MSRA Flashcards
(1144 cards)
1
Q
Criteria for AKI
A
Rise in creatinine of 26µmol/L or more in 48 hours OR
>= 50% rise in creatinine over 7 days OR
Fall in urine output to < 0.5ml/kg/hour for more than 6 hours in adults (8 hours in children) OR
>= 25% fall in eGFR in children / young adults in 7 days.
2
Q
Diabetic drug causing SIADH
A
SU - gliclazide, end in -ide
3
Q
Night blindness, tunnel vision, black pigmentation in peripheral retina
A
Retinitis pigmentosa
4
Q
Most common nephritic syndrome
A
IgA nephropathy - presents following upper respiratory tract infection - treat proteinuria with ACEi
5
Q
Lump in ear canal associated with cold water swimming
A
Osteoma
6
Q
First line neuropathic pain killers
A
Pre-gabalin, amitriptyline, gabapentin, duloxetine
7
Q
Cushings triad
A
Irregular breathing, hypertension, bradycardia
8
Q
Example of dopamine agonist
A
Ropinirole
9
Q
What can help with rigidity, tremors in particularly in drug induced Parkinsonism
A
Procyclidine
10
Q
When to treat campylobacter
A
> 8 stools per day, high fever, lots of blood in stool, last >1w
11
Q
Amiodarone monitoring
A
Liver and thyroid function tests on a 6 monthly basis. Chest x-rays should be performed prior to starting
12
Q
Stemi criteria on ECG
A
M, <45 - > 2.5mm in V2-3
M, >45 - > 2mm in V2-3
W - > 1.5mm V2-3
Elsewhere >1mm
New LBBB
13
Q
What is used to treat bacterial conjunctivitis in pregnant woman
A
Fusidic acid
14
Q
C.diff mx
A
- first-line therapy is oral vancomycin for 10 days
- second-line therapy: oral fidaxomicin
- third-line therapy: oral vancomycin +/- IV metronidazole
- If recurrent episode within 12w - oral fidaxomicin, after 12w oral vancomycin
- Can consider faecal transplant if 2 or more episodes
15
Q
Obstruction of what artery can cause 3rd degree heart block
A
R coronary artery
16
Q
How soon before surgery to stop COCP
A
4w
17
Q
Cause of persistent ST elevation post MI with no chest pain
A
Ventricular aneurysm
18
Q
Post MI - acute heart failure associated with a pan-systolic murmur
A
VSD
19
Q
Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness that turns bloody after several days
A
HUS - most likely triggered by E.coli
Most common cause of acute renal failure in kids
20
Q
Retinal haemorrhages, subdural haematoma and encephalopathy in baby
A
Shaken baby
21
Q
What to do if high risk tetanus exposure and had vaccines >10yr ago or unknown vaccination history
A
Give vaccine + tetanus immunoglobulins
22
Q
M/F ages for precocious puberty
A
F - 8yo
M - 9yo
23
Q
Itching after hot shower
A
Polycythemia vera
24
Q
Cough, haemoptysis many years after TB - air crescent sign on CXR
A
Aspergilloma
25
First line tx for scalp psoriasis
topical potent corticosteroids. If no improvement in 8w try topical vitamin D
26
QTC changes with hypo/ hypercalcaemia
Hypo - Prolonged QTC
Hyper - Short QTC
27
Cluster headache tx
100% O2 and SC triptan, Verapamil used as preventative.
28
Obstetric cholestasis tx
- ursodeoxycholic acid is used for symptomatic relief
- weekly liver function tests
- women are typically induced at 37 weeks
29
What medication causes dupuytrens
Phenytoin
30
Tender, oedematous skin with haemorrhagic blebs and bullae. Crepitus may present on palpation
Gas gangrene - C perfringens
31
How long to wait for LP to detect xanthachromia
12 hours
32
Treatment for SAH vasospasm
Nimodipine
33
Small irregular pupil that do not react to light but accommodate normally
Argyll Robinson pupil
34
Baby with double bubble sign
Duodenal atresia
35
ABPI cutoff for PVD
<0.9
36
What is somatisation disorder
person experiences excessive distress due to a variety of physical symptoms, with no identifiable cause.
37
What does antipsychotic in elderly increase risk of
Stroke
38
What abx increases risk of Achilles tendon rupture/ tendinopathy
Ciprofloxacin/ levofloxacin
39
SSRI of choice in children and adolescents
Fluoxetine
40
Older person, bowing of legs, bone pain, isolated ALP rise
Pagets - bisphosphonate
Osteomalacia has bone pain, fracture, proximal myopathy, low vit D level
41
IM adrenaline dose anaphylaxis
0.5ml 1in1000
42
First line management for immune thrombocytopenia pupura
Oral prednisolone
43
Triad of normal pressure hydrocephalus
Ataxia (wide shuffling gait), memory problems, urinary incontinence
44
What can occur after E coli
HUS
45
What can occur after Campylobacter
Guillain Barre
46
Most common cause of death in those with CKD on dialysis
Ischaemic heart disease
47
What drug reduces the effectiveness of clopidogrel
PPI (omeprazole)
48
Anti Jo/ anti Mi
Polymyositis/ dermatomyositis
49
Anticentromere
limited systemic sclerosis
50
Antihistone
Drug induced SLE
51
Anti-Scl70, anti topoisomerase 1
Diffuse systemic sclerosis
52
Anti ro/ Anti la
Sjogrens
53
Anti Smith/SM, Anti DS DNA
SLE
54
Treatment for headlice
Dimeticone
55
Normal D-dimer level
0.5 or less
56
High fever for 3-4 days followed by rose coloured non itchy macular rash
Roseola infantum - sixth disease
57
What childhood rash can precipitate an aplastic crisis
Slapped cheek - parvovirus
58
Unsteady, <20, East Asian or American Indian
Friedereich's ataxia - autosomal recessive
59
Peak age for kids with bronchiolitis
3-6m
60
What drug can mask warning signs for hypoglycaemia
B-blocker
61
What organism causes epiglottitis, sign on X-ray and management
Haemophilus influenza type B, thumb sign, ceftriaxone, steroids
62
What is dissociative fugue
memory loss and ends up in an unexpected place
63
What must you do for all babies in breech position after 36w
US hip at 6w
64
tietze vs costochondritis
tietze is swelling
65
what is the max permitted dose of lidocaine
3mg/kg or 7mg/kg with ephedrine
66
what is Asherman's syndrome
adhesions within uterus causing amenorrhoea - occurs after dilation and curretage for miscarriage
67
bg of eczema, blistering rash, fever - cause, mx
Eczema herpeticum - admit to hospital, may need IV acyclovir
68
Drugs that increase lithium levels
NSAID, ACEi, Metronidazole, diuretics (Thiazides) - treat with IVI, dialysis
69
Benign fibrous skin lump. small, rubbery, usually solitary- dimple when pinch
Dermatofibroma
70
Raised purple plaques/ papule, HIV
Kaposi Sarcoma
71
HRT contraindications
Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
72
Reed-sternberg cells
Hodgkins lymphoma
73
Alcohol causes LN pain - cause
Hodgkins lymphoma
74
Raised WCC, splenomegaly causing early satiety, abdomen pain - cause?
CML - philadelphia chromosome 9,22
75
confusion, ataxia, nystagmus/ ophthalmoplegia (abducens N palsy)
Wernickes
76
Dementia, ataxia, urinary incontinence
normal pressure hydrocephalus
77
When to do urine antigen tests in pneumonia
If suspect legionella or pneumococcal
78
Headache, diurnal fever 1w after returning from Africa
Malaria
79
Bone/ spine pain, proximal muscle weakness and hypocalcaemia
Osteomalacia
80
what shouldn't be given prior to thiamine replacement
IV glucose
81
Main complication of neonatal jaundice
Kernicterus
82
Breast lump that changes size with periods
Breast cyst
83
Bleeding, mildly prolonged APTT, normal PT - cause and tx
Von willebrands
- tranexamic acid
- desmopressin
- platelet transfusion
84
What organism causes hand foot and mouth
Coxsackie
85
What organism causes chancroid
Haemophilus ducreyi
86
Drugs that worsen glycemic control
Beta blocker, thiazide, furosemide, antipsychotic, steroids
87
infections that cause bloody diarrhoea
salmonella, e.coli, entamoeba, campylobacter, shigella, yersinia enterocolita
88
Diarrhoea, followed by liver failure/ abscess - causative organism
entamoeba histolytica
89
Old, weight loss, fear of eating due to abdominal pain - cause?
Chronic mesenteric ischaemia
90
Raised calcium, low phosphate, normal PTH - cause
Primary hyperparathyroidism - most common cause of hypercalcaemia
91
SE of adenosine
Bronchospasm, flushing, chest pain
92
Amiodarone SE
Pulmonary fibrosis, grey skin discolouration, corneal deposits, altered taste
93
Digoxin SE
dizziness, blurred/yellow vision, arrhythmia, insomnia, gynaecomastia
94
Headache, flu like illness, rising and falling fever following travel - how to confirm?
Malaria - Giemsa thick and thin peripheral blood films
95
flushing, high fever, skin mottling, rash over face, thorax, flexors, abdo pain and hemorrhagic manifestations. Hx of recent travel - cause?
Dengue fever - serology to diagnose
96
What is pellagra, how does it present, what deficiency causes it and what type of tumour is it associated with
Deficiency of niacin (vit D3) causes dermatitis, diarrhoea, dementia. Associated with carcinoid syndrome due to neuroendocrine tumour - most commonly in GI tract
Neuroendocrine tumours can present with flushing, wheeze, diarrhoea
97
Delayed puberty and reduced sense of smell
Kallmans syndrome
98
Formula for plasma osmolarity
2xNa + Glucose + urea
99
Quick forming red lump with keratin, dip in centre
Keratoacanthoma
100
Hepatomegaly, diabetes and tan coloured skin
Haemochromatosis - autosomal recessive - diagnosed with raised transferrin saturation >45%
101
Most common inherited thrombophilia
Factor V leiden
102
Overdose causing Hyperventilation, nausea, confusion, tinitus and mild deafness - what drug and how to treat
Aspirin overdose - urine alkalisation, dialysis
103
Failure to thrive, symmetrical poor weight/ length, umbilical hernia
Congenital hypothyroidism
104
Poor height in child, subcut fat around trunk, immature face - cause?
Growth hormone deficiency
105
Patient on ITU with meningococcal septicaemia - develops adrenal insufficiency - cause?
Waterhouse friderichsen syndrome
106
Patient has hypokalaemic alkalotic hypertension - not on any diuretics - cause?
Conns/ primary aldosteronism
107
Widespread pain on both sides of body, upper and lower for at least 3m, fatigue, multiple localised tender areas (11 of 18) - cause
Fibromyalgia
108
How long after conception does a pregnancy test become positive
9 days
109
Thyroid lump in upper lobe, facial flushing, diarrhoea, raised calcitonin - cause
Medullary thyroid cancer
110
Slow growing painless irregular thyroid lump, LN spread, previous irradiation - cause?
papillary thyroid cancer
111
Most common cause of sterile pyuria
Partially or recently treated UTI - it is presence of leukocytes in urine without demonstrable infection
112
Pinworm infection - presentation and treatment
Itchy anus, worse at night - mebendazole
113
Skin pigmentation, weight loss, hypotension - cause
Addisons
114
Bilateral hydronephrosis with drawing together of ureters in midline - cause
Retroperitoneal fibrosis -
115
How to treat hypercalcaemia
IV NACL, bisphosphonates
116
Common causes of hypocalcaemia
Renal failure, vit d deficiency, acute pancreatitis, tumour lysis, parathyroid gland removal
117
common drugs that cause erectile dysfunction
Beta blocker, thiazides, finasteride, spironolactone, SSRI
118
Mild anaemia, low MCV and normal ferritin - cause
Thalassaemia trait
119
Low renin, hypertension, low potassium - cause
Conns syndrome
120
How to differentiate bowel obstruction from ileus
Obstruction - high pitch tinkling bowel sounds, ileum - absent bowel sounds
121
Pain and swelling in one hand - associated with skin atrophy/ skin colour changes
Reflex sympathetic dystrophy (regional pain syndrome)
122
Cause of bright green on Congo red staining
Amyloidosis - extracellular deposition of abnormal proteins
123
Measles - cause and presentation
paramyxovirus - prodromal conjunctivitis, coryza, cough - then develops rash starting on face - white koplik spots on mucosa
124
How to manage potential scaphoid fracture
Cast anyone with pain in snuffbox - re Xray at 7-10 days
125
Young person with muscle wasting in hands, loss of pain and temperature sensation over arms and trunk in shawl distribution
Syringomyelia- fluid filled cyst in spinal cord
126
Difficulty chewing, swallowing and slurred speech - associated with MS, MND
Pseudobulbar palsy
127
When to not use DOAC
eGFR <15-30
Pregnancy or breast feeding
Hepatic impairment - transaminase >2x ULN or bilirubin >1.5x ULN
Mechanical heart valve
Weight >120kg
128
When to commence metformin and SGLT2
If known CVD or Risk >10%
129
20-30 yo, difficulty whistling and sucking through straw, winging of scapula. Eyes remain open when asleep.
facioscapulahumeral muscular dystrophy
130
Eye deviated upwards, difficulty going downstairs - which cranial nerve
IV - trochlear nerve
131
Headache associated with sexual activity
Coital cephalgia
132
If have asbestosis - what cancer most at risk of?
