MSRA Flashcards
(256 cards)
1
Q
Which 5 medications are commonly first line in the treatment of TB?
A
Isoniazid
Ethambutol
Rifampicin
Pyrazinamide
+Pyridoxine (vitamin supplement given with Isoniazid to prevent peripheral neuropathy)
2
Q
What is the most common cause of adrenal insufficiency?
A
Secondary - Long term exogenous steroid exposure
3
Q
What is the first line treatment for an Addisonian Crisis?
A
IV Hydrocortisone (e.g. 100mg STAT)
4
Q
Is primary biliary cirrohsis/cholangitis (PBC) more common in women or men?
A
Women
5
Q
Is primary sclerosis cholangitis more common in women or men?
A
Men
6
Q
Are anti-mitochondrial antibodies positive in PBC or PSC?
A
Anti-mitochondrial (AMA) antibodies are positive in PBC
7
Q
What appearance of the bile ducts is indicative of PSC on cholangiogram/MRCP/ERCP?
A
Beaded appearance of the bile ducts
8
Q
Which condition is strongly associated with ulcerative colitis? PBC or PSC?
A
PSC
9
Q
Both PBC and PSC can lead to cirrhosis however which one can lead to cholangiocarcinoma?
A
PSC
10
Q
For a diagnosis of COPD, what is the FEV1/FVC ratio?
A
<0.7
11
Q
Mild COPD FEV1 is?
A
> 80% predicted
11
Q
Moderate COPD FEV1 is?
A
50-79% predicted
12
Q
Severe COPD FEV1 is?
A
30-49% predicted
13
Q
Very severe COPD FEV1 is?
A
<30% predicted
14
Q
What is the first line treatment for COPD patients?
A
Offer a
- Short acting beta-2 agonist (SABA) - e.g. salbutamol, terbutaline
Or
- Short-acting muscarinic antagonist (SAMA) e.g. ipratropium
15
Q
If patients have exacerbations despite first line treatment for COPD, with NO asthmatic features, what should be offered?
A
- Long acting beta-2 agonist (LABA) e.g. salmeterol, formoterol PLUS a long acting muscarinic antagonist (LAMA) e.g. tiotropium
16
Q
If patients have exacerbations despite first line treatment for COPD, with NO asthmatic features but have trialled a LABA/LAMA, what should be offered?
A
Consider a 3 month trial of LABA+LAMA AND inhaled corticosteroid (ICS).
If not improvement @ 3 months - stop ICS and continue LABA+LAMA
If symptoms have improved, continue LABA+LAMA+ICS and review annually.
17
Q
If patients have exacerbations despite first line treatment for COPD, WITH asthmatic features, what should be offered?
A
LABA (e.g.salmeterol,formoterol) + ICS
If continue to be symptomatic, offer LABA+LAMA+ICS
18
Q
Complication of taking an ACE inhibitor during pregnancy
A
First trimester: Relatively safe
Second and third trimester: Associated with renal tubular aplasia and intrauterine growth retardation (IUGR)
19
Q
Which antibiotics are safe during pregnancy?
A
Penicillins, erythromycin and cephalosporins
20
Q
Which trimester is trimethoprim contraindicated in?
A
First
21
Q
Which trimester are tetracyclines contraindicated in?
A
Third
22
Q
What is diethylstillbestrol and why is it contraindicated in pregnancy?
A
Synthetic, non-steroidal oestrogen used in the treatment of breast cancer in postmenopausal women.
Causes a rare vaginal tumour (vaginal clear cell adenocarcinoma) in girls and young women exposed in utero
23
Q
Malformation linked to Vitamin A (e.g. retinoid acid) and pregnancy?
A
Malformations of the ear
24
Malformation linked to warfarin and pregnancy?
First trimester:
- Foetal warfarin syndrome: skeletal abnormalities, brachydactyly (short fingers and toes), underdeveloped extremities
Second and third trimester:
- Less commonly assoc with birth defects. Most commonly: CNS disorders
25
Most common paediatric malignancy?
Acute lymphoblastic leukaemia (ALL)
26
Peak age incidence of Acute lymphoblastic leukaemia (ALL)?
2-5 years old
27
Which type of haematological malignancy is associated with clonal expansion of immature lymphoid progenitor cells (e.g. T-lympocytes) that express a protein called terminal deoxynucleotidyl transferase (TdT)?
Acute lymphoblastic leukaemia (ALL)
28
Which infectious disease often presents with erythema migrans?
Lyme Disease
- Bulls eye rash around tick bite
29
Which oral antibiotics can be used to treat Lyme disease?
Doxycycline or Amoxicillin
30
Which haematological malignancy features the Philadelphia chromosome?
Chronic Myeloid Leukaemia
31
What a two main risk factors for chronic myeloid leukaemia?
- Male Sex
- Exposure to ionising radiation
32
Most common age affected by CML?
65-74 years old
33
FBC findings in CML?
- Raised WCC
- Anaemia
- Platlets can be normal, raised or low
34
3 conditions which can worsen during pregnancy?
- SLE
- HSV
- Acne Rosacea
35
First cranial nerve?
Olfactory
- smell
36
Second cranial nerve?
Optic
- Vision
37
Third cranial nerve?
Oculomotor
- Pupillary constriction (light and accommodation)
- Moves eye up, down and peripherally
- Moves eye lid
38
Fourth cranial nerve?
Trochlear
- Inferior lateral movement of the eye (superior oblique - SO4)
39
Fifth cranial nerve?
Trigeminal
- Corneal reflex
- Sensation of eyebrows, cheeks and chin)
- Chewing, biting and lateral jaw movements
40
Sixth cranial nerve?
Abducens
- Inferior lateral movements of the eye (lateral rectus - LR6)
41
Seventh cranial nerve?
Facial
- Taste - anterior 2 thirds of tongue
- Forehead and facial movements
42
Eighth cranial nerve?
Vestibulocochlear
- Hearing and balance
43
Ninth cranial nerve?
Glossopharyngeal
- Swallowing and phonation
- Posterior third of tongue
44
Tenth cranial nerve?
Vagus
- Tongue and back of throat sensation
- Gag reflex
- Swallowing
45
Eleventh cranial nerve?
Accessory
- Shoulder movement
46
Twelfth cranial nerve?
Hypoglossal
- Tongue movement
47
Incubation period of campylobacter jejuni?
2-5 days (long)
48
Incubation period of Bacillus cereus?
2-12 hours (short)
49
Incubation period of clostridium perfringens?
8-18 hours (short)
50
Incubation period of s aureus (gastroenteritis)?
2-6 hours (short)
51
Recurrent infection, especially with n. meningitidis and n. gonorrhoea could indicate what kind of immunodeficiency?
Membrane attack complex (MAC) deficiency
- Made up of C5-9
- Final stage of complement activation which leads to the formation of a hole in the cell wall and cell lysis
52
Anaphylaxis to blood transfusions could indicate what kind of immunodeficiency?
IgA deficiency
53
Which cancers does the COCP increase risk of?
Breast and Cervical
- Way to remember: increased the risk of cancers we screen for
54
Which cancers does the COCP decrease risk of?
Endometrial and ovarian
55
Unwanted side effect of nicorandil?
Oral ulceration
56
Which other skin condition is palmoplantar pustulosis associated with?
Psoriasis. Also strong association with smoking.
57
Which type of hypersensitivity reaction is mediated by IgE?
Type 1 (allergy) - mast cell degranulation
58
Which type of hypersensitivity reaction is antibody mediated i.e. antibody/antigen interaction? And what are some examples?
Type 2. Examples include haemolytic anaemia of the newborn and goodpastures syndrome.
59
Which type of hypersensitivity reaction is immune complex mediation? Give examples.
Type 3 - e.g. rheumatoid arthritis and SLE
60
Which type of hypersensitivity is 'delayed hypersensitivity' reaction? Give examples
Type 4 - chronic transplant rejection and contact dermatitis.
61
Which type of hypersensitivity is 'receptor mediated' or 'autoimmune'? Give examples
Type 5 - Grave's disease, Myasthenia gravis
62
What is the first stage of diabetic retinopathy and what are some of the findings on fundoscopy?
