Paper 1 Flashcards
1
Q
Which virus causes measles?
A
RNA paramyxovirus
2
Q
Give the values for M+F for prolonged QTc
A
Males >440, Females >470
3
Q
What can be given for gynaecomastia in bicalumide prostate treatment?
A
Tamoxifen
4
Q
What is given for hot flushes in goserelin (LHRH) treatment?
A
Methoxyprogesterone acetate
5
Q
How many months is TB treatment?
A
6 months -> 2 months isoniazid, rifampicin, pyrazinamide, ethambutol + 4 months isoniazid and rifampicin
6
Q
Which score is used for melanoma?
A
Glasgow 7 point (major = size, colour and shape)
7
Q
Which diabetic drug is given if triple therapy has failed and BMI >35?
A
GLP-1 analogue (e.g. exenatide)
8
Q
What is first line for mild-moderate acne?
A
Topical retinoid
9
Q
Is long-sightedness or short-sightedness a risk factor for retinal detachment?
A
Short
10
Q
Which drug is associated with skin necrosis?
A
Warfarin and heparin
11
Q
Which drugs can induce SLE?
A
Tetracyclines, hydralazine, procainamide
12
Q
What is the most common + aggressive malignant melanoma?
A
Superficial spreading + Nodular
13
Q
Which heart defects are paradoxical embolisms associated with?
A
ASD and VSD -> embolus migrates to systemic circulation leading to cerebrovascular events
14
Q
Describe Kernig’s Sign + associated conditon
A
Flexion of hip and knee to 90 degrees before straightening -> meningeal irritation + meningitis
15
Q
How should long acting insulin dose be corrected during surgery? (%)
A
80% to prevent rebound hyperglycaemia upon referring
16
Q
What is the most common source of UTIs?
A
GIT to urethra
17
Q
What is first line ORAL + TOPICAL AB for acne?
A
Oral -> tetracycline (doxycycline)
Topical -> macrolide (clindamycin)
18
Q
Define serial ECGs in ACS
A
ECG every 10 minutes
19
Q
What is the first marker to rise and fall in ACS?
A
Myoglobin
20
Q
Give MONA for ACS
A
Morphine
O2 (if hypoxic)
Nitrates (GTN)
Antiplatelet therapy (aspirin + clopidogrel -> both 300mg)
21
Q
What is the difference between LMWH and unfractionated heparin in terms of half life?
A
LMWH has a longer half life -> unfractionated used when wanting to move to Cath labs
22
Q
Which organ impairment would indicate unfractionated heparin?
A
Renal impairment
23
Q
What is Tirifoban an example of? (NSTEMI)
A
Glycoprotein IIb/IIIa (acts on another coagulation pathway compared to other drugs)
24
Q
What is the cause of a mitral regurgitation post-MI?
A
Papillary muscle rupture
25
What is the most common cause of glandular fever?
EBV
26
What is the anatomy of a Type A Stanford aortic dissection?
Proximal to left subclavian artery
27
What is the initial management for an aortic dissection? + First line?
500mL bolus to see if they are fluid responsive + crossmatch and transfuse blood
28
What does an intimal flap indicate on chest CT?
Aortic dissection
29
What is the blood pressure control drug for aortic dissection? + Target BP?
IV labetalol -> 100-120mmHg
30
Which murmur could occur as a complication if a Type A aortic dissection extends proximally?
Mid-diastolic high pitched murmur (aortic regurgitation)
31
Which complicate triad can an aortic dissection cause?
Becks -> muffled heart sounds, high JVP, hypotension
32
Which hep is more common in MSM without recent travel?
Hep B
33
Which type of disease does pseudoxanthoma elasticum (knees, antecubital fossa) appear?
Early coronary artery disease
34
Alcoholic, pain shortly after eating, elevated AST and ALT, epigastric pain spreading to the back, elevated serum amylase -> what is the likely underlying cause?
Acute pancreatitis secondary to gallstones
35
How does acute pancreatitis cause hypocalcaemia?
Fat necrosis and chelation of calcium salts
36
Which type of pancreatitis is seen as a complication of acute pancreatitis and shows as variable contrast enhancement on CT?
Necrotic pancreatitis
37
Biopsy shows mononuclear cell infiltrates with multinucleated giant cells -> diagnosis?
GCA
38
Give the 369 rule for bowel obstructions
Small bowel >3cm
Large bowel >6cm
Caecum >9cm
39
What is a common immediate ileostomy complication to be aware of?
High output stoma (>1.5) -> dehydration and electrolyte abnormalities -> replace fluids and can use anti motility (e.g. loperamide and codeine phosphate)
40
41
Where does somatostatin and dopamine act in the growth hormone axis?
Acts on the pituitary to reduce GH secretion -> give dopamine agonist to treat acromegaly
42
Give the first line management for acromegaly + prolactinoma
Acromegaly (surgical) -> transphenoidal resection
Prolactinoma (medical) -> cabergoline (long acting dopamine agonist)
43
What type of tumour is choriocarcinoma?
Germ cell
44
Testicular lump, elevated T4, palpitations -> diagnosis?
Choriocarcinoma -> bHCG -> increases release of thyroid hormone
45
What is the cause of toxic multi nodular goitre?
Iodine deficiency
46
How does iodine deficiency cause toxic multi nodular goitre
Compensatory TSH -> hyperplasia -> nodule formation -> mutations over time -> becomes independent of TSH
47
Which antibody other than anti-TSH can be found in Graves?
Anti-microsomal (anti-TPO)
48
49
What is bicuspid aortic valve and hypo plastic aortic arch associated with?
Coarctation of the aorta
50
How does ciprofloxacin affect warfarin? (e.g. while used in Antiphospholipid syndrome)
Increases INR
51
What is the management for subclinical hypothyroidism at first appointment?
Repeat TSH in 3 months (2 results required before treatment)
52
In overt hypothyroidism -> how is levothyroxine dose changed in IHD and pregnancy?
