563

AD

Question 564

Rotator cuff injury Painful arc of abduction between 60 and 120 degrees Tenderness over anterior acromion What do these sx suggest ?

Answer 564

Supraspinatus tendonitis (subacromial impingement, painful arc)

Question 565

Give me a poem for the nerves involved for different reflexes

Answer 565

S1-2 buckle my shoes (ankle) L3-4 kick open the door (knee) C5-6 pick up the sticks (biceps) C7-8 lay them straight (triceps)

Question 566

Which diabetes drugs are CI in HF?

Answer 566

Thiazalidizones - "zones" They can cause fluid retention

Question 567

What test should be performed in NAFLD to check for liver fibrosis?

Answer 567

Enhanced liver fibrosis (ELF) blood test

Question 568

How is barrets oesophagus mx?

Answer 568

High dose PPIs Endoscopic surveilance w/ biopsies every 3-5 years If dysplasia identified: - Radiofrequency ablation (particularly for low-grade = 1st line) - Endoscopic mucosal resection

Question 569

What conditions are the following fundoscopy findings present in?

Answer 569

Question 570

What does a headache related to valsalva manourve suggest (eg straining on toilet)? Ix?

Answer 570

Raised ICP - non contrast CT head

Question 571

Which cerebral vessel is normally affected in strokes that show aphasia?

Answer 571

MCA

Question 572

What is the mx of acute clot retention aki?

Answer 572

continuous bladder irrigation + catheter insertion

Question 573

What liver problem are pts w/ haemochromatosis at risk of ?

Answer 573

HCC + liver cirrhosis

Question 574

Reduced GCS, paralysis and bilateral pin point pupils - suggest what condition?

Answer 574

Pontine haemorrhage

Question 575

If there is a high enough Wells score what ix should be ordered prior to CTPA?

Answer 575

CXR - to rule out other causes of chest pain eg pneumothroax

Question 576

All house bound patients should be prescribed what?

Answer 576

Vit D

Question 577

Salter harris fracture types

Answer 577

Question 578

Definitive dx ix for small bowel obstruction?

Answer 578

CT abdo

Question 579

How do you measure the severity of COPD?

Answer 579

Using FEV1 >80% of predicted - mild 50-79 - moderate 30-49 - severe <30 - v severe

Question 580

Primary care w/ pt who has suspected UGI -mx?

Answer 580

Endoscopy in hospital w/in 24h Do not give PPIs before endoscopy - after this you can give for variceal bleeds If variceal give terlipressin and prophylactic abx

Question 581

How can you know if acute limb ischaemia is due thrombis or embolus?

Answer 581

Question 582

How can you distinguish between AKI and dehydration?

Answer 582

Both have raised creatinine and urea however rise in urea is greater than rise in creatinine May also see a mild hypernatraemia (In dehydration)

Question 583

What to do if triple therapy doesnt work / isn't tolerated in T2dm?

Answer 583

Switch a drug for a GLP-1 mimetic if BMI >=35 or insulin would have occupational implications Can only add GLP-1mimetic to insulin under specialist care

Question 584

What is a possible complication of radiotherapy for prostate ca?

Answer 584

Increased risk of bladder, colon and rectal cancer

Question 585

Liver USS - There is a single 12cm x 9cm, hyperechoic lesion in the left lobe of the liver. No other abnormalities detected. No abnormalities noted in the biliary tree. In another otherwise normal person suggests what?

Answer 585

Hepatic hemangioma

Question 586

Pt recently diagnosed w/ parkinsons falls - what do you need to consider and how can you assess this?

Answer 586

Consider alternative dx of of parkinsons-plus syndromes such as PSP can assess CN III, IV and VI - vertical supranuclear gaze palsy

Question 587

Urine sodium and osmolality in pre-renal disease and ATN causing AKI?

Answer 587

pre-renal - Na <20, osmolality >500, good response to fluid challenge ATN - Na >40, osmolality <350, poor response to fluid challenge

Question 588

When calculating drug doses, what does 2% mean?

Answer 588

2g is dissolved in 100ml

Question 589

What oesophageal ca is at increased risk in pts w/ achalasia?

Answer 589

SCC

Question 590

If a pt w/ hypocalcaemia has had calcium adequately replaced but still remain hypocalcaemic what other electrolyte may be deficient?

Answer 590

Magnesium - important for Ca absorption

Question 591

Mx of urinary retention in urethral injury?

Answer 591

Suprapubic catheter

Question 592

Most common renal ca?

Answer 592

Renal adenocarcinoma

Question 593

What are some reasons pts may fail to respond to erythropoietin therapy?