First stage = Background diabetic retinopathy
Features:
- Microaneurysms
- Haemaorrhages
- Exudates
No Rx needed. Needs annual screening and improving diabetic control
63
What is the second stage of diabetic retinopathy and what are some of the findings on fundoscopy?
Second stage = Pre-proliferative retinopathy
Features:
- Multiple large deep haemorrhages (blots)
- Cotton wool spots
Second = blots and spots
64
What is the third stage of diabetic retinopathy and what are some of the findings on fundoscopy?
Third stage = Proliferative retinopathy
Features:
- Neovascularisation however these are fragile vessels which can burst and cause vitreous haemorrhages
More common in T1DM
65
What is the fourth stage of diabetic retinopathy and what are some of the findings on fundoscopy?
Fourth stage = Diabetic maculopathy
More common in T2DM
66
Which pneumonia (causative organism) often follows a viral infection such as influenza and is commonly seen in IVDUs? And what changes are seen on FBC?
Staphylococcus chest infections. Causes a raised leucocyte count.
67
What is the most common causative organism in community acquire pneumonia?
S. Pneumoniae
68
Which type of pneumonia (causative organism) is associated with cavitating lesions in the upper lobes and associated with alcoholism and the elderly?
Klebsiella
69
Which immunoglobulin deficiency predisposes to mucosal infections?
IgA
70
Which immunoglobulin deficiency predisposes to parasitic/helminthic infections and non-allergic reactive airways disease?
IgE
71
Which immunoglobulin deficiency predisposes to bacterial, fungal and viral infections?
IgM
(think M = microbes)
72
Which immunoglobulin deficiency predisposes to infections from encapsulated bacteria?
IgG
(e.g. N. meningococcus, H. influenzae, S. Pneumoniae)
73
What type of inheritance pattern is seen in multiple endocrine neoplasia (MEN)?
Autosomal dominant
74
What type of tumours are seen in multiple endocrine neoplasia 1 (MEN1)?
3 Ps
- Parathyroid
- Pituitary
- Pancreas
75
What type of tumours are seen in multiple endocrine neoplasia 2A (MEN2A)?
Phaeochromocytoma
Parathyroid
Medullary thyroid
76
What type of tumours are seen in multiple endocrine neoplasia 2B (MEN2B)?
Phaeochromocytoma
Medullary thyroid
Marfanoid appearance
Mucosal neuromas
77
What is the preferred option for treatment of thyrotoxicosis in pregnancy? What are the potential risks of the contraindicated treatments?
Thyroidectomy
- Carbimazole = teratogenic
- Propylthiouracil = crosses the placenta and can cause neonatal goitre and hypothyroidism
78
Fetal limb injury is a risk with amniocentesis? TRUE OR FALSE
TRUE although uncommon
79
After how many weeks should amniocentesis be carried out?
15 weeks
80
What is the ICD-10 criteria for anorexia nervosa? (5 criteria - all must be fulfilled)
1. BMI <17.5
2. Self induced weight loss
3.Body image distortion
4. Endocrine consequences e.g amenorrhoea
5.If onset if prepubertal, it can cause delay of pubery
81
In adrenal insufficiency (e.g. addisons), what will the potassium, sodium, calcium and glucose be? (high or low)
Hyperkalaemia
Hyponatraemia
Hypoglycaemia
Hypercalcaemia
82
What is the gold standard test for diagnosing adrenal insufficiency? E.g. Addisons. And how is it carried out?
Short synacthen test
- Administer exogenous ACTH, then measure cortisol levels at 30 or 60 minutes
- Normal response = rise in cortison. If there is a deficiency then there will be no rise
- Failure to rise above 550nmol/l = deficiency
83
By what age should a child be able to walk?
18 months
84
By what age to children develop shyness around strangers?
12 months
85
By what age should a child be able to pull themselves up from the floor to standing and cruise?
12 months
86
By what age should primitive reflexes have disappeared e.g. moro and grasp reflex?
6 months
87
By what age can most children hop on one foot?
4 years
88
By what age can most children jump on 2 feet?
3 years
89
Why are children with DiGeorge syndrome pre-disposed to recurrent infections?
Absent or hypoplastic thymus leading to low T-cell production
90
Features of DiGeorge syndrome (CATCH 22)?
