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Other Flashcards

1
Q

0Where does L5 provide sensation to? What happens if it is damaged?

A

Big toe sensation and dorsum of the foot
If damaged causes foot drop and a positive sciatic nerve stretch test

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2
Q

Ix of pancreatitis?

A

Raised serum lipase, amylase and pain is diagnostic. Lipase is the most sensitive and specific test
Only US to confirm cause

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3
Q

How much must CK be elevated by to diagnose Rhabdomyolysis?

A

> 5 times the upper limit of normal
It may be elevated less than this due to other causes e.g. dehydration/hypovolaemia

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4
Q

What is the most common cause of protozoal diarrhoea in the UK? Who is it commonly seen in and how do you test for it?

A

Cryptosporidium = most common
Seen in the immunocompromised and young children
It is diagnosed on the Ziehl-Neelsen stain (shows red cysts)

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5
Q

Which way does the tongue deviate in hypoglossal nerve injuries?

A

TOWARDS the damaged side

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6
Q

Sx of Acute angle closure glaucoma?

A

Severe pain (ocular or a headache), reduced visual acuity, Sx worse in the dark (i.e. on mydriasis), semi-dilated non-reactive pupil, hard red eye, halos around lights, dull/hazy cornea and nausea/vomiting/abdo pain

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7
Q

Ix and Definitive Mx of Acute angle closure glaucoma?

A

Ix = measure IOP
Definitive Mx = laser peripheral iridotomy

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8
Q

What can B12 deficiency cause if uncorrected?

A

Sub acute combined degeneration of the spinal cord

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9
Q

Name the non-sedating antihistamines?

A

Cetirizine, Fexofenadine, Loratadine and Acrivastine

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10
Q

What signs may be seen on fundoscopy in hypertensive retinopathy?

A

Silver/copper wiring = walls of the arterioles become thickened and sclerosed
Arteriovenous nipping = arterioles compress the veins where they cross

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11
Q

Describe Bowen’s disease?

A

Red scaly slow growing patches on sun exposed sites. Is a precursor to squamous cell carcinoma
Mx = TOP 5-flurouracil

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12
Q

What is the initial Mx of hyperthyroidism?

A

Propranolol
This will control symptoms whilst a definitive Mx is started

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13
Q

How will arterial ulcers appear?

A

Deep and punched out ulcers, they are painful with a low ABPI measurement.
Feet will be cold with no peripheral foot pulses

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14
Q

When should you stop metformin before giving contrast?

A

48 hours before, this reduced the risk of lactic acidosis

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15
Q

How do you calculate serum osmolality?

A

2x(Na+) + glucose +urea

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16
Q

What is the transfusion threshold?

A

Hb <70g/L if no ACS
Hb <80g/L if ACS

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17
Q

What is the role of a fluid challenge?

A

Should be done in patients for whom you think fluids will be beneficial but you are not sure if they will tolerate them

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18
Q

Mx MRSA?

A

Vancomycin

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19
Q

Describe central retinal artery occlusion?

A

Sudden painless unilateral vision loss, RAPD and a pale retina with a cherry red spot

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20
Q

How can you manage peripheral neuropathy in renal impairment?

A

Amitriptyline, Pregabalin or Gabapentin
Duloxetine should not be used if the eGFR <30

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21
Q

What are the endoscopic findings in coeliac’s disease?

A

Crypt hyperplasia, villous atrophy, increased intraepithelial lymphocytes and lamina propria infiltration with lymphocytes

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22
Q

True or false, mesothelioma causes pleural effusion?

A

True - and it more commonly affects the right lung than the left

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23
Q

What should you measure in erectile dysfunciton?

A

Free testosterone level between 9am-11am. If this is abnormal/borderline measure FSH, LH and prolactin levels

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24
Q

Risk factors and Mx of erectile dysfunciton?

A

Risk factors = any risk factors for cardiovascular disease, alcohol use, SSRIs and beta blockers
Mx = PDE-5 inhibitors e.g. sildenafil

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25
Q

What is Choledocholithiasis?

A

Gall stones in the CBD. Can cause obstructive jaundice

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26
Q

Drug causes of hyperkalaemia?

A

K+ sparring diuretics, ACEis, ARBs, ciclosporin and heparin. Beta blockers can contribute if there is renal failure

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27
Q

How do you interpret the results of AAA screening?

A

<3cm = no further action
3-4.4 cm = rescan every 12 months
4.5-5.4 cm = rescan every 3 months
>=5.5cm or symptomatic or rapidly growing (>1cm/year) = 2WW to vascular surgeons

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28
Q

Mx of oral candidiasis secondary to steroid inhaler?

A

Give anti-fungal oral suspension and use a large volume spacer

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29
Q

How can we biochemically differentiate between sarcoidosis and TB?

A

Sarcoidosis causes hypercalcaemia, TB does not

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30
Q

Who should conduct the initial Ix for pressure sores in the community?

A

District nurses

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31
Q

Mx of needlestick injury?

A

Encourage the wound to bleed (hold it under running water), wash the wound, cover it with a dressing and contact occupational health

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32
Q

COPD Mx if not steroid responsive?

A

1st line = SABA (e.g. salbutamol) or SAMA (e.g. ipratropium)
2nd line = LABA (e.g. salmeterol), LAMA (e.g. tiotropium) and SABA (if on SAMA switch to SABA)
3rd line = LAMA, LABA, SABA and ICS (e.g. beclometasone)

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33
Q

COPD Mx if steroid responsive?

A

1st line = SABA (e.g. salbutamol) or SAMA (e.g. ipratropium)
2nd line = LABA (e.g. tiotropium), ICS (e.g. beclometasone) and SABA or SAMA
3rd line = LAMA + LABA + ICS + SABA (if on SAMA switch to SABA)

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34
Q

Signs that COPD may be steroid responsive?

A

Previous asthma/atopy, raised eosinophils, variation in FEV1 or PEFR with diurnal variation

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35
Q

Describe BCC?

A

The most common cancer in the western world
Lesions are slow growing and occur at sun exposed sites. They start off flesh coloured but may ulcerate
If you suspect make a routine referral to derm (metastases are rare)

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36
Q

Describe Squamous cell carcinoma?

A

Usually occur at sun exposed sites, they are rapidly expanding painless ulcerated nodules which may have a cauliflower like appearance and show areas of bleeding.
If <20mm diameter excise with 4mm margins, if >20mm diameter excise with 6mm margins.
Metastases are rare

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37
Q

How do we screen for malnutrition?

A

Malnutrition Universal Screen Tool (MUST)

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38
Q

What should you do with any abrupt onset headache?

A

Consider immediate referral to hospital

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39
Q

Ix of Granulomatosis with Polyangitis?

A

cANCA positive, CXR may show cavitating lesions, renal biopsy may show epithelial crescents in the Bowman’s capsule. Red cell casts may be seen on urinalysis (this is haematuria)

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40
Q

Mx of Granulomatosis with Polyangitis?

A

Steroids and cyclophosphamide

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41
Q

What do you characteristically see in disseminated miliary TB?

A

Millet seeds on CXR

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42
Q

Name the TB drugs and their side effects?

A

Rifampicin (6/12) = red/orange discolouration of the urine/tears, reduced the efficacy of the contraceptive pill
Isoniazid (6/12) = peripheral neuropathy (give pyridoxine aka vit B6)
Pyrazinamide (2/12) = hyperuricaemia leading to gout
Ethambutol (2/12) = colour blindness and reduced visual acuity

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43
Q

What is the bone profile like in bony metastases?

A

Calcium and ALP are high. PTH is low (due to high calcium) and so phosphate will also be high

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44
Q

What is the bone profile like in primary hyperparathyroidism?

A

Calcium is high and phosphate is low.
PTH will either be high or inappropriately normal (given the high calcium). ALP may be high

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45
Q

What is Zolpidem?

A

A sedative hypnotic used in the Mx of insomnia, it may cause dizziness

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46
Q

Describe Scurvy?

A

Vitamin C (aka ascorbic acid) deficiency. Causes easy bruising, bleeding/receding gums (gingivitis) and poor wound healing

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47
Q

A patient has low testosterone and low LH and FSH, what may be the cause of his erectile dysfunction?

A

Hypogonadotropic hypogonadism. May be caused by pituitary or hypothalamus pathology

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48
Q

What is seen in acute mitral regurgitation secondary to MI? What is the cause?