Answer 593

iron deficiency - pencil cells inadequate dose concurrent infection/inflammation hyperparathyroid bone disease aluminium toxicity

Question 594

What to do in mx of bradycardia if atropine and transcutaneous pacing isn't tolerated?

Answer 594

isoprenaline/adrenaline IV titrated to response

Question 595

HNF-1 MODY diabetes mx ?

Answer 595

Sulfonureas (glicalazide)

Question 596

For Ottowa fracture rules (ankle0 where is lateral and medial malleolar zones?

Answer 596

lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular) medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)

Question 596

Postural headache but normal MRI suggests what?

Answer 596

Idiopathic intracranial HTN

Question 597

Diverticulitis symptoms + pneumaturia or faecaluria → ???

Answer 597

Colovesical fistula

Question 598

What are the 2 classifications of the aortic dissection?

Answer 598

Stanford classification - type A - ascending aorta, 2/3 of cases - type B - descending aorta, distal to left subclavian origin, 1/3 of cases DeBakey classification - type I - originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally - type II - originates in and is confined to the ascending aorta - type III - originates in descending aorta, rarely extends proximally but will extend distally

Question 599

Mx of Aortic dissection?

Answer 599

Type A - Ascending aorta - ASS Aortic root replacement Systolic BP target 100-120 Surgery Type B - BooBs Bed rest and Beta blockers

Question 600

Sudden weight loss / starvation + ljaundice suggests what?

Answer 600

NAFLD

Question 601

OSA findings:

Answer 601

Daytime somnolence Compensated resp acidosis HTN

Question 602

When are nasopharyngeal airwaysCI?

Answer 602

Suspected base of skull fractures

Question 603

PPI electrolyte abnormalities?

Answer 603

Hyponatraemia + hypomagnesiumaeia

Question 604

Elderly, alcoholic, head injury, insidiuous onset symptoms What dx is likely?

Answer 604

Subdural haematoma

Question 605

Newly diagnosed dermatomyositis what ix is needed?

Answer 605

Malignancy screen

Question 606

What drug can cause cold peripheries?

Answer 606

BB - baby your feet are cold!!!

Question 607

Mx of hyperkalaemia - what is the role of clacium resonium?

Answer 607

RemovesK fromt the body

Question 608

Renal biopsy shows: Podocyte fusion and effacement of foot processes on electron microscopy Dx?

Answer 608

Minimal change disease

Question 609

Which airway is bad if the pt hasnt fasted?

Answer 609

Laryngeal mask

Question 610

SAH can cause what type of ECG changes?

Answer 610

Torsades du pointes - Polymorphic VT

Question 611

Poor prognostic factors for ACS?

Answer 611

age development (or history) of heart failure peripheral vascular disease reduced systolic blood pressure Killip class* initial serum creatinine concentration elevated initial cardiac markers cardiac arrest on admission ST segment deviation

Question 612

Which diabetes drug is CI in HF?

Answer 612

Thiazalidinones (-zone)

Question 613

What durg scan be used in combination of triple therapy in T2DM?

Answer 613

If this fails, NICE recommends triple therapy with either Metformin + gliclazide + gliptin/glifozin/pioglitazone or Metformin + pioglitazone + glifozin or Insulin +/- other drug

Question 614

What should you do in T2DM if pt is on metformin and develops GI side effects

Answer 614

Switch to modified release metformin before trying anything else

Question 615

Adrenaline dose in ALS?

Answer 615

1mg

Question 616

What electrolyte abnormlaity can be caused by excessive fluid resus w/ NACL

Answer 616

Hyperchloraemic met acidosis

Question 617

Who should not be givenHartmanns solution?

Answer 617

Hyperkalaemic pts - contains K

Question 618

Visual field defect likely seen in pituitary tumours?

Answer 618

Bitemporal hemianopia -> if not big enough for full compressiojn - bitemporal superior quadrantanopia (only squashes the top)

Question 619

Sex hormones in Kallmans syndrome?

Answer 619

LF, FSH - low / normal Testosterone - low -> will need supplementation

Question 620

What is the triad of budd chiari syndrome?

Answer 620

abdominal pain: sudden onset, severe ascites → abdominal distension tender hepatomegaly Raised SAAG Ix w/ doppler flow studies

Question 621

Can you use multiple drugs for neuropathic pain?

Answer 621

No tends to be monotherapy if one doesn't work you normally switch drugs Amitripyline, pregabalin, gabapentin, duloxetine

Question 622

What are the features of syringomelia?