C - Cardiac abnormalities (most common = ToF)
A - Abnorma faces - smooth philtrum, low set nasal bridge
T - Thymic aplasia
C - Cleft palate
H - Hypocalcaemia and hypoparathyroidism
22 - Deletion on chromosome 22
91
Complication of tetracyclines and pregnancy?
Discoloured teeth if taken in 2nd and 3rd trimester and skeletal development abnormalities if taken in 1st trimester
92
Complication of ACE inhibitors in pregnancy?
Renal impairment of the foetus + possible skull deformities and oligohydramnios
93
Complication of streptomycin (and all other aminoglycosides) in pregnancy?
Auditory and vestibular nerve damage
94
Complication of B-blockers in pregnancy?
Neonatal hypoglycaemia, bradycardia and intrauterine growth restriction
95
Complication of NSAIDs in pregnancy?
MANY!
- Premature closure of ductus arteriosus
- Persistent pulmonary hypertension of the child
- Reduced placental blood flow
- Prolonged labour
96
When does physiological jaundice in newborns usually develops and when does it usually disappear?
2-7 days, usually clears by 10 days
97
When is jaundice pathological in newborn?
Within 24 hours of birth
98
When is jaundice considered prolonged in term babies?
14 days - causes inc biliary atresia, hypothyroidism, G6PD deficiency
99
When is jaundice considered prolonged in pre-term babies?
21 days - causes inc biliary atresia, hypothyroidism, G6PD deficiency
100
How is jaundice monitored to assess if action is needed? Which blood test is used? What are three outcomes?
Treatment threshold charts
Uses TOTAL BILIRUBIN LEVELS
3 outcomes:
- No action
- Phototherapy
- Exchange transfusion
101
A raised conjugated bilirubin in the newborn suggest the pathology originates from where?
Hepatobiliary e.g. biliary atresia
102
In neonatal jaundice, what does a direct coombs test look for?
Haemolysis
103
Why are thyroid function tests important in the investigation of neonatal jaundice?
Hypothyroidism is a cause
104
How do you test of G6PD deficiency?
G6PD levels
105
What is the causative agent in measles?
Paramyxovirus
106
What is the incubation period of measles?
7-21 days
107
What is the time children should be kept off school with measles?
5 days after rash develops
108
How does the rash develop in measles?
Face and descends crainio-caudally
109
Is measles a notifiable illness?
YES
110
Name 3 complications of measles
Otitis media
Subacute sclerosing pan-encephalitis
Acute encephalitis
Pneumonia
111
Laboratory serology test for measles? And which sites can be samples also in acute infection
Measles IgM
In acute infection, throat and urine can be sampled
112
Causative agent in scarlet fever?
Group A Beta-haemolytic strep
113
Incubation period of scarlet fever?
2-5 days
114
What is the rash like in scarlet fever?
Confluent erythematous rash which feels like sandpaper to touch
115
Is scarlet fever notifiable?
YES
116
Other signs/symps of scarlet fever
Strawberry Tongue
Pastias Lines - erythematous lines in creases of flexors
117
What is the gold standard test for scarlet fever?
Throat swab culture - need good quality sample
118
Management of scarlet fever?
Antibiotics for 10 days. Options
- Pen V
- Erythromycin
- Cephalosporins
119
How long does a child need to stay off school with scarlet fever?
5 days AFTER STARTING ANTIBIOTICS
120
Causative agent in rubella?
Rubella virus
121
Incubation period of rubella?
2 weeks
122
What is the rash like in rubella?
Similar to measles
- starts on face and descends to feet
123
Name 3 other features in rubella?
- Fever
- Tender occipital and posterior auricular lymphadenopathy
- Forschheiner spots: spots on soft palate and uvula
124
Lab serology test for rubella?
IgG + IgM
125
How long does a child need to stay off school with rubella?
5 days after onset of rash
126
How long after a rubella vaccination should a woman avoid pregnancy?
3 months
127
Incubation period of erythema infectiosum/slap cheek?
4-14 days
128
Rash characteristics in slap cheek?
facial rash which spares periorbital areas and nasal bridge. After this rash then develop a rash on body
129
Which individuals are high risk in terms of slap cheek?