IHD -> reduce due to stimulant effects of thyroxine
Pregnancy -> increase dose due to increased metabolic rate
53
What is first line long acting insulin?
Levemir (then Lantus)
54
Which regimen is given if unable to tolerate basal-bolus?
Mixed insulin regimen
55
Give examples of rapid + short + intermediate + long acting insulin
Rapid (2-5h) -> novorapid, humalog
Short (5-9h) -> humulin S, actrapid
Intermediate (12-24h) -> humbling I, Insulinatard
Long (16-42h) -> Levemir, Lantus
56
What happens if 1L NaCl 0.9% stat is given above systolic 90?
Central pontine myelinolysis
Cerebral oedema
57
Which 2 drugs are indicated in pregnant diabetes?
Insulin, metformin
58
After metformin -> what is the HbA1C threshold before starting another diabetic drug?
58mmol/L
59
Most common cause of SBO?
Adhesions (following previous surgery)
60
What is the first line diagnostic + staging investigation for oesophageal cancer?
Diagnostic -> endoscopy and biopsy
Staging -> CT CAP
61
3 months haematuria, flank pain, mass, dragging feeling in testicle -> diagnosis + why does it cause dragging sensation?
RCC -> left RCC due to varicocoele formation -> left RCC invades renal vein causing back pressure -> varicocele (right sided drain into IVC and does not cause varicocele)
62
How does GCA cause vision loss?
Invasion into short ciliary arteries -> anterior ischaemic optic neuropathy
63
Give the first line for extracapsular NOF for subtrochanteric + intertrochanteric
Intertrochanteric -> Dynamic hip screw
Subtrochanteric -> IM nail
64
Asymptomatic gallstones -> diagnosis?
Reassurance
65
Which enzyme is produced by vibrio cholera? + how does this cause watery diarrhoea?
Adenylate cyclase -> adenylate cyclase -> increase in cAMP -> inhibits chloride secretion + sodium reabsorption in intestinal lumen -> watery diarrhoea
66
Struvite crystals, urine pH >7 -> which renal pathology? + which bacteria?
Urease producing bacteria -> stag horn calculi
67
Which 2 genes are associated with coeliac?
HLA-DQ2
HLA-DQ8
68
Which drug class is most associated with ATN?
Sulfa- drugs
69
Which ACR ratio indicates CKD?
ACR >3, 2 eGFR reading 3 months apart
70
As part of a renal transplant -> tacrolimus -> what is a common peripheral side effect?
Tac flap
71
Which electrolyte disturbance is commonly seen in AKI?
Hyperkalaemia
72
what is the leading cause of death in CKD?
Cardiovascular disease
73
Give the triad for Alport's Syndrome + inheritance pattern
Frank haematuria, ophthalmology, sensorineural hearing loss + X-linked
74
Which nephritic pathology does heroin use increase the risk of?
Focal segmental glomerulosclerosis
75
Hypocomplementenemia + tram track on microscopy, BBV, SLE -> which nephrotic pathology? + type
Type 1 membranoproliferative glomerulonephritis
76
How does nephrotic syndrome affect calcium?
Hypocalcaemia -> loss of albumin (main calcium transporter) = less circulating calcium
77
Which bacteria is associated with aspiration pneumonia?
Klebsiella
78
Give the NT-proBNP thresholds for ECHO in HF
>400 -> 6 weeks
>2000 -> 2 weeks
79
First line infective endocarditis AB
Amoxicillin
80
Give the empirical AB for native + prosthetic valve
Vanc
Gent
Rifampicin
81
Give the ABPI range for PAD
0.5-0.9
82
Which electrolyte is deficient in hyperthyroidism?
Calcium
83
Which investigations after thyroid antibodies?
Technecium uptake scan
84
Heterogenous uptake on technecium scan suggests which type of hyperthyroidism?
Toxic multi nodular goitre
85
Which liver marker is elevated in hyperthyroidism?
ALP
86
During a thyroidectomy -> inferior thyroid artery is ligated -> what is this a branch of?
Thyrocervical trunk
87
Give the management for cerebral toxoplasmosis in HIV
Pyrimethamine
Sulfadiazine
88
Which cancer is associated with AIDS?
Anal
89
Which vaccination is safe in HIV?
MEN ACWY
90
Which GI pathology is crypt hyperplasia associated with?
Coeliac
91
Which GI pathology is associated with reduced goblet cells on microscopy?
UC
92
Which guideline is used for severity of UC? + Give range for mild + moderate/severe
Truelove + Witts
Mild: >4 (Rectal mesalazine)
Moderate/Severe: 4-6 (IV corticosteroids to induce remission)
93
4 Weeks have passed since starting rectal mesalazine for a UC flare -> there has been no improvement -> what can be added as second line?
Rectal corticosteroids
94
Which derm condition is associated with mother/herald patch?
Pityriasis rosea
95
What do Kerley B lines represent?
Interstitial oedema
96
What does a globular heart represent?
Pericardial effusion
97
Which syndrome is montelukast associated with?
Churg-Strauss (eosinophilia, vasculitic rash, peripheral neuropathy, respiratory symptoms)
98
Give the mechanism of carvedilol
alpha and beta receptor antagonist
99
Give an example of an angiontensin 2 inhibitor
Losartan
100
Which complement is low in MPGN?
C3 Complement
101
Which syndrome starting with R causes thyroid hormone resistance?
Refetoff Syndrome
102
Which vitamin deficiency can lead to an accumulation of undifferentiated kertinocytes in striatum spinosum?
Vitamin A
103
Clusters of gram positive cocci -> which organism?
Staph aureus
104
Why is metoclopramide avoided in Parkinson's?
It is a D2 receptor antagonist -> worsen Parkinson motor
105
Vision loss, dementia, cherry red macula, GM2 gangliosides -> diagnosis
Tay-Sachs Syndrome
106
Dementia, myoclonus, prion -> diagnosis
Creutzfeld-Jakob Disease
107
SLE/Sjogrens/systemic sclerosis, mottled skin, reticulated patches, worse in cold -> diagnosis
Lived reticular
108
Give the class of bromocriptine + how does it affect prolactin
Dopamine agonist -> decreases prolactin
109
Which side BBB + axis deviation means right heart disease?