Lung cancer - not mesothelioma (is a lot more rare)
133
Pizza fundus - flame and blot haemorrhages - patient has HIV - cause
Chorioretinitis - due to CMV retinitis (are other causes)
134
What condition does Keratoconjunctivitis sicca occur in
Sjogrens
135
What genetic condition pre-disposes to COPD in younger individuals
Alpha-1-antitrypsin deficiency
136
Anaemia, bleeding/ bruising and recurrent infections in child - may also be bone pain, splenomegaly
ALL
137
Bilateral progressive symmetrical weakness, increased protein, normal cells in CSF
GBS
138
Recurrent rest infections, diarrhoea, sinusitis - need to warn Dr if have blood transfusion or IVIG
IgA deficiency
139
Dermatitis, recurrent infections of all types (particularly candida, otitis media/ pneumonia and viral infections), chronic diarrhoea, absent or small tonsils/ LN and failure to thrive
SCID - treat with bone marrow transplant
140
What is the cause of hereditary angioedema
low plasma protein c1 inhibitor - allows activation of complement pathway
141
pregnancy - severe abdominal pain, bruising, swelling after coughing
epigastric vessel rupture - rectus muscle haematoma
142
Repetitive, involuntary, purposeless movements
Tardive dyskinesia
143
what test to do for acromegaly
insulin like growth factor 1 levels
144
What blood pressure medication limits statin to 20mg
Amlodipine
145
Serotonin syndrome presentation
Neuromuscular excitation, altered mental status, autonomic effects
146
delusion that are loved by celebrity
De clerambault syndrome
147
Delusion when identifies strangers as close friend or family member
Fregoli syndrome
148
Delusion family member has been replaced by identical stranger
Capgras syndrome
149
Delusion part of body has disappeared
Cotards syndrome
150
Flushing, dizziness, splenomegaly, itching worse after hot shower
Polycythaemia vera - causes thrombosis
151
what electrolyte change does rhabdomyolysis cause
Hyperkalaemia
152
3 most common causes of late onset HAP
Pseudomonas aeruginosa, staph aureus, klebsiella
153
Common causes of early onset HAP (<5d)
Strep pneumoniae, haemophilus
154
When to do urine antigen testing in pneumonia
If legionella or pneumococcal pneumonia suspected
155
What organism that causes CAP is associated with bulls myringitis
Mycoplasma pneumonia
156
Most common cause of SIADH
Idiopathic
157
when to do knee X-ray in trauma
Age > 55
Isolated patella tenderness
Tenderness of fibula head
Inability to flex to 90 degrees
Inability to weight bear
158
Child < 2 presents with failure to pass meconium within 48hrs, longstanding constipation, abdominal distension and vomiting
Hirschprungs disease
159
What pain killer can cause short, self limiting tonic clonic seizures
Tramadol
160
What is prinzmetal syndrome
Cyclical angina at rest due to vasospasm also known as variant angina
161
First line treatment for biliary colic
NSAID e.g. naproxen
162
When is lithium contraindicated
Cardiac disease
Renal failure
Addisons, low sodium
untreated hypothyroidism
1st trimester pregnancy
Breastfeeding
163
X linked condition causing sensorineural deafness at birth, haematuria, eyes abnormalities, pyelonephritis and renal failure
Alport syndrome
164
Foreign travel, abdominal pain, bloating, constipation, fever, rash on abdomen - cause
Salmonella typhi (typhoid) - diagnose with blood culture - treat with ciprofloxacin
165
watery nasal discharge that turns purulent and bloody. Swelling of lymph nodes in neck causing bulls neck. Inflamed pharynx with grey membrane
Diphtheria - treat with antitoxin and IV ben pen for 10-14d
166
Intestinal polyps and pigmented freckles on the lips, face, palms and soles. - cause?
Peutz-jeghers syndrome
167
Aggressive rapidly growing lung cancer associated with paraneoplastic syndromes
Small cell lung cancer - SIADH, ACTH
168
red/purple bumps that become Yellow brown plaque on shin of patient with diabetes - surrounded by telengectasia
Necrobiosis lipoidica - can ulcerate and transform to SCC
169
Small red/ skin colour bumps on wrist, hands, ankles - form rings/ circles
Granuloma annulare is associated with thyroid disease, hyperlipidaemia and diabetes
170
yellow/white papule/pustules with erythematous base on 3d-2w old baby who is otherwise well - cause
erythema toxic neonatorum
171
When Is pericardial friction rub best heard
Left lower sternal boarder, sat up during expiration
172
medical management of ectopic
Methotrexate
173
Termination of pregnancy drugs
Mifepristone and 48hr later misoprostol
Give anti-D if after 10w if rhesus D negative
Multilevel pregnancy test that detects HVG level should be done 2w after
174
lateral epicondylitis - common name
Tennis elbow
175
Diagnosis and treatment of scarlet fever
antistreptolysin antibodies, pen V for 10 days
antistreptolysin also raised in post strep glomerulonephritis
176
Carbamazepine - what need to monitor and why - what drug need to be careful about interaction with
Monitor FBC as can cause aplastic anaemia - careful about interaction with COCP
177
How to treat supra ventricular tachycardia
Vagal manœuvre, if not then adenosine 6mg, 12mg, 18mg - 1to 2 min intervals
178
Condition causing rash and febrile seizures
Roseola infantum
179
Patient with arthritis, diabetes develops lump behind knee after twisting ankle
Bakers cyst
180
Yellow waxy rash on feet of people with reactive arthritis
keratoderma blenorrhagica
181
Pregnancy glucose diagnostic levels - fasting and 2hr, treatme
Fasting 5.6, 2hr 7.8
Fasting > 7 start insulin
Fasting 5.6-7 - 1-2w diet and exercise, if no improvement then commence metformin
182
What drug can cause anal ulceration
Nicorandil
183
Older man with bone pain, isolated raise ALP, bossing of skull and bowing of legs - cause and tx
Pagets, tx = Bisphosphonate
184
Dose of atropine for bradycardia
0.5-1mg IV repeated every 3-5min to max 3mg
185
What organism causes peritonsillar abscess
Strep pyogenes - treat with benpen and metro
186
Antepartum haemorrhage after artificial rupture of membranes - cause
Vasa praevia
187
Which diabetic drug can cause B12 deficiency
Metformin
188
what drug can interact with azathioprine to cause myelosupression?
Ace inhibitor
189
CKD eGFR definition
eGFR < 60 on 2 or more occasions separated by 90 days
190
Child pulling on ears, red swollen bulging tympanic membrane - cause?
Otitis media
191
Most common nephrotic syndrome in adults and kids
Adult: membranous, kids: minimal change disease
192
Most common cause of nephritic syndrome
IgA
193
White lump in external auditory meatus, hearing loss, ear pain, associated with cold swimming
Osteoma
194
when and how to treat campylobacter infection
>8 stools per day, high fever, blood in stool, >7d length - clarithromycin
195
MI ECG definition
2.5mm V2-V3 in men <40, 2mm >40, 1.5mm women
1mm all other leads
New LBBB
196
what diuretics can precipitate gout attack
Thiazide like diuretic, furosemide
197
Treatment for breast candida
Topical miconazole applied to nipple and baby mouth after feeding
198
When to stop COCP prior to surgery
4w
199
When can start COCP post partum
6w
200
Cephalohaematoma vs caput succadeneum
Cephalo - forceps delivery, not present at birth, not cross suture lines
Caput - present at birth, crosses suture lines - associated with prolonged labour
201
Definition of hypertension in pregnancy
After20w: > 140/90
rise >30 systolic or >15 diastolic
202
Contraindications to External cephalic version and when to perform
Perform if breech after 36w
Contraindications:
* where caesarean delivery is required
* antepartum haemorrhage within the last 7 days
* abnormal cardiotocography
* major uterine anomaly
* ruptured membranes
* multiple pregnancy
203
punctate fluoroscein staining of cornea - cause
Dry eye
204
Cervical screening
25-49 every 3 years
50-64 every 5 years
205
Tender oedematous skin, hemorrhagic blebs and bullae, crepitus on palpation - cause
Gas gangrene - Clostridium perfringens
206
what meds contraindicated in HOCM
ACEi, Nitrates, Ionotropes
207
Meds for PVD
Statin and clopidogrel
208
How long after SAH does xanthachromia take to develop. What drug is given in SAH to prevent vasospasm
12 hr, nimodipine
209
Treatment for whooping cough
<6m old - admit
If <21d Clarithromycin - treat family, exclude from school for 48hrs after abx
210
DKA diagnostic criteria and mx, resolution criteria
Glucose >11/ known diabetes, pH <7.3, Ketones >3 or ++ on dipstick, bicarb <15. commence insulin at 0.1 unit/kg/hour. Once blood glucose is < 14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in addition to the 0.9% sodium chloride regime. Replace K+ (>5.5 nil, 3.5-5.5 40mmol/L in each bag, <3.5 - ITU). Fluid: 1,2,2,4,4,6. Resolution when pH >7.3, Ketones <0.6, bicarb >15.
211
Diabetic with shiny, painless areas of yellow/red/brown skin typically on the shin. often associated with surrounding telangiectasia
Necrobiosis lipoidica
212
Causes of postpartum haemorrhage and definition
>500ml blood loss
Uterine atony
Trauma - tear
Tissue - retained placenta
Thrombin - clotting disorder
213
PPH management
Bimanual compression
IV oxytocin
Ergometrine - not give if HTN
IM carboprost - not give if asthma
Rectal misoprostol
Balloon tamponade
214
Common cause of recurrent UTI in children, how to diagnose
Vesicoureteric reflux - micturating cystourethrogram
215
When to give dexamethasone in meningitis?
* frankly purulent CSF
* CSF white blood cell count greater than 1000/microlitre
* raised CSF white blood cell count with protein concentration greater than 1 g/litre
* bacteria on Gram stain
216
Cut off for normal ABPI
<0.9 = PVD
217
Pain when walking, improves when sitting or leaning forward. No pain when walking up hill - cause
Canal stenosis
If similar symptoms but normal straight leg raise = facet joint disease
218
hormone levels in premature ovarian failure - how to test is ovulating
Oestrogen/ progesterone Low
FSH/LH high
Mid luteal progesterone (7d prior to period)
219
white cyst in mouth, mistaken for tooth - name?
Epsteins pearl - spent resolve
220
Fever, LUTS, lower abdominal/ back pain, urethral discharge and pain on ejaculation - cause and tx
Acute prostatitis - Ciprofloxacin 500mg BD for 14d
221
Bleeding, bruising and non blanching petechial rash post viral illness - cause (mainly in kids)
Immune thrombocytopenic purpura
222
Safety net time period for forgetting POP
3 hours unless taking desogestrel which is 12 hours
223
Wide (>120ms) QRS in V1
LBBB
224
Abdominal distension, constipation, fever, pain, rose coloured spots on abdomen - organism
Salmonella typhi
225
Treatment for latent TB
3m of isoniazid and rifampicin or 6m rifampicin
226
Treatment of hypercalcaemia
1st - IV NaCl
2nd - Biphosphonate
If sarcoid - steroid
227
Drugs that cause bulls eye retinopathy
Chloroquine and hydroxychloroquine - can also cause whorl like corneal deposits
228
What does CHADSVAS stand for
Congestive HF 1
Hypertension 1
Age - >75 (2), 65-74 (1)
Diabetes 1
Stroke/ TIA/ VTE (2)
Vascular disease (1)
Sex - female (1)
2 or more anticoag
Male 1 - consider anticoagulant
Female 1 - do not offer
229
What electrolyte can show kidney disease is chronic
Hypocalacaemia - due to reduced active Vit D
230
Graves disease, orange peel skin lesions - name
pretibial myxoedema
231
Physical developmental milestones when to refer
Baby should be able
- to sit at 7-8 months refer if not able at 12m
- to walk at 13-15m, refer if not able at 18m
- Refer if unable to smile at 10w
232
How to treat chlamydia in pregnancy
Azithromycin, erythromycin or amoxicillin
233
What additional drug should those having a MI due to cocaine have - dilated pupils, hypertonia and hyper-reflexia
IV benzo and GTN
Reduces vasospasm which is the cause of MI
234
Bishop score and induction
Bishop <6
- vaginal prostoglandins or oral misoprostol
- mechanical e.g. balloon catheter
Bishop >6
- Amniotomy and IV oxytocin
235
Endometrial cancer RF
nulliparity
early menarche
Late menopause
Unopposed oestrogen
tamoxifen
PCOS
236
Diagnostic values for gestational diabetes - also targets
* fasting glucose is >= 5.6 mmol/L, or
* 2-hour glucose level of >= 7.8 mmol/L
* If fasting >7 go straight onto insulin
Targets
- Fasting 5.3
- 1 hr post meal 7.8
- 2 hr post meal 6.4
237
What antibiotic do you need to stop statin whilst taking
Erythromycin, clarithromycin
238
Centor scoring (out of 4) - when to give abx?
Fever
Tonsilar exudate
Tender lymphadenopathy
Absence of cough
Give abx if >3
239
At what age is intermittent squint normal
<3m
240
What meds can reduce levothyroxine absorption so should be taken 4hr apart
Iron and calcium carbonate
241
Neurosyphilis/ DM, small irregular pupil that accommodates but not react to light
Argyll-robinson pupil
242
neonatal resp distress syndrome - cause, how can be presented, what can be given to wean from ventilator
Lack of surfactant, give steroids to mother, caffeine can help wean from ventilator
243
Overdose, hyperventilations, sweating, tinnitus - cause and tx
Aspirin overdose - urine alkalisation, haemodialysis.
244
Baby 1-2m old presents with episodes where turns blue, tachypnoeic and faint - cause, tx
Tet spell - caused by tetralogy of fallow - treat with beta blocker
245
Child: Pallor, dizziness, frequent infections, bruising, fever, bone pain - cause
Acute lymphoblastic leukaemia - all 3 cell lines involved
- leukopenia
- thombocytopenia
- Anaemia
246
what can be used to ease pain associated with constricted pupil in anterior uveitis
Cyclopentolate
Also treat with steroid drops
247
sharply defined, ragged, painful ulcer on genitals with undermined border and tender LN - cause
Chancroid - Haemophilus ducreyi
248
Common ph/ electrolyte disturbance in cushings syndrome
Hypokalaemic metabolic alkalosis
249
Red eye, gritty foreign body sensation, photophobia, hypopyon - cause and tx
Keratitis (staph or pseudomonas in contact wearer), topical ciprofloxacin, cyclopentolate for pain relief
250
Overgrowth of what bacteria causes BV
Gardnerella vaginalis
251
How to differentiate IgA and post strep glomerulonephritis as causes of nephritic syndrome (haematuria, hypertension, oliguria)
IgA - 1-2d post, strep 1-2w
252
1st line treatment for CML
Imatinib
253
Cutoff for cup disc ratio being abnormal
0.7 (0.4-0.7 normal)
254
Intense itchy, burning blisters/ vesicles on palms - worse in hot sweaty environment
pompholyx eczema - emollient, avoid irritants and potent steroids
255
pustules on palms and feet with thick red scaly skin and hx of psoriasis
palmoplantar pustulosis
256
definition of neutropenic sepsis
Neutrophil <0.5, Temp >38
257
newborn child with dry erythematous rash on scalp with yellow scale
Cradle cal (seborrheic dermatitis) - emollient, reassurance, can consider imidazole cream
258
Second line gout urate lowering therapy
Febuxostat
259
RUQ pain in patient with history of chlamydia/ gonorrhoea
Fitz - Hugh- Curtis syndrome
- scar tissue and peri-hepatic adhesion formation
260
What diabetic med C/I in HF
Pioglitazone
261
Xray findings in child with surfactant deficiency
Ground glass
262
Only drug that prolongs survival in MND
Riluzole
May eventually require BiPAP/ PEG
263
Raised C-peptide - T1 or T2
T2
264
Thiazide like diuretic - electrolyte disturbance
hyponatraemia, hypokalaemia, hypercalcaemia
265
What diabetic drug increases risk of bladder cancer
Pioglitazone
266
what antimalarial can cause anxiety, depression
mefloquine
267
papular lesions on back of hands, hyper pigmented and depressed centrally
Granuloma annulare
268
First line for raynauds
CCB e.g. nifedipine
269
What medication should be stopped when giving iodine containing contrast
Metformin
270
Heliotrope rash and gottrons papule are signs of what
Dermatomyositis
271
How to differentiate neuroleptic malignant syndrome and serotonin syndrome
NMS - muscle rigidity and normal pupils - treat with dantrolene
Serotonin - increased tone and dilated pupils
272
What lung cancers produce SIADH, ACTH, Lambert eaton, PTHrP
Small cell - SIADH, ACTH, Lambert
Squamous PTHrP
273
What to do if DVT US normal but D-dimer raised
Stop Interim anticoagulant and repeat scan in 6-8d
274
Acute dystonia vs akathisia vs tar dive dyskinesia
* acute dystonia - sustained muscle contraction (e.g. torticollis, oculogyric crisis). may be managed with procyclidine
* akathisia (severe restlessness)
* tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
275
Drug/ dose for trigeminal neuralgia
Carbamazepine 100mg BD
276
Pred course in asthma vs COPD
COPD 30mg 7d
Asthma 40-50mg for 5d
277
Best antiemetic for Parkinson's disease
domperidone
278
Hb lower limit normal, very low MCV
Beta thalassaemia trait
279
Dexamethasone dosing croup
0.15 mg/ kilogram.
280
What ligament is injured in a ankle inversion injury?
Talofibular
281
lymes disease management
Doxycycline
282
Raised LFTs and ferritin in patient with diabetes
Haemochromatosis
283
Liver, transaminases in non-alcoholic fatty liver disease and alcoholic disease
ALD AST>ALT
NAFLD ALT>AST
284
Small painless lesion that forms, and heals within few days, swollen LN, adenopathy and proctocolitis
Lymphogranuloma venerum
285
What antibiotic should be avoided when taking methotrexate
Trimethoprim and co-trimoxazole
286
How long after taking methotrexate, should men and women wait to get pregnant
6m
287
1st line mx of dermatomyositis
steroid
288
What drug should be given before for fibrinolysis to prevent clotting
fondaparinux
289
anticoagulant used during PCI
UFH with bailout GPI
290
Chalky white plaque on tympanic membrane
tympanosclerosis = calcification due to repeat/ chronic infections
291
How to convert oral to SC morphine dosing
divide by 2
292
screening tool for postnatal depression
Edinburgh scale
293
Name of bulls eye rash with tic bite
erythema migrans
294
First line treatment for prolactinoma
Dopamine agonist e.g. bromocriptine, capergoline
295
HRT contraindications
Prev breast cancer or oestrogen sensitive cancer
History of VTE
Undiagnosed vaginal bleeding
296
Polygonal rash with white lines on surface
Lichen planus - treat with steroid
Can cause scaring alopecia
297
Fever >5d, red tongue, desquamation, conjunctival injection, lymphadenopathy - cause and treatment, necessary ix
Kawasaki - give aspirin, do echo
298
What abx can cause cholestasis
co-amox
299
Abdo pain, arthritis, haematuria, purpuric rash over buttocks
Henoch-schonlein purpura
300
Treatment of acute angle closure glaucoma - acute and definitive
pilocarpine (constricts pupil), IV acetazolamide (reduces secretions)
Laser peripheral iridotomy
301
Xray findings rheumatoid vs osteo
Rheum
- soft tissue swelling
- junta-articular osteoporosis
- joint space narrowing
- erosions
Osteo
- joint space narrowing
- subchondral cysts
- subchondral sclerosis
- osteophyte
302
eye pain/swelling, proptosis, rock hard eyelids, RAPD - cause and treatment
Orbital compartment syndrome - urgent canthotomy
303
what changes in eGFR/ creatinine are acceptable when commencing ACEi
25% drop in eGFR and 30% rise in creatinine
304
When is FIT testing offered
Every 2 years between 60-74
305
What conditions are associated with ankylosing spondylitis - all the A's
Aortic regurgitation
Apical fibrosis
Ant uveitis
Achilles tendonitis
Amyloidosis
AV node block
CE
306
Management of POAG
360 selective laser trabeculoplasty
Prostoglandin analogue e.g. latanoprost
Beta blocker e.g. timolol
Carbonic anhydrase inhibitor e.g. brinzolamide
Sympathomimetic - brimonidine
307
Knee pain associated with prolonged kneeling
Prepatellar (more upright, housemaids) and infra patellar (more leant forward, clergyman) bursitis
308
Injury from anterior force hitting proximal tibia e.g. dashboard of car
Posterior cruciate ligament
309
At what point in pregnancy should nitrofurantoin be avoided
Near term
310
How long to treat UTI/ asymptomatic UTI in pregnancy
7d
311
<55 or diabetic what BP med
ACEi
312
>55 or black what BP med
CCB
313
Dose of atorvastatin if known CVD
80mg
314
What electrolyte level should be measured following long lie/ rhabdomyolysis and is it high or low
Hypocalcaemia - binds to myoglobin when being excreted
Can also get hyperkalaemia from myocyte breakdown
315
Older female presents with petechia, purpura, epistaxis. FBC shows low platelets - cause and tx
Idiopathic thrombocytopenia purpura - treat with prednisolone, IVIG
316
Teenage girl or older person with arthritis, knee pain walking up and down stairs or getting up from sitting
chondromalacia patellae
317
Sporty teen, pain and swelling on tibial tubercle
Osgood schlatter
318
Knee pain after exercise, locking and intermittent swelling
Osteochondritis dissecans
319
Anterior knee pain worse after running, tender below patella - teenage boy
Patellar tendonitis
320
Small red lump in umbilicus - name and treatment
Umbilical granuloma
- application of salt/ cautery
321
Persistent urachus vs vitello-intestinal duct
urachus - urine from umbilicus
vitello - faeces from umbilicus
322
Most common extra-articular manifestation of IBD
Arthritis
323
How to reduce insulin for surgery
Once daily dose - reduce by 20%
Twice daily long acting - half morning, evening dose as normal
324
Burn - dry, red, painful, blanching - thickness
Superficial, 1st degree
325
Burn - weeping, blistering, painful, blanches with pressure - thickness?
Superficial partial thickness
326
Burn - red, leathery, only painful with pressure, non blanching - thickness?
Deep partial thickness
327
White leathery/ charred burn, painless, stiff - thickness?
Full thickness
328
Pregnant woman exposure to VZV - how to manage - no sx
Check vaccine status/ immunity
If neither of above:
acyclovir day 7-14 post exposure
329
Left homonymous hemianopia - cause
R optic tract lesion
330
L Homonymous quadrantinopia
Upper - R Temporal
Lower - R parietal
331
SCC margins
4mm if <20mm
6mm if >20mm
332
Painful heavy calves, pruritis, ulcers, swelling, varicose veins post DVT - cause and tx
Post thrombotic syndrome causing venous insufficiency
Treat with compression stockings
333
Very painful ulcer on lower leg bg of arthitis/ IBD/ haematological condition
Pyoderma gangrenosum - treat with oral steroids, infliximab, cyclosporin
334
What drugs can be used for cholestatic itch
Rifampicin, cholestyramine, sertraline
335
What antidepressant to give in diabetes/ Parkinson's - why
Mirtazepine - Give as SSRI reduce hypo awareness
336
Patient presents with epistaxis, rectal bleeding and skin/ mucosal telangiectasia. Family member with same - cause
Hereditary hemorrhagic telangiectasia - Autosomal dominant.
337
AV nicking on fundoscopy
Hypertensive retinopathy
338
Treatment of epipidymo-orchitis old vs young
Old - ciprofloxacin or ofloxacin for 14d
Young ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days
339
CAP with erythema multiform and haemolytic anaemia - cause
Mycoplasma pneumonia
340
Autosomal dominant condition causing exertion dyspnoea, angina, syncope. Systolic murmur that quietens on squatting and becomes louder on valsava. Bifid double apex pulse
HOCM
- Most common cause of sudden cardiac death in young people
- Treat with Ca channel blocker, Beta blocker
- Heart transplant
341
How to differentiate radial tunnel syndrome and lateral epicondylitis
Radial tunnel - tenderness distal to epicondyle and pain worse on pronation
Lateral epicondylitis - pain over condyle, worse on supination
342
Drugs causing tinnitus
- Aspirin/ NSAID
- Aminoglycosides e.g. gentamicin
- Loop diuretic
- Quinine
343
What organism causes CAP with flu-like symptoms and a dry cough, relative bradycardia and confusion. Blood tests may show hyponatraemia
Legionella - urine antigen test, treat with clarithromycin
344
Chest pain, SOB, exertional syncope, ejection systolic murmur
Aortic stenosis
345
Apixaban/ rivaroxaban reversal agent
Andexanet alfa
346
Dabigatran reversal agent
Idarucizumab
347
Older patient presents with episodic sweating, palpitations, headache and hypertension - cause
Phaeochromocytoma
348
What electrolyte disturbance typically triggers digoxin toxicity
Hypokalaemia
349
What drugs precipitate digoxin toxicity
amiodarone, thiazide like, quinidine, CCB, spironolactone, furosemide
350
What chromosome is Huntingtons gene on
4
351
Farmer, sewage worker, river fisherman etc with:
- fever
- myalgia
- subconjunctival haemorrhages
Leptospirosis - contact with infected rat urine
Dry cough, headache, aching muscles
Can then develop Weil's disease
- AKI, jaundice
- Hepatitis
- Aseptic meningitis
Treat with benpen or doxy
352
Salmonella/ typhoid abx management
Ciprofloxacin
353
Cellulitis second line abx if pen allergic
Clarithromycin
354
What type of RBC seen on blood film in DIC
Schistocytes
355
Young female with amenorrhoea, stigmata of liver disease and deranged LFT - cause
Autoimmune hepatitis
356
What drugs falsely lower BNP
Acei, aldosterone, beta blocker, diuretic
357
Haemophilia a - what factor deficiency
Factor 8
358
Haemophilia b - what factor deficient
Factor 9
359
Type of pneumonia that causes cavitating upper lobe disease in diabetics and alcoholics
Klebsiella
360
Has only been demonstrated to improve mortality in patients with NYHA class III or IV heart failure who are already taking an ACE inhibitor
Spironolactone
361
What drug is strongly indicated if co-existing HF and AF
Digoxin
362
Peripheral cyanosis in otherwise well baby
acrocyanosis
363
How long to wait between MMR doses
3m
364
Groin pain, limited range of movement in 3rd trimester of pregnancy
Transient idiopathic osteoporosis
365
Groin pain, Femoral nerve stretch test positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee.
Referred lumbar back pain
366
All clotting factors low except factor VIII
Liver failure
367
When and how to treat bradycardia
If shock, MI, HF, syncope
Atropine 500mcg, repeat up to 3mg
Transcutaneous pacing
isoprenaline/ adrenaline infusion
Transvenous pacing
368
Neonate with feeding intolerance, abdominal distension, bloody stool, discoloured abdomen
Necrotising enterocolitis
On XR:
bowel wall oedema
pneumatosis intestinalis (intramural gas)
air both inside and outside of the bowel wall (Rigler sign)
air outlining the falciform ligament (football sign)
369
what helps differentiate episcleritis and scleritis
Scleritis causes pain, episcleritis does not
370
Cushings ulcer
Stomach ulcer after head trauma
371
Curlings ulcer
Stomach ulcer after severe burn
372
Advice for hip replacements to reduce dislocation risk
* avoiding flexing the hip > 90 degrees
* avoid low chairs
* do not cross your legs
* sleep on your back for the first 6 weeks
373
First line for excess sweating
Aluminium chloride
Iontophoresis - electric current
Botulinum injection
374
Young male smoker with cold, poorly perfused finger tips, ulcers - or patient with reynauds develops new ischaemia - cause and findings on angio
Buergers disease - corkscrew collaterals
375
Pain and tenderness over lateral thigh middle aged woman worse when lying on affected side, tender to palpation
Greater trochanteric pain syndrome
376
Burning/ paraesthesia over antero-lateral thigh, nerve affected
Meralgia parasthetica - lat cutaneous nerve of thigh
377
First line treatment of VTE in pregnancy
LMWH
378
Older woman presenting with bruising, epistaxis and petechiae - FBC shows isolated low platelets - cause and tx
ITP, oral prednisolone
379
Malignant otitis externa mx
Ciprofloxacin
380
Breast screening programme
50-70 every 3 years
381
Medical mx of PPH, which drug is contra-indicated in asthma
* IV oxytocin: slow IV injection followed by an IV infusion
* ergometrine slow IV or IM (unless there is a history of hypertension)
* carboprost IM (unless there is a history of asthma)
* misoprostol sublingual
* there is also interest in the role tranexamic acid may play in PPH
382
How to differentiate crohns and UC
UC more bloody diarrhoea, faecal urgency and tenesmus
Crohns more malabsorbtive, whole GI tract sx
383
Pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter. Lesions appear in clusters in areas anywhere on the body (except the palms of the hands and the soles of the feet)
Molluscum contagiosum - pox virus- no active treatment
384
What drug to give in phaeochromocytoma crisis
Phentolamin
385
White tongue, bleed when scraped, changes in taste, cracking at corner of mouth - cause and tx
Candidiasis - nystatin
386
Drugs to reduce alcohol consumption
Acamprosate - reduce cravings
disulfram - severe symptoms when drink
387
Treatment for atypical pneumonia
clarithromycin
388
Persistent ST elevation following MI with no chest pain
Ventricular aneurysm
389
What nerve damaged?