- Haemoglobinopathies (e.g. sickle cell patients) - can get aplastic crisis
- Immunocompromised
- Pregnant women
130
When is serological testing for slap cheek indicated and what test should be sent?
In high risk groups
- Haemoglobinopathies (e.g. sickle cell patients) - can get aplastic crisis
- Immunocompromised
- Pregnant women
Sent IgG/IgM
131
Causative agent in exanthem subitium/sixth disease/roseola infantum?
HHV-6 AND HHV-7
132
Incubation of exanthem subitium/sixth disease/roseola infantum?
5-15 days
133
In what percentage of patients with exanthem subitium/sixth disease/roseola infantum does a rash occur? And what are the characteristics of this rash?
10%
Starts behind ears (macules and papules) and descends down
Lasts 1-2 days
134
Common symps in exanthem subitium/sixth disease/roseola infantum?
- Fever
- Diarrhoea (68%)
- Cough (50%)
- Eyelid swelling (30%)
135
Children with exanthem subitium/sixth disease/roseola infantum are high risk of..?
Febrile seizures
136
Is exanthem subitium/sixth disease/roseola infantum notfiable?
NO
137
Is slap cheek notifiable?
NO
138
Oral rehydration solution is recommended in children with gastroenteritis who are high risk of dehydration, what are the criteria of high risk for dehydration?
Any of:
- Age <1 year old
- Low birth weight
- More than FIVE diarrhoeal stools within 24 hours
- More than TWO diarrhoeal stools within 24 hours
- Unable to tolerate fluids or breastfeeding
- Signs of malnutrition
139
IV fluids are recommended in children with gastroenteritis who are clinically dehydrated and meet the what criteria?
- Deteriorating despite oral rehydration solution (ORS)
- Not tolerating ORS orally or via NG tube
- Have confirmed or suspected shock
140
Which ethnic group is at highest risk of developing prostate cancer?
African-caribbean
141
Give 4 extrapyramidal side effects
Acute dystonia
Parkinsonism
Tardive dyskinesia
Akathisia
142
What are the signs/symps of acute dystonia associated with drug extrapyramidal side effects and what is the management?
Painful contractions of neck, jaw or eye muscles
Onset: hours - days
Management: IM/IV anticholinergics e.g. procyclidine
143
What are the signs/symps of parkinsonism associated with drug extrapyramidal side effects and what is the management?
Shuffling gait, termor, stiffness
Onset: Within a few weeks of starting treatment
Management: Reducing dose or adding anticholinergic
144
What are the signs/symps of akathisia associated with drug extrapyramidal side effects and what is the management?
Restlessness
Occurs within first few months of starting treatment
Management: Lower dose or add in propranolol
145
What are the signs/symps of tardive dyskinesia associated with drug extrapyramidal side effects and what is the management?
Uncontrollable movements of face, tongue, upper body.
Occurs when taking anti-psychotics for long time
Irreversible in 50% if cases.
146
In general, a raised TSH and low T3/T4 indicates what? And what are some causes?
Primary Hypothyroidism
- Autoimmune thyroiditis (50%) e.g. Hashmioto's thyroiditis - antibodies against thyroid peroxidase (TPO) and thyroglobulin. Will get a large, firm, lobulared thyroid gland
- Iodine deficiency or excess
- Thyroidectomy
147
In general, a low or normal TSH and low T4 indicates what?
Secondary hypothyroidism
148
In general, a low TSH and high T3/T4 indicates what? And what are some causes?
Primary Hyperthyroidism
- Grave's Disease - 75% of cases. Cause by anti-THSR antibodies.
- Toxic multinodular goitre
- Toxic adenoma
149
In general, a high TSH and high T3/T4 indicates what?
Secondary hyperthyroidism
- Usually causes by a TSH-secreting tumour
150
A stone hard thyroid with euthyroid on TFTs (although 1/3 become hypothyroid) may indicate what disease?
Riedel's Thyroiditis
151
A painful thyroid, fever and initial hyperthyroidism which develops to hypothyroidism may indicate what condition?
De Quervain's Thyroiditis
152
Which is the most common thyroid cancer?
Papillary thyroid carcinoma
153
What are the components of Charcot's triad? And which condition does it indicate?