Answer 622

a ‘cape-like’ (neck, shoulders and arms) loss of sensation to temperature but the preservation of light touch, proprioception and vibration classic examples are of patients who accidentally burn their hands without realising this is due to the crossing SPINOTHALAMIC TRACTS in the ANTERIOR COMMISURE of the spinal cord being the first tracts to be affected spastic weakness (predominantly of the lower limbs)

Question 623

Distal transverse or descending colon cancer mx?

Answer 623

Left hemicolectomy

Question 624

upper rectal tumours low rectal tumours mx?

Answer 624

High anterior resection Low anterior resection

Question 625

cecum, ascending or a proximal third of the transverse colon cancer mx?

Answer 625

Right hemicolectomy

Question 626

Gold standard for dx and screening of HIV?

Answer 626

Combination tests (HIV p24 antigen and HIV antibody) @ 4w and 3m

Question 627

What causes milky fluid drained from chest after surgery?

Answer 627

Chylothorax

Question 628

19. Cholesterol >9.0, triglycerides normal, HDL normal. Dx?

Answer 628

heterozygous Familial hypercholesteraemia

Question 629

Amaaurosis fugas - what vessel is affected ?

Answer 629

Retinal / ophthalmic artery - usually caused by atherosclerosis of ipsilateral internal carotid

Question 630

dizziness and palpitations. The ECG shows an irregular trace with a QRS complex of 130 ms, accompanied by a heart rate of 150/min. These are defining features of an irregular broad complex tachycardia. What is the dx?

Answer 630

AF w/ bundle branch block - differernt from just AF due to presence of slightly longer QRS

Question 631

Why can adenosine cause chest pain?

Answer 631

Due to its vasodilatory effects, it can cause flushing, nausea, sweating, bronchospasm and also chest pain

Question 632

Mx of variceal haemorrhage?

Answer 632

Once terlipressin, abx(+- transfusions, FFP, vit k etc) have been administered Endoscopic - variceal band ligation > sclerotherapy If uncontrolled bleeding - sengstaken blakemore tube TIPSS if these fail - however this can make hepatic encephalopathy worse

Question 633

A 28-year-old female sex worker presents to her general practitioner with a sore throat, fever and fatigue which has been going on for two weeks. When examining the throat, the GP notices several white patches on the lateral borders of the tongue as well as the buccal mucosa. These lesions are not painful and had not been noticed by the patient until now. The patches can't be removed by the application of light pressure. Given the patient's history, what is the most likely cause of the lesions on the tongue?

Answer 633

Oral hairy leukoplakia

Question 634

What is the mx of latent tb?

Answer 634

3 months of isoniazid (with pyridoxine) and rifampicin, or 6 months of isoniazid (with pyridoxine)

Question 635

What is a sign of L5 radiculopathy?

Answer 635

Pain upon straight leg raise + weak hip abductors

Question 636

What are the main features of CJD?

Answer 636

Rapid onset dementia + myoclonus DM - linked w/ united called CJD

Question 637

Why should nitrates be used iw/ caution in patients w/ pneumothorax?

Answer 637

Can cause a tension pneumo

Question 637

Why should nitrates be used iw/ caution in patients w/ pneumothorax?

Answer 637

Can cause a tension pneumo

Question 638

When starting goserelin (gonadorelin analogue) for mx of prostate ca - what should be co prescribed and why?

Answer 638

Anti-androgen treatment such as cyproterone acetate -> due to the risk of tumour flare

Question 639

What is the most common cause of HCC?

Answer 639

Hep B - worldwide Hep C - Europe

Question 640

most common symptom of Crohn's disease in children?

Answer 640

Abdo pain

Question 641

What else is H pylori infection associated w?

Answer 641

peptic ulcer disease - strongest associations - 95% of duodenal ulcers - 75% of gastric ulcers gastric cancer B cell lymphoma of MALT tissue (eradication of H pylori results causes regression in 80% of patients) atrophic gastritis

Question 642

What should invasive diarrhoea (causing bloody diarrhoea and fever) be treated w?

Answer 642

Ciprofloxacin

Question 643

Whats live attenuated vaccines?

Answer 643

Mi BOOTY M - MMR I - Influenza (intranasal) B - BCG O - Oral rotavirus O - Oral polio T - Typhoid Y - Yellow fever

Question 644

What stoma can be used to defunction the colon to protect an anastomosis?

Answer 644

Loop ileostomy

Question 645

What stoma is performed when when the colon is diverted or resected and anastomosis is not primarily achievable or desirable

Answer 645

End colostomy

Question 646

What stoma is done following complete excision of colon or where ileocolic anastomosis is not planned. It may be used to defunction the colon, but a reversal is more difficult.

Answer 646

End ileostomy

Question 647

What stoma is used for gastric decompression or feeding.

Answer 647

Gastrostomy

Question 648

Loop ileostomy is a method to divert bowel contents away from a distal anastomosis. It is often indicated in rectal cancers. And can be reversed to restore bowel continuity?

Answer 648

Loop ileostomy

Question 649

AR murmur + Inferior MI ECG changes suggests what?

Answer 649

II, III and aVF ST elevation + AR murmur suggests ascending aortic dissection (proximal aortic dissection)

Question 650

Bilateral hydronephrosis - mx?

Answer 650

If stone based = bilateral nephrostomy If UTi baed = Urethral catheter

Question 651

Urea breath test - what should be done prior to test to improve accuracy?

Answer 651

No ABX in 4w before No anti-secretory drugs 2w before (eg PPI)

Question 652

What isthe ECG finding that is sometimes found in PE and why?

Answer 652

S1Q3T3 pattern (deep S in lead I, pathological Q waves in lead III, and T wave inversion in lead III) - acute right heart strain

Question 653

Mx of primary hyperparathyroidism?

Answer 653

Parathyroidectomy

Question 654

TFTs in sick euthyroid?

Answer 654

Normal TSH Low T3/T4

Question 655

What antibody is most specific for pdermatomyositis?

Answer 655

anti-jo-1 antibody 80% = ANA positive as well

Question 656

What ca is likely to cause myasthenia gravis?

Answer 656

Thymomas

Question 657

What is the most sensitive scan to diagnose diffuse axonal injury

Answer 657

MRI brain

Question 658

What is the nipple discharge associated w prolactinoma likely to look like?

Answer 658

bilateral + often cream coloured

Question 659

What do the following tests test for? Lachmanns Empty can McMurrays Posterior Draw Sweep test

Answer 659

Lachmanns - ACL Empty can - Supraspinatus integrity McMurrays - Meniscus Posterior Draw - PCL Sweep test - Knee effusion

Question 660

Fundoscopy finding in temporal arteritis?

Answer 660

Ischaemia to anterior optic nerve - Anterior ischemic optic neuropathy accounts for the majority of ocular complications in temporal arteritis

Question 661

In ALS if there is no amiodarone, what drug can be used instead?

Answer 661

Lidocaine

Question 662

What are some recognised complications of enteral feeding?

Answer 662

Diarrhoea Aspiration Metabolic - Hyperglycaemia and refeeding syndrome

Question 663

On examination, her observations are heart rate 85/minute, respiratory rate 18/min, blood pressure 124/82mmHg, temperature 38.5ºC. There is a 1cm wound on her lower right calf. It is surrounded by an area of prominent erythema and swelling that is approximately 15cm at its widest diameter. There is also a very dark purple area around the wound. There is one blister with foul-smelling discharge. The wound is very tender. An emergency x-ray demonstrates air bubbles in the tissues. Swabs are taken and broad-spectrum antibiotics are started. What is the most likely organism to be isolated? What is the condition called? what increases the risk?

Answer 663

Gas gangrene caused by Clostridium perfringens Having peripheral vascular disease increases your risk

Question 664

Why is nephrotic syndrome associated w ith a hypercoagulable state?

Answer 664

due to loss of antithrombin III via the kidneys

Question 665

When should you surgical mx of dupuytrens contracture?

Answer 665

MCP cant be straightened and cant be lied flat on table

Question 666

What is kussmauls sign and what is it sseen in ?

Answer 666

Raised JVP upon inspiration and seen in constrictive pericardiits

Question 667

What is the main benefit of epidural form of analgesia compared to alternative forms?

Answer 667

Fasster return to normal bowel func following abdo surgery

Question 668

What test should be offered to all people w TB?

Answer 668

HIV test

Question 669

What are some possible complications of axillary node clearance?

Answer 669

arm lymphedema and functional arm impairment Intercostobrachial nerve damage

Question 670

What is a possible comlication that can occur if a pleural effusion is drained too quickly?

Answer 670

re-expansion pulmonary oedema

Question 671

An x-ray confirms a fracture of the surgical neck of the humerus. Which nerve is at risk?

Answer 671

Axillary nerve

Question 672

What is klumpkes paralysis?

Answer 672

Classically there is weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner's syndrome. It occurs as a result of traction injuries or during delivery. Involves brachial trunks c8-t1

Question 673

What is Erbs palsy?

