PassMed 6

Question 1

What should be monitored b4 starting SNRI

Answer 1

Blood pressure - SNRI increase HTN risk

Question 2

What should be monitored prior to starting citalopram in this patient?

Answer 2

ecg

Question 3

observe all ppl on SSRI for

Answer 3

• Hyponatraemia
• . For people at high risk, measure the serum sodium level before starting treatment, 2-4 weeks after starting treatment and every 3 months thereafter.

Question 4

CENTOR criteria

Answer 4

• Tonsillar exudate
• Tender anterior lymphadenopathy or lymphadenitis
• History of fever
• Absence of cough
• 3/4 -> ab

Question 5

Young male smoker with symptoms similar to limb ischaemia - think

Answer 5

buergers disease

Question 6

retinal haemorrhages (red patches) confined to a limited area of the retina

Answer 6

branch retinal vein occlusion

Question 7

? is now contraindicated with any form of cardiovascular disease

Answer 7

diclofenac

Question 8

active mx of third stage of labour =

Answer 8

• Uterotonic drugs: oxytocin
• Deferred clamping and cutting of cord, over 1 minute after delivery but less then 5 minutes
• Controlled cord traction after signs of placental separation

Question 9

pink blanching lesion on the nape of a babies neck

Answer 9

salmon patch

Question 10

what is CI in VT

Answer 10

VERAPAMIL

Question 11

Posterior STEMI ECG

Answer 11

• Reciprocal changes in V1-V3
• ST depression
• Tall, broad R-waves
• Upright T-waves

Question 12

After the first VTE, patients with antiphospholipid syndrome should be on

Answer 12

lifelong warfarin

Question 13

ivabradine SE

Answer 13

Bright spots appearing in vision + green lumiescence

Question 14

Post-exposure prophylaxis for HIV: oral antiretroviral therapy for

Answer 14

28 days

Question 15

mx of aspirin OD

Answer 15

urinary alkalinization with IV bicarbonate
haemodialysis - ulmonary oedema and metabolic acidosis

Question 16

Children presenting to GP with squint

Answer 16

refer to opthalm

Question 17

LP mx

Answer 17

potent topical steroids

Question 18

features of tuberous sclerosis

Answer 18

• depigmented ‘ash-leaf’ spots which fluoresce under UV light
  roughened patches of skin over lumbar spine (Shagreen patches)
  adenoma sebaceum (angiofibromas): butterfly distribution over nose
  fibromata beneath nails (subungual fibromata)
  cafe-au-lait spots* may be seen
• epilspey and developmental delay

Question 19

Large artery acute ischaemic stroke? Consