pack 1 Flashcards
(123 cards)
1
Q
Hydroxychloroquine adverse side effect
A
Retinopathy - can result in severe and permanent visual loss
therefore need to monitor visual acuity
2
Q
Hypercalcaemia:
bones, stones, groans, moans
A
- Painful bones
- Renal stones
- Abdo GI nausea, vomiting, constipation
- Psychosis, memory loss, lethargy
3
Q
Hypocalcaemia:
CATS go numb
A
Convulsions
Arrhythmias
Tetany
Spasms (trousseau’s and chvostek’s sign) and stridor
Numbness in the fingers
4
Q
Which has mucosal involvement i.e. mouth/vulva:
- bullous pemphigoid
- pemphigus vulgaris
A
pemphigus vulgaris
5
Q
- Itchy, tense blisters
- Blisters heal without scarring
- No mucosal involvement
A
Bullous pemphigoid
6
Q
5 causes of massive splenomegaly
A
- myelofibrosis
- CML
- visceral leishmaniasis (kala-azar)
- malaria
- Gaucer’s syndrome
7
Q
philadelphia chromosome t(9:22) BCR-ABL gene, is present in patients with what ?
A
Chronic myeloid leukaemia CML
8
Q
First line treatment for chronic myeloid leukaemia
A
Imatinib
(tyrosine kinase inhibitor)
second line: hydroxyurea, IFN-a, allogenic bone marrow transplant
9
Q
Head injury with a lucid interval, what haemorrhage
A
Extradural haemorrhage
10
Q
Convex/lens-shaped haemorrhage on CT
A
Extradural haemorrhage
11
Q
Concave/crescent moon shaped haemorrhage on CT
A
Subdural haemorrhage
12
Q
- Bone-spicule pigmentation on fundoscopy
- Worsening tunnel vision
- Night blindness
A
Retinitis pigmentosa
13
Q
Diagnostic test for glandular fever/Epstein Barr virus
A
Monospot test
14
Q
Sore throat
Pyrexia
Cervical lymphadenopathy
classic triad of what infection
A
Epstein barr virus HHV4
Glandular fever, infectious mononucleosis
15
Q
classical triad of renal cell carcinoma
A
haematuria
loin pain
abdominal mass
16
Q
The Cushing reflex is a physiological nervous system response to increased intracranial pressure (ICP) that results in…
A
Bradycardia
Hypertension
Wide pulse pressure
17
Q
Acute and PAINFUL swelling to the thyroid gland with raised TSH
A
Subacute (De Quervain’s) thyroiditis
- likely preceded by viral infection
- initially hyperthyroid, then hypothyroid, then euthyroid
18
Q
Grave’s disease autoimmune disease has what antibodies
A
TSH receptor antibodies
- goitre is PAINLESS
- proptosis, pretibial myxoedema, hyperthyroid picture
19
Q
what is the most common well-differentiated thyroid cancer
A
papillary carcinoma
20
Q
triad of Behcets disease
A
oral ulcers
genital ulcers
uveitis
+ venous thromboembolism
21
Q
Lymphogranuloma venereum (LGV) is caused by what pathogen
A
chlamydia trachomatis
- small painless pustule that forms an ulcer
- painful inguinal lymphadenopathy
- proctocolitis
22
Q
what is treatment for Lymphogranuloma venereum (LGV) - caused by chlamydia
- small painless pustule that forms an ulcer
- painful inguinal lymphadenopathy
- proctocolitis
A
Doxycycline
23
Q
A 23-year-old man presents with an ulcer on the coronal sulcus of the penis. The ulcer is not causing him any discomfort. On examination an ulcer with an erythematous border and a clean base is found. What STI is the cause?
A
Syphilis
24
Q
Treatment of provoked PE vs unprovoked PE
A
Provoked = 3 months of DOAC e.g. apixaban
Unprovoked = 6 months
25
first line treatment for scabies
permethrin
26
what is a normal ankle-brachial pressure index value (ABPI)
0.9-1.2
```
<0.9 = arterial disease
>1.3 = disease with calcification
```
27
what autoantibody has the highest specificity for rheumatoid arthritis
anti-CCP
28
Management of venous ulceration
1. Compression bandage
| 2. Oral pentoxifylline
29
treatment for gonnorrhoea
IM ceftriaxone
30
treatment for chlamydia
oral doxycycline
31
treatment for BV and trichomonas
oral metronidazole
32
4 main features of PTSD
1. Avoidance
2. Hyperarousal/vigilance
3. Emotional numbing
4. Flashbacks/nightmares
33
COPD patients if they are non-smokers, optimised all other therapy and have any of:
- frequent exacerbations with sputum
- prolonged exacerbations
- hospitalisations from exacerbations
can have what medication for prophylaxis?
azithromycin
34
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced <70%
What is the cause
Obstructive disease e.g. COPD, asthma
35
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased >70%
What is the cause
Restrictive disease e.g. fibrosis
36
Background retinopathy features
- microaneurysms (dots)
- blot haemorrhages
- hard exudates
37
- Cotton wool spots (soft exudates)
- >3 blot haemorrhages
- Cluster haemorrhages
Pre-proliferative retinopathy
treat with laser photocoagulation
38
- Retinal neovascularisation
- Vitreous haemorrhage
- Fibrous tissue forming
Proliferative retinopathy
39
- Hard exudates
| - Background changes on macula
Maculopathy
40
Adrenaline IM dose for anaphylaxis
500 micrograms (0.5mg)
0.5ml 1:1000
can be repeated every 5 mins
41
coeliac disease genes
HLA-DQ2
| HLA-DQ8
42
coeliac disease auto-antibodies
IgG anti-endomysial
IgG anti-gliadin
IgA tissue transglutaminase
43
Central retinal artery occlusion causes sudden unilateral visual loss. It is due to ...
1. thromboembolism (from atherosclerosis); or
| 2. arteritis e.g. temporal arteritis
44
Afferent pupillary defect
Cherry red spot on pale retina
Unilateral sudden visual loss
What is the diagnosis
Central retinal artery occlusion
45
Acute management of SVT (haemodynamically stable)
1. Vagal manoeuvres
2. IV adenosine 6mg -> 12mg -> 12mg
3. Electrical cardio version
n.b adenosine is contraindicated in asthmatics so verapamil is used
46
Most common type of peptic ulcer and epigastric pain relieved by eating
Duodenal ulcer
47
Most common cause of travellers diarrhoea
E coli
48
what antibiotic can cause long QT interval
erythromycin
49
what medication exacerbates plaque psoriasis
```
beta-blockers
lithium
antimalarials
NSAIDs
ACE inhibitors
infliximab
```
50
what antibiotics should be avoided in patients on methotrexaate
trimethoprim
| co-trimoxazole
51
fluctuating reduction in visual acuity, especially at night, with druse - small accumulations of extracellular material between Bruch's membrane and retinal pigment epithelium of the eye.
What is the diagnosis
DRY age-related macular degeneration
wet = has choroidal neovascularisation
52
Presbyopia
lack of eye accommodation with age, cannot focus on close objects
53
Ankylosing spondylitis features - the six 'A's
1. apical fibrosis
2. anterior uvetitis
3. aortic regurg
4. achilles tendonitis
5. AV node block
6. amyloidosis
54
What is the genotype positive in 90% of ankylosing spondylitis patients
HLA-B27
55
what is 1st line management for ankylosing spondylitis
Exercise regimes
NSAIDs e.g. meloxicam
If these don't work then adalimumab
56
post-herpetic neuralgia treatment
amitriptyline
or gabapentin
57
1st and 2nd line treatment for c diff
1. vancomycin
| 2. fidaxomicin if the above does not work
58
what section allows treatment up to 6 months
Section 3
| section 2 = 28 days
59
72 hour assessment order section for a patient NOT in hospital
section 4
60
police mental health act order at home vs in public
section 135 - home
| section 136 - public
61
what section allows treatment up to 28 days
section 2
| section 3 = 6 months
62
haematoma between the dura and arachnoid
subdural haematoma
- concave shaped
63
Palpating under the right costal margin causes her to catch her breath with cholecystitis is what sign
Murphy's sign
64
Ascending cholangitis triad
1. fever
2. RUQ pain
3. jaundice
65
Constipation in children first line medication
movicol
66
Primary pneumothorax treatment if:
(a) <2cm /no SOB
(b) >2cm
(a) Discharge or aspiration
| (b) Chest drain
67
Secondary pneumothorax treatment if:
(a) <2cm
(b) >2cm/SOB/ older than 50
(a) Aspiration - or chest drain if fails
| (b) Chest drain
68
toxoplasmosis treatment in:
(a) immunocompromised
(b) normal immune system
(a) pyrimethamine
| (b) no treatment needed
69
what diabetic meds bind to ATP-dependent potassium channels on pancreatic b-cells to increase insulin release?
sulfonylureas
e.g. gliclazide
oral hypoglycaemic drug.
70
treatment for minimal change glomerulonephritis
prednisolone steroids
if steroids doesn't work, biopsy is indicated
71
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, what is the next step
admitted immediately for CT imaging to exclude a haemorrhage
72
The partial horner's syndrome is actually a fairly common sign seen in what headaches
cluster headaches
73
horner's syndrome signs
ptosis - drooping eyelid
miosis - small pupil
anhidrosis
74
Most common complication of measles is...
otitis media
| +/- pneumonia
75
The most common complication of measles is otitis media.
What are 4 late complications of measles infection:
1. keratoconjunctivitis
2. encephalitis
3. subacute sclerosing panencephalitis
4. pneumonia
76
what is the antibiotic treatment for salmonella
ciprofloxacin
77
what pathogen is the most common cause of discitis
staph aureus
78
what is gold standard test for degenerative cervical myelopathy
MRI spine
XRAY CANNOT DIAGNOSE IT
79
Sudden painless loss of vision
Severe retinal haemorrhages on fundoscopy
What is the diagnosis
Central retinal VEIN occlusion
80
Otitis externa can be caused by bacteria (staph aureus, pseudomonas), dermatitis and swimming. It has an itchy discharge ear with red, swollen, eczema canal on otoscopy.
What is the treatment for this
1. Topical antibiotic
2. With topical steroid
malignant otitis externa is more common in elderly diabetics
81
Malignant otitis externa is the extension of infection into the bony ear canal. What group of patients is it most common in?
elderly diabetics
usually needs IV Abx
82
huntington's disease is a defect in what gene on what Chr
Huntingtin gene on Chr 4
83
Pneumocystis jiroveci penumonia treatment
co-trimoxazole
in severe cases = IV pentamidine
84
parkinson's disease - if motor symptoms are affecting patient's life the most, what treatment
L-dopa
85
parkinson's disease - if motor symptoms are NOT affecting patient's life, what treatment
1. dopamine agonist (non-ergot derived) e.g. cabergoline, bromocriptine
2. or levodopa
3. or MAO-B inhibitor e.g. selegiline
86
Obese, young female with headaches / blurred vision
idiopathic intracranial hypertension
87
Obese, young female with headaches and blurred vision has benign idiopathic intracranial hypertension.
What is management
1. Weight loss program
2. Azetazolamide if abnormal visual findings
3. Topiramate
4. Lumbar puncture
5. Surgery - optic nerve sheath decompression, shunts to reduce intracranial pressure
88
In the UK, men are offered abdominal aneurysm screening at what age with what method ...
single abdominal ultrasound at 65 years
89
trigeminal neuralgia treatment
carbamazepine
90
Guillain-Barre syndrome is classically triggered by which infection
Campylobacter jejuni
91
Which pathogen is the most common cause of viral meningitis in adults
Coxsackie virus
92
Miller Fisher syndrome is a variant of Guillain-Barre syndrome (but it is descending paralysis rather than ascending). What is the triad
Opthalmoplegia
Areflexia
Ataxia
93
Miller Fisher syndrome is a variant of GBS (but it is descending paralysis rather than ascending) with ophthalmoplegia, areflexia and ataxia.
What antibodies are seen in Miller Fisher syndrome?
Anti-GQ1b antibodies
94
What 3 criteria exist for urgent endoscopy 2 week cancer wait cancer referral?
1. Dysphagia
2. Upper abdo mass that feels like stomach cancer
3. >55yo with weight loss AND pain, reflux or dyspepsia.
95
The most common organism causing infective exacerbations of COPD is
Haemophilus influenzae
96
rifampicin side effects
hepatitis
orange secretions
liver inducer
97
isoniazid side effects
peripheral neuropathy
hepatitis
agranulocytosis
liver enzyme inhibitor
98
pyrazinamide side effects
hyperuricaemia - gout
arthralgia
myalgia
hepatitis
99
ethambutol side effects
optic neuritis
| renal impairment
100
haematoma between the dura and the skull
epidural haematoma
- convex shape
101
How to differentiate between Erythema multiform major and Steven Johnson's syndrome?