A

Systolic murmur heard at the apex with hypotension and pulmonary oedema
Occurs due to rupture of the papillary muscles.

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49
Q

What type of visual field defect does acromegaly cause?

A

An upper (superior) bitemporal visual field defect due to inferior compression of optic chiasm by the pituitary gland

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50
Q

Obesity Mx?

A

1st line = diet and exercise
2nd line = Orlistat (pancreatic lipase inhibitor) or liraglutide/semaglutide (GLP-1 inhibitor - also used in T2DM)
3rd line = Bariatric surgery

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51
Q

Name 3 diseases strep pneumonia most commonly causes?

A

Pneumonia (most common cause), Meningitis (second most common cause, after N. meningitidis) and Otitis media

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52
Q

How do you Mx bladder issues in MS?

A

USS of the bladder
If significant residual volume = intermittent self-catheterisation
If no significant residual volume = anticholinergics

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53
Q

Mx MS relapse?

A

5 days oral/IV high dose steroids (e.g. methylprednisolone)

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54
Q

Why is C.diff hard to destroy?

A

Due to its spore formation

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55
Q

Mx of post-operative ileus?

A

Make NBM, insert NG tube, monitor/correct electrolyte imbalances, early mobilisation and reduce opioid analgesia

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56
Q

How does Bendroflumethiazide affect electrolytes?

A

Causes low K+ and Na+ and hypochloraemic alkalosis

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57
Q

What structure is affected 1st in Alzheimer’s? Where is it located?

A

The hippocampus is affected first, it is buried in the temporal lobe

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58
Q

Describe CHA2DS2-VASc?

A

CHF - 1 point
HTN - 1 point
Age >= 75 - 2 points, 65-74 - 1 point
DM - 1 point
Stroke/TIA/VTE - 2 points
Vascular disease (CVD or PVD) - 1 point
Sex - Female - 1 point

0 = no management required
1 = anticoagulate if male
>= 2 = anticoagulate

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59
Q

Which artery is most commonly affected in bleeding secondary to peptic ulcer disease?

A

The gastroduodenal artery

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60
Q

Describe Lymphogranuloma Venereum?

A

Caused by chlamydia
Sx = small painless pustule leading to an ulcer, painful inguinal lymphadenopathy and proctocolitis (pain on defecation)
Mx = doxycyline

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61
Q

Ix and Mx of DI?

A

Ix = raised plasma osmolality, decreased urine osmolality. Do a water deprivation test
Mx = nephrogenic DI give thiazide like diuretics and low sodium diet
craniogenic DI give desmopressin

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62
Q

What is the normal LH:FSH? What is the LH:FSH in PCOS?

A

LH:FSH = 1:1 normally
In PCOS LH:FSH = 2:1

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63
Q

What is silicosis?

A

Upper-zone fibrosing lung disease leading to egg shell calcification of the hilar lymph nodes
Seen in those who worked in mining, slate and potteries

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64
Q

What is central retinal vein occlusion?

A

Sudden painless vision loss which will lead to retinal haemorrhages.
If haemorrhages are more localised on fundoscopy this may be branch retinal vein occlusion

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65
Q

How can we differentiate between gastric and duodenal ulcers?

A

Gastric ulcers are worse after eating
Duodenal ulcers are worse when hungry and better after eating - they are more common

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66
Q

Haloperidol is absolutely contraindicated in PD. How can we manage agitation/acute confusional state in these patients?

A

Manage agitation with lorazepam
In an emergency acute confusional state can be managed with quetiapine or clozapine (other antipsychotics are also contraindicated in PD)

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67
Q

Mx of tricyclic antidepressant OD?

A

IV bicarbonate

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68
Q

When can BiPAP be useful in COPD exacerbation?

A

When there is type 2 respiratory failure with a pH of 7.25-7.35 when medical management has failed

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69
Q

What is a case control study?

A

Compares the history of a group of people with a condition to the history of a group of people without it - is retrospective

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70
Q

What is a cohort study?

A

Follows a group of people to track the presence of risk factors and outcomes over time - may be prospective (the condition of interest has not yet happened but there are clear outcomes and risk factors defined) or retrospective (the illness has already occurred and the histories are looked at to find risk factors)

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71
Q

What is a cross-sectional study?

A

Assesses the prevalence of an outcome in a broad population at 1 specific time

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72
Q

What is a case-report study?

A

Takes a detailed history of a small number of individuals or a specific group

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73
Q

Gout Mx?

A

Acute = Colchicine or NSAID, if already taking allopurinol this should be continued
Chronic prevention = Allopurinol, cover with colchicine or and NSAID when starting/if not tolerated

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74
Q

Most common cause of Osteomyelitis?

A

Staph Aureus unless they have sickle cell - then Salmonella

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75
Q

What are supraventricular premature beats?

A

A cause of arrhythmias and palpitations in otherwise healthy individuals

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76
Q

1st line Mx of agitation in palliative care?

A

Haloperidol

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77
Q

Ix of PSC?

A

ERCP (is more sensitive than MRCP) may be p-ANCA positive

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78
Q

PSC vs PBC?

A

PSC = UC associated, is pANCA positive
PBC = seen in middle aged women, is AMA (M2) positive (highly specific) and associated with raised IgM

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79
Q

What should you consider if the plasma osmolality is decreased and the urine osmolality is >400?

A

Psychogenic Polydipsia

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80
Q

What options are available to treat STEMI?

A

PCI or thrombolysis

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81
Q

What medications should everyone receive on discharge after MI?

A

ACEi, Beta blocker, Statin and dual antiplatelet therapy

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82
Q

Name 5 cardiac enzymes raised in cardiac damage e.g. MI?

A

Troponin T, Troponin I, CK-MB, LDH and myoglobin (is the first to rise)

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83
Q

What ECG abnormalities may persist after a STEMI?

A

Pathological Q waves, inverted T waves

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84
Q

Can you drive after MI?

A

Yes but not for 4 weeks - no need to inform the DVLA

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85
Q

Apart from exercise name some possible triggers of angina?

A

Anger/excitement, cold weather, lying down, vivid dreams

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86
Q

Apart from chest pain/heaviness name some symptoms seen in angina?

A

SOB, sweating and feeling light headed/dizzy

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87
Q

What bloods may you request on diagnosing angina?

A

FBC - exclude anaemia, TFTs - exclude thyrotoxicosis, U&Es - exclude renal disease/if considering ACEi, Lipid profile - exclude hypercholesterolaemia, FPG/OGTT - exclude diabetes,

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88
Q

How does aspirin work?

A

Cyclooxygenase 1 and 2 inhibitor which reduces the ability of platelets to aggregate by blocking thromboxane A2 formation

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89
Q

Give 5 signs of pulmonary oedema?

A

Tachycardia, Tachypnoea, Raised JVP, Cyanosis, Dyspnoea and coarse crepitations on auscultation

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90
Q

Mx of acute pulmonary oedema?

A

Oxygen, IV furosemide, IV morphine, GTN

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91
Q

What is a capture beat on ECG?

A

A normal QRS seen between VT complexes

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92
Q

How does salbutamol work?

A

Causes relaxation of the airway smooth muscles by activating beta 2 receptors in the respiratory tract

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93
Q

Mx of COPD exacerbation?

A

Oxygen (targets 88-92% until pCO2 is confirmed as normal), Salbutamol/ipratropium nebulisers, steroids, consider IV theophylline and NIV and chest physio

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94
Q

What tests would you do when seeing a ?CAP in hospital?

A

CXR, sputum cultures, ABG, urinary antigen testing

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95
Q

Why are 4 antibiotics used in TB?

A

To combat multi-drug resistance

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96
Q

What can cause erythema nodosum?

A

TB, sarcoidosis, idiopathic, Crohn’s/UC, strep infection, oral contraceptives and chlamydia

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97
Q

Causes of reduced chest expansion?

A

Symmetrical = pulmonary fibrosis
Asymmetrical = pneumothorax, pneumonia and pleural effusion

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98
Q

Abnormal findings in percussion and their causes?

A

Dullness = tumour, lung collapse, consolidation
Stony dullness = pleural effusion
Hyper-resonance = pneumothorax

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99
Q

Causes of increased and decreased vocal resonance?

A

Increased = consolidation, tumour or collapse
Decreased = pleural effusion or pneumothorax

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100
Q

Name some abnormal findings on auscultation of the lungs and their causes?