Answer 673

Clinically his arm is hanging loose on the side. It is pronated and medially rotat C5-6

Question 674

Smiths fracture possble nerve injury - weakness of thumb opposition?

Answer 674

Median

Question 675

hot solitary nodule indicates what thyroid pathology

Answer 675

Toxic adenoma

Question 676

pain and swelling of the left shoulder. There is a large radiolucent lesion in the head of the humerus extending to the subchondral plate. x-ray have a 'soap bubble' appearance. They present as pain or pathological fractures. They commonly metastasize to the lungs.

Answer 676

Giant cell umour

Question 677

reduces Glasgow coma score, quadriplegia, miosis, and absent horizontal eye movements - waht type of stroke

Answer 677

Pontine stroke?

Question 678

ppearance (progressive, erythema and oedema of the breast in the absence signs of infection such as fever, discharge or elevated WCC and CRP) and an elevated CA 15-3 dx?

Answer 678

Inflammatory breast ca

Question 679

What is the triad of fat embolism syndrome?

Answer 679

Respiratory Neurological Petechial rash (tends to occur after the first 2 symptoms)

Question 680

How can you distinguish between unilateral adenoma and bilateral hyperplasia in primary hyperaldosteronism?

Answer 680

Adrenal venous sampling

Question 681

HOCM is associated w/ what other heart sondition?

Answer 681

WPW

Question 682

After starting an ACE inhibitor, significant renal impairment may occur if ....

Answer 682

the pt has undiagnosed bilateral renal stenosis

Question 683

Reactive arthritis - synovial fluid resulsts?

Answer 683

Develops after an infection where the organism cannot be recovered from the joint - Will normally be sterile synovial fluid where organism cannot be recovered from the joint Even thought its normally caused by chlamydia trachomatis

Question 684

Mechanism behind carpal tunnel

Answer 684

Carpal tunnel syndrome causes action potential prolongation in both sensory and motor axons

Question 685

What are the RFs for testicular cancers?

Answer 685

Infertility (increases risk by a factor of 3) cryptorchidism family history Klinefelter's syndrome mumps orchitis

Question 686

............................. is characterised by fever, hypotension and a rash → desquamation

Answer 686

Staphylococcal toxic shock syndrome

Question 687

Tetanus vaccine history last dose <10y what to do?

Answer 687

no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

Question 688

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago

Answer 688

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

Question 689

If vaccination history is incomplete or unknown

Answer 689

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

Question 690

What is conduction aphasia and what causes it?

Answer 690

A stroke affecting the arcuate fasiculus - the connection between wernickes and brocas area Here the speech is fluent but repitition is poor

Question 691

What is global apahasia and what causes it?

Answer 691

A large stroke affecting - broca, wernickes and the arucate fasiculus Causes severe expressive + receptive apahasia - may be able to communicate using gestures

Question 692

Questionnaire to assess frailty?

Answer 692

Frailty should be specifically assessed through the evaluation of gait speed, self-reported health status, or the PRISMA-7 questionnaire

Question 693

Which CNs can be affected vestibular schwannoma?

Answer 693

CN VIII, VII, V Vestibular schwannoma - cant hear you right so they thought 578 ml in a pint

Question 694

Gold standard ix for small bowel obstruction?

Answer 694

CT abdo

Question 695

The following are all NICE criteria for referring a patient to secondary care for consideration of interventional treatment of varicose veins as laid out in the NICE CKS summary:

Answer 695

Symptoms associated with varicose veins such as 'heavy' or 'aching' legs. Skin changes associated with chronic venous insufficiency such as venous eczema or haemosiderin deposition. Superficial vein thrombosis. A venous leg ulcer (a break in the skin below the knee that has not healed in 2 weeks), either active or healed.

Question 696

Mx of nephrogenic DI?

Answer 696

Thiazides + low salt / protein diets

Question 697

A 19-year-old woman presents to the emergency department with new-onset chest pain and shortness of breath. The pain started today and is centrally located, sharp in nature and doesn't change with breathing or position. She has been unwell for the past week, with fever and joint pains. She has no past medical history of note. On examination, she has bibasilar crackles, with dull heart sounds with no added sounds. Her vital signs are normal apart from a respiratory rate of 24/min. An ECG is performed and shows diffuse T-wave inversion. What is the most likely diagnosis?