1. Erythema multiform major has target lesions, usually after INFECTION e.g. herpes
2. Steven Johnson's syndrome usually follows DRUG reaction with blistering.
102
Difference between Steven Johnson's Syndrome and Toxic Epidermal Necrolysis
SJS is <10% surface area involvement
TEN >30% involvement
103
areas of darkened and thickened skin in the axillary creases in obese person
Acanthosis nigricans
usually associated with Cushing's syndrome, PCOS, steroids, insulin
104
Hepatocellular carcinoma most common causes:
(a) worldwide
(b) in Europe
(a) hep B
| (b) hep C
105
Koebner phenomenon (new skin lesions at site of trauma) and polygonal white-line (wickham's striae) shaped rashes are seen with what skin lesion
Lichen planus
usually on palms, soles, genitalia, flexor surfaces of arms
106
The standard HbA1c target in type 2 diabetes mellitus if on metformin/no meds is
48mmol/mol
| it is 53 if taking sulfonylurea e.g. gliclazide
107
Treatment of lichen planus
Topical steroids
Oral lichen plants - benzydamine mouthwash or spray
108
Transferrin (aka TIBC) levels and transferrin saturation levels in iron deficiency anaemia are usually...?
Transferrin (TIBC) = high
Transferrin saturation levels = low
109
Carpal tunnel syndrome is the entrapment of which nerve
Median nerve
- thenar muscle wasting
- parasthesia
- pain at night
- weakness of LOAF muscles
110
cutaneous form of T-cell lymphoma that can present like eczema or psoriasis
Mycosis fungoides
111
Loss of foot dorsiflexion + sensory loss dorsum of the foot, positive sciatic nerve stretch test - what nerve root is affected
L5
112
What is this patient's audiogram results below suggestive of?
- Bilateral impairment
- High-frequency hearing loss
- Downward-sloping pure tone thresholds
presbyacusis
113
Otoscopy would show a greasy, pearly-white lump in the 'attic' of the tympanic membrane. An audiogram will show a conductive hearing loss with an 'air-bone gap' suggests what diagnosis?
Cholesteatoma
114
After acute ischaemic stroke, aspirin 300mg should be given, and then switched to..
75mg clopidogrel lifelong
if clopidogrel contraindicated, then aspirin 75mg and MR dipyridamole can be used.
115
This patient is presenting with flashers and floaters which are associated with...
retinal/vitreous detachment
- retinal = starts peripherally, goes centrally, straight lines appear curved
- vitreous - peripherally
116
Ischaemic optic neuropathy is also known as
amaurosis fugax
- pale swollen optic disc
- cotton wool spots
- curtain coming down
- treat with aspirin 300mg
117
What is step-up management of acne
1. Single topical retinoids/benzoyl peroxide
2. Combination topical therapy (Abx, BP, retinoid)
3. Oral Abx with topical retinoid/benzoyl peroxide
4. COCP in women as an alternative to oral Abx
5. Oral retinoids
118
Sudden onset sensorineural hearing loss (SSNHL) is caused by what in 80% of cases
acoustic neuroma
119
Hearing loss
Vertigo
Tinnitus
ABSENT corneal reflex
Are important signs of...?
Acoustic neuroma
- with sudden onset sensorineural hearing loss
Associated with neurofibromatosis type 2
120
What two chromosomes do neurofibromatosis type 1 and type 2 affect?
NF1 - Chr 17
| NF2 - Chr 22
121
What is the diagnosis with the signs of:
- cafe-au lait spots
- CUTANEOUS neurofibromas
- Lisch nodules - iris hamartomas
Neurofibromatosis 1
Chr 17
These are a/w phaeochromocytomas and optic gliomas
122
What is the diagnosis with the signs of:
- sensorineural hearing loss
- bilateral acoustic neuroma (vestibular schwanoma)
- meningiomas
- cataracts
- ependynomas
Neurofibromatosis 2
Chr 22
123
What topical agent may be used on a long-term basis for psoriasis?
Calcipotriol