A

Bronchial breathing = consolidation
Quiet breath sounds = pleural effusion or pneumothorax
Wheeze = asthma, COPD or bronchiectasis
Stridor = foreign body inhalation and subglottic stenosis
Coarse crackles = pneumonia, bronchiectasis and pulmonary oedema
Fine end-inspiratory crackles = pulmonary fibrosis

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101
Q

Causes of CKD?

A

DM, HTN, Chronic Glomerulonephritis, Chronic Pyelonephritis, Polycystic Kidney Disease

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102
Q

When should you start ACEis in CKD?

A

If there is DM and ACR >3
If there is HTN and ACR >30
If there is ACR >70

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103
Q

Signs of chronic kidney disease?

A

Pallor, flapping tremor, HTN, peripheral oedema, bruising/purpura, proximal myopathy

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104
Q

Complications of peritoneal dialysis?

A

Local infection at catheter site, peritonitis, sclerosing peritonitis and failure

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105
Q

When is transplant rejection classed as chronic?

A

If it occurs after 6 months

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106
Q

What is the action of PTH?

A

Increases calcium and phosphate resorption from the bones. Increases activation of vitamin D which increases calcium and phosphate absorption from the gut. Increases reabsorption of calcium at the kidneys and increases phosphate excretion at the kidneys

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107
Q

Where is vitamin D activated?

A

First the liver and then the kidneys

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108
Q

What is it called when the bones are damaged secondary to CKD (and hyperparathyroidism)

A

CKD Mineral Bone Disease aka Renal Osteodystrophy

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109
Q

Name some pre-renal, renal and post-renal causes of AKI?

A

Pre-renal = Hypovolaemia, renal artery stenosis and sepsis
Renal = Glomerulonephritis, acute tubular necrosis, acute interstitial nephritis, rhabdomyolysis, tumour lysis syndrome and nephrotoxic drugs/contrast
Post-renal = kidney stones, BPH and prostate/bladder cancer compressing the ureter

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110
Q

When is haemodialysis indicated in AKI?

A

Treatment resistant hyperkalaemia, pulmonary oedema, metabolic acidosis an uraemic encephalopathy/pericarditis

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111
Q

How does rhabdomyolysis cause AKI?

A

Myoglobin becomes stuck in the tubules leading to acute tubular necrosis

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112
Q

What is seen on urinary microscopy in AKI caused by rhabdomyolysis?

A

Urinary myoglobin

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113
Q

Causes of rhabdomyolysis?

A

Statins, long lie, excessive exercise, crush injuries, burns, seizures, neuroleptic malignant syndrome, heroin and MDMA

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114
Q

What are the 4 most common causes of pneumonia?

A

Strep. Pneumoniae (most common), Haemophilus Influenzae, Mycoplasma Pneumoniae, Staph Aureus (common after influenza infection)

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115
Q

X-ray changes in RA?

A

Early = loss of joint space, juxta-articular osteoporosis/osteopenia, soft tissue swelling
Late = periarticular erosions and subluxation

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116
Q

Extra-articular manifestations of RA?

A

Pulmonary fibrosis, bronchiolitis obliterans, pleural effusions, Sjogren’s syndrome, scleritis/episcleritis, anaemia, rheumatoid nodules, carpel tunnel syndrome

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117
Q

What is Felty’s syndrome?

A

RA, Neutropenia and splenomegaly

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118
Q

How do NSAIDs treat rheumatological issues?

A

They are COX inhibitors, this reduces prostaglandin secretion thereby reducing inflammation

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119
Q

What is it called when there are calcium phosphate crystals seen in the joint space on XR?

A

Chondrocalcinosis. If seen this is pathognomic of pseudo-gout

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120
Q

Which joints are most commonly affected in pseudogout?

A

Knee (most common), shoulders, wrists and hips

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121
Q

Which conditions pre-dispose to Pseudogout?

A

Hemochromatosis, Hyperparathyroidism, Acromegaly, Wilson’s disease, increasing age, low magnesium and low phosphate

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122
Q

What is seen on examination in a OA joint?

A

Swelling and tenderness, crepitus, reduced ROM, muscle wasting, may be bony deformity (e.g. Heberden’s/Bouchard’s nodes or fixed flexion deformities)

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123
Q

Name some features of Acromegaly?

A

Coarse facial appearance, spade like hands, increased shoe size, large tongue, protrusion of the mandible, increased interdental space, excessive sweating and oily skin, pituitary tumour Sx and galactorrhoea

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124
Q

Name 4 important complications of acromegaly?

A

HTN, DM (GH is anti-insulin), Cardiomyopathy (CVD is the most common cause of death) and colorectal cancer

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125
Q

How does the OGTT help in diagnosing acromegaly?

A

Normally GH is suppressed with hyperglycaemia however in acromegaly it will not be suppressed

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126
Q

Which drug can cause hyper and hypo thryoidism?

A

Amiodarone

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127
Q

Signs of hypothyroidism?

A

Weight gain, lethargy, cold intolerance, dry skin, coarse hair/hair loss, loss of lateral aspect of the eyebrows, constipation, oedema, hyporeflexia, menorrhagia and carpal tunnel syndrome

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128
Q

Which anatomical structure represents the site at which the thyroid gland originated before embryological descent?

A

The foramen caecum

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129
Q

Signs of Hyperthyroidism (not specific to Grave’s)

A

Anxiety/irritability, sweating, heat intolerance, tachycardia, weight loss, fatigue, diarrhoea, sexual dysfunction, menorrhagia, palmar erythema and warm peripheries

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130
Q

What hormones are secreted by the posterior pituitary?

A

Vasopressin and Oxytocin

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131
Q

What are the autonomic Sx of hypoglycaemia - occur when BM is <3.3?

A

Sweating, shaking, anxiety, hunger and nausea

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132
Q

What are the neuroglycopenic Sx of hypoglycaemia (when BM is <2.8)?

A

Weakness, vision changes, confusion, dizziness, convulsion and coma

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133
Q

Causes of hypoglycaemia in non diabetics?

A

Insulinoma, liver failure, Addison’s disease, alcohol excess

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134
Q

What signs do you see commonly in lymphoma?

A

Lymphadenopathy, and hepatosplenomegaly

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135
Q

How do you stage Hodgkin’s Lymphoma?

A

Ann-Arbor staging

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136
Q

Signs of iron deficiency anaemia?

A

Pallor, Tachypnoea, Tachycardia, Ejection systolic murmur, Hair loss, Koilonychia, Atrophic glossitis, Angular stomatitis

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137
Q

Mx of Sickle cell anaemia?

A

Hydroxycarbamide (aka Hydroxyurea), Penicillin V and ensure vaccines are UTD

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138
Q

Name some precipitants for thrombotic crises in sickle cell?

A

Infection, dehydration, cold weather and deoxygenation (e.g. high altitude)

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139
Q

What is multiple myeloma?

A

Malignant clonal proliferation of beta lymphocytic plasma cells

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140
Q

What is seen on serum electrophoresis, peripheral blood film and in the urine in myeloma?

A

Serum electrophoresis = raised IgA and IgG
Peripheral blood film = Roleaux formations
Urine = Bence Jones Proteins

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141
Q

Name some complications of myeloma?

A

Infection, Pain, AKI, Anaemia, Hypercalcaemia, Peripheral neuropathy, Spinal cord compression and hyperviscosity

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142
Q

What are the causes of massive splenomegaly?

A

Myelofibrosis, CML, Malaria

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143
Q

How can we tell between chronic and acute leukaemia on blood film?

A

In acute leukaemia there are only immature white blood cells (blast cells)
In chronic leukaemia there are white cells at all stages of maturation (including mature)

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144
Q

What is the 1st line Mx of CML?

A

Imatinib - a tyrosine kinase inhibitor

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145
Q

What monitoring should you do in myasthenia crisis

A

Do serial FVC measurements and negative inspiratory force measurements

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146
Q

Sx of haemachromatosis

A

Fatigue, erectile dysfunction, arthralgia, bronze pigmentation of the skin, liver disease, DM, dilated cardiomyopathy and arthritis

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147
Q

Ix of hereditary haemachromatosis

A

Raised transferrin saturation (most useful), raised ferritin, low TIBC, Hypogonadotrophic hypogonadism.
Also test family for HFE mutation (it is autosomal recessive)

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148
Q

Mx of haemachromatosis?