- Fever
- Right upper quadrant pain
- Jaundice
Acute cholangitis
154
What is the definition of a staggered overdose of paracetamol?
An overdose taken over a period >1 hour
155
In a paracetamol overdose, when is it indicated to commence immediately?
- Staggered overdose (taken over a period >1 hour)
- ALT in the upper limits of normal
156
Which PaO2 range is an indication for LTOT?
Which conditions (3) should also be present (just need one to be present)?
7.3 - 8.0 kPa
Plus
- Secondary polycythaemia
- Pulmonary hypertension
- Peripheral oedema
157
Which anti-epileptic has the side effects the following side effects?
- Gingival hypertrophy
- Facial hair in women (hirtuism)
- Coarse facial features
- Acne
Phenytoin
- Think -toin, -goin to look like a man
158
Which anti-epileptic has the side effects the following side effects?
- Aggressive behaviour
- Transient hair loss
- Weight gain
Sodium Valproate
think - valerie jackson - thin har, aggressive, fat
159
Which anti-epileptic has the side effects the following side effects?
- Hyponatraemia
- Dry mouth
- Gynaecomastia
- Male infertility
- Bloods: aplastic anaemia, thrombocytopenia, haemolytic anaemia, eosinophilia)
Carbamazapine
160
Which anti-epileptic has the side effects the following side effects?
- Sleep disturbance
- Blurred vision
- Skin rashes/hypersensitivity
- Joint pains
Lamotrigine
161
Which anti-epileptic has the side effects the following side effects?
- Diarrhoea
- Abdominal pain
- Weight loss
- Nausea
Levetiracetam (keppra)
GI SEs
162
What is the single most important thing to control in polycystic kidney disease in terms of long-term survival?
Blood pressure (<130/90)
163
Tumour marker used to monitor colorectal cancer?
CEA
(NOT! a screening or diagnostic test)
164
Tumour marker used to monitor hepatocellular cancer?
AFP
165
Tumour marker used to monitor pancreatic cancer?
CA-19-9
166
Tumour marker used to monitor/diagnose ovarian cancer?
CA-125
167
Tumour marker used to aid a diagnosis of breast cancer?
CA-15-3
168
Most common cardiac abnormality in Marfan's?
Aortic root dilatation
169
Along with phenytoin, which other medication is associated with gum hypertrophy?
Nifedipine
170
What is the murmur associated with HOCM?
Mid-systolic murmur
171
What is the murmur associated with aortic stenosis?
Crescendo-decrescendo which radiated to the carotids
172
NICE guideline - first line management of OA?
Paracetamol with topical NSAIDs
173
NICE guideline - patient newly diagnosed with T2DM and weight LOSS, which test should be arranged within 2 weeks and why?
CT abdomen - T2DM can be a first sign of pancreatic ca when associated with weight loss
174
Which abnormalities in the FBC can clozapine cause?
Agranulocystosis and neutropenia
175
What age should a child be able to crawl?
9-12 months
176
What age should a child be able to walk unsupported?
13 months
177
What age should a child be able to sit unsupported?
6-8 months
178
In phaeochromocytoma, should alpha or beta blockers be used? And give some examples of the correct agents.
Alpha blockers e.g. doxazosin
(Isolated beta blockade causes refractory hypertension)
179
What is first line used in paediatric constipation when dietary changes have been made?
Movicol (macrogol)
180
What is the effect of prescribing omeprazole and clopidogrel together?
Reduced efficacy of clopidogrel
181
Which epilepsy medication is associated with gum hypertrophy?
Phenytoin
182
In which patients is it appropriate to use oestrogen-only HRT for management of menopause?
Women who have had a hysterectomy (unopposed oestrogen can cause endometrial hyperplasia which is a pre-cursor to endometrial cancer)
183
Which pulmonary function test is reduced in both restrictive and obstructive lung conditions?
Tidal volume
184
How long should a person who has had a stroke or TIA not drive for?
And when should they inform the DVLA?
1 month
Should inform DVLA if there is any neurological deficit
185
what is the triad of symptoms in mernier's disease?
- Hearing loss
- Tinnitus
- Vertigo
186
Is the PR interval shortened or prolonged in WPW?