motor: paralysis of knee flexion and all movements below knee
sensory: loss below knee
reflexes: ankle + plantar lost, knee jerk intact
Sciatic
390
most common reason total hip replacements need to be revised
Aseptic loosening
391
Child with asymptomatic flank mass
Wilms tumour
392
When to offer urgent PCI for NSTEMI
GRACE > 3 or unstable
393
Common drugs that precipitate psoriasis
Alcohol, beta blocker, ACEi, NSAID, lithium
394
What level measure to confirm anaphylaxis
Tryptase
395
Sildenafil contraindications
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
Can cause blue discolouration of vision
396
What drug used to open/ close patent ductus arteriosus
Keep open - prostaglandins
Close - indomethacin or ibuprofen
397
Coarse tremor, hyper-reflexia, polyuria, weakness, seizures, diarrhoea, vomiting, abdominal pain, muscle twitches and blurred vision
Lithium toxicity - treat with IVI
398
dry red regions become plaques with adherent scale - can cause scarring and alopecia associated with lupus
discoid lupus
399
Multiple misscarriages, skin rash - cause, APTT level and treatment
Antiphospholipid syndrome
Raised APTT
Low dose aspirin prophylaxis, warfarin after ischaemic event INR 2-3, if recurrent 3-4
400
What is pseudocushings
Symptoms of cushings associated with alcohol consumption that improve on cessation
401
Ptosis and pupil constriction
horners
402
Ptosis and pupil dilation
3rd nerve palsy
403
What to do if young person with hydrocele
2ww referral for testicular cancer
404
Neonate with
- SOB
- Sweating
- Hepatomegaly
HF
405
What to give women if GBS grown in urine during pregnancy
IV benpen during labour
406
When can you insert IUD/ IUS post pregnancy
48hr or 4w
407
Hypopigmented lesions more noticeable following sun tan
pityriasis versicolour - treat with ketoconazole
408
If pneumonia secondary to influenza what abx should be added
Amox + fluclox as caused by staph aureus
409
Tender swelling near edge of external ear canal
furunculosis - infected hair follicle
410
What type of testicular cancer causes raised AFP
teratoma (non-seminonatous testicular cancer)
411
Treatment for organophosphate poisoning
Atropine
412
How to treat breastfed infants who have persisting symptoms of frequent regurgitation associated with marked distress
Alginate therapy (gaviscon)
413
What to do if Sudden onset sensorineural hearing loss
Same day ENT referral
414
Can HIV mothers breast feed
No
415
How to convert from codeine to morphine
Codeine/10 = morphine
416
transfusion threshold for patients with ACS
< 80
417
Metformin contraindications
Recent MI, Sepsis, AKI
dose should be reviewed if the creatinine is > 130 µmol/l (or eGFR < 45 ml/min) and stopped if the creatinine is > 150 µmol/l (or eGFR < 30 ml/min)
Iodine containing contrast
Alcohol abuse
418
How long to exclude from school the following
- scarlet fever
- whooping cough
- measles
- rubella
- mumps
- impetigo
- scarlet - 24hrs post abx
- whooping - 48hrs post abx
- measles - 4d after rash
- Rubella - 5d after rash
- Mumps - 5d after swollen gland
- Impetigo - until crusted and healed or 48hr post abx
419
Mx of Alzheimers
Acetylcholinesterase inhibitor e.g. rivastigmine, donepezil
Memantine if can't tolerate above
420
How to manage rheumatoid flares
oral or IM steroids
421
How to treat genital wart
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
422
How to maintain remission if severe UC flare or >2 in last year
Azathioprine or Mercaptopurine
423
Do newborn inguinal hernias need surgical treatment
Yes
424
Excessive cough and lump in epigastrium
Epigastric hernia
425
A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect
Richter hernia
426
Amenorrhoea at 15, little or no pubic hair, groin swellings - cause
Androgen insensitivity syndrome - treat with counselling, orchidectomy and oestrogen therapy
427
Best antiemetic for Parkinson's
Domperidone
428
What organism commonly causes CAP in cystic fibrosis patients
Pseudomonas aeurginosa
429
How to treat venous ulcer - normal ABPI >9
Compression bandages
430
How to take bisphosphonate
swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking
431
Child with AKI, bloody diarrhoea, abdominal pain, vomiting
HUS
432
Child presenting with petechiae but no fever following recent viral illness
Immune thrombocytopenia
433
Scleritis treatment
Oral NSAID first line, 2nd line steroid
434
Most common cyanotic heart disorder present at birth
Transposition of great vessels
435
Hip pain, stiffness and snapping sensation, previous perthes disease - active young adult
femoral acetabular impingement
436
Vasculitis associated with asthma and raised eosinophilia
Churg strauss
437
Should PPI be given prior to endoscopy in non vatical bleeds
No
438
What drug can cause protein in the urine (nephrotic syndrome) and exacerbation of myasthenia gravis
Penicillamine - have urinalysis 3monthly
439
What are reflexes like in severe pre-eclampsia
Hyper-reflexia, can also have papilloedema, low platelet
440
Army recruit/ runner presents with tender lump on top (dorsum) of foot
March fracture - due to repetitive walking - 2nd MT shaft
441
Badly swollen, deformed knee with bruising following trauma
Tibial plateau fracture
442
Weakness worse in morning that improves with movement, reduced reflexes, autonomic sx (dry mouth, impotence) - bg of lung cancer
Lambert eaton syndrome
- Small cell LC
- Spares resp muscles and face muscles
- steroids, azathioprine
443
Toddler with delayed milestones, calf hypertrophy, proximal hip girdle tenderness, raised CK
DMD - X linked recessive
444
25yo patient presents with long haggard face, bilateral ptosis, cataracts, frontal balding, distal weakness, myotonia, DM, testicular atrophy - cause
Myotonic dystrophy - autosomal dominant
445
Microcytic anaemia with normal ferritin
Beta thalassaemia trait
446
Two causes of pancytopenia
Aplastic anaemia (reduced stem cell production) and Myelodysplastic syndrome (abnormal stem cell production)
MDS commonly caused by chemo/radio and can become AML
447
What bacteria does a splenectomy expose you to
Encapsulated backteria
- Salmonella
- Haemophillus
- Neisseria
- GBS
- Strep pneumonia
- klebsiella
448
Management of intracranial abscess
Craniotomy
IV abx - cef+metro
Dex to reduce pressure
449
L sided neck lump present at birth/ early life - posterior triangle of neck
soft and compressible
typically not painful
no movement on swallowing
transillumination is detected
may interfere with respiration or compromise the airway
Cystic hygroma
450
Oval mobile painless cystic mass that sits between sternocleidomastoid and pharynx. Presents in early adulthood, slowly growing
Branchial cyst
451
When to screen neonatal hips with US
* first-degree family history of hip problems in early life
* breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
* multiple pregnancy
452
When to refer for cerebral palsy during babies development
* Not sitting by 8 months
* Not walking by 18 months
* Early asymmetry of hand function before 1 year
* Persistent toe-walking
453
When is Men B vaccine given
2,4,12m
454
First line for urticaria
Antihistamines
455
How to treat hiccups in palliative care
Chlorpromazine or haloperidol
456
Round red lesion on scalp causing alopecia, becomes pustular and boggy - cause and tx
Tinea capitis - boggy pustular change is called a kerion
Treat with terbinafine, ketoconazole shampoo, oral griseofulvin
457
Erythematous, scaly plaques with an active, advancing, and often pruritic border. The centre of the lesion clears up as expands, resulting in ring-like appearance,
Tinea corporis
- oral terbinafine, clotrimazole
458
Tinea pedis management
Topical terbinafine/ miconazole
459
Othello syndrome
Othello syndrome is the irrational belief that one's partner is having an affair with no objective evidence.
460
Itchy tense blisters without mucosal involvement
Bullous pemphigoid
- steroid
461
Flaccid blisters progressing to erosions affecting mucosal membranes
pemphigus vulgaris
- steroid
462
Systemic sepsis and changing lower lim neurology
Epidural abscess
463
When to refer fibroadenoma for surgery
>3cm
464
Recurrent watery/ sticky eye in neonates
Congenital lacrimal duct obstruction - self resolves by 1yo - reassure, massage lacrimal duct
465
Left subclavian thrill, continuous machinary murmur, large volume bounding pulse with wide pulse pressure
patent ductus arteriosus- give indomethacin or ibuprofen
466
only method of contraception which has a proven link with weight gain
Depo Provera - injectable contraception
467
Management of meningitis across ages
<3m or >50 Cefotaxime and amoxicillin
3m-50 Cefotaxime
IM benpen if meningococcal suspected
IV dexamethasone to reduce neurological sequelae
468
Hairless following stressful period
telogen effluvium
469
trichotillomania
compulsive desire to pull ones hair out
470
How to decide between alpha/beta blocker and spironolactone as antihypertensive
K < 4.5 - spirono
K >4.5 - alpha or beta blocker
471
Decolonisation regime for MSRA
nasal mupirocin and chlorhexidine wash for the skin
472
When to double levonorgestrel dose, how soon after can take hormonal contraception, how affect breast feeding
if BMI >26 or weight > 70kg
Can start immediately
Nil affect
473
When to avoid ellaone and how soon after can start hormonal contraception, how affect breastfeeding
Severe asthma, 5d
Delay breastfeeding for 1w
474
Anti-Hbs after hep B vaccine course
>100 - good response
<10 - poor response, repeat full vaccination series
10-100 - booster
475
What ix for adult with hydrocele
US to exclude testicular cancer
476
Combined pill - increase/ decrease risk of what cancers
Increase breast and cervical
Reduce endometrial and ovarian
477
Hep B antigens - what do they mean
HbsAg - active infection
Anti-Hbc - previous or current infection
Anti-Hbs - marker of immunity (previous vaccine/ infection)
HbeAg - marker of infectivity
478
Flushing, diarrhoea, bronchospasm, hypotension, and weight loss. Cause and investigation?
Carcinoid syndrome
investigation for this is urinary 5-HIAA, as the tumour will secrete serotonin. Treat with octreotide.
Octreotide also used for acromegaly
479
Metabolic ketoacidosis with normal or low glucose
Alcohol
480
Patient presents with confusion, hypothermia, non pitting periorbital and leg oedema, anaemia, reduced resp drive - bg of weight gain - cause and mx
Myxoedema coma
IVI
IV thyroxine
IV steroid
481
Bowed legs in <3yo - normal or abnormal
Normal
482
Main side effect of colchicine
Diarrhoea
483
Downs screening dates
- The combined blood sample can be taken from 10w - 14w + 1d PAPPA-A and BHCG
- US 11w + 2d and 14w + 1d
- The quadruple test 14 + 2 to 20 + 0
- High risk women: offer them diagnostic testing using either NIPT, chorionic villus sampling (if less than 13 weeks of gestation) or amniocentesis (if beyond 15 weeks of gestation).
484
What mutation is associated with prostate cancer in men
BRCA 2
485
Pigmentation of bowel wall - name and cause
Melanosis coli - caused by laxative abuse e.g. Senna
Pigment laden macrophages
486
When does pregnancy count as para/ + for miscarriage
After 24w counts as para irrespective of whether child is born alive
487
When to treat subclinical hypothyroidism
>10
5.5-10 on 2 occasions over 3m, age >65 and symptoms
488
What is Bennett fracture
Fracture of base of thumb into 2 parts
489
What to consider if otitis external not respondant to abx
consider aspergillus/ candida
490
flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs
hepatitis A
491
What drug should be used in caution for patients with sick sinus syndrome
Donepazil
492
Needle stick in someone who not completed hep b vaccinations
accelerated course of the hepatitis B vaccine and administration of hepatitis B immune globulin
493
What is used to calculate GRACE score
age, ECG, troponin, renal function.
494
What phototherapy is first line for psoriasis
narrowband ultraviolet B light
495
Patient presents with ophthalmoplegia followed by areflexia and ataxia. Associated descending weakness - after recent campylobacter
Miller Fisher syndrome
496
When to start statin in T1 DM
older than 40 years, or
have had diabetes for more than 10 years or
have established nephropathy or
have other CVD risk factors
497
When to increase statin dose in CKD
<40% reduction, eGFR >30
498
CURB 65
Confusion
Urea >7
RR > 30
BP < 90/60
Age >65
499
Newborn with SOB, CXR shows hyperinfalated lungs with fluid in horizontal fissure
Transient tachypnoea of newborn
Fluid in lung, more common post C-section
500
Newborn with SOB, CXR shows ground glass
RDS - surfactant deficiency
Pre-term babies
501
Newborn with SOB, CXR shows patchy consolidation
Meconium aspiration
Post term babies
502
Heinz bodies - cause
G6PD deficiency
503
- Bone pain, muscle tenderness, proximal myopathy causing waddling gait.
- Low ca, low phos, raised ALP
- Translucent bands on XR
Osteomalacia
Due to Vit D deficiency
Give calcium and vit d replacement
504
RLQ pain with prodrome of fever, bloody diarrhoea
Campylobacter
505
What drugs cause corneal opacities
Amiodarone, indomethacin
506
What drugs cause retinopathy
chloroquine, quinine
507
What drugs cause optic neuritis
* ethambutol
* amiodarone
* metronidazole
508
First line Abx for COPD non-smokers with recurrent infections
Azithromycin
509
Baby in first 24-48 hours of life presents with abdominal distension and bilious vomiting
Meconium ileus - most common in cystic fibrosis
510
Waxy yellow/brown papule on feet associated with joint pain
Reactive arthritis - keratoderma blenorrhagica
511
When to measure plasma paracetamol level after overdose
4 hours
512
Osler vs Janeway lesions
Osler on finger tips, painful
Janeway on palm, non-painful
513
Most common ovarian cyst
follicular
514
Contraindication to triptan use
CVD
515
Causes of spider navi
Liver disease, COCP, pregnancy
516
When to women need contraception post birth
21 days
517
What type of eye drop causes brown pigmentation of iris and elongation of eyelashes
Latanoprost (prostoglandin)
518
What eye drop should be avoided if taking TCA or MAOi
Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)
519
What is seen on a blood smear in DIC
Schistocytes
520
CCB - what used in angina
Monotherapy - Verapamil or diltiazem
With B-blocker - nifedipine, amlodipine
521
What is puerperal pyrexia, what concerned about and how to treat
Temp > 38 within 14 days post partum
Concernded about endometritits
Treat with IV clindamycin and gentamicin
522
Incarcerated vs strangulated hernia
Incarcerated - irreducible
Strangulated - ischaemia
523
How to treat methanol poisoning
* fomepizole or ethanol
* haemodialysis
524
Abrupt onset of haemoptysis, cough, shortness of breath, peripheral oedema, dark urine and oliguria.