A

Venessaction 1st line
Desferrioxamine 2nd line

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149
Q

Sx of Wilson’s disease

A

Hepatitis, Cirrhosis, basal ganglia degeneration, psychiatric problems, asterixis, chorea, dementia, kayser-fleisher rings, blue nails, haemolysis and renal tubular acidosis

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150
Q

Ix of Wilson’s disease?

A

Decrease serum caeruloplasmin, decreased serum copper, 24 hour urinary copper excretion is increased
It is AR

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151
Q

Mx of Wilson’s disease

A

Penicillamine

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152
Q

1st line Mx prolactinoma

A

Carbergoline or Bromocriptine

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153
Q

1st line Ix of a neck lump?

A

USS of the neck

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154
Q

What drug class is dipyrimadole?

A

Antiplatlet

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155
Q

Mx SVCO

A

IV Dexamethasone, Insert endovascular stent if there is stridor

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156
Q

Most common cause of cellulitis?

A

Strep pyogenes

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157
Q

If there is an isolated unexpected rise in potassium?

A

Repeat the sample as it may be haemolysed

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158
Q

What nerve lesion causes foot drop

A

Common peroneal nerve

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159
Q

Mx biliary colic

A

Elective laproscopic cholecystectomy

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160
Q

What should you give if major bleeding on warfarin?

A

IV vitamin K and prothrombin complex, only use fresh frozen plasma if there is not PTC available

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161
Q

How do you manage venous ulcers?

A

Compression stockings

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162
Q

Where does ovarian cancer commonly metastasise to?

A

The pelvic/para-aortic lymph nodes

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163
Q

What are the blood tests like in DIC?

A

Low platelets, low fibrinogen, high PT, high APTT, high fibrinogen degradation products
Schistocytes are seen

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164
Q

What will water deprivation tests show in nephrogenic DI?

A

After water deprivation (8 hours) urine osmolality = low
After ADH is given urine osmolality = low
There is also hypernatremia

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165
Q

What will water deprivation tests show in cranial DI?

A

After water deprivation (8 hours) urine osmolality = low
After ADH is given urine osmolality = high
There is also hypernatremia

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166
Q

What will water deprivation tests show in psychogenic polydypsia?

A

After water deprivation (8 hours) urine osmolality = high
After ADH is given urine osmolality = high

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167
Q

Where is pain felt in De Quervian’s tenosynovitis? Which test do you investigate it with? Mx?

A

Over the radial aspect of the wrist
Ix = Finkelstein’s test
Mx = Analgesia, splinting and steroid injections

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168
Q

How should you manage DM drugs if you are undergoing a morning surgery?

A

Take metformin or DDP 4 inhibitors (-gliptins) as normal
Omit sulfonylureas (e.g. gliclazide), GLP-1 analogues (-tides) and SGLT-2 inhibitors (-flozins)

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169
Q

What can cocaine cause?

A

Coronary artery spasm (leading to ischaemia or infarction). It can also cause seizures

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170
Q

What is fibrocystic disease?

A

Aka fibroadenosis
It causes cyclical breast pain and lumpy breasts in middle aged women

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171
Q

Which joints are most commonly affected in RA?

A

The hands and feet

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172
Q

Where are epidydimal cysts found?

A

Above and behind the testes

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173
Q

What should you do with a patient presenting with an unprovoked DVT?

A

Offer CT abdo pelvis to identify possible malignancies

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174
Q

True or false, both ESR and CRP are often elevated in PMR?

A

True! Elevated ESR is associated with a worse prognosis

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175
Q

What can be seen histologically in Crohn’s disease?

A

Granulomas, transmural inflammation, lymphocytic infiltration

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176
Q

Which part of the bowel is most commonly affected in Crohn’s?

A

The terminal ileum

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177
Q

Name some extra-intestinal symptoms of Crohn’s?

A

Aphthous mouth ulcers, erythema nodosum, conjunctivitis/episcleritis, enteropathic arthritis, metabolic bone disease

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178
Q

Complications of Crohn’s long term?

A

Colorectal cancer, perianal abscess/fistulas, perforated bowel, SBO, malnutrition

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179
Q

Ix of oesophageal varices and peptic ulcers?

A

Oesophagogastroduodenoscopy

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180
Q

Name a portosystemic anastomoses and the symptom it causes in portal vein hypertension?

A

Paraumbilical vein shunt leading to visible veins in the chest

181
Q

How does the urea breath test work?

A

H.pylori produces urease which breaks down urea to ammonium and carbon dioxide, therefore increasing ammonium levels

182
Q

Mx of H.pylori?

A

Amoxicillin + Clarithromycin OR Metronidazole + PPI
If pen allergic Clarithromycin AND Metronidazole + PPI

183
Q

Ix of ?peptic ulcer perforation?

A

Erect chest XR - looking for pneumoperitoneum

184
Q

What conditions may cause gastrin levels to be high in the body?

A

Gastrin secreting tumour of the duodenum or pancreas, seen in MEN 1 or Zollinger-Ellison Syndrome

185
Q

What is the gold standard for investigating GORD?

A

24 hour Oesophageal pH monitoring

186
Q

Name some causes of dysphagia?

A

Oesophageal CA, Oesophagitis, Achalasia, Pharyngeal pouch, MG, Oesophageal stricture

187
Q

How does Nissen Fundoplication work? Name a side effect?

A

Helps to strengthen the gastro-oesophageal junction and sphincter. There is a risk that it can compress the GOJ leading to dysphagia

188
Q

1st line Ix for obstructive jaundice (confirmed on blood tests)?

A

Abdo USS

189
Q

What is the most common type of pancreatic cancer? How do you investigate?

A

adenocarcinoma - CT abdo

190
Q

Name some complications of persistent jaundice?

A

Increased susceptibility to infection, pruritus, liver dysfunction, AKI and nutritional dysfunction

191
Q

Describe Kernig’s sign

A

Pain on passive extension of the knee when the hips and knees are flexed to 90 degrees, is associated with meningitis

192
Q

What is Brudzinski sign?

A

Severe neck stiffness which causes a patients hips and knees to flex when the neck is flexed

193
Q

Which bones meet at the pterion?

A

Temporal, parietal, frontal and sphenoid bones

194
Q

What shape is SAH, EDH and SDH on CT?

A

SAH = blood distributed in the basal cisterns and sulci, EDH = biconvex, SDH = crescent

195
Q

RFs for an ischaemic stroke?

A

Cardiovascular disease, AF, TIA/previous stroke, carotid artery disease, HTN, DM, smoking, COCP, thrombophilia

196
Q

Define hemiparesis and hemiplegia?

A

Hemiparesis = partial weakness of both limbs on 1 side
Hemiplegia = complete paralysis of both limbs on 1 side

197
Q

When can you consider doing a carotid endarterectomy/stenting post stroke?

A

If there is carotid artery disease with >70% stenosis

198
Q

Define epilepsy?

A

Intermittent abnormal electrical activity in the brain which manifests as seizures

199
Q

Define aura?

A

Symptoms experienced at the start of a seizure which precede other seizure symptoms

200
Q

Name some metabolic causes of seizure?

A

Hyponatraemia/Hypernatraemia, Hypocalcaemia, uraemia, low blood glucose and anoxia

201
Q

What is it called when you lose vision in both peripheries?

A

Bitemporal hemianopia

202
Q

Causes of a homonymous hemianopia?

A

Incongruous (uneven) defect? = lesion of the optic tract
Congruous (the same in both eyes) = lesion of the optic radiation or occipital cortex
Macula sparing = lesion of the occipital cortex

203
Q

Why does the pain in appendicitis move?

A

Initially the visceral peritoneum is irritated, this has no somatic innervation so pain is referred to the periumbilical region. As it becomes more inflamed the appendix irritates the parietal peritoneum, this has somatic innervation so pain localises

204
Q

What is a diverticulum?

A

An outpouching of the bowel mucosae through a whole in the muscular wall. Most commonly seen in the sigmoid colon

205
Q

Define diverticulosis, diverticular disease and diverticulitis?

A

Diverticulosis = the presence of asymptomatic diverticula
Diverticular disease = symptomatic diverticula
Diverticulitis = infection and inflammation of the diverticula

206
Q

Complications if diverticulitis?

A

Bowel perforation, bleeding, abscess, strictures and colovesical/colovaginal fistula

207
Q

What is a hernia?

A

The protrusion of a structure through the wall of the cavity it is usually contained in

208
Q

What causes indirect inguinal hernias?

A

A patent processus vaginalis

209
Q

Define obstructed and strangulated hernias?