RBBB + LAD
110
Which hep is porphyria cutanea tarda, lichen plants, cryoglobulinaemia, B cell lymphoma associated with?
Hep C (Cryo)
111
Which 2 catecholamines can nerve endings make?
Noradrenaline
Dopamine
112
Which hep is associated with polyarteritis nodosa?
Hep B
113
Which arteritis affects the aortic arch and branches?
Takayasu's
114
Which type of haemorrhage is seen in shaken baby syndrome?
Subdural haemorrhage
115
How does secondary hypothyroidism (e.g. pituitary adenoma) affect follicular cells?
Atrophy due to decreased production of TSH
116
Which type of liver disease are Mallory bodies seen in?
Alcoholic liver disease
117
What does absent GAD and low C-peptide (what does this mean?) indicate?
T1D -> low C-peptide due to decreased endogenous production of insulin
118
How does urease-producing bacteria affect urine?
Proteus mirabilis -> urease hydrolyses urea to ammonia and CO2 -> increases pH of urine -> growth of struvite crystals
119
Which type of nephropathy are Kimmelsteil-Wilson lesions associated with?
Diabetic nephropathy
120
Diffuse alveolar infiltrate, pink frothy sputum, chest pain
Legionella pneumophilia
121
Which stone is the most radio-opaque? + Common?
Calcium phosphate
Calcium oxalate
122
Give the values for high + low SAAG + examples of each
>11g/dL -> constrictive pericarditis
<11g/dL -> pancreatitis, malignancy
123
Give the criteria for asthma exacerbation discharge
PERF >75%
Review inhaler technique
Review take home plan
Inform GP for community review within 48 hours
124
Hyperinflated lung fields on CXR -> Which resp?
COPD
125
What is the mechanism of GLP-1 Mimetics?
Mimics incretin -> incretin's target tissue is beta cells in the pancreas -> stimulate insulin release
126
What is the mechanism of DPP4-inhibitor?
Inhibits DPP4 (breaks down incretin) to allow for incretin's action on increasing insulin production
127
What is the first line for COPD? + Give mechanism
Ipratroprium bromide (bronchodilator) -> inhibits ACh at muscarinic receptors -> decrease cGMP -> dilates vessels in airways by decreasing smooth muscle
128
Which antibiotics is used in MRSA in renal insufficiency?
Linezolid
129
Which nerve innervates soft palate, pharynx, larynx? + Which side is the lesion if the uvula is deviated to the right?
Vagus
Left
130
Define Marjolin ulcer
Malignant change in a longstanding wound/scar
131
Give the electrolyte disturbance in RFS
Hypophosphataemia, hypokalaemia, hypomagnesaemia
132
Which deficiency causes wet beriberi? + Give pathophysiology
Thiamine deficiency
Affects CVS -> high CO despite RVF
133
Which peripheral sign can indicate Peutz-Jeghers?
Hyperpigmented lips, mouth and other areas
134
What is Curschmann's spiral pathognomic for?
Asthma
135
Which organism is linked with CF TB?
Pseudomonas aeruginosa
136
Which tumour arises from the dura mater? + which histology feature?
Meningioma
Psammoma body
137
Which type of renal malignancy is associated with schistosomiasis?
Squamous cell carcinoma
138
Which malignancy can a mutation in CDK2A cause?
Malignant melanoma
139
Which murmur can an aortic dissection cause?
Aortic regurgitation if the dissection extends proximally to involve the aortic valve
140
Which complement is involved in membranoproliferative glomerulonephritis Type II?
C3
141
What is the most common secondary cause of FSGS?
HIV
142
Which vasculitic disease is associated with c-ANCA?
Granulomatosis w/polyangiitis
143
How does a PPI affect Cl- production in the gastric lumen?
PPI decreases H+ exchange through Na+/K+ ATPase -> more Cl- available and not used for HCl production -> less Cl secretion through negative feedback
144
Which area of the GIT is the most common for spontaneous perforation?
Duodenum, usually due to ulceration
145
What is the most common subtype of prostate cancer?
Testicular lymphoma
146
Which neurotransmitter is linked with Alzheimers?
Low levels of acetylcholine
147
What is first line for pertussis?
Erythromycin
148
Which antibiotic can cause a metallic taste?
Metronidazole
149
What is firs line for HF?
NT-ProBNP
150
Give an example of Vaughn-William I + II
I -> sodium channel blocker
II ->
151
Cerebellar symptoms, quadriparesis/hemiparesis, reduced consciousness -> which artery?
Vertebrobasilar
152
Which vision loss is seen with PCA stroke?
Contralateral homonymous hemianopia with macular sparing
153
Which diabetic drug can be a rare cause of pancreatitis?
DPP4-inhibitor (e.g. sitagliptin)
154
Give the Ig status for acute + chronic Hep B infection
Acute IgM > IgG
Chronic IgG > IgM
155
What is a congenital cause of aortic stenosis? + which other heart pathology is this associated with?
Bicuspid valve
Co-arctation of aorta
156
Give the 2 most common organisms in acute cholangitis
E.coli
Klebsiella
157
Give first line for ascending cholangitis
IV Co-amoxiclav (or cefuroxime/metronidazole) for 5-7 days then ERCP 48h after starting AB to clear any obstructions
158
If ERCP is not available -> what is second line?
Percutaneous transhepatic cholangiography
159
Most common organism in bronchiectasis
H. influenzae
160
Which enzyme can lead to emphysema?
Alveolar macrophages and neutrophils release macrophages which releases elastase -> if uncontrolled (e.g. through smoking) -> alveolar destruction -> dilatation of air sacs and destruction of alveolar walls
161
Severe psoriatic exacerbation, febrile, 90% scale red patches -> treatment?
Methotrexate
162
What is mandatory prior to starting isotretinoin in females?
Contraception due to teratogenicity
163
Give the criteria for surgery in EDH
Midline shift >5mm
Volume >30cm3
EDH thickness >15mm
GCS<8
Neurological deterioration
164
What does aspirin inhibit? + what does this mediate?
Inhibits COX1 predominantly -> medicates thromboxane A2 -> disrupts TXA2-mediated platelet aggregation
165
Give the effects of carbamazepine on U+E
Hyponatraemia
SIADH
166
Which type of bacteria poses the most risk for patients with hyposplenism
Encapsulated
167
5-HIAA, facial flushing, diarrhoea, bronchospasm -> diagnosis? + Which heart valve pathology is most common?
Carcinoid tumour
Tricuspid regurgitation
168
Which syndrome demonstrates necrolytic migratory erythema which is pathognomic?
Glucagonoma Syndrome (pancreatic tumour that overproduces glucagon)
Associated with mild diabetes, anaemia
169
Give the pathology of diabetic nephropathy starting from hyperglycaemia
Hyperglycaemia promotes the glycosylation of efferent arteriole surface -> hyaline arteriole sclerosis -> hyperfiltration in the glomerulus and mesangial cell expensation -> over time leads to reduced filtration and leakiness
170
Which cells are preferentially lost during cerebellar degeneration from chronic alcohol abuse?
Purkinje cells
171
Which agent can be given in beta blocker overdose?
Glucagon
+ IV fluids for hypotension, atropine for bradycardia
172
Which meningitis is common in immunocompromised patients? + Which staining is used?
Cryptococcal (TB or fungi)
India ink negative stain -> encapsulated organisms
173
Young, ophthalmological pathologies, frank haematuria -> which syndrome? + Which gene and inheritance pattern?
Alport Syndrome
COL4A5
X-linked
174
Young, episodic chest pain at rest and night -> diagnosis?
Prinzmental angina
175
Meningitis with hyponatraemia and hyperkalaemia, adrenal haemorrhage on imaging -> diagnosis?
Waterhouse-Friedrichsen Syndrome
176
How long to wait before H. pylori test after PPI trial?
2 weeks
177
Which blood group increases the risk of peptic ulcers?
O
178
How do NSAIDs cause gastric ulcerations?
Inhibit COX-1 -> reduction in prostaglandins -> reduction in gastric mucus secretion
179
Ataxia, dysarthria, loss of reflexes, kyphoscoliosis, positive Babinski, young, autosomal recessive, GAA repeat mutation in FXN -> diagnosis?
Friedrich's Ataxia
180
What is the most common cause of death in Friedrich's?
HOCM
181
Herald patch, previous sore throat, widespread rash -> diagnosis?
Pityriasis rosea
182
Which organism is most associated with pityriasis rosea?
HHV 6/7
183
What is start if stroke symptoms has an onset <4.5h? + what must be ruled out? + target BP?
Thrombolysis
Non-contrast CT to rule out haemorrhage
180/110
184
Is aspirin 300mg or thrombolysis given first?
If thrombolysed -> give aspirin and anti platelet therapy the following day
185
Give the time period for thrombectomy + two stroke areas indicating thrombectomy
<24h
Proximal anterior
Posterior circulation stroke
186
Which monoclonal antibody is used for recurrent C.diff?
Bezlotoxumab
187
What should be suspended from C.diff infection?
PPI
188
Which carcinoma arises from Kulchistsky cells?
SCLC
189
Give some autonomic dysregulation symptoms in LES
ED, postural hypotension, dry mouth
190
Give the NT-proBNP values for transthoracic ECHO in 2w + 6w
>2000 pmol/L -> 2 weeks
>400 pmol/L -> 6 weeks
191
Give the ABCDE CXR in HF
Alveolar oedema
B lines (Kerley)
Cardiomegaly
Dilated upper lobe vessels
Effusion
192
Why is bisoprolol preferred over atenolol?
Bisoprolol is more cardioselective and results in better outcomes in HF patients
193
As 3rd line therapy -> when can't ivabradine be used?
HR <75
194
What % reduction is acceptable in CKD when using ACEI?
25
195
First line test for female + male gonorrhoea + chlamydia + trichomoniasis
Male -> FVU, NAAT chlamydia, gonorrhoea, culture trich
Fem -> Swab
196
Which arthritis is more commonly associated with chlamydia?
Reactive -> can't see, pee or climb a tree
197
What is the most common renal manifestation of SLE?
Type IV diffuse proliferative glomerulonephritis
198
Intense thirst, polyuria, weakness, takes lithium for Bipolar -> diagnosis?
Nephrogenic DI from chronic lithium use
199
Which clinical sign is a strong indication of lithium toxicity?
Hyperreflexia
200
Which cancer can haemodialysis cause?
RCC
201
How can RCC cause vaircoele? + which side?
Left sided varicoele from left RCC compression of the left renal vein
202
Which type of effusion does HF cause?
Transudative
203
Which triad is seen in asthma-exacerbated respiratory disease?
Samter's Triad -> aspirin sensitivity, nasal polyps, bronchial asthma
204
What is ninetadanib and perfenidone used for? + Give FVC requirements for perfenidone
Both are anti-fibrotic for IPF
FVC 50-80%
205
What is the most common type of MODY? + Which gene is affected?
Type 3
Hepatocyte nuclear factor-1-alpha
206
Which hypersensitivity is Grave's disease?
Type 2
Specific antibody against antigen
207
What is sacubitril valsartan indicated for? + What does it replace in therapy?
3rd line option for HF (along with ivabradine and digoxin [with AF])
Replaces ACEI when used
208
Give the first line for GBS
IVIG for 5 days
209
Give the 3 times to take a serum tryptase after an anaphylactic reaction
Immediately
1h
24h
210
What is given after an anaphylactic for patients to take home?
2 adrenaline autoinjectors
211
Give the tests for contact and food reactions
Contact -> patch
Prick - food
212
Give 3 criteria for blood transfusion in context of anaemia
Hb <70
Hb <80 + cardiac
Active bleeding
213
Which staging is used for colorectal carcinoma?