Answer 697

Myocarditis - The dull heart sounds are due to the myocardium being inflamed and thickened. The shortness of breath and bibasilar crackles are likely due to myocardial dysfunction causing pulmonary congestion

Question 698

Upper GI bleed: the xxxxxxxx score is used after endoscopy and provides a percentage risk of rebleeding and mortality

Answer 698

Rockall

Question 699

Surgery / sulfonylureas on day of surgery:

Answer 699

- Omit on the day of surgery - Exception is morning surgery in patients who take BD - they can have the afternoon dose

Question 700

xxxxxx lesion features = Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

Answer 700

S1

Question 701

HF + Fluid overload + low BP what is mx?

Answer 701

This is cardiorenal syndrome IV loop diuretics / increased dose - to ensure there's enough conc in the tubules

Question 702

What are the features of small intestine bacterial overgrowth syndrome? ix? mx?

Answer 702

It should be noted that many of the features overlap with irritable bowel syndrome: - chronic diarrhoea - bloating, flatulence - abdominal pain ix = hydrogen breath test mx = abx - rifaximin

Question 703

CK levelsin temporal arteritis?

Answer 703

Normal

Question 704

Hep B PEP?

Answer 704

accelerated course of hep b vaccine + hep b Ig

Question 705

EBV associated ca?

Answer 705

Burkitt's lymphoma* Hodgkin's lymphoma nasopharyngeal carcinoma HIV-associated central nervous system lymphomas

Question 706

Hypothyroid taking levothyroxine- Right T3/4 + HIGH TSH - dx?

Answer 706

They have poor compliance w/ meds

Question 707

What to do before giving TB vaccines?

Answer 707

It is important that a tuberculin skin test is performed (to exclude past exposure to tuberculosis) prior to giving the vaccine.

Question 708

What to do before giving TB vaccines?

Answer 708

It is important that a tuberculin skin test is performed (to exclude past exposure to tuberculosis) prior to giving the vaccine.

Question 709

On the soles of both feet you notice a waxy yellow rash + swollen joints - dx? what is the rash?

Answer 709

Rash = Keratoderma blenorrhagic Dx = Reactive arthritis

Question 710

Neuroleptic malignant syndrome more common in newly initiated treatment or prolonged treatment?

Answer 710

Prolonged

Question 711

What is the latest time that HIV post-exposure prophylaxis may be given?

Answer 711

72 h after

Question 712

What is Zollinger Ellison syndrome?

Answer 712

multiple gastroduodenal ulcers causing abdominal pain and diarrhoea - this is seen in pts w/ MEN1

Question 713

Contraindications to thrombolysis?

Answer 713

active internal bleeding recent haemorrhage, trauma or surgery (including dental extraction) coagulation and bleeding disorders intracranial neoplasm stroke < 3 months aortic dissection recent head injury severe hypertension

Question 714

Mx of lung ca?

Answer 714

Low grade disease - T1-2a, N0, M0 = surgery High grade = Chemo + radio

Question 715

Factors which may affect the result of egfr?

Answer 715

pregnancy muscle mass (e.g. amputees, body-builders) eating red meat 12 hours prior to the sample being taken

Question 716

Renal transplant + infection ?

Answer 716

CMV

Question 717

Features of aortic stenosis?

Answer 717

narrow pulse pressure slow rising pulse a thrill palpable over the cardiac apex a fourth heart sound (S4) indicative of left ventricular hypertrophy a soft/absent S2

Question 718

The flu-like symptoms, bilateral consolidation and erythema multiforme point to a diagnosis of .......

Answer 718

Mycoplasma pneumoiniae

Question 719

How does yellow fever present?

Answer 719

flu like illness → brief remission→ followed by jaundice and haematemesis

Question 720

DPP4 inhibitors and weight gain /loss?

Answer 720

Dont cause weight gain

Question 721

Sx of sinusitis a few weeks ago --> headache, fever and focal neurology - possible complication?

Answer 721

Brain abscess - use CT to confirm will need a craniotomy , iv abx and intracranial pressure mx (dex)

Question 722

Which anasthetic can cause addisonian crisi? and how?

Answer 722

Etomidate may result in adrenal suppression - potentiating of GABAa receptors

Question 723

What is the presentation of entamoeba histolytica?

Answer 723

dysentery (bloody diarrhoea, fever, and abdominal cramps) following travelling. There has been a long incubation period, along with profuse bloody diarrhoea, fevers, and right upper quadrant pain (suggesting liver involvement and the potential formation of a liver abscess)

Question 724

Productive cough + choking after feeds + aspiration pneumonia in a long term vintaltion pt suggests what?

Answer 724

Tracheo eosophageal fistula

Question 725

What is seen in a CN IV leison?

Answer 725

Trochlear leison = Defective downward gaze + vertical diplopia

Question 726

What is drug is used to treat schistosomiasis?