Goodpastures
525
Painless, monocular loss of vision in Marfan's syndrome
Lens dislocation
526
How to confirm h pylori eradication
Urea breath test
527
Cause of hand foot and mouth disease
Coxsackie A19
528
Electrolyte changes in rhabdomyolysis
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
Hyponatraemia
Raised CK > 5x ULN
Myoglobinuria
Acidosis
529
Treatment for Toxic epidermal necrolysis
IVIG
530
Painless vision loss - starting peripherally and moving centrally
retinal detachment
531
Schirmers test
Used to test for sjogrens
532
Epididymo-orchitis - unknown cause
IM cef 500mg IM single dose, doxy 100mg BD for 10-14d
533
Patient presents with :
Ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's
contralateral: limb sensory loss
Lateral medullary syndrome (posterior inferior cerebellar artery)
534
Patient presents with
* ipsilateral III palsy
* contralateral weakness
Weber's syndrome
Midbrain stroke
535
Most common cause or erysipelas
Strep pyogenes
- has sharp boarders
536
Patient with bleeding/ bruising has large platelets, low platelet count and prolonged bleeding time
Bernard soulier syndrome
537
amenorrhea, short stature and webbed neck - condition, heart defect, chromosomal cause
Turners, Single X, associated with bifid aortic valve causing systolic murmur
538
Pink, irregularly shaped mark on back of babys neck
Stalks kiss - telengectatic naevus
539
IIH management
Carbonic anhydrase inhibitor - acetazolamide, topiramate, repeat LP, shunt
540
Boggy enlarged tender uterus - US shows ectopic endometrial tissue in myometrium - what condition
Adenomyosis
541
What vitamin deficiency causes angular cheilitis, mouth ulcers, inflammation of oral mucosa, red sensitive eyes
Riboflavin - Vit B2
542
Molluscum contagiosa cause
Pox virus
543
Sever acne with burrowing and interconnected abscesses and irregular scars
Acne conglobata
544
At what age should all children with suspected UTI be urgently admitted/ referred
<3m
545
How to treat upper UTI in child
Cefalexin or co-amox
546
How long after last drink does alcohol withdrawal occur
10-72hrs
- tachycardia, HTN
- tremor
- confusion
- seizure
547
Conjunctivitis within first 4w of life
Think about chalmydia/ gonorrhoea
548
Superior vs inferior Quadrantanopia - cause
Superior - temporal
Inferior - parietal
549
Hypertension stages
Stage 1
- 140/90 - 159/99
- Home BP 135/85-149/94
Stage 2
- 160/100 - <180/120
- >150/95
Stage 3
- > 180/120
Malignant hypertension
- >180/120
- Signs of retinal haemorrhage or papilloedema
550
Colorectal screening
FIT from 60-74 - every 2yr
551
Patient with symptoms of COPD but no smoking history, raised LFT on bloods
Alpha 1 anti-trypsin deficiency
552
Iron studies in patient with haemochromatosis
* transferrin saturation > 55% in men or > 50% in women
* raised ferritin (e.g. > 500 ug/l) and iron
* low TIBC
553
Treatment for haemochromatosis
phlebotomy or Deferoxamine
554
Travel history, recurrent UTI not improving with abx, sterile pyuria, fever
Genitourinary TB
555
First line tx for impetigo
Hydrogen peroxide 1%, second line fuscidic acid - if systemically unwell flucloxacillin
556
557
How is HOCM inherited
Autosomal dominant
558
Upper and lower resp tract symptoms and glomerulonephritis
Granulomatosis with polyangiitis
559
What vitamin deficiency causes bleeding of the gums
Vitamin C Ascorbic acid
560
What vitamin deficiency causes Dermatitis, seborrhoea
Vit B7 Biotin
561
What vitamin deficiency causes mild haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
Vit E
562
What vitamin deficiency causes anaemia, irritability, seizures
Vit B6 Pyridoxine
563
What is used to treat conjunctivitis in pregnancy
Fuscidic acid
564
Papular rash with scales after tonsillitis/ strep infection
Guttate psoriasis
565
Woman presenting with amenorrhoea, loss of libido, milky discharge from breast - endocrine problem and drug that causes
Raised prolactin - metopclopramide, prochlorperazine, domperidone
566
Patient with AF and acute stroke - when to start anticoagulant
After 2w
567
How to treat pain in corneal ulcer
Oral analgesics - don't give topical as can cause further injury
568
What investigation must be done prior to starting biologics for rheumatoid or other
CXR for TB
569
2 level wells cutoff for US - time period to get done
Greater or equal to 2 - do within 4hrs
570
Unpredictable, irregular bleeding that can range from spotting to larger volume bleeding - ix show no identifiable cause - diagnosis and mx
Dysfunctional uterine bleeding
1 - mirena coil
2 - tranexamid acid, NSAID, COCP
3 - Norethisterone
4 - <10w size ablation, >10w size uterine artery embolization or myomectomy
5. Hysterectomy
571
Blood vessels on iris - cause and mx
rubeosis iridis - caused by retinopathy/ retinal ischaemia - treat with pan retinal photocoag, anti-VEGF - can cause angle closure glaucom
572
Lump over Childs lateral eyebrow, contains mixture of tissues including fat, bone, nails, teeth
dermoid cyst - cystic teratoma
If in midline consider MRI for intracranial extension
573
Young East Asian <20 presents with ataxia, kyphoscoliosis, clumsiness and deterioration in athletic performance
Friedreichs ataxia - autosomal recessive
574
Young child 1-5yo presents with ataxia, recurrent infections and telengectasia
Ataxic telengectasia
575
Primary vs secondary vs tertiary hyperparathyroidism
Primary - raised PTH due to pituitary adenoma
Secondary - raised PTH due to condition causing hypocalcaemia
Tertiary - raised PTH due to longstanding secondary - due to autonomous secretion following long period of hypocalcaemia - can cause hypercalcaemia
576
Primary vs secondary vs pseudohypoparathyroidism
Primary - reduced production due to post excision, di George, pernicious anaemia, vitiligo
Secondary - due to hypercalcaemia
Pseudo - Due to failure of target cells to respond to PTH
577
Bruising, epistaxis, purpura following infection/ immunisation in child
ITP - often not need tx, repeat FBC in 10d
578
Lymphadenopathy, night sweats, splenomegaly, weight loss, fatigue
Non Hodgkins lymphoma
579
Hodgkins vs non-hodgkins differences
Hodgkins - less common, upper body lymphadenopathy, spreads from one group of LN to another
Non Hodgkins - more common, affects LN all over body, spreads discontinuously, may be rash or CNS involvement
580
Diagnostic level FENO
>35 in kids
>40 in adults
581
Cushings disease vs syndrome
Disease = due to pituitary secreting ACTH
Syndrome = any cause
582
Conns vs Addisons electrolytes
Conns - hypokalaemia, hypernatraemia
Addisons - Hyperkalaemia, hyponatraemia
583
Characteristics of innocent murmur
Soft, continuous or during systole, change with position, otherwise healthy, no thrill
Diastolic murmur always pathologic
584
Graves treatment during pregnancy
- Propylthiouracil in 1st trimester
- Switch to carbimazole in 2nd trimester for rest of pregnancy (PTU has small risk of hepatotoxicity)
585
UTI - nitrites +ve vs -ve
+ve in E coli, gram negatice
-ve in staph, gram positive
586
What investigations to do for older person with persistent back/bone pain, renal damage, raised calcium or unexplained fracture
Myeloma screen - M protein (serum free light chains), ESR/CRP, FBC (low cell counts due to bone marrow infiltration - anaemia, bleeding ), Calcium, hence jones, U&E, blood film showes rouleaux formation
587
Blood film finding in myeloma
rouleaux formation
588
Rain drop vs pepper pot skull
Rain drop = myeloma
Pepperpot = primary hyperparathyroidism
589
Asymmetrical loss of motor/ sensory function of individual nerves, associated deep aching pain worse at night
Mononeuritis multiplex- associated with diabetes
590
Recent tonsillitis, presents with lymphocytosis and neutropenia
EBV - glandular fever
591
Steroid responsive features for COPD management
Prev diagnosis of asthma or atopy
>20% diurnal variation
Raised eosinophils
Substantial variation in FEV1 (400ml)
592
What is Evans syndrome
ITP with autoimmune haemolytic anaemia
593
Swelling over the posterior aspect of the elbow. There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.
Olecranon bursitis
594
When to consider Familial hypercholesterolaemia
in adults total cholesterol (TC) > 7.5 mmol/l and LDL-C > 4.9 mmol/l or children TC > 6.7 mmol/l and LDL-C > 4.0 mmol/l, plus:
for definite FH: tendon xanthoma in patients or 1st or 2nd degree relatives or DNA-based evidence of FH
for possible FH: family history of myocardial infarction below age 50 years in 2nd degree relative, below age 60 in 1st degree relative, or a family history of raised cholesterol levels
Often treat with high dose statin - autosomal dominant
595
Dextrocardia and bronchiectasis
Kartagners syndrome - primary ciliary dyskinesia
596
Asthma, vasculitis, sinusitis, mononeuritis multiplex
Churg straus - Eosinophilic granulomatosis with polyangiitis
597
vasculitis - pANCA vs cANCA
pANCA - churg straus (Eosinophilic granulomatosis with polyangiitis)
cANCA - Wegeners (granulomatosis with polyangitis)
also differ as churg has raised eosinophils
598
How many antenatal visits in first and second pregnancy if uncomplicated
1st - 10
2nd - 7
599
When to give first and second dose of rhesus D
28,34 weeks
600
When is booking visit in pregnancy
8-12w
601
When is dating scan pregnancy
10-13+6w
602
When is anomaly scan
18-20+6 week
603
When to check baby presentation and consider ECV
36w
604
When to consider iron in pregnancy
Hb <110 at 16w
Hb <105 at 28w
605
What anti diabetic drug can cause cholestasis
Sulphonylurea
606
What BP is an absolute contraindication for thrombolysis and how to manage
>200/120
Give Labetalol
607
Triad of longstanding CO2 retention on ABG
pH normal
CO2 high
HCO3 high
608
Oral lichen planus mx
Benzydamine spray
609
Flu like symptoms proceed a dry cough with cold AI haemolytic anaemia, vesicles on ear drum - Cause + treatment
Mycoplasma pneumonia - doxycycline
610
BG of HIV, few chest signs, exertion dyspnoea
Pneumocystic jirovecci
611
Treatment/ Ix for Giardia
Metronidazole
Stool microscopy for ovum and parasites, stool antigen tests
612
Medial knee pain and increased movement of patella
Patella subluxation
613
Heart defects in TOF
Overriding aorta
Pulmonary stenosis
VSD
RV hypertrophy
614
What murmur is seen in turners syndrome
Ejection systolic due to bicuspid aortic valve
615
High yield features of MND
Eyes spared
Fasciculations
No sensory involvement
Often get wasting of the small muscles of hand
616
Palpable enlarged gallbladder in presence of painless jaundice - cause
Pancreatic cancer
617
Cancer site and type of bowel resection
Anal verge - abdomino-perineal resection
Lower rectum - anterior resection (low TME)
Upper rectum - anterior resection (TME)
Sigmoid - High anteior resection
Distal transverse descending - left hemi
Caecal, ascending or proxcimal transverse - right hemi
618
Overdose - lacrimation, salivation, urination, diarrhoea, hypotension, bradycardia, small pupils , muscle fasciculation - cause and tx
Organophosphide poisoning - treat with atropine
619
What ix should be done to screen for cause of discitis
Echo for endocarditis
620
Early vs late pericarditis post MI
Early - fibrous pericarditis (1-3d)
Late - dressler (w to month)
621
What drug is used to prevent RSV infection in children at high risk
Palivizumab
622
painful nodule on ear
chondrodermatitis nodularis helicis
623
When to refer sore throat under 2ww
If last >4w
624
Hashimoto vs subacute thyroiditis
Hashimoto non tender thyroid
Subacute - tender thyroid
625
What drug sensitivity is associated with asthma and nasal polyps
Aspirin
626
Proteinuria cutoff for pre-eclampsia
> 0.3g/24hrs
627
Indication for 5mg folic acid replacement in pregnancy
Obesity with BMI >30
Previous NTD child in either parent
Family history
Anti-epileptics
Coeliac
Diabetes
Thalassaemia trait
628
Vision changes including flashers and floaters - cause
Vitreous/ retinal detachment
With retinal detachment get associated dense shadow across vision
629
Target like lesions initially on back of hands, feet, spreads to mucosa - can involve mucous membranes - can occur post strep/ mycoplasma infection, herpes/ viral infection or due to drugs e.g. COCP
Erythema multiform
630
What type of drug is bumetanide
Loop diuretic
631
Cause of cold sores
HSV 1
632
How to treat TCA overdose
IV bicarb
633
Ethylene glycol antidote
Fomepizone
634
cyanide antidote
Hydroxycobalamin
635
most common primary malignant bone tumour - sun burst appearance, conman triangle on XR, pRB gene
Osteosarcoma
636
Benign overgrowth of bone, mainly on skull associated with gardners syndrome, FAP
Osteoma
637
Most common benign bone tumour - cartilage cap on XR
Osteochondroma
638
Child with severe pain in long bone, blue cells, XR shows onion skin appearance
Ewings sarcoma
639
Becks triad Cardiac tamponade
Muffled heart sounds
Hypotension
Raised JVP
640
Baby born with patent ductus arteriorsus, congenital cataract, sensorineural deafness - what infection
Rubella
641
Polycythema vera mutation and tx
Jak2
Aspirin, venesection
Higher risk get hydroxycarbamide and interferon Alfa or jak2 inhibitors
642
puristic rash that appears in last trimester of pregnancy - may start in abdominal striae
Polymorphic eruption of pregnancy
643
Excruciating pain, absent reflexes on bg of poorly controlled diabetes
Diabetic amyotrophy
644
influenza after contact with dead/unwell bird
Chlamydophilia psittaci
645
Examination findings in cerebellar disease
Dysdidokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
646
st line for excess sweating
topical aluminium chloride - other options include botulinum, CCB, anticholinergics
647
Hb and platelet threshold in pregnancy
Hb <110
Platelet <100
648
well circumscribed round patches of hairless
Alopecia acreta
- watchful wait
- Topical steroids or steroid injections
- minoxidil
649
Young person with Weight loss, diarrhoea, RLQ pain
Crohns
650
Recent infection, fever, painful thyroid and hyperthyroidism followed by hypothyroid
De quervains thyroiditis
651
652
Congenital disorder with high forehead, large testicles, large low set ears, long thin face, hypotonia, mitral valve prolapse
fragile X syndrome - tri-nucleotide repeat
653
Elf like facial appearance, cardiac defects
Williams syndrome - chromosome 7
654
Psudopolys on colonoscopy/ barium enema - cause
UC
655
Cutoff in temperature rise to warrant stopping transfusion
>1 degrees
656
What blood test should be done in all women with hyperemesis
TSH - BHCG can act to increase T3/T4 in same way to TSH
657
Presenting symptoms of compartment syndrome
Increasing pain despite resting
Sensory defecit
Swelling and tenderness
Pain on passive stretch of muscles
658
Grey-white line around corneal margin - name and cause
Arcus senilis - hypercholesterolaemia
659
Type of breathing seen in metabolic acidosis
Kussmauls - at first rapid and shallow, then becomes deep and slow, laboured and gasping
660
What is a sign of septic arthritis rather than transient synovitis
Pain on passive movement, joint held in position that maximises joint space (flexion, abduction and external rotation for the hip)
661
Forefoot pain, most commonly in the third inter-metatarsophalangeal space. Feels as though has pebble in shoe
Mortons neuroma - nerve compression between metatarsal heads
Click noise on metatarsal squeeze
- metatarsal pad, referral if still ongoing pain at 3m
662
What marker to use to assess for repeat MI
CK-MB
663
Recreational drug causing dilated pupils, sweating, fits, tachycardia, nausea, nose bleed
Amphetamines
664
Options for fungal nail treatment
Topical nail liquor
Oral terbinafine - 6w-3m for finger, 3-6m for toe
Oral itraconazole - 1w on 3w off
665
Anion gap calculation
Na - Cl+HCO3
666
Behaviour changes, headache, urinary incontinence in DKA - what has happened
Cerebral oedema
667
First line abx for bronchitis
Doxycycline
668
Impulsivity, emotional instability, intense and unstable relationships, suicidal thoughts, pseudohallucinations - type of personality disorder
Borderline
Pseudohallucination = hallucinations that individual recognises aren't real
669
Change to TB abx if TB meningitis
Use streptomycin instead of ethambutol
670