Short
187
Which lung pathology is associated with alpha-1-antitrypsin?
Emphysema
188
What class of diabetes medication is sitagliptin?
DPP-4 inhibitor
189
Which autoantibodies are associated with SLE?
Anti-double stranded DNA antibodies
190
Which autoantibodies are associated with systemic sclerosis?
Anti-centromere
191
First line treatment for primary hyperparathyroidism?
Parathyroidectomy
192
Which blood tests are used in monitoring patients on amiodarone? And how often?
TFTs
LFTs
U+Es
Every 6 months
193
Which blood tests are used in monitoring patients on lithium? And how often?
U+Es - 6 months
TFTs - 6 months
Lithium levels - 3-6 months
194
Which blood tests are used in monitoring patients on methotrexate? And how often?
FBCs
U+Es
LFTs
2-3 months
195
Which age range are teratomas more common in?
20-30
196
Which age range are seminomas more common in?
35-45
197
What is the most common causative organism of an infective exacerbation of COPD?
H. influenzae
198
What pattern of vision loss is described in amaurosis fugax?
Curtain coming down
199
What are the features of life-threatening acute asthma?
SpO2 <92%
PEFR <33% predicted
Silent Chest
Cyanosis
Poor resp effort
Hypotension
Exhaustion
Confusion
200
What are the features of acute severe asthma?
SpO2 <92%
PEFR 33%-50%
Can speak in full sentences
Heart rate >125 (or >140 1-5 y/o)
Resp rate >30 (>40 1-5 y/o)
201
Which medication used in heart failure are shown to reduce mortality?
ACE inhibitors and beta-blockers
202
Which anti-hypertensive is first line in african-carribean patients and patients >55 years old?
CCB - e.g. amlodipine
203
Which anti-hypertensive is first line in non-african-carribean patients and patients <55 years old?
ACEi or ARB
204
In the menopause, a woman >50 years old requires contraception until how many months after their last period?
12 months
205
In the menopause, a woman <50 years old requires contraception until how many months after their last period?
24 months
206
Common causes of drug induced lupus? (2)
Procinamide (anti-arrhythmic)
Hydralazine (vasodilator)
207
Most common cause of primary hyperparathyroidism?
Solitary adenoma (80%)
208
Features of primary hyperparathyroidism?
- Demographic
- Calcium
- Phosphate
- PTH level
- Main symp
Elderly females
Hypercalcaemia
Low phosphate
Polydipsia
Normal or raised PTH
209
Skull x-ray finding in primary hyperparathyroidism?
Pepperpot skull
210
Definitive management of primary hyperparathyroidism?
Total parathyroidectomy
211
Patients who are not suitable for surgical management of primary hyperparathyroidism can be offered which medication?
Cinacalet - calcimimetic
212
Biochemical findings in secondary hyperparathyroidism?
- Calcium, PTH, phosphate and ALP
- Low calcium
- Raised PTH
- Raised phosphate
- Raised ALP
213
Cause of secondary hyperparathyroidism?
Chronic hypocalcaemia e.g. CKD
214
Biochemical findings in tertiary hyperparathyroidism?
- Calcium, PTH, phosphate and ALP
- Raised calcium
- Low phosphate
- Raised PTH ++
- Raised ALP
215
Cause of tertiary hyperparathyroidism?
Occurs following prolonged secondary hyperparathyroidism and get autonomous PTH secretion e.g end stage CKD
216
4 ECG findings in hypokalaemia?
U- waves
Small or absent T-waves
Prolonged PR interval
Long QT
217
MI secondary prevention - key feature (ABCDEF)
A - ACE inhibitor
B - Beta blocker
C - Cholesterol - statin
D - Dual anti-platelet (e.g. aspirin and either prasugrel, ticagrelor, clopidogrel)
E - Exercise (20-30 mins a day)
F - Fucking (resume sex 4 weeks after MI)
218
First line treatment in heart failure?
ACEi + Beta blocker (start one at a time)
219
Second line treatment in heart failure?
Aldosterone antagonist e.g. eplerenone or spironolactone
220
Possible consequence of ACEi and aldosterone antagonist prescribed together?
Hyperkalaemia
221
Features of anterior uveitis?
- Acute onset
- Pain
- Irregular + small pupil
- Intense photophobia
- Red eye
- Hypopyon
222
Management of anterior uveitis?
Urgent referral to opthalmology
Cycloplegics - dilates pupil and relieves the pain (e.g. atropine, cyclopentolate)
Steroid eye drops
223
First line treatments in angina?
Aspirin
Statin
Beta-blocker
Calcium channel blocker
224
If using a calcium channel blocker as monotherapy (without beta blocker) in angina, which type should be used?
Rate limiting CCB e.g. verapamil, diltiazem
225
If using beta blocker AND CCB for angina, which kind of CCB should be used?
Long acting dihydropyridine e.g.nifedipine
226
Patients who require urgent referral for endoscopy with dyspepsia?
- Any patient with dysphagia
- Any patient with an upper abdominal mass
- Patients aged >55 years old + weight loss AND any of:
- Upper abdo pain
- Reflux
- Dyspepsia
227
What are some of the symptoms of a prolactinoma in a man?
- Impotence
- Loss of libido
- Galactorrhoea
228
What are some of the symptoms of a prolactinoma in a woman?
- Amenorrhoea
- Infertility
- Osteoporosis
- Galactorrhoea
229
Management of prolactinoma?
Dopamine agonists e.g. cabergoline, bromocriptine
Inhibits prolactin release
230
Protein level of >30g/L indicates what kind of pleural effusion?
Exudate
231
Protein level of <30g/L indicates what kind of pleural effusion?
Transudate
232
Older male, bone pain, isolated raised ALP and normal calcium indicates what? What is the management?
Paget's disease
- Bisphosphonates
233
Most common cause of death post-MI?
Cardiac arrest secondary to ventricular fibrillation
234
Dose of folic acid in non-high risk women during pregnancy?
400 mcg until 12th week
235
Dose of folic acid in high risk women during pregnancy?
5mg until 12th week
236
First line treatment for trigeminal neuralgia?
Carbamazepine
237
First line treatment for acne
Topical treatment - either retinoids or benzoyl peroxide
238
Second line treatment for acne
Combination topical treatment - Topical antibiotics plus topics retinoid/benzoyl
239
Third line treatment for acne, given examples of agents used
Oral antibiotics - tetracyclines (doxy, lyme, oxytetra) - not suitable in pregnancy
In pregnancy - erythromycin
Prescribe for 3 months
Always continue topical retinoid or benzoyl peroxide to reduce chance of abx resitance
240
Fourth line treatment for acne
Oral retinoids
241
MHA section 2 - purpose and how long valid
Admission for assessment
28 days - can't be renewed
242
MHA section 3 - purpose and how long valid
Admission for treatment
6 months - CAN be renewed
243
Pulmonary function tests:
- Obstructive picture, what will it show?
- FEV1
- FVC
- FEV1/FVC ratio
FEV1 - significantly reduced
FVC - Normal (can be reduced)
FEV1/FVC ratio - reduced
244
Pulmonary function tests:
- Restrictive picture, what will it show?
- FEV1
- FVC
- FEV1/FVC ratio
FEV1 - reduced
FVC - significantly reduced
FEV1/FVC ratio - normal or increased
245
Features of vestibular neuronitis?
- Vertigo
- Horizontal nystagmus
- NO hearing loss or tinnitus
Usual cause: viral infection
246
After starting metformin, which HBA1c would prompt to add in a second agent?
>58 mmol/mol
247
Rinne's:
- Is bone conduction louder or quieter in CONDUCTIVE HEARING LOSS?
LOUDER
248
Rinne's:
- Is bone conduction louder or quieter in SENSORINEURAL HEARING LOSS?
QUIETER
249
Webber's
- When does the sound localise to the affected ear?
CONDUCTIVE
250
Webber's
- When does the sound localise to the contralateral ear?
SENSORINEURAL
251
Anti-dsDNA associated with...
SLE
252
Anti-mitrochindrial associated with..
PBC
253
Anti-smooth muscle associated with
chronic active hepatitis C
and autoimmune hepatitis
254
pANCA associated with
Ulcerative colitis
255
Anti-centromere associated with
CREST/Scleroderma