Answer 726

Praziquantel - anti helminth

Question 727

How do you check for malignancy in dermatomyositis@?

Answer 727

CT chest, abdo and pelvis

Question 728

What cardiac features can be caused by carcinoid tumours?

Answer 728

Affected right side of heart - The valvular effects are tricuspid insufficiency and pulmonary stenosis

Question 729

Mx of asymptomatic gallbladder stones??

Answer 729

Reassure people with asymptomatic gallbladder stones. Stones that are found incidentally, as a result of imaging investigations unrelated to gallstone disease in people who have been completely symptom-free for at least 12 months before diagnosis do not require intervention. They must be found in a normal gallbladder and normal biliary tree. Symptomatic patients or those with stones within the common bile duct (CBD) do require intervention to clear the CBD. This can be done: Surgically at the time of laparoscopic cholecystectomy or With endoscopic retrograde cholangiopancreatography (ERCP) before or at the time of laparoscopic cholecystectomy.

Question 730

Mx of cardiac arrest due to hypothermia?

Answer 730

In cases of hypothermia causing cardiac arrest, defibrillation is less effective and only 3 shocks should be administered before the patient is rewarmed to 30 degrees centigrade Drugs should be withheld until the patient is 30 degrees and then should be given at double time intervals until the patient is reaching normothermia or has the return of spontaneous circulation (ROSC)

Question 731

What are the indications for indications for adjuvant ipsilateral chest wall and regional lymph node radiotherapy following masectomy?

Answer 731

positive axillary lymph nodes and residual tumour at resection margins post-mastectomy a

Question 732

Mx of women with breast cancer and no palpable lymphadenopathy, w/ pre-operative axillary ultrasound is positive

Answer 732

sentinel node biopsy to assess the nodal burden axillary node clearance if extensive nodal burden identified at SNB

Question 733

Returning traveller fever + bradycardia =?

Answer 733

Typhoid!!

Question 734

What side effects are seen to the different chemotherapy agents - remember toxicity bear!

Answer 734

Question 735

finger abduction weakness - what nerve leison?

Answer 735

T1

Question 736

What is the preferred way to support nutrition in MND?

Answer 736

Using a percutaneous gastrostomy tube (PEG)

Question 737

Use of BB in acute HF?

Answer 737

Beta-blockers should only be stopped in acute heart failure if the patient has heart rate < 50/min, second or third degree AV block, or shock

Question 738

Addisons causes what effect on blood glucose?

Answer 738

hypogycaemia

Question 739

Most common cause of addisons in the UK?

Answer 739

AI

Question 740

Sudden hypoxia and increased ventilation ipresure in a pt w/ flail chest being treated w/ intubation + ventilation may suggest what?

Answer 740

Tension pneumothorax

Question 741

What drug can increase survival rates in MND?

Answer 741

Riluzole

Question 742

Which endo hormones are increased in response to stress and which are decreased?

Answer 742

Increased: GH Cortisol Renin ACTH Aldosterone Prolactin ADH Glucagon Decreased Insulin Testosterone + Oestrogen

Question 743

mx of chronic subdural?

Answer 743

Burr hole

Question 744

What does high SAAG suggest?

Answer 744

Portal HTN

Question 745

What tests are required before TB meds?

Answer 745

Urea and Electrolytes, LFTs, vision testing, FBC 57%

Question 746

What vessel is affected in subdural haemorrhage?

Answer 746

Bridging veins between cortex and venous sinuses

Question 747

How should diabetic nephropathy be screened for?

Answer 747

all patients should be screened annually using urinary albumin:creatinine ratio (ACR)should be an early morning specimenACR > 2.5 = microalbuminuria

Question 748

fundoscopy typically shows a swollen pale disc and blurred margins in what condition?

Answer 748

Anterior ischaemic optic neuropathy

Question 749

Peptic ulceration, galactorrhoea, hypercalcaemia suggest what condition

Answer 749

MEN1

Question 750

Right-sided tenderness on PR exam - dx?

Answer 750

think appendicitis

Question 751

How does Malignant hyperthermia pressent? What anasthetic can cause it? Mx?

Answer 751

autosomal dominant disorder presenting as a hypermetabolic crisis characterised by an increased end-tidal carbon dioxide [ETCO2] (hypercapnia), tachycardia, muscle rigidity, rhabdomyolysis, hyperthermia, and arrhythmia Associated w/ volatile inhalational anasethetics + suxamethonium (succinylcholine) treat w/ dantrolene

Question 752

How long is treatment of graves carried out for?