Dukes criteria
214
Which investigation for suspected bladder cancer?
Cystoscopy
215
What is 5-fluorouracil used for?
Renal SCC (esp in mets)
216
Which blood test is used for neuroleptic malignant syndrome?
Serum creatine kinase
217
What is the initial management for NMS?
Rapid fluid resus to prevent AKI secondary to rhabdomyolysis
218
What class is dantrolene? + Give 2 conditions it's used for
Muscle relaxant -> reduces metabolic demand
Malignant hyperthermia
NMS
219
Stiff shoulder with pain, limited external rotation -> what is a risk factor?
Diabetes
220
Single unprovoked seizure, type 2 license for work -> how long to stay off the road?
5 years seizure free
221
Give the class of donepezil
Acetylcholinesterase inhibitor -> boosts cholinergic neurotransmission in Alzheimers (used for symptomatic relief)
222
Give the histological changes after MI
Neutrophil invasion (6-12h)
Macrophages (24-72h)
Granulation tissue (1-2w)
223
Give the chelating agent for iron overdose
Desferrioxamine
224
Give the changes in potassium during rhabdomyolysis
Increases (along with CK)
225
What are rose spots associated with?
Typhoid (high fever, bloody diarrhoea)
226
Which vaccine is given coeliac disease?
Pneumococcal due to functional hyposplenism
227
What is the most common cause of SAH?
Trauma
228
Which medication is given once SAH is diagnosed?
Nimodipine (CCB) to prevent vasospasm
Generally given for 3 weeks
229
Which vasopressor + anti-arrhythmic is given during resuscitation + when?
1mg Adrenaline, 300mg amiodarone
End of 3rd CPR cycle
230
What is first line for cluster headache?
Subcutaneous sumatriptan, high flow O2
231
Give the mechanism of triptans
5HT-1B/D agonists for vasoconstriction
232
What is the prophylaxis for cluster headaches?
Verapamil
233
Give the triad name for iliac artery occlusion giving symptoms of thigh/buttock claudication, absent or reduced femoral pulse, ED
Leriche Syndrome
234
Which condition has the 3 stages: catarrhal, paroxysmal, convalescent
Whooping coughWhich
235
Which marker is raised in any germ cell tumour? + When do AFP + bhCG raise?
LDH rises in any tumour
AFP -> Yolk sac, teratomas
bHCG -> seminomas, choriocarcinoma
236
Which cancer arises from inhibition of p53 and rb TSGs?
HPV inhibits p53 and rb
-> CIN
237
What is first line treatment for fast AF?
IV fluids
238
Redcurrant jelly sputum, upper lobe, gram negative rod, incompetent swallow -> which organism pneumonia?
Klebsiella pneumoniae
239
What is first line for Alport's (X-linked)?
ACEI
240
Give first line + second line for stable angina
1 -> bb OR non-dihydropyridine
2 -> beta blocker and dihydropyridine CCB
241
Give a rate control + rate limiting option for AF in haemodynamically stable patients
Rate control -> BB (bisoprolol)
Rate limiting -> diltiazem
242
Give the effects on BP + HR from complete section at cervical level + give pathophysiology
Hypotension
Bradycardia
Loss of sympathetic function, unopposed parasympathetic function leading to bradycardia and hypotension
243
Why is CT chest important in myasthenia gravis?
10% have thymoma, 70% have thymic hyperplasia
244
Which stains are used for SCC + BCC?
SCC -> EMA
BCC -> Cytokeratin
245
What is the Leser-Trelat sign associated with?
Seborrheoic keratoses (gastric cancer)
246
What is first line for CRVO?
Fluorescein angiography
247
What is first line for CRVO? + flashing floaters after, which complication has occurred?
Intravitreal VEGF inhibitor
Retinal detachment
248
Which asthma drug can reduce seizure threshold?
Theophylline
249
What is the most common cause of Addison's worldwide?
TB
250
What is the electrolyte disturbance in Addisonion crisis?
Hyponatraemia, hyperkalaemia, metabolic acidosis
251
How is NMS and SS differentiated by pupils + reflexes
SS -> dilated pupils, hyper-reflexia
NMS -> normal pupils, hypo-reflexia
252
Which lung cancer is associated with HPOA?
Hypertrophic osteoarthropathy (onion skin on x-ray) -> SCC
253
Which lung cancer is associated with early metastases to the brain?
SCLC
254
What is the time criteria for CKD?
3 months
255
What is first line for UTI in children?
Co-amoxiclav
Cephelexin
256
Which hep infection is lichen planus associated with?
Hep C
257
What is the overall most common cause of tonsillitis?
Rhinovirus
(GAS for bacterial cause)
258
How is aortic sclerosis and stenosis differentiated?
Stenosis has no radiation to the carotids
259
Which malignancy is lichen planus associated with?
SCC of the skin
260
Which side of the heart is louder during expiration?
More blood flow in left side as pulmonary flow increases due to less expansion of lungs
261
What is the most common cause of status epilepticus in children + adults?
Adults -> epilepsy (poor compliance)
Children -> febrile convulsions
262
When is IM benzylpenicillin given in community for meningitis?
Meningococcal suspected -> rash, signs of sepsis
263
Give upper zone causes of fibrosis
Sarcoidosis
Coal miner pneumoconiosis
Ankylosing spondylitis
Silicosis
Hypersensitivity pneumonitis
CF
264
What is the most common cause of fibrosis? + which zone
IPF -> lower zone
Asbestosis
Drugs -> methotrexate, amiodarone, bleomycin
Radiation
Rheumatoid -> SLE, RA
265
Which organism causes pneumococcal meningitis? + which type of haemolysis?
Strep pneumonia (gram positive coccus)
Alpha
266
What is first line gastric + oesophageal varices?
Sclerotherapy -> gastric
Band ligation -> Oesophageal
267
How do burns + raised ICP cause ulcers?