A

Obstructed = bowel contents can not pass through it
Strangulated = ischaemia of the bowel

210
Q

Name some complications of hernia repair?

A

Reoccurrence, bladder/bowel damage and hydrocoele

211
Q

Sx and Ix of haemarrhoids?

A

Sx = fresh red rectal bleeding, sore/itchy anus and feeling a lump around or inside the anus.
Ix = FBC, PR examination and proctoscopy

212
Q

Mx of haemarrhoids?

A

TOP analgesics or steroids, increase the amount of fibre/fluid intake, rubber band ligation, infra-red coagulation, haemorrhoidal artery ligation and haemorrhoidectomy

213
Q

Which blood vessels supply the bowel?

A

Foregut = coeliac artery
Midgut = superior mesenteric artery
Hindgut = inferior mesenteric artery

214
Q

Ix of Acute Mesenteric Iscaemia? What is the aim of surgery?

A

Contrast CT or Ct angiogram
Metabolic acidosis, raised lactate, raised CRP and WCC
Surgery aims to remove necrotic bowel and remove or bypass the thrombus to reperfuse the bowel

215
Q

How should you investigate ascites?

A

Do an Abdo USS to assess the liver, spleen, pancreas and lymph nodes. Then if it is painful (tense ascites) do an investigative ascitic tap or a therapeutic paracentessis

216
Q

What will the LP be like in bacterial meningitis?

A

Raised opening pressure, increased WCC (mainly neutrophils), raised protein and low glucose

217
Q

What will the LP be like in viral meningitis?

A

Normal opening pressure, mildly raised WCC (lymphocyte dominant), mildly raised protein and normal glucose

218
Q

What may be seen in a contaminated urine sample?

A

Mixed growth (on culture) or epithelial cells (on microscopy)

219
Q

On oesophageal biopsy you find columnar epithelium and goblet cell with paneth cells. What is this?

A

Barrett’s oesophagus (intestinal metaplasia)

220
Q

What is para protein?

A

AKA Bence Jones Protein it is seen in the blood/urine in multiple myeloma

221
Q

Sx, Ix and Mx of HSP?

A

Purpuric rash (on the buttocks and extensor surfaces of the legs), arthritis/arthralgia, abdo pain, proteinuria/haematuria
Ix = IgA deposits, protein/haematuria
M = supportive, monitor BP (to look for HTN) and do urine dip (to monitor renal status)

222
Q

What is involved in a triple assessment of a breast lump?

A

Physical exam, imaging (mammogram or USS) and core biopsy

223
Q

What are monoclonal IgG Kappa associated with?

A

Multiple Myeloma

224
Q

Describe phaeochromocytoma?

A

Sx = Episodic headaches, HTN, palpitations, sweating and anxiety
Ix = 24 hour urinary metanephrines
Mx = phenoxybenzamine then propranolol then surgery

225
Q

Sx of vestibular neuronitis?

A

Recurrent vertigo lasting hours-days, N+V, horizontal nystagmus and no hearing issues

226
Q

Describe atelectasis?

A

Basal alveolar collapse post surgery. Causes dyspnoea and hypoxia less than 72 hours post surgery.
Mx = position the patient upright and give chest physio

227
Q

Sx of a temporal focal seizure?

A

A rising epigastric sensation (aura) and automatisms

228
Q

What is the Ix of choice for ?lung cancer?

A

CT scan

229
Q

What does a low base excess imply?

A

A lower than normal base level

230
Q

What should you do in those taking clozapine who become ill?

A

Do a FBC

231
Q

1st line Mx of PBC?

A

Ursodeoxycholic acid

232
Q

True or false, inflammation of the parotid glands can be seen in Sjogren’s Syndrome?

A

TRUE

233
Q

Mx pericarditis?

A

NSAIDs and Colchicine

234
Q

What is seen on Ix of ITP?

A

Isolated thrombocytopenia

235
Q

Describe SBP?

A

Ascites, abdo pain and fever in those with existing liver disease.
Ix = Neutrophils >250 on paracentesis, grows E.coli
Mx = IV cefotaxime and prophylaxis ciprofloxacin/norfloxacin

236
Q

When should you use rhythm control over rate control in AF Mx?

A

HF, 1st onset of AF or if there is an obvious reversible cause e.g. CAP
If AF >48 hours anticoagulate for at least 3 weeks before cardioversion

237
Q

Describe the results of the treponemal and non-treponemal test?

A

TT positive and NTT positive = active syphilis
TT negative and NTT positive = false positive (e.g. due to HIV, TB, SLE or pregnancy)
TT positive and NTT negative = treated syphillis

238
Q

How long should you treat with metformin before you can consider increasing the dose?

A

At least 1 week

239
Q

Sx of acute haemolytic reaction?

A

Abdo pain, fever and wheeze following transfusion

240
Q

Sx and Mx of Rheumatic Fever?

A

Sx = recent sore throat, rash, arthritis and murmur (mitral or aortic stenosis)
Mx = Pen V and NSAIDs

241
Q

Describe Beta hCG?

A

It is secreted by the syncytiotrophoblast. It is detectable from day 8 and doubles every 48 hours before peaking at 8-10 weeks

242
Q

What should you consider as the cause of bilateral carpel tunnel syndrome?

A

<50 = ?RA
>50 = ?Acromegaly

243
Q

What are the causes of post-splenectomy sepsis?

A

NHS
Neisseria Meningitidis
H. influenzae
Strep. pneumoniae

244
Q

Describe Autonomic hyperreflexia?

A

Seen in those with a spinal lesion at T6 or above
Constipation or urinary retention causes extreme HTN, flushing and sweating. This can lead to a haemorrhagic stroke

245
Q

How do kidney stones appear on X-ray?

A

Urate and Xanthine stones are radiolucent
Cystine stones are semi-opaque

246
Q

Miscarriage Mx?

A

Expectant for 7-14 days unless there is infection, increased risk of haemorrhage (late 1st trimester or coagulopathy) or previous trauma
Medical = vaginal misoprostol
Surgical or vacuum aspiration

247
Q

True or false, severe iron deficiency anaemia can cause dysphagia?

A

True

248
Q

Where are sebaceous cysts most commonly located?

A

On the scalp

249
Q

Which antibodies are seen in anti-phospholipid syndrome?

A

Lupus anticoagulant and anti-cardinolipin antibodies

250
Q

What diagnosis should you consider in a patient with diarrhoea, fatigue and osteomalacia?

A

Coeliac’s disease

251
Q

What is Eisenmenger’s syndrome?

A

The reversal of a left to right shunt leading to cyanosis

252
Q

What indicated beta thalassaemia trait as the cause of anaemia?

A

Microcytic anaemia with a very low MCV compared to Hb levels and normal iron

253
Q

What is a Richter Hernia?

A

Strangulation of a hernia without the Sx of bowel obstruction
Ix = metabolic acidosis and an erythematous mass with signs of ischaemia and necrosis

254
Q

What should you always prescribe when you prescribe a bisphosphonate?

A

Calcium supplements if the dietary intake is insufficient and vitamin D supplements

255
Q

Mx of hypercalcaemia?

A

IV fluids unless calcium is >3 then give IV bisphosphonates

256
Q

When should you never do an LP in ?meningitis?

A

Non-blanching petechial rash or Sx of raised ICP (e.g. papilloedema)

257
Q

What scale is used in post-natal depression?

A

The Edinburgh scale

258
Q

Which nerve root leads to foot drop if damaged?

A

L5

259
Q

What is the Simmonds triad of Achilles tendon rupture?

A

Palpation of the Achilles tendon, perform a calf squeeze and observe for a normal angle of declination of the foot (one foot is more dorsiflexed than the other)

260
Q

Which type of betablockers can cause peripheral vasoconstriction?

A

Non-cardioselective e.g. propranolol, carvedilol or labetalol

261
Q

SEs of the contraceptive implant?

A

Irregular heavy bleeding (can be managed with the COCP), headache, nausea and breast pain
No increased of VTE or migraines
It can be inserted immediately post TOP

262
Q

True or false, enzymes in the small intestine are more acidic than enzymes in the colon?

A

False, they are more alkaline!

263
Q

List 5 causes of acute urinary retention?

A

BPH, UTI, constipation, anticholinergics/opioids, post-analgesia and calculi stuck in the urethra

264
Q

What can occur after catheter insertion for urinary retention?

A

Post-obstruction diuresis. Ensure you monitor fluid output and correct losses

265
Q

Causes of macroscopic haematuria?

A

BPH, renal calculi, UTI, nephritic syndrome and renal tract trauma/tumours

266
Q

Risk factors for bladder cancer?

A

Smoking, exposure to alanine dyes, rubber manufacture and cyclophosphamides

267
Q

Mx of bladder CA?

A

TURBT or radical cystectomy

268
Q

Define sensitivity?

A

The ability of a test to correctly identify patients with a disease

269
Q

Define specificity?

A

The ability of a test to correctly identify people without the disease

270
Q

What factors must be true for a screening test to be made available to the public?

A

Test must be cost effective and acceptable to the population, the course of the disease being screened for must be known, there must be early symptoms of the disease which can be seen, there must be an effective treatment available to all with the disease

271
Q

Ix of prostate cancer?

A

Multiparametric MRI

272
Q

Ix of testicular torsion?

A

Urgent scrotal exploration. Timely identification and treatment is needed to prevent scrotal ischaemia and necrosis

273
Q

Name 4 layers which are dissected in scrotal exploration?

A

Skin, Cremaster muscle, External/Internal spermatic fascia

274
Q

What are the most common type of renal tumours in children vs adults?

A

Children = Nephroblastoma (Wilm’s tumour)
Adults = Renal cell carcinoma

275
Q

What can happen to Hb in renal CA?

A

Some renal CA cause increase in EPO levels leading to a rise in Hb

276
Q

RFs for RCC?

A

Smoking, obesity, increasing age, HTN, male and long term dialysis

277
Q

Which bacteria is most likely to cause septic arthritis? Which should you consider if there is a metal prosthesis?

A

Most likely staph aureus, consider Staph. epidermis if there is a prostesis

278
Q

RFs for septic arthritis?

A

Immunocompromise, intra-articular injections, RA, DM, penetrating injury

279
Q

Which muscles allow shoulder abduction?

A

Supraspinatus for 1st 15 degrees then deltoid to 90 degrees then trapezius and serratus anterior

280
Q

Which blood tests should you always do in trauma with a low BP?

A

FBC, U&Es, Coagulation screen/clotting profile and group and save/crossmatch

281
Q

Mx of tension pneumothorax?

A

Needle decompression then insert a chest drain

282
Q

What should you consider as a cause of dull percussion and tracheal deviation away in trauma? How would you manage?

A

Haemothorax, Mx = insert chest drain

283
Q

Which three knee structures are often injured together?

A

ACL, MCL and medial meniscus

284
Q

Where can a graft be taken from to repair ACL injruy?

A

Hamstring/Quadriceps tendon

285
Q

What should you consider as the cause of an AKI in a hypovolaemic patient?

A

Pre-renal hypoperfusion of the kidney

286
Q

What is seen in Acute Tubular Necrosis?

A

AKI with muddy brown casts on urinalysis

287
Q

What is seen in asbestosis?

A

Lower lobe fibrosis associated with dyspnoea, clubbing and bilateral end inspiratory crackles

288
Q

What should you suspect if there are multiple nodules on a CXR and weight loss?

A

?Metastatic CA

289
Q

Sx of adhesive capsulitis?

A

Dull shoulder pain which often disturbs sleep which is followed by stiffness and loss of shoulder mobility. It is commonly seen in those with DM

290
Q

Can COPD cause weight loss? How do you Ix COPD

A

Yes!
Ix = spirometry

291
Q

How raised is amylase in pancreatitis?

A

Typically >3x upper limit of normal

292
Q

Reversal of hypoglycaemia in an unconscious patient?

A

IV 20% glucose

293
Q

When does neutropenic sepsis often occur after chemotherapy? What should you do if you suspect it?

A

7-14 days after chemotherapy
If you suspect it give immediate ABx (do NOT wait for WBC count)

294
Q

What should you do if serum creatinine has increased but by <30%?

A

No need to change medications, instead repeat renal function at 2-4 weeks

295
Q

Ix of any acute abdomen post-surgery?

A

Contrast CT abdomen

296
Q

When should you give oxygen in STEMI?

A

If sats fall below 94%

297
Q

Ix of renal colic?

A

Non-contrast CT KUB

298
Q

What should you do in ?septic arthritis if the gram stain is negative?

A

Still give IV Abx whilst you await culture results

299
Q

Mx RA flares?

A

PO/IM steroids

300
Q

Which drugs should you consider starting if metformin is contraindicated in T2DM?

A

Pioglitazone, Sulfonylurea, DPP-4 inhibitor or SGLT-2 inhibitor

301
Q

What should you do if a patient has a large PE but is high risk of haemorrhage?

A

Give IV unfractionated heparin

302
Q

Can you give indapamide for BP management when the creatinine clearance is <30?

A

No, thiazide like diuretics are ineffective when creatinine clearance is <30
Consider furosemide instead

303
Q

True or false, you must always have focal neurological signs to have cerebral metastases?

A

FALSE
They can cause raised ICP Sx without focal neurology

304
Q

What is classes as pre-diabetes?

A

HbA1c 42-47
FPG 6.1-6.9
Refer these patients to a diabetes prevention programme

305
Q

Mx of short duration lower back pain in an otherwise healthy individual?

A

No Mx required, continue usual activities

306
Q

Sx of an Addisonian crisis?

A

Reduced consciousness, hypoglycaemia, hyponatraemia, hyperkalaemia, hypotension
It is often preceded by weight loss and lethargy

307
Q

Ix of ?norovirus?

A

Stool PCR

308
Q

Coagulation profile in DIC?

A

Low platelets, low fibrinogen, high PT, high APTT, high fibrinogen degradation products

309
Q

What is Meckel’s diverticulum?

A

Abdo pain which may mimic appendicitis, massive painless GI bleeding in children and bowel obstruction

310
Q

SBO Mx?

A

NG tube insertion and IV fluids

311
Q

What is classed as a moderate UC flare?

A

4-6 loose stools per day with minimal systemic upset.
Less than this is a mild flare up

312
Q

True or false, ciprofloxacin lowers the seizure threshold?

A

True

313
Q

Pyoderma gangrenosum is associated with IBD, what skin manifestations can it cause?

A

Very painful skin ulceration - especially on the legs

314
Q

What metabolic abnormality is caused by vomiting?

A

Metabolic alkalosis with low potassium

315
Q

Mx of SVT in a shocked patient?

A

Synchronised D/C cardioversion

316
Q

Which TB drug can cause lupus? Which antibody is drug induced lupus associated with?

A

Isoniazid
Anti-histone antibody

317
Q

Mx of PMS?

A

Conservative measures (e.g. frequent small meals which are rich in carbohydrates)
COCP
SSRIs if severe

318
Q

What does down’s syndrome cause on the quadruple test?

A

Low alpha fetoprotein, low unconjugated oestradiol, high beta HCG and high inhibin A

319
Q

What are electrical alternans?

A

QRS complexes which have amplitudes which alternate between each beat.
Seen in pericarditis

320
Q

What does the Barthel index measure?

A

The degree of assistance which is required by an individual

321
Q

What should you offer to all women who have had a previous child with illness secondary to group B strep?

A

Intrapartum IV Benzylpenicillin

322
Q

What should you do with a perforated TM?

A

Advise the patient to keep it dry and review in 6-8 weeks

323
Q

What is the gold standard investigation for a perianal fistula in Crohn’s?

A

MRI of the pelvis

324
Q

Which antibodies are seen in sjogren’s syndrome?

A

Anti-Ro and ANA

325
Q

What should you do if a patient has been on a bisphosphonate for more than 5 years?

A

Repeat DEXA and FRAX sore and reassess risk

326
Q

When is chronic urinary retention classed as high pressure?

A

If there is impaired renal function or bilateral hydronephrosis

327
Q

What should you ALWYAS consider in a patient with a RUQ mass and painless jaundice?

A

Pancreatic cancer

328
Q

True or false, CBD stones can cause epigastric pain which radiates to the back?

A

TRUE

329
Q

What is PSC a risk factor for?

A

Cholangiocarcinoma

330
Q

What is an important complication of chronic Chagas disease?

A

Cardiomyopathy

331
Q

What are the missed pill rules from the COCP e.g. microgynon?

A

If 1 pill is missed no EC is required, take last pill asap
If 2 or more pills missed take the last pill and use barrier methods for 7 days. If week 1 take EC, if week 2/3 no EC required but if week 3 omit pill free interval

332
Q

Which lung function test can be reduced in recurrent PEs and why?