Painful cutaneous nodules with gelatinous consistency - red/brown apple jelly appearance - bg of TB
Lupus vulgaris
671
Painless skin nodules, abscesses overlying LN in patient with TB
Scrofuloderma
672
Young female with chronic pelvic pain develops sudden onset pain following fall, trauma, sexual intercourse - tenderness and guarding on exam
Ruptured ovarian cyst
673
Intermittent episodic severe retrosternal pain associated with dysphagia and feeling of food stuck in throat - corkscrew appearance on barium swallow
Oesophageal spasm
674
Haemophilia a/b inheritance pattern
X linked
675
Child with rose pink rash or trunk, back and buttocks, each macule surrounded by halo, fever, mild pharyngitis - cause
Roseola infant - human herpes virus 6
676
Drug that commonly increases and reduces sulphonyl urea function
Rifampicin reduce
Fluconazole increase
677
Definition of simple febrile seizure
Generalised tonic clonic
Last <15mins
Not recur within 24hr
Back to normal within 1h
678
Name for most common damage to kidney in AKI
Acute tubular necrosis lido
679
Horners syndrome, unilateral arm oedema, facial engorgement, hoarse voice - cause
Pancoast tumour
680
Antidepressant of choice post MI
Sertraline
681
Length of phenoxymethylpenicillin course for tonsillitis
7-10d
682
1st and second line gestational HTN mx
1st labetalol
2nd nifedipine or hydralazine
683
XR of child shows double bubble/ soap bubble sign in long bone
Giant cell tumour
684
Valproate monitoring
LFT
685
Pioglitazone monitoring
LFT
686
Lithium monitoring
TFT, U&E, lithium level
687
Methotrexate monitoring
FBC, LFT, U&E
688
Azathiprine monitoring
FBC, LFT
689
How long does ear drum take to heal, when to refer
At 6-8w
690
FEV1 reduced, FEV/FVC >0.7
restrictive
691
FEV1 reduced, FEV/FVC <0.7
Obstructive
692
most common SE of varenicicline
Nausea
693
Ipsilateral loss of motor and proprioception, contralateral loss of pain and temperature
Brown sequard syndrome
694
Upper/lower resp tract (ulcers, sinusitis, pulmonary nodules/ ILD), pulmonary haemorrhage, saddle shaped nose and glomerulonephritis
Wegeners (Granulomatosis with Polyangiitis)
695
White/yellow nodule on nasal side of cornea - name and what is it called if it grows over the edge of the cornea
pinguecula - if over cornea = pterygium
696
White inflammatory patches on genitalia causing constriction/ phimosis
lichen sclerosis (aka Balanitis xerotica obliterans)
697
What is used to stage Hodgkins/ NH lymphoma
Ann arbor staging
698
FBC findings in myeloma
Anaemia, thrombocytopenia and neutropenia
699
What vitamin is deficient in wernickes
Vitamin B1
700
Asymmetrical tremor, rings in eyes, severe depression
Wilsons disease
701
How to differentiate caput medusae from portal hypertension vs IVC obstruction
Blood flows towards umbilicus in IVC
Away from umbilicus in portal HTN
702
Flasher, floated, reduced visual field and acuity
Retinal detachement
703
Bartonella henselae - what is it
Catch scratch disease - fever, constitutional sx and lymphadenopathy
704
What types of jaundice is always pathalogical in newborns
Conjugated billirubinaemia is always pathological, rule out obstruction - duodenal atresia
Within first 24hrs always pathalogical
- Haemolysis
- infection
- abo compatability
- Maternal SLE
705
When can measure transcutaneous vs serum bilirubin level in newborn
Transcutaneous - >35w, >24hrs old, level <250
Serum - <35w or <24hrs old or level >250
Stop phototherapy once >50 below line
706
What allergy is associated with penicillins
Cephalosporins e.g. ceftriaxone
707
Small for gestational age cutoff
<10th centile
707
Oligoclonal bands in CSF - diagnosis
MS
708
Breast lump that changes size with period
Breast cyst
709
Patient presents with amino acid, glucose, phosphate in urine and signs of rickets/ osteomalacia
Fanconi syndrome
710
What do red cells look like on blood film in hereditary spherocytosis
small, round, hyper chromatic RBC without a central area of pallor
711
Episodes of haemolysis and anaemia following infections - pallor, jaundice, abdo pain, splenomegaly
G6PD deficiency - X linked
712
MS: Uhtoffs vs Lhermitte
- Uhtoffs - worsening symptoms with increase in temperature
- Lhermittes - electric shock sensation down spine when flex neck
713
neurogenic vs nephrogenic Diabetes inspidus
Neurogenic = absence of ADH - low urine osmolality on water deprivation test that improves with ADH
Cranial = insensitivity to ADH - low osmolality on water deprivation with no improvement when given ADH
714
Bloody diarrhoea, abdo cramps, fever and hepatomegaly -cause
entamoeba histolytica
715
What can give to women with anti phospholipid syndrome if 3 or more pregnancies lost
LMWH and low dose aspirin
716
Abdo pain out of proportion with clinical findings
Mesenteric ischaemia
717
Focal liver lesion >2cm and raised AFP in patient with cirrhosis
HCC
718
SOB, chest pain, tachypnoea after trauma but no acute signs on XR - cause
Pulmonary contusion
719
Coin shaped lesions - begin as itchy/ vesicular/ papular - ooze and crust over - recur at same site
Discoid eczema
720
What supplement for breastfeeding women
Vitamin D 10mcg daily
721
What contraceptive should be stopped if older than 50
Injectable e.g. depro provera
722
What antiepileptic can cause weight gain
Sodium valproate
723
Newborn with blue/ purple marks all over body - cause
TORCH infections
724
Toxoplasmosis mx
Pyrimethamine, sulfadiazine
725
most common cause of otitis external
pseudomonas
726
Short stature, short neck, shortened 4th metacarpals, obesity, dental hypoplasia
pseudohypoparathyroidism
Ca low
PTH and phos high
727
- Suprasternal continuous murmur
- Different BP on R/L
- Radial radial delay
- Hypertension
Coarctation of aorta
= narrowing of a section of the aorta
728
Gravida, Para X+Y - define
Gravida = number of pregnancies
Para:
X = number of pregnancies after 24w - twins count as 1
Y = number of pregnancies lasting <24w
729
'good baby' poor feeding, poor weight gain, constipation, coarse facial features, macroglossia, large fontanelle, umbilical hernia may be present
Hypothyroidism - levothyroxine
730
Short child achondroplasia vs GH deficiency
Achondroplasia - asymmetrical
GH deficiency - symmetrical - immature face, prominent forehead, puberty delayed
731
Treatment for stable VT
amiodarone 300mg IV over 10-60mins
732
What to consider if not on diuretics and presents with hypokalaemia metabolic alkalosis and hypertension
Conns
733
Causes of nephrogenic diabetes insipidus and treatment
Lithium
Hypokalaemia
Hypercalcaemia
CKD
Demeclocycline
Desmopressin, Thiazides, NSAID, Sodium restriction
734
Size cutoff for toxic megacolon
>6cm dilation on AXR
735
Rapidly growing thyroid lump commonly associated with hoarseness and dyspnoea
Anaplastic thyroid cancer
736
Testicular microlithiasis
Small intratesticular calcifications, asymptomatic and seen incidentally on US
737
Thickened, intensely itchy plaque forms from long term itching in patient with eczema
Lichen simplex
738
A HIV test at what time rules out HIV
3m
739
First line treatment of allergic rhinitis in pregnant women
Topical intranasal steroid
740
Abnormal PSA levels
50-59 - >3
60-69 - >4
>70 - >5
741
Cause of :
- Dull flank pain
- Hypertension due to obstruction of ureters
- Renal insufficiency
- Bilateral hydronephrosis with drawing together of ureters in midline
- Peri-aortic mass on CT/MRI
Retroperitoneal fibrosis
742
Elderly person, not opened bowels, gradual abdominal distension , XR shows dilated bowel loops with gas in rectum
Pseudo-obstruction
743
Patient presents with fever, cough, purulent sputum, weight loss - has been to GP and had multiple courses of abx with no improvement
Lung abscess - treat with clindamycin for 4-6w
744
What kidney condition can cause berry aneurysms
PKD
745
First line for absence seizure
Ethosuximide
746
First line for myoclonic seizure M/F
M - valproate
F - Levetiracetam
747
First line for tonic/ atonic seizure M/F
M - vlaproate
F - lamotrigine
748
First line for Tonic/clonic seizure M/F
M - valproate
F - levetiracetam/ lamotrigine
749
First line for Focal seizures
Levetiracetam/ lamotrigine
750
What drug may exacerbate absence seizures
Carbamazepine
751
Cutoff for giving anti D in spont misscarriage
12 w
- need to give in any medical/ surgical TOP or treatment of miscarriage
- Need to give in amniocentesis, CVS, ECV and ectopic
- threatened miscarriage > 12w
752
Most commonly affected valve in IVDU with endocarditis
Tricuspid - otherwise is mitral
753
Most common non STI causes for epididymis-orchitis
Ecoli, pseudomonas
754
Best investigation to exclude Crohn's flare
Faecal calprotectin
755
Best antiemetic for metabolic causes of nausea
Haloperidol
756
what type of drug is first line for BPH
Alpha blocker
757
Patient presents with diabetes, diarrhoea, DVT, depression and widespread rash
Gluconoma
758
What organism from undercooked poultry can cause diarrhoea and reactive arthritis
Campylobacter
759
No urine output following urology surgery
Clot retention
760
Treatment of anal fissure
Topical GTN/ diltiazem
761
Most common epilepsy syndrome in children
Benign Rolandic epilepsy - seizures occur at night
762
First line for shoulder dystocia
McRoberts manoeuvre (hyperflexion of the maternal legs) is the first management approach
763
Auer rods on blood film
acute myeloid leukaemia
764
What can long term overdose of vitamin B6 cause?
Peripheral neuropathy
765
when to consider pneumonia in patients with bronchiolitis
Fever over 39° or persistent focal crackles
766
What drug causes Heinz body anaemia?
Sulfasalazine
767
What rheumatoid drug can cause demyelination
Etanercept
768
What cytotoxic, drug causes peripheral neuropathy?
Vincristine
769
How many hours after paracetamol ingestion to measure level
4- should give NAC by 8hrs
770
Most common presenting symptom of posterior circulation stroke
Dizziness
771
What eye drops should be avoided if taking a MAOBi
Brimonidine
772
What diabetic drug can cause pancreatitis
Gliptin
773
Pioglitazone side effects
Weight gain, fluid retention, liver dysfunction and fractures
774
Skin rash seen in rheumatic fever
Erythema marginatum
775
What is erythema ab igne associated with
Exposure to infrared
776
First investigation to identify if ischaemic or non-ischaemic priapism
Cavernosal blood gas
777
What vessels are affected in posterior circulation stroke
Vertebrobasilar arteries
778
How long should wait for d-dimer before starting doac
4 hours
779
What to do if scan is negative but d-finer positive
Stop anticoagulant and repeat scan in 1w
780
What rheumatoid drug can cause demyelination
Etanercept
781
Lumpy breast with pain worse around period
Fibroadenosis
782
How to treat severe otitis external
Flucloxacillin
783
Definition of premature ovarian failure
Menopausal symptoms and raised FSH/LH before 40
784
When is bow legs normal
<3 years old
785
Are out toeing and knock knees normal
Yes - out toeing resolves by 2years, knock knees resolves spontaneously
786
When to treat stage 1 hypertension
If age <80 and any of:
Target organ damage
Diabetes
Renal disease
Cardiovascular disease
Qrisk >10%
787
Most common ocular manifestation of rheumatoid arthritis
keratoconjunctivitis sicca - dry gritty eyes
788
Definition and causes of oligohydramnios
<500mls at 32-36w
- PROM
- potters: renal agenesis and pulmonary hypoplasia
- IUGR
- Post Term Gestation
-Pre eclampsia
789
Cause of poly-hydramnios
Tracheo-oesophageal fistula
Diabetes
Multiplepregnancy
Duodenal atresia
790
Salmonella presentation
Severe vomiting and high fever, can cause bloody diarrhoea, 12-48 hour incubation period
791
Dry cough and bilateral painless parotid swelling
Sarcoidosis
792
Causes of unilateral parotid swelling
Tumour (pleomorphic adenoma), stone, infection
793
How to adjust once daily insulin for surgery
Reduce by 20% on day of and day prior to surgery
794
How to adjust twice daily insulin for surgery
Reduce morning by 50%, keep evening as normal
795
How does IUS prevent pregnancy
Prevents endometrial proliferation
796
What to do if child with squint in GP
Refer to ophthalmology
797
What type of ovarian cyst if ruptures can cause paeudomyxoma peritonei
Mucous cystsdenoma
798
Most common type of ovarian epithelial cell tumour
Serous cystadenoma
799
Painful bruises on shins - cause
Erythema nodosum
800
How to treat toxoplasmosis
If immunocompetent no treatment needed
If immunocompromised - pyrimethamine and sulphadiazine
801
What should all children with asthma exacerbation be given
Prednisolone - 3-5 days
10mg if <2
20mg if 2-5
30-40 if >5
802
Young child presents with pellagra, red scaly photosensitive rash , neuro involvement with fainting followed by stiffness and spasticity.
Hartnup disease
803
Risk of dapagliflozin
LL amputation
fourniers
Normoglycaemic ketoacidosis
UTI
804
Whooping cough tx
Clarithromycin if within 21 days of cough onset
805
CT head showing temporal lobe changes - cause
Herpes encephalitis
806
Most common cause of argyll Robinson pupil
Diabetes
807
What can affect urea breath test
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
808
What can artificially increase/ decrease HbA1c
Increase - B12/ folate, splenectomy, IDA
Decrease - sickle, thalassaemia, G6PD, spherocytosis
809
Night blindness and tunnel vision with family history - cause
Retinitis pigmentosa
810
Lithium monitoring
Weekly after every dose change - 12 hours post dose. Once stable monitor 3 monthly
TFT, U&E every 6m
811
Drugs causing lung fibrosis
Amiodarone, bleomycin, methotrexate, sulfasalazine, nitrofurantoin, bromocriptine, cabergoline
812
Croup cause
parainfluenza virus
813
Ix for renal colic, 1st line pain relief
Non contrast CT, IM diclofenac
814
When to give platelets/ ffp
Platelets if bleeding + <30, surgery + <50, no symptoms and <10
ffp if fibrinogen <1 of PT > 1.5x normal
815
women that should be started on low dose aspirin for pre-eclampsia prophylaxis - when to start
AI condition
Diabetes
CKD
HTN in previous pregnancy
Chronic hypertension
Take from 12 w
816
HSV 1 vs 2
1 - oral ulcers
2 - genital ulcers
817
What to do if primary herpes attack at > 28w gestation
Elective C section
818
Young person with bilateral vision loss colour desaturation - no pain, -optic disc oedema on fundoscopy
Lebers optic neuropathy
819
Gentamicin - what to do if peak/ trough level are high
Peak - reduce dose
Trough - increase dose interval
820
What drug to give in SVT if patient has asthma
Verapamil
821
Causes of aortic stenosis in children
Williams, turners, coarctation of aorta
822
When can fly post pneumothorax
1w after check Xray if complete resolution
823
What GRACE score indicates need for coronary angiography +/- PCI
>3%
824
Baby with pulmonary stenosis, pectus excavatum
Noonans syndrome
825
When to start DOAC if stroke, found to be in AF
After 2w
826
Symptoms of Hodgkins that represent poor prognosis
Weight loss >10% in last 6m
Temp >38
Night sweats
827
What should be given to patient if ascites and protein < 15
Ciprofloxacin for SBP prophylaxis
828
Diagnostic neutrophil value for SBP - treatment
>250 - IV cefotaxime
829
How long during pregnancy to take folic acid replacement
until 12w
830
Diagnosis if fever headache, psychiatric symptoms, seizure and vomiting - most common cause
Encephalitis - most common cause = HSV-1
831
Section 2
Admission for assessment up to 28d 2 doctors
832
Section 3
Admission for treatment up to 6m, can be renewed
833
Section 4
72 hour assessment order, single healthcare professional
834
section 17a
Community treatment order, can recall to hospital
835
Section 136
Taken from public place to place of safety for up to 24hrs
836
Most common bacterial cause of endocarditis
Staphylococcus aureus
837
Unilateral dilated pupil, sluggish response to light - what ix and why
CT head to assess for raised ICP and tentorial herniation causing 3rd nerve palsy
838
Most common cause of bacterial endocarditis, following prosthetic valve surgery
Staphylococcus epidermidis
839
How to treat genital warts - multiple vs solitary
Multiple, non keratinised - podophyllum
Solitary, keratinised - cryotherapy
840
What drug can cause acute dystonia in children?