Answer 752

Carbimazole is given for 12-18 m to induce remission

Question 753

Rheumatoid + nail changes =?

Answer 753

Psoriatic arthritis

Question 754

Rheumatoid + nail changes =?

Answer 754

Psoriatic arthritis

Question 755

Effect of the following drugs on QT interval? Salbutamol Solatol

Answer 755

Salbutamol = shortened QT (all SABAs do this) Solatolol = prolonged QT (only BB that does this)

Question 756

Wernickes and Brocas - locationin the brain?

Answer 756

Wernicke and Broca make me STIF Wernicke 'sends' to Broca's -> Superior Temporal gyrus then Inferior Frontal

Question 757

What location of the brain is affected by what ataxia? Gait v finger-nose?

Answer 757

gait ataxia = cerebellar vermis finger-nose = cerebellar hemisphere

Question 758

Hypersenitivity in SLE?

Answer 758

Type 3

Question 759

The rash consists of a raised purple plaque of indurated skin that affects the tip of her nose and the skin around the right nostril. It is neither itchy or painful however the patient is distressed by its appearance. What does this describe and what condition causes it?

Answer 759

Lupus pernio - sarcoidosis

Question 760

C-peptide production does NOT fall on exogenous insulin injection in patients with xxxxxx

Answer 760

insulinoma

Question 761

Which NM blocker is CI in pts w/ hyperkalaemia? (particularly inmportant in trauma and burns pts?

Answer 761

Suxamethonium

Question 762

NF1 v NF2 easiest way to notice different?

Answer 762

Both cause cafe-au-lait spots however NF2 is the one that casues bilateral vestibular schwannomas -> sensorineural hearing loss

Question 763

How are murmurs graded?

Answer 763

Levine scale Grade 1 - Very faint murmur, frequently overlooked Grade 2 - Slight murmur Grade 3 - Moderate murmur without palpable thrill Grade 4 - Loud murmur with palpable thrill Grade 5 - Very loud murmur with extremely palpable thrill. Can be heard with stethoscope edge Grade 6 - Extremely loud murmur - can be heard without stethoscope touching the chest wall

Question 764

What must be assessed in pts w/ potential bilateral urinary tract obstruciton?

Answer 764

Renal function - U+E

Question 765

Mx of pituitary incidentaloma?

Answer 765

If a pituitary incidentaloma is found within the sellar, laboratory investigation must be done to determine if it is functional or non-functional

Question 766

Which diabetes drugs are ahypoglycaemics??

Answer 766

Sulphonylureas, Metformin, Glitazones GLP receptor agonists DPP-4 inhibitors

Question 767

What is the definition of a UGI?

Answer 767

Haemorrhage w/ orgigin proximal to ligament of treitz

Question 768

Which organism causes type1 and type2 nec fac?

Answer 768

type 1 = clostridium perfringens type 2 = strep pyogenes

Question 769

Which type of motor neuron disease carries the worst prognosis?

Answer 769

Progressive bulbar palsy

Question 770

Painful shin rash + cough = ????

Answer 770

Sarcoidosis

Question 771

homonymous quadrantanopias: which part causes inferior and which part causes superior?

Answer 771

PITS (Parietal-Inferior, Temporal-Superior)

Question 772

Fever, facial spasms, dysphagia in an intravenous drug use? - what if the facial paralysis was flaccid?

Answer 772

Clostridium tetani Clostridium botulinum

Question 773

allergic bronchopulmonary aspergillosis mx of choice?

Answer 773

Oral pred itraconazole 2nd line sometimes

Question 774

What tumour can cause cranial DI? what is the visual field defect seen?

Answer 774

Lower bitemporal hemianopia

Question 775

What nerve is used for finger adduction?

Answer 775

Ulnar

Question 776

What nerver is used for finger extension?

Answer 776

Radial

Question 777

What type of hernia can go into the testicles?

Answer 777

Indirect inguinal

Question 778

Mx of renal stones?

Answer 778

Question 778

What test can you do to help distinguish between ATN and dehydration?

Answer 778

Fluid challenge - ATN = poor response

Question 779

How can you distinguish between emphysema in a1at deficiency and copd?

Answer 779

Emphysema is most prominent in the lower lobes in A1AT deficiency and the upper lobes in COPD

Question 780

What is the main mx of wilsons?

Answer 780

Pencillamine

Question 781

What might pPeriureteric fat strandin on CT KUB suggest?

Answer 781

Recently passed ureteric stone

Question 782

Young female who develops AKI after starting ACEi - consider what dx?

Answer 782

Fibromuscular dysplasia