A

Reduced TLCO as oxygen is not able to diffuse efficiently from alveoli to capillaries

333
Q

Which type of diuretics can be associated with digoxin toxicity?

A

Thiazide diuretics

334
Q

Ix menorrhagia?

A

TVUS

335
Q

Can calcium be raised in secondary hyperparathyroidism?

A

NO, never
If it is raised and there is a low/normal phosphate you should suspect tertiary hyperparathyroidism

336
Q

What are bullae?

A

Air spaces in the lungs. Large emphysematous bullae may imitate pneumothorax
Large blisters of the skin share the same name

337
Q

Mx athletes foot?

A

TOP miconazole

338
Q

Mx OE in diabetics?

A

Ciprofloxacin to cover pseudomonas

339
Q

When should you give acetylcysteine without waiting for paracetamol plasma concentration in paracetamol OD?

A

When a patient presents with an OD 8-24 hours ago where they have taken >150mg/kg

340
Q

SVT Mx if haemodynamically stable?

A

Adenosine IV 6mg, then 12mg then 18mg, then DC cardioversion.
If asthmatic give verapamil

341
Q

Which antibodies can be used as part of follow up in thyroid cancer?

A

Thyroglobulin

342
Q

What is raised in medullary thyroid cancer?

A

Calcitonin

343
Q

Which type of MND has the worst prognosis?

A

Progressive bulbar palsy

344
Q

Imaging in ?TIA?

A

Diffusion weighted MRI

345
Q

What is the strongest risk factor for anal cancer?

A

HPV infection

346
Q

Mx of perthe’s disease in children under 6?

A

Observation only

347
Q

Which muscle initiates arm abduction at the shoulder?

A

Supraspinatus

348
Q

What medication should you use in MI if cocaine is the cause?

A

Diazepam

349
Q

Ix of carotid artery stenosis?

A

Duplex USS

350
Q

Which electrolyte abnormality can precipitate digoxin toxicity?

A

Hypokalaemia

351
Q

Define orthostatic hypotension?

A

A drop in BP of >20 systolic or >10 diastolic within 3 mins of standing

352
Q

Prophylaxis of VTE in pregnancy?

A

MUST be LMWH

353
Q

Most common cause of tonsillitis?

A

Strep Pyogenes

354
Q

Name 2 side effects of bendroflumethiazide?

A

Can cause ED and affect glucose tolerance

355
Q

How should you monitor the Mx of hemochromatosis?

A

With transferrin saturation and serum ferritin

356
Q

What should you do if the expectant Mx of miscarriage fails after 14 days?

A

If haemodynamically stable offer misoprostol medical Mx
If unstable offer surgical Mx

357
Q

What is seen in CT in diverticulitis?

A

Mural thickening of the colon with pericolic fat stranding the sigmoid colon

358
Q

Should you mix adrenaline in to the lidocaine when applying local anaesthetics to the digits?

A

NO
It can cause ischaemia

359
Q

What is suxamethonium apnoea?

A

An AD condition which leads to prolonged muscle paralysis requiring ITU admission

360
Q

Posterior inferior cerebellar stroke signs?

A

Cerebellar signs, contralateral sensory loss and ipsilateral horners syndrome

361
Q

1st line Mx impetigo?

A

1% TOP hydrogen peroxide

362
Q

Define PPH?

A

Blood loss of more than 500mls of blood after vaginal delivery
If it occurs within 24 hours it is primary, secondary is 24 hours to 6 weeks

363
Q

From when should you start doing smears every 5 years?

A

From 50

364
Q

What are Cullen’s and Grey-Turner’s sign?

A

Cullen’s = Periumbilical discolouration
Grey-Turner’s = flank discolouration

365
Q

What is lichen planus?

A

Polygonal flat-topped papule lesions that are purple and pruritic. Seen on flexural surfaces and oral involvement is common

366
Q

Most common cause of discitis?

A

Staph Aureus

367
Q

What is the difference between ALS and PLS?

A

ALS = UMN and LMN signs
PLS = UMN signs only

368
Q

1st line Mx of T1DM?

A

Basal bolus using twice daily insulin

369
Q

1st line Mx of spasticity in MS?

A

Baclofen and Gabapentin

370
Q

Sudden painless vision loss with dark spots in the vision in a diabetic should raise suspicion of what?

A

Vitreous haemorrhage

371
Q

Ix Mallory-Weiss Tear vs Boerhaave?

A

Mallory-Weiss = endoscopy
Boerhaave = CT contrast swallow

372
Q

A PEFR below what % is considered life threatening?

A

<33% predicted

373
Q

Describe intermittent claudication?

A

Cramping leg pain on exercise relived by rest
Mx = exercise training, atorvastatin 80mg, aspirin/clopidogrel. Consider angioplasty and stenting, endarterectomy or bypass surgery

374
Q

Describe Critical Limb Ischaemia?

A

Burning pain which is worse at night and relieved by hanging the leg over the bed.
6Ps = Pain, Pallor, Pulseless, Paraesthesia, Paralysis and Perishingly cold
Mx = urgent vascular referal for angioplasty and stenting, endarterectomy or bypass surgery

375
Q

Describe acute limb ischaemia?

A

Rapid onset of ischaemia of a limb due to thrombus or emboli
Mx = urgent vascular referral for angioplasty and stenting, endarterectomy or bypass surgery

376
Q

What is leriche syndrome?

A

Thigh/buttock claudication, male impotence and absent leg pulses seen due to atherosclerosis of the distal aorta/common iliac arteries

377
Q

What is an arterial aneurysm?

A

A weakness in the muscular wall leading to abnormal dilation of >150% of the original diameter
True if there is an abnormal dilation of a blood vessel
False if there is a collection of blood around the vessel which communicates with the lumen

378
Q

Define number needed to screen?

A

The number of people needed to screen for a condition to prevent one excess death or morbidity

379
Q

Causes of AAA?

A

Connective tissue disorder e.g. Marfan’s or Ehlers Danlos, Syphilis, HTN or atheroma degeneration

380
Q

Complications of AAA repair?

A

DVT/PE, MI, limb ischaemia due to distal thrombus, bleeding and death

381
Q

Disadvantages of using endovascular repair for AAA?

A

Long term follow up is require, not all aneurysms are suitable and there is a high rate of re-intervention

382
Q

Ix of a ruptured AAA if the patient is stable vs unstable?

A

Stable = CT abdo with contrast
Unstable, = FBC, G&S, U&Es and send to surgery

383
Q

What is a cholesterol embolism?

A

Occurs after repair of (ruptured) AAA, atheromatous debris is shed and lodges in distal vessels often leading to ischaemia of the feet/toes

384
Q

Name the layers of a blood vessel?

A

Tunica externa (adventitia), tunica media, tunica intima and endothelium

385
Q

What cells are commonly seen in an aneurysmal wall?

A

Fibroblasts, macrophages and lymphocytes

386
Q

Name 2 complications of heparin infusions?

A

Can cause heparin induced thrombocytopenia, increases the bleeding risk elsewhere in the body

387
Q

Mx of acute limb ischaemia before surgery can be done?

A

Analgesia, oxygen, heparin infusion and IV fluids

388
Q

Define incidence?

A

The number of cases seen in a given population in a specific period of time

389
Q

What causes amaurosis fugax?

A

Central retinal artery occlusion

390
Q

Name some risks of carotid endartectomy?

A

Dislodging of the atheroma/clot leading to stroke/MI, wound haematoma and death. Also a risk of damage to the hypoglossal or vagus nerve if open surgery

391
Q

Where does epistaxis most commonly occur?

A

Little’s area

392
Q

What is the medical term for pain on swallowing?

A

Odonophagia

393
Q

Which lymph node is most commonly inflamed in tonsilitis?

A

Jugulodigastric lymph node

394
Q

Name some differentials for tonsillitis?

A

Infectious mononucleosis, tonsillar cancer, peritonsillar abscess or parapharyngeal abcess

395
Q

Why is Penicillin V prescribe over Amoxicillin in tonsillitis?

A

Amoxicillin can cause maculopapular rash if the diagnosis is actually infecious mononucleosis

396
Q

RFs for oesophageal cancer?

A

GORD, Barrett’s oesophagus, smoking, obesity, alcohol and achlasia

397
Q

Why is left recurrent laryngeal palsy more common than right? Sx?