Burns -> hypovolaemia causes reduced perfusion to stomach lining -> Curling Ulcer
Raised ICP -> increased vagal stimulation -> increased gastric acid secretion -> Cushing ulcer
268
What is Rigler's sign indicative of?
Gas on either side of bowel wall -> Large pneumoperitoneum
269
What is the most common cause of acute pancreatitis?
Gallstones
270
How do NSAIDs exacerbate asthma?
COX inhibitor -> leukotriene synthesis increases -> bronchoconstriction
271
Give the treatment for mild + moderate + severe acne rosacea (worsens in sunlight, onset with stress, butterfly distribution, worse with vasodilators (e.g. amlodipine)
Briminodine
Metronidazole
Oxytetracycline
272
What the medical management of thyroid storm? + which effect does it induce?
Lugol's solution -> Wolff-Chaikoff effect (contains iodine but inhibits thyroid hormone production by inhibiting iodine organification)
273
Give the 2 antibiotics given in acute cholecystitis
Cefotaxime
Metronidazole
to cover gram positive, negative and anaerobes
274
What primary prevention can be given in Lynch syndrome?
Aspirin
275
Why is flexible sigmoidoscopy not preferred in diverticulitis?
Risk of perforation is increased due to false lumens (diverticulae)
276
Which arrhythmia can MR cause?
AF
277
Which medication is given for metallic heart valves?
Vitamin K antagonist -> Warfarin
278
How do you differentiate orbital cellulitis + peri orbital abscess?
Orbital cellulitis causes visual disturbances
278
Which imaging is gold standard for optic neuritis?
MRI orbit with contrast
278
What is P-mitrale associated with?
MR
279
What is the most common cause worldwide of hypothyroidism?
Iron Deficiency (Hashimoto's in developed world)
280
Which type of cells are over expressed in asthma?
T-helper type 2 cells
281
Which cancer is Hashimoto's associated with?
Non-Hodgkin's Lymphoma
282
How does an ACEI cause a dry cough?
ACE normally breaks down bradykinin (causes bronchoconstriction)
-> ACEI -> reduces degradation and bradykinin accumulates in upper and lower respiratory tracts
283
What is the most common cause of mesenteric ischaemia?
Embolus in SMA, most due to AF
284
Give a body part involved in essential tremor + how is ET affected with alcohol and benzodiazepines use?
Head
Improves
285
Which type of sepsis does agranulocytosis lead to?
Neutropenic
286
What is the advice for flying post-pneumothorax?
Fly 1 week after post-check CXR
287
Give the management for both ureteric and renal <5mm stones + ureteric >10mm + renal 10-20 + renal >20mm
Watchful waiting
Uteroscopy
EWSL
PCNL
288
What is the treatment for active cancer after PE?
LMWH for 6 months
289
What is the limit for statins before discontinuing?
3x upper limit of ALT/AST
290
Which shoulder pathology is hypothyroidism a risk factor?
Adhesive capsulitis
291
Give the 3 phases of adhesive capsulitis
Freezing 2-9 months - pain
Frozen 4-12 months - restricted movement
Thawing 12-24 months - gradual improvements
292
Which nerve palsy is seen in Lyme disease?
Early disseminated -> facial nerve
293
Give a cardio manifestation of Lyme disease
AV block
294
What biologic is first line for metastatic seminoma?
Cisplatin - platinum based therapy
295
What ECG changes is seen in tricyclic antidepressant?
QRS widening
296
Give the triad seen in HUS from E.coli O157 shiga toxin
Thrombocytopenia, haemolysis and renal failure
297
What is the gold standard investigation for bronchiectasis?
CT Thorax
298
Give the gold standard investigation for bullous pemphigoid (bullae, does not affect mouth)
Skin biopsy with direct immunoflourescence
299
In DKA -> what are the ranges for K+ for treatment?
>5.5 nothing
3.5-5.5 40mmol/2h K+
<3.5 -> ITU/HDU consideration
300
What is the signet ring sign indicative of on a CT chest?
Bronchiectasis from multiple dilated bronchi
301
What medication change should take place if patient has long term HF not controlled properly and has LVEF <35%
Switch ACEI to ARB
302
Which type of rash is seen in rheumatic fever?
Erythema marginatum
303
Give the mechanism of metronidazole + effectiveness on aerobic organisms
Reduced by anaerobic only -> disrupts DNA replication
Ineffective against aerobic
304
Give 2 investigations for long QT syndrome
ECG
Holter
305
What is first line for long QT syndrome? + refractory?
Beta blocker and lifestyle
ICD
306
What is first line for Bell's palsy?
Oral prednisolone
307
What the management for:
1) 5-8 INR, no bleeding
2) >8, no bleeding
1) Withold 1-2 doses
2) 1-5mg oral vitamin K
308
What is the blood test for sarcoidosis?
Serum ACE (elevated)
309
What is the pathophysiology of hypercalcaemia in sarcoidosis?
Increase in alpha-1-hydroxylase -> activates vitamin D
310
How do opioids cause respiratory depression?
Mu receptors cause medullary diminished central response to hypercapnia and hypoxia
311
Give the first line medical treatment for achalasia
Long acting nitrate
CCB (nifedipine)
312
Which imaging is used in acute diverticulitis?
CT abdo pelvis
313
What is the metabolic cause of DKA?
Unopposed lipolysis and oxidation of FFAs -> ketoacidosis
314
What is the most common organism in adult conjunctivitis?
Adenovirus
315
Diverticulitis -> bubbles in urine -> which complication?
Colovesical fistula
316
How is retrobulbar optic neuritis differentiated?
Normal optic disc on fundoscopy with eye pain and vision loss
317
Which supplement is given with methotrexate?
Folic acid
318
How to differentiate between myxoedema criss + thyroid storm?
Myxoedema -> hypothermia <35.5
Thyroid storm >40
319
Which antibodies can cross placenta and cause neonatal lupus leading to complete heart block with SLE mother?