Prochlorperazine
841
How to treat anorexia in palliative patients
Prednisolone or dexamethasone
842
What is decubitus angina
Angina when lying flat
843
What kind of murmur occurs in mitral regurg
Pansystolic
844
What size of AAA should have 3 monthly surveillance, what size should be referred urgently via 2ww
> 4.5cm - 3m
>5.5 - urgent surgical review 2ww
3-5.5 - vascular review within 12w
845
What 2 vaccines need to be given 4w apart
Yellow fever and MMR
846
Patient has longstanding transient synovitis - >6w - what has happened
Developed perthes disease
847
Treatment of narcolepsy
Modafinil
848
Child presenting with headache followed by cough, wheeze and crackles on chest - cause and tx
Mycoplasma pneumoniae - oral clari
849
Inspiratory stridor: high-pitched and crowing. This is usually intermittent, occurring in the supine position e.g. when the child lies on its back, when feeding or when agitated
Laryngomalacia
850
Contraindications for POP
Acute porphyria and current breast cancer
851
Young child presents with anaemia, failure to thrive and frontal bossing
Thalassaemia
852
Monochorionic (identical) - why should have US every 2w
To check for twin twin transfusion syndrome
853
Painless genital ulcer with lymphadenopathy later patient develops pustular urethral discharge and pain when passing stool
Lymphogranuloma venereum
854
Teardrop cells on blood film
Myelofibrosis
855
What can precipitate a G6PD crisis
Thiazides, ciprofloxacin, fava beans
856
Child with haemarthrosis, bleeding into joints/ muscles - cause
Haemophilia
857
Elderly person sat next to heater presents with reticulated erythematous rash
Erythema ab igne
858
Rash treated with steroid worsened rapidly - why
Infected
859
TIBC in IDA vs anaemia of chronic disease
TIBC raised in IDA as want more iron, low or normal in anaemia of chronic disease
860
Defect of what immune component can make susceptible to recurrent meningococcal infection
Complement defect
861
Child turns blue and LOC when crying - cause and mx
Breath holding attack, reassurance - most grow out of it by 5yr
862
Young person presents with falls, difficulty running, pes cavus, muscle atrophy/ weakness, loss of ankle reflexes and loss of sensation
Charcot marie tooth - motor sensory neuropathy
863
Young child presents with sensorineural hearing loss, cerebral palsy, developmental delay and CT head shows intracranial calcification - cause
Congenital CMV infection
864
Childhood condition with sensorineural deafness and hypothyroid/ goitre
Pendred syndrome
865
Most common cause of diarrhoea in those with HIV
Cryptosporidium - treat with Nitazoxanide
866
How to take bisphosphonates
Empty stomach 30 mins before breakfast, stand or sit upright for 30mins after taking
867
How much to increase TSH in pregnancy
25-50mcg
868
Erythematous oval scaly lesions - starts with single patch then spreads across trunk following lines of langer
Pityriasis rosea
869
Rash more noticeable following a sun tan
Pityriasis versicolour
870
Visual hallucinations and worse vision at night
Charles bonnet syndrome due to macular degeneration
871
Painless loss of vision, swollen eyelid, proptosis, swollen optic disc - cause
Posterior scleritis
872
What test can differentiate between cardiac and non cardiac causes of hypoxia in neonates
Nitrogen washout test - give 100% O2 for 10 mins, if pO2 < 15 on gas then is cardiac - TOF, transposition or tricuspid atresia
873
Deficiency causing red crusted lesions, alopecia, short stature, hypogonadism, hepatosplenomegaly, geogaphia (ingesting clay/soil)
Zinc deficiency
874
When can treat ectopic medically
No rupture
<35mm
No heart beat
No symptoms
B-HCG <1000
875
Emotional lability, depression, asymmetrical tremor and stigmata of liver disease - cause
Wilsons disease
876
What does the heel prick test look for
Cystic fibrosis, MCADD, PKU, sickle cell, congenital hypothyroidism
877
878
How to treat severe propranolol overdose not responding to atropine
Glucagon
879
Recurrent episodes of pruritis, jaundice, abdo pain and fever. Bg of IBD
Primary sclerosing cholangitis
880
Patient presents with lethargy, constipation, non pitting oedema of ankles. FBC shows monochromic macrocytic anaemia - cause
Hypothyroid
881
Lemon tinge to skin and glossitis
B12/ folate deficiency
882
What diabetic drug increases fracture risk
Pioglitazone
883
Pulmonary fibrosis in coal miners who have rheumatoid arthritis - cause and signs on CXR
Caplan’s syndrome - multiple, round, well defined nodules
884
What is given as prophylaxis for contacts of meningococcal meningitis
Ciprofloxacin
885
Toxoplasmosis mx during pregnancy
If mum affected spiramycin
If baby also infected then pyrimethamine and sulfadiazine
886
Treatment of organophosphate poisoning
Atropine
887
Example alpha blocker used for phaeochromocytoma
Phenoxybenzamine
888
Definition of impaired glucose tolerance
Fasting <7, OGTT 2hr value 7.8-11.1
889
Definition of impaired fasting glucose
Fasting >6.1, <7
890
What abx lowers seizure threshold
Ciprofloxacin
891
How to differentiate Parkinson's from dementia with Lewy bodies
Depends if motor/ rigidity/ tremor develop first or dementia, confusion etc - often have REM sleep disorders in patients with DLB
892
How to treat flexural psoriasis
Steroid cream
893
What type of blood product has the highest risk of bacterial contamination
Platelets
894
Child presents with triad of infrequent generalised seizures, daytime absences and involuntary shock like jerking movements
Janz syndrome, juvenile myoclonic epilepsy
895
What cytotoxic agent causes hypomagnesaemia
Cisplatin
896
What methods of contraception are unaffected by enzyme inducing drugs
Examples of contraceptives that are unaffected by EIDs are:
Copper intrauterine device
Progesterone injection (Depo-provera)
Mirena intrauterine system
897
Marker associated with anti phospholipid syndrome
Anti- cardiolipin
898
What eye drop can cause low potassium, paraesthesia and dyspepsia and should be avoided in pregnancy ?
Dorzolamide (carbonic anhydrase inhibitor)
899
Recurrence of cloudy vision following cataract surgery
Posterior capsule thickening
900
3d old presents with scaphoid abdomen, poor feeding and bilious vomiting
Duodenal atresia
901
10d old baby presents with abdominal distension and mass, hx of prolonged meconium passage, may have bleeding from the rectum
Intussuseption
902
Painful growth within longstanding ulcer
Marjolins ulcer - a cutaneous malignancy
903
What criteria is used to diagnose rheumatic fever
Jones' criteria
904
Non cystic manifestations of PKD
Berry aneurysms, mitral valve prolapse, colonic diverticula, renal cell carcinoma
905
Proximal fibula and malleolar fracture - cause
Maisonneuve fracture
906
How to differentiate viral and bacterial meningitis from the CSF
Bacterial - low glucose, neutrophils and raised protein
Viral - normal glucose, lymphocytes and raised/ normal proteins
907
Rockall scoring - GI bleed - factors
Age, comorbid status, signs of haemorrhage on endoscopy, SBP
908
What is functional incontinence
Physical or mental disability that stops from passing urine normally despite normal urinary tract e.g. parkinsons
909
Causes of overflow incontinence
BPH causing obstruction, neurological conditions, neuropathy due to diabetes mellitus
910
Cause of hemiballismus - how presents
Unilateral involuntary flailing movements - caused by infarct/ haemorrhage in sub thalamic nucleus
911
Patient presents with features of meningitis, CSF sample shows organism that stains positive with India ink
Cryptococcosis
912
Criteria for pre-eclampsia referral
Rise in BP >30/20 over booking, >160/120 or >140/90 with proteinuria, symptoms, IUGR
913
Patient with endometritis symptoms has ongoing fevers despite abx and resolution of pain
Septic pelvic thrombophlebitis - Treat with heparin
914
Foetal scalp pH that indicates possible foetal distress and hypoxia
pH < 7.19 - immediate C-section
915
What should be done if meconium stained liquor
Immediate induction with continuous CTG
916
Patient in late pregnancy presents with painless bleeding
Placenta praevia
917
Acute pain and swelling in cheek
sialolithiasis
918
When should foetal poles be visible
6w
919
Condition causing telengectasia, recurrent epistaxis with positive family history
osler webber rendu (hereditary hemorrhagic telengectasia)
920
921
Low grade fever and SOB up to 48hrs post op
Atelectasis
922
Laxatives to use in ileostomy vs colostomy
Ileostomy - magnesium sulphate (osmotic)
Colostomy - bulk forming (ispaghula husk)
923
What symptom is a good indicator of dengue fever
Facial flushing
924
Most common cause of glomerulonephritis in adults
Focal segmental glomerulonephritis
925
Organism causing scarlet fever
Strep pyogenes
926
Rash that starts behind the ears
Measles
927
How to treat pain due to tumour nerve compression
Dexamethasone
928
What SSRI has a long half life and is most likely to cause serotonin syndrome when changing medication
Fluoxetine
929
Common side effect of methylphenidate
Reduced growth
930
What abx increases risk of cardiac events and strokes due to rupture of existing plaques
Clarithromycin
931
What medication needs to be slowly weaned due to risk of rebound myocardial ischaemia
Beta blocker
932
Abx causing oesophagitis, severe pain on swallowing
Doxycycline
933
What asthma treatment can cause vivid bad dreams
Monteleukast
934
What asthma treatment if taken alone can cause severe asthma attacks
LABA e.g salmeterol - should be taken with inhaled steroid
935
Abx that can cause ototoxicity
Erythromycin, gentamicin
936
UTI abx that can cause pulmonary fibrosis
Nitrofurantoin
937
Medication causing low magnesium levels
PPI
938
Antidepressants most likely to cause withdrawal symptoms
Venlafaxine - short half life
Paroxetine
939
Symptoms of clozapine toxicity
Hyperthermia, drowsiness, confusion, hypersalivation, seizures
940
What abx interacts with clozapine
Ciprofloxacin
941
What drug liscenced for children with insomnia and autism can cause odd dreams
Melatonin
942
For what antibiotics should alcohol be avoided
Metronidazole - for at least 48hrs after - can cause arrhythmia, cardiotoxicity and hepatotoxicity
Doxycycline- reduces effectiveness
943
What ssri and abx prolong QT
Citalopram, escitalopram, clarithromycin
944
What contraception is contraindicated in hepatocellular carcinoma
Combined pill as oestrogen can increase malignancy
945
Vaccines contraindicated in egg allergy
Hep A, yellow fever, influenza
946
What drug can cause first dose hypotension
Tamsulosin, ACEi
947
What drug when taken with opioid can cause resp depression
Benzodiazepines
948
Cause of pityriasis versicolor
Malassezia furfur
949
First line for urticaria
Cetirizine 10mg OD and Prednisolone 40mg daily
950
Skin lesions that heal to leave pigmented or hypopigmented atrophic skin
Discoid lupus
951
What tx not available on NHS can help with hair loss
Minoxidil
952
Actinic keratosis mx singular vs many
Singular - cryotherapy
Many - 5FU
953
What to give during cardiac arrest if PE suspected
Altaplase
954
Doses of adrenaline for anaphylaxis
<6 - 0.15mg
6-12 - 0.3mg
>12 - 0.5mg
955
What kind of virus is HIV
Double stranded RNA virus
956
Rust coloured sputum - cause
Strep pneumoniae
957
Redcurrent jelly sputum cause
Klebsiella
958
Infective causes of cardiomyopathy
Chagas
Coxsackie
959
Travel hx with slow pulse and raised temp, muscle pain, n+v -cause
Yellow fever
960
Foreign travel, itchy rash, fever, cough, wheeze, muscle aches - cause
Schistosomiasisis
961
Sub-Saharan Africa - present with skin changes, itching, nodules, alterations in vision -cause
Onchoceriasis
962
What TB drug can precipitate gout
Pyrazinamide
963
Green coloured sputum cause
Pseudomonas, haemophilus, pneumococcal
964
Hx of foreign travel, Hepatosplenomegaly, jaundice, fever, low platelets
Malaria
965
What is testosterone used for post menopause
To increase libido
966
Definition of PPH
Vaginal bleeding >500mls
C-section >1000mls
967
Primary vs secondary pph
Primary - within 24hrs
Secondary - 24hrs to 12w
968
What analgesic should be used for symphysis pubis dysfunction during pregnancy
Paracetamol or codeine
969
Type of anaemia in rheumatoid arthritis
Normochromic normocytic anaemia
970
What skin condition is associated with RA, SLE, lymphoma, TB, polymyositis, raynauds
Livedo reticularis
971
Drug causes of gingival hyperplasia
Phenytoin
Ciclosporin
Nifedipine
972
What is Charcot triad in MS
Nystagmus, intention tremor and staccato speech
973
What can precipitate megaloblastic crisis in hereditary spherocytosis
Folate deficiency
974
Brief sharp stabbing pain or longer lasting dull ache in lower abdomen/ groin of women in late stage pregnancy
Round ligament pain
975
Condition where body can’t make iron into haemaglobin
Sideroblastic anaemia - see ring sideroblast on blood film
976
What is a bartons fracture
Fracture of distal radius with intra-articular involvement and dislocation of radiocarpal joint - can be volar or dorsal
977
What is a rolando fracture
Fracture of base of thumb into 3 parts
978
Gamekeeper/ skiers thumb
Avulsion fracture of thumb at site of insertion of ulnar collateral ligament
979
How to treat local anaesthetic overdose
Lipid emulsion
980
What is echopraxia
Psychiatric condition when someone can’t stop copying you
981
Pinna cellulitis vs perichondritis
Cellulitis affects ear lobe, perichondritis doesn’t
982
What fluid to use in bladder washout
0.9% saline
983
Most common cause of significant pleural effusion
Malignancy
984
When should colchicine be avoided for acute gout
Blood disorder
eGFR < 10
Severe hepatic impairment
Pregnancy or breastfeeding
Taking clarithromycin or erythromycin, verapamil, ketoconazole
985
Learning disability, behavioural problems including self harm, must odour and pale complexion compared to family
Phenylketonuria - treat with low phenylalanine diet
986
Encephalopathy, neurodegeneration, sweet smelling urine and sweat
Maple syrup urine disease
987
Poor feeding, vomiting, seizure and odour of sweaty feet
Isovaleric acidaemia
988
PCOS hormone levels
LH raised
Testosterone raised
Low Sex hormone binding globulin
989
What is tested for on Guthrie test (blood spot test)
CF
PKU
Sickle Cell
Congenital Hypothyroid
Downs is not tested
990
Disease with pancytopenia, hepatosplenomegaly, jaundice and lipid laden macrophages
Gauchers disease
991
Triad of symptoms in budd chiari
Abdo pain, hepatomegaly and ascites
992
Triad of rheumatoid, splenomegaly and neutropenia
Felty syndrome
993
What drug precipitates gout
Thiazide like diuretics
994
Name for cold sores
Herpes labialis
995
What pulse change is common in severe asthma and cardiac tamponade
Pulsus paradoxus
996
Most common causes of drug induced SLE
Hydralazine, procainamide, phenylbutazone, isoniazid
997
When do you see red cell casts in urine
Glomerulonephritis
998
If on 2x DMARDS what is next step for RA
Anti TNF
999
What to start in mild SLE not improving with steroids
Hydroxychloroquine
1000
What medication is given to reduce intracranial pressure
Mannitol
1001
What antidepressant is contraindicated with tamoxifen
Fluoxetine, paroxetine, bupropion
1002
What to do if switching from warfarin to apixaban and INR >2.5
Wait for it to drop to less than 2
1003
What rheumatoid drug can cause agranulocytosis and therefore requires screening for infection e.g. chicken pox before admin
Adalimumab
1004
How to wean off steroid
Rapid wean to a physiological dose of 7.5mg daily - reduce by 2.5 every 3-4 days
Then reduce by 2.5mg every 7-28 days
1005
What antiemetic used 3rd line in pregnancy has increased risk of cleft lip and heart defects
Ondansetron
1006
Switching to what drug helps with benzodiazepine withdrawal
Diazepam
1007
What drug can cause paradoxical aggression and hostility
Diazepam
1008
What drug can cause delayed wound healing and infections following tooth extraction
Bisphosphonate
1009
What drug can cause euglycaemic diabetic ketoacidosis
SGLT2 inhib
1010
What drug reduces hypo awareness and precipitates psoriasis
Beta blockers
1011
When to commence buprenorphine patch when switching from methadone
Once withdrawal symptoms develop
1012
What can happen if replace folate before b12
Subacute combined degeneration of the cord - paraesthesia, leg weakness, ataxia, loss of sensation
1013
What weight loss drug can increase INR
Orlistat
1014
What is ranson criteria
Used to predict pancreatitis mortality
1015
ECG changes in digoxin overdose
St depression and inverted T waves in V5/6 (reverse tick)
1016
ECG changes in PE
Right axis deviation
RBBB
Sinus tachy
S1Q3T3
1017
What ECG change is seen in hypothermia
J wave
1018
ABG finding in CKD
Metabolic acidosis with resp compromise
1019
Cataracts, muscle weakness and frontal balding in young male
Myotonic dystrophy
1020
Unable to close eyes after blepharoplasty
Lagopathalmos
1021
What is globus
Sensation of lump in throat
1022
Infantile spasms with drawing up of knees, 3-8m of age
West syndrome
make a w with legs
1023
What STIs cause pH > 4.5
BV and TV
1024
How to manage bcc on eyelids or nasal ala
Urgent referral for removal
1025
Tylosis - associated malignancy
Oesophageal
1026
Acquired ichthyosis - associated malignancy
Lymphoma
1027
Treatment for widespread pityriasis versicolor
Ketoconazole shampoo
1028
What do haemolytic anaemias e.g. spherocytosis increase risk of
Gallstones
1029
Finger infection in herpes
Herpetic whitlow
1030
Allergic vs irritant dermatitis
Irritant is just red
Allergic is red, scaly, blistering, weeping
1031
What epworth score for sleep apnoea requires further investigation
>10
1032
What score on MMSE and addenbrookes suggests dementia
MMSE < 24
Addenbrookes 82-88
1033
Cause of Burr cells
Uraemia
1034
Agoraphobia
Anxiety in big crowds
1035
Smear cells on blood film
CLL
1036
Precocious puberty, unilateral cafe au lait spots, fractures
McCune-Albright syndrome
1037
Most common cause of oesophageal cancer in upper oesophagus vs lower
Upper - Squamous cell carcinoma
Lower - Adenocarcinoma
1038
What diet should be used for ascites
Low salt
1039
Criteria for bariatric surgery
BMI > 40
BMI > 35-40 + co-morbidity that would be improved by weight loss e.g. diabetes
1040
Red/ white discolouration of inside of cheek in patient who smoked and drinks
Squamous cell carcinoma
1041
painful, clearly defined, round or ovoid, shallow ulcers that are confined to the mouth and are not associated with systemic disease.
Aphthous ulcer
1042
First line investigation for haemorrhoids
Proctoscopy
1043
Choriocarcinoma tx
Methotrexate
1044
Most common parotid tumour
Pleomorphic adenoma
1045
Beaded appearance on ERCP
Primary sclerosing cholangitis
1046
How to treat pernicious anaemia
B12 replacement - IM hydroxycobalamin
1047
What is beri beri
Thiamine deficiency causing polyneuropathy and heart failure
1048
What laxative to use in opioid induced constipation
Osmotic and stimulant laxative
1049
Ankle and knee reflex dermatomes
Ankle S1-2
Knee L3-4
1050
IM benzylpenicillin dose for meningitis in kids
<1 - 300mg
1-10 - 600mg
>10 - 1200mg
1051
Most common benign ovarian tumour in women under 30
Dermoid cyst
1052
Ovarian tumour associated with ascites and pleural effusion
Meigs’ syndrome - caused by fibroma
1053
Jaundice and anaemia following infection, new medication or broad beans
G6-PD
1054
Recurrent clots with prolonged APTT and low platelets
Anti phospholipid
1055
Macrocytic anaemia with hypersegmented polymorphs on blood film
B12 / Folate deficiency
1056
If terminal ileum resection what vitamin won’t be absorbed
B12
1057
What is a rare complication of chloramphenicol eye drops
Aplastic anaemia, bone marrow suppression
1058
Transfusion - develop fever, hypotension, red coloured urine
Immediate haemolytic transfusion reaction
1059
Treatment of essential thrombocytopenia
If platelets >1000 commence aspirin 75mg OD
If age > 60 or previous thrombosis give hydroxycarbamide
1060
ABG in aspirin overdose
1st resp alkalosis then develop acidosis from metabolites
1061
Drugs for post exposure prophylaxis of flu
Oseltamavir and zanamivir
1062
How to test for acromegaly
Oral glucose tolerance test with growth hormone
1063
Painless vision loss with colour changing haemorrhages, streaky dark shadows
Vitreous haemorrhage
1064
What condition is associated with uveitis and HLA B5
Bechets
1065
Punched out lesion on macula
Macula hole
Stage 1 not need treatment
Stage 2 or more need vitrectomy
1066
Cover uncover vs cover test
Cover test shows tropia - always present squint
Cover uncover shows phoria - not always present
1067
Lump on upper eyelid with eyelash loss and no improvement with hot compress or abx ointment
Sebaceous cell carcinoma
1068
Pain, swelling of medial lower eyelid with increased tear production and possible purulent discharge
Dacrolytis - refer to opthalm for incision and drainage
1069
What causes pupil to be irregular and dilated poorly in anterior uveitis
Posterior synechiae - pupil sticks to lens
1070
Best test for aortic dissection
Transoesophageal echocardiogram
1071
Barter’s syndrome
Inherited hypokalaemia, low sodium and low chloride with normotension
1072
What type of bilirubinaemia in newborns is always pathological
Conjugated
1073
Incoordination of rapidly alternating movement
Dysdiadochokinesis
1074
Hypertension that can’t be controlled with medication, sudden renal failure when commencing ACEi
Renal artery stenosis
1075
How does HIV affect HbA1c and diabetes diagnosis
Can’t use HbA1c as is underestimated
1076
Bone infections in child with sickle cell disease - what organism
Non- typhi salmonella
1077
Bone infections in child with sickle cell disease - what organism
Non- typhi salmonella
1078
Bone infections in child with sickle cell disease - what organism
Non- typhi salmonella
1079
When to consider retreating scabies
Itching can take 6w to settle. Only repeat treatment if further burrows or rashes
1080
What NSTEMI patients should have coronary angiography
immediate: patient who are clinically unstable (e.g. hypotensive)
within 72 hours: patients with a GRACE score > 3% i.e. those at intermediate, high or highest risk
coronary angiography should also be considered for patients if ischaemia is subsequently experienced after admission
1081
Causes of Dupuytrens contracture
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
1082
What antidepressant shouldn’t be prescribed with warfarin
SSRI
1083
First line for spasticity in MS
Baclofen and gabapentin
1084
What antihypertensive causes altered taste sensation
Amlodipine
1085
Diagnostic test for necrotising enterocolitis
Abdo XR - treat with IVI, NG tube, NBM,
IV Abx
1086
Pituitary tumour following adrenalectomy
Nelson’s disease
1087
Child <3 starts to develop pubic hair
Hamartoma of post pituitary- treat with GNRH analogue
1088
45 XO
Turners - gonadal hypoplasia and short stature, wide nipples, webbed neck, bicuspid aortic valve, primary amenorrhoea
1089
Short synatchen test use
Adrenal insufficiency
1090
Primary vs secondary hypothyroidism
Primary - problem with thyroid so T3/4 not produced and TSH high
Secondary - problem with pituitary/ hypothalamus so TSH not produced and T3/4 low
1091
Patient with pituitary tumour develops rapid onset headache and drop in GCS
Pituitary apoplexy - bleed into pituitary
1092
What drug is used for HER2 positive breast cancer and needs cardiac monitoring
Trastuzumab
1093
Hernia at lateral edge of rectus sheath
Spigelian
1094
Test used to assess for level of venous valve deficiency in varicose veins
Trendelenburg test
1095
Hammans sign when listening to chest
Crunching sound in time with heart - due to mediastinal emphysema caused by oesophageal rupture
1096
Delusion of infestation with insects
Ekboms syndrome
1097
Young Asian women with renal artery stenosis/ aneurysm
Takayasus arteritis
1098
Bipolar 1 vs 2
1 - Depression and Mania
2 - Depression and Hypomania ( no delusions, no hallucinations, no impairment in functioning, <7d)
1099
What antidepressant to try if already tried 2x SSRI without benefit
SNRI e.g. venlafaxine
1100
Parkinsons meds that can cause visual hallucinations
Levodopa and amantadine
1101
What Parkinson’s meds cause pulmonary, retroperitoneal and pericardial fibrosis
Ergot derived dopamine agonist e.g. bromicriptine
1102
Howell jolly bodies
Post splenectomy, coeliac
1103
Tingling, deadness, pain in hand associated with wasting of intrinsic muscles, clawing of fingers
Ulnar nerve lesion
1104
Richters vs maydl’s hernia
Richters is when one of bowel walls goes through defect - can become strangulated and necrotic without obstructing
Maydl’s is when bowel comes out in 2 loops forming a w shape
1105
Bloods in polycythemia Vera
High Hb, PCV, may have raised platelets and WCC
Ferritin may be low
1106
How to differentiate holmes-adie and Argyll-Robinson pupils
Holmes adie = dilated pupil and reduced tendon reflexes
Argyll Robinson = small pupil
1107
Antibodies raised in graves vs hashimotos
Graves - TSH receptor antibodies
Hashimotos - Thyroid peroxidase and thyroglobulin antibodies
1108
Schwartz sign on eardrum
Pink patch - seen in otosclerosis
1109
Patient from Africa presents with nasal symptoms nodules and nose enlargement
Rhinoscleroma - Klebsiella
1110
Sweating over cheeks, temples and facial flushing after parotid surgery
Freys syndrome - damage to auriculotemporal nerve
1111
Cause of progressive dysphagia from solids to liquids
Hypopharyngeal cancer
1112
What age do children achieve night and day continence
3-4 years
1113
When to consider valve replacement in aortic stenosis
- Symptomatic
- Asymptomatic with valvular pressure gradient > 40 and features of systolic dysfunction
1114
Diabetes mellilitus, optic atrophy, deafness in child
Wolfram syndrome
1115
Does lithium cause cranial or nephrotic diabetes insipidus
Nephrogenic
1116
Type 1 vs 2 AI liver disease
Type 1 - Anti smooth muscle antibodies, ANA
Type 2 - anti LMK (liver/kidney microsome), anti LC
1117
Anorexia - what’s raised
most things low
G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
1118
Brief spasms/ jerks in first year of life
Infantile spasms (west syndrome)
1119
First line treatment for benign Rolandic epilepsy
Carbamazepine
1120
Normal sodium and potassium values
Sodium 135-145
Potassium 3.6-5.2
1121
What abx can cause c.diff
Clindamycin
1122
Salt intake in hypertension
<6g/day, but ideally <3g/day
1123
Red flags for back pain
Red Flags for back pain include -
Thoracic pain
Age <20 or >55 years
Non-mechanical pain
Pain worse when supine
Night pain
Weight loss
Pain associated with systemic illness
Presence of neurological signs
Past medical history of cancer or HIV
Immunosuppression or steroid use
IV drug use
Structural deformity
1124
Perthes disease presenting features, age
4-8, progressive hip pain, limp, stiffness
1125
When can copper coil be inserted
Up to 5 days after sex
Or up to 5 days after earliest estimated date of ovulation
1126
Painful arc with/ without weakness - cause
With weakness - rotator cuff tear
Without - subacromial impingement
1127
Popping, clicking, swelling of shoulder and positive scarf test
Acromioclavicular degeneration
1128
When can deliver vaginally in HIV
Viral load <50 at 36w
1129
What drug is given to neonate and as infusion to mother for HIV during C-section
Zidovudine
1130
How to treat b12 deficiency
1mg IM hydroxycobalamin 3x weekly for 2w then once every 3m
1131
Acute onset fever, strider and drooling, no choking
Epiglottitis
1132
What to do if >2 exacerbations of UC in last 12m
Azathioprine or oral mercaptopurine
1133
Flu prodrome, RUQ pain, tender hepatomegaly, jaundice, deranged LFT
Hepatitis A
1134
What drug can be used in COPD if FEV1 < 50% and 2 or more exacerbations whilst on triple therapy
PDE- 4 inhibitor - roflumilast
1135
Oedema, raised JVP, heave and loud S2 on background of COPD - cause and tx
Cor pulmonale - treat with loop diuretic, LTOT
1136
Wilson’s disease - diagnostic test and treatment
Reduce caeruloplasmin, reduced serum total copper, raised free copper, confirmed by genetic analysis
Treat with penicillamine
1137
What to do after tried LTRA for child < 5 with asthma
Refer
1138
Cellulitis near eyes/ nose
Co-amox
1139
Raynauds, dysphagia and telengectasia on exam
Systemic sclerosis
1140
Abx for sinusitis
Phenoxymethylpenicillin
1141
Vitreous vs retinal detachment vs vitreous haemorrhage
Vit detachment - flasher/ floater no vision loss
Vit haemorrhage - as above with vision loss
Retinal detachment - shadow across vision from periphery inwards
1142
When to give abx for otitis media
Age <2, bilateral
More than 4 d
Unwell
Immunocompromised
Discharge or perf
1143
Colles vs smith fracture
Colles - dorsal displacement
Smith - volar displacement