A

It has a longer course
Sx = hoarse voice, quiet voice, vocal fatigue, SOB and cough

398
Q

Which laryngeal muscle is not supplied by the recurrent laryngeal nerve? What supplies it?

A

Cricothyroid, supplied by superior laryngeal nerve

399
Q

Name some causes of unilateral facial weakness?

A

Stroke, TIA, Bell’s palsy, Ramsay Hunt Syndrome, Parotid glad swelling/tumour, Acoustic Neuroma, Trauma, GBS

400
Q

Name the branches of the facial nerve?

A

Temporal, Zygomatic, Buccal, Marginal Mandibular, Cervical

401
Q

Name some complications of Bells Palsy?

A

Ongoing facial weakness, corneal damage/abrasions and altered taste

402
Q

Ix of C.diffe?

A

Stool microscopy and culture, Stool C.diff toxin testing (antigen shows exposure only)

403
Q

How is C.diffe spread?

A

Direct contact via person-to-person spread or from environmental contamination

404
Q

What should you always do first in hypercalcaemia?

A

ECG to exclude arrythmias (causes a shortened QT)

405
Q

What are the 2 most common causes of hypercalcaemia?

A

Primary hyperparathyroidism
Malignancy (e.g. PTHrP from squamous cell lung cancer, bony mets or melanoma)

406
Q

Mx of hypercalcaemia?

A

IV NaCl 0.9%
If this does not work IV bisphosphonate

407
Q

How can we tell between Testicular Torsion and Epididymo-orchitis?

A

Torsion = testicle is retracted and lies transversely, cord is most tender, absent cremasteric reflex and Phren’s sign negative
EO = erythema/warmth, the whole testicle is tender with scrotal involvement and Phren’s sign positive

408
Q

Ix of Neisseria Gonorrhoea and Chlamydia Trachomatis in males?

A

NAAT from first catch urine sample (1st line) or urethral swab

409
Q

Why does peritonsillar abscess cause trismus?

A

Pus causes the pterygoid muscle to spasm

410
Q

Mx of peritonsillar abscess?

A

IV NaCl, Analgesia, Penicillin + Metronidazole IV and Needle aspiration

411
Q

Mx of CAP requiring hospital admission?

A

Co-amoxiclav and a macrolide e.g. clarithromycin IV

412
Q

Which blood result can help you decide the urgency of CAP treatment?

A

Lactate

413
Q

Name some indications for considering ITU in CAP?

A

Severe pneumonia (CURB65 >= 3) and serious co-morbidities
Respiratory or metabolic acidosis
Hypotension
Progressive hypercapnia and hypoxia indicating respiratory failure
Exhaustion, drowsiness or LOC
Septic Shock

414
Q

Which treatments should you initiate early in Pyelonephritis?

A

IV NaCl 0.9%, IV Abx, oxygen if needed

415
Q

Imaging which can be done in pyelonephritis?

A

Abdominal USS or Non-contrast CT KUB

416
Q

What classifies as transudate and exudate pleural effusion? What is the most common cause of each?

A

Transudate = <30g/L - Heart Failure
Exudate = >30g/L - Pneumonia

417
Q

What is seen in a complete miscarriage?

A

Vaginal bleeding, products of conception completely expelled and a closed cervical os (but may be open if caught early)

418
Q

Signs of hypokalaemia?

A

Muscle weakness/Tetany/cramps, Lethargy, Constipation/hypoactive bowel sounds, hypotension, high urine output, irregular pulse, hypotonia

419
Q

Sx of Hyperkalaemia?

A

Muscle weakness, low urine output, respiratory failure, palpitations, muscle twitching/cramps, nausea/vomiting

420
Q

Imaging in possible lymphoma?

A

Whole body CT scan for staging

421
Q

Mx lymphoma?

A

Chemotherapy, radiotherapy and stem cell transplant

422
Q

What should you mix drugs with when putting them in a syringe driver?

A

Water unless granisetron, ketamine, ketorolac, octreotide or ondansetron - mix these with 0.9% NaCl

423
Q

What does the double effect doctrine say?

A

It is sometimes acceptable to cause harm as a side effect of bringing a good result so long as the side effect was not the intended outcome

424
Q

Which 2 drug classes should be avoided in the last few weeks of pregnancy and why?

A

NSAIDs due to increased risk of prolonged pulmonary hypertension and inter-utero closure of the PDA
Opioids due to risk of respiratory depression and withdrawal

425
Q

Describe eczema?

A

Symmetrical flexural scaly erythematous areas with signs of excoriation, linchenification and crust/weeping if infected

426
Q

Mx eczema?

A

Emollients, topical steroids, oral steroids, methotrexate/ciclosporin/azathioprine and phototherapy

427
Q

Name the types of psoriasis?

A

Plaque psoriasis (most common), flexural psoriasis (skin is smooth), guttate psoriasis (due to strep infection) and pustular psoriasis (on palms and soles)

428
Q

Name some common sites for psoriasis to be found?

A

Elbows, knees, scalp and sacrum

429
Q

Describe Pemphigus Vulgaris?

A

Autoimmune disorder (or drug induced) typically seen in Ashkenazi-Jewish population.
Sx = mucosal ulceration, painful non-itchy skin blistering. Nikolsky’s sign = spread of the bullae when pressure is applied to the skin
Ix = biopsy bulla and screen for autoantibodies
Mx = steroids and immunosppression

430
Q

What are the types of malignant melanoma?

A

Superficial spreading, nodular, lentigo maligna and acral lentiginous

431
Q

RFs for malignant melanoma?

A

Fair skin (Fitzpatrick Type 1), sunburn or radiotherapy treatment, UVB exposure, family history

432
Q

Name 3 sites melanoma can occur at other than the skin?

A

CNS, GI tract and Choroid of the eye

433
Q

Appearance of SCC vs BCC?

A

SCC = rapidly expanding painless ulcerated nodules which can have a cauliflower like appearance and bleed
BCC = slow growing pearly flesh coloured papule with telangiectasia which may ulcerate leaving a central crater

434
Q

What are the 2 main broad causes of conjunctivitis?

A

Allergy and infection

435
Q

Name the common causes of a red eye?

A

Acute angle closure glaucoma, anterior uveitis, scleritis, conjunctivitis, subconjunctival haemorrhage and endophthalmitis

436
Q

What should you consider as the cause if there is conjunctivitis in a new born?

A

Chlamydia Trachomatis

437
Q

Name the fundoscopy findings in non-proliferative diabetic retinopathy?

A

Microaneurysms, blot haemorrhages, hard exudates, cotton wool spots

438
Q

Mx proliferative diabetic retinopathy?

A

Panretinal laser photocoagulation

439
Q

What should you suspect if there is reduced visual acuity in a patient with diabetic retinopathy?

A

Maculopathy

440
Q

Apart from diabetic retinopathy what eye conditions are diabetic patients at increased risk of?

A

Vitreous haemorrhage, retinal detachment, cataract and glaucoma

441
Q

What is seen at the different stages of hypertensive retinopathy

A

I = arteriolar narrowing and silver/copper wiring
II = arteriovenous nipping
III = cotton wool exudates and flame/blot haemorrhages
IV = papilloedema

442
Q

Causes of sudden painless vision loss?

A

Central retinal artery/vein occlusion, retinal detachment, vitreous haemorrhage, TIA/stroke and ischaemic optic neuropathy

443
Q

RFs for cataracts?

A

Increasing age, DM, long term steroids, radiation exposure, trauma, smoking and alcohol XS

444
Q

Sx of cataracts?

A

Loss of the red reflex and clouded lens. Reduced vision and colour vision with glare/halos around lights

445
Q

Complications of cataract surgery?

A

Early = posterior capsule rupture/endothalamitis
Late = posterior capsule opacification

446
Q

We measure intraocular pressure with a tonometer, what is the upper limit of normal? What may you see on fundoscopy?

A

=< 21mmHg
Examine the optic disc, you may see optic disc cupping, pallor and notching or bayonetting of vessels

447
Q

What is gonioscopy?

A

Measures the anterior chamber angle to look at the drainage of the aqueous humour to differentiate open and closure angle glaucoma

448
Q

Mx open angle glaucoma?

A

1st line = prostaglandin analogue eye drop
2nd line = carbonic anhydrase inhibitor, beta blocker or sympathomimetic eye drop

449
Q

RFs for glaucoma?

A

Increasing age, family history, myopia (short sightedness), black ethnic origin

Finals Revision (23 decks)

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