Anti-Ro
320
What is the most common type of renal complication in SLE
Diffuse proliferative glomerulonephritis
321
What is required immediately if Torsades de Pointes is detected?
Magnesium sulphate
322
Which condition affects desmoglein-1?
Staph aureus -> impetigo
323
Which tumour marker is elevated in non-seminamatous testicular cancer?
APC
324
What is the most likely complication of chronic pancreatitis?
Oteoporosis
325
Give the treatment for cellulitis with facial involvement
Co-amoxiclav
or Erythromycin with metronidazole
326
Which serious skin condition can occur following varicella?
Nec fasc
T1 = polymicerobial
T2 = strep pyogenes
T3 = marine
T4 = fungal
327
What can a left sided varicoceole indicate?
left sided RCC
328
Which CT chest finding will you find with RCC?
Canonball metastases
329
What is intravesical mitomycin C given for?
Post-surgery TURBT for bladder cancer
330
How to differentiate between CES and spinal cord mets?
CES -> LMN signs only
331
Which reflex outcomes differentiates CES and CMS
CMS -> knee reflex preserved, ankle lost
CES -> both lost
332
What is the gold standard for anti-GBM? + What is a key finding?
Renal biopsy
Crescenteric glomerulonephritis
333
Tender singular goitre -> diagnosis?
Subacute granulomatous goitre (de Quervains)
334
Give the calculation for estimated serum osmolality
(2*Na) + urea + glucose
335
Pleural thickening, chest pain, weight loss -> diagnosis?
Pleural mesothelioma
336
Which bloods is used for diagnosing NMS?
Serum creatine kinase
337
Which lung cancer is associated with SVCO?
SCLC
338
Which cancer risk increases in acromegaly?
Colorectal
339
What is first line for serotonin syndrome?
Cyproheptadine
340
Give a notable side effect of GLP-1 mimetic and DPPIV-inhibitors
Acute pancreatitis
341
Which antibiotic is given second line for acne with history of DVT?
Lymecycline
342
Epigastric pain improves after eating -> where is the location of the ulcer?
Duodenum
343
Which endocrine complication can occur from use of lithium?
Hypothyroidism
344
What is the most common organism in encephalitis + first line?
HSV
IV acyclovir
345
What is first line for SCLC + NSCLC?
Chemotherapy with radiotherapy
Surgical resection
346
CXR -> cough, dyspnea, lower lung base bullae, young -> diagnosis?
A1AT
347
What does a testicular blue dot sign indicate?
Torsion of testicular appendage (cremasteric reflex preserved)
348
How does ARB cause hyperkalaemia?
ARB blocks production of aldosterone -> less excretion of K+
349
COPD not managed with bronchodilator -> which FEV1 value for next line + What is next line?
<80
Inhaled tiotroprium (LAMA) combined with salmeterol (LABA)
350
What is the significance of folliculitis on chest with other infective symptoms?
Late stage HIV -> HIV serology
351
Which cancer is actinic keratoses associated with?
SCC
352
When is septic shock diagnosed?
Severe sepsis + hypotension + raised lactate despite fluid resus
353
Which type of glomerulonephritis can IgA develop into?
Rapidly progressive -> loss of eGFR 50% or 50% crescent formation <3M
354
What prophylaxis is required after splenectomy?
Daily Pen V
355
What is first line for P.falciparum? + Give the triad + when is step down started?
IV artesunate
Hypotension, hypoglycaemia, parasitaemia >10%
step down to oral at <1%
356
Which RTA is hypergammaglobulinaemia associated with?
RTA (Type 1) - Fanconi -> distal RTA
Hypokalaemia, hypophosphataemia,
357
COPD exacerbation, life threatening features -> tried nebulised salbutamol and hydrocortisone -> next steps?
40mg prednisolone, admit to hospital, review in the morning
358
SIADH -> what is first line?
Fluid restriction
359
Good response to synacthen test -> what does this rule out?
Addison's
360
Bronchiectasis, pseudomonas aeruginosa infections, resistance to fluoroquinolone -> what is the next management?
Trial nebulised colistin and chest physio
361
Swelling, dull dragging pain in scrotum -> diagnosis?
Varicocoele
362
Which vitamin D supplement does not require kidney hydroxylation?
Alfacalcidiol (1-hydroxycholecalciferol)
363
Which endocrine pathology is associated with congestive cardiac failure?
Myoedema (hypothyroidism)
364
Which HSV is more common in viral meningitis?
HSV2 > HSV1
365
What is the most common bacterial meningitis in neonates?
GBS
366
What is contraindicated in ACS if hypotensive?
GTN
367
How is a posterior STEMI seen on ECG? + Which artery?
Reciprocal only ST depression V1-4
Posterior descending branch of RCA
368
Painless indurated penile ulcer -> diagnosis?
Syphilis (trepenoma pallidum)
369
How is primary and secondary Conn's differentiated?
Primary -> increase aldosterone, negative feedback = low renin
Secondary -> inappropriate activation of RAAS -> increases both
370
What is Virchow's node significant for?
Upper GI malignancy
371
Close contacts with what can cause which parasitic encephalitis?
Toxoplasmosis
372
Define decubitus angina
Angina symptoms on laying flat
373
Give the ECG change in prinzmental angina
Transient ST elevation due to coronary artery vasospasm
374
Which drug can cause coronary artery spasms?
Cocaine
375
How to know if fibrinolysis has worked?
1 hour ECG afterwards for STEMI
376
What is a good agent to use to reduce resp rate and breathlessness without causing hypoxia or hypercapnia?
IV morphine
377
What can ventricular wall aneurysms (persistent ST elevation) lead to?
Stroke due to thrombi formation from turbulent blood flow in ventricle
378
Give the effect of hypoparathyroidism on phosphate and calcium
Low calcium, high phosphate
379
Give the BM targets for fasting after waking + before meals
Fasting BM after waking = 5-7
Before meals = 4-7
380
What is first line septic shock?
IV adrenaline/noradrenaline infusion
381
After fluid resus, when is insulin given in HHS?
Ketosis
382
Why is ketosis seen less in HHS?
There is more circulating insulin -> drives glucose into cells -> turns off ketotic pathways
383
What is first line medical management in phaeochromocytoma?
Alpha blocker (phenoxybenzamine) then beta blocker
384
Give the genetic mutations for MEN1 + MEN2
MEN1
RET
385
What does the liver increase the production of in compensation for hypoalbuminaemia? + how does this affect the blood?
Clotting factors
Hypercoagulability (plus loss of antithrombin III in urine)
386
Which type hypersensitivity reaction is acute interstitial nephritis?
Type IV
387
What causes prinzmental angina?
Coronary spasm
388
After GTN and non-dihydropyridine CCB -> what is second line? + for asthma?
Switch verapamil to dihydropyridine and BB
Asthma -> avoid beta blockers -> ivabradine
389
Which histological type carries the worse prognosis and progression to end stage renal disease in FSGS?
Collapsing type
390
How does CKD cause bone and joint pain with reduced mobility?
CKD -> reduced 1-alpha hydroxylase -> reduced activation of vitamin D (active form = 1,25-dihydrocholecalciferol)
391
Why is there crepitus on palpation of MRSA severe cellulitis?
Nec fasc from anaerobic organisms causing gas
392
How would you treat A1AT?
Like COPD
393
Which 2 enzymes is implicated in A1AT? + Therefore, what does A1AT deficiency lead to?
Inhibit protease
Prevents neutrophil elastase from breaking down elastin
-> Alveolar destruction and emphysema
394
Which other system can A1AT affect?
Liver -> cirrhosis -> scleral icterus
395
Which imaging for diagnosing PSC?
MRCP
396
Are intra or extra hepatic ducts affected in PSC + PBC?
PSC -> inside and outside
PBC -> inside only
397
Which dermatological pathology is associated with Parkinson's?
Seborrhoeic dermatitis
398
How do you differentiate white out in pleural effusion and total lung collapse?
Lung collapse -> towards white out
Pleural effusion -> away
399
Which blood gas will primary hyperaldosteronism show?
Metabolic alkalosis (from loss of H+ with K+)
400
What type of diet is required power bowel resection?
High protein
Low fat
401
What is seen in LHF + Pulmonary hypertension for mPAP + pCWP?
PH -> >20mmHg mPAP, normal pCWP
LHF -> increase both
402
How does alcohol affect magnesium?
Decreases (which decreases potassium)
403
How is SJS and TEN differentiated?
SJS <10% skin involvement
TEN >30%
Both have mucosal involvement
404
If T1D not well controlled, how much is the increase in long acting and short acting?
Both 10%
405
What is the first line for pancreatic head tumour?
Whipple's (pancreatoduodenectomy)
406
Give a dermatological condition associated with otitis externa and blephritis
Seborrhoeic dermatitis
407
Give the bowel screening programme
Over 60 to 74, every 2 years, qFIT
408
What can guttate psoriasis turn into?
Plaque psoriasis
409
What is the reversal agent for beta blockers?
Glucagon
410
What is given in long term + short term serotonin syndrome?
Long term -> cyproheptadine
Short term -> benzo
411
Which bundle branch + fascicular blocks causes LAD + RAD?
LAD -> left anterior fascicular block, LBBB + inferior MI
RAD -> left posterior fasciular block + lateral MI
412
Tonsillitis can cause which type of psoriasis?
Guttate psoriasis
413
Which derm condition is associated with a herald patch?
Pityriaisis rosea
414
Give the target + step up targets in diabetes after metformin has not managed?
Target = 53
Step = 58
415
Which lobe is the most commonly affected by aspiration pneumonia?
RLL
416
Give the UTI treatment course for non-pregnant + pregnant + male
Non-pregnant - 3 days (7 days if catheterised)
Pregnant and male - 7 days
417
Give the AB for pyelonephritis in mild-moderate non pregnant + pregnant + severe
Mild-moderate non pregnant -> cefalexin, co-amox
Pregnant - cefalexin
Severe - IV co-amoxiclav +/- gentamicin
418
Give the timing for CT head for:
GCS<12
GCS<15 in 2 h
Open or depressed skull fracture
Basal skull fracture
>1 vomiting
Focal neurological deficit
+
>65
Bleeding disorders
Dangerous mechanism
>30 minutes retrograde amnesia
1h
8h
419
Wickhams striae, Koebnar, itchy rash on wrist, URTI, oral mucosal involvement -> diagnosis?
Lichen planus
420
What is first line for arteriovenous malformation in kidneys?
Embolisation
421
IgA deposition in dermal cells on immunofluorescence, papules and vesicles -> diagnosis? + management?
Dermatitis herpetiformis
Dapsone
422
Give the 4 symptoms of pellagra + which vitamin?
B3 (niacin)
Diarrhoea, dermatitis, depression, dementia
423
Polymorphic VT -> what is first line?
IV magnesium sulphate 2g
424
What are 2 side effects of oral iron?
Black stools
Constipation
425
Give 2 complications 24-48h after + before + after 4 weeks pancreatitis
24-48 -> necrotising pancreatitis
Before -> peripancreatic fluid
After -> pseudocyst
426
How to calculate 24h insulin?
Weight x 0.5-0.75
427
Which Duke stage requires adjuvant chemotherapy?
Duke C (regional lymph node involvement)
428
Give the surgical repair for a large direct inguinal hernia + bilateral
Large direct -> open mesh repair
Bilateral -> lap mesh repair
429
What is the next step if recent stroke/TIA or >75 in massive PE?
Treatment dose LMWH
430
Diabetic, IVDU, recurrent abscess -> what should be considered when selecting an antibiotic?
MRSA
431
Younger, fever, rash, gram negative diplococci -> diagnosis?
Gonococcal
432
What rhythm can chronic MR cause?
AF due to chronic remodelling of LA which disrupts electrical activity of SAN
433
What does portal hypertension indicate?
Portal hypertension (transudative)
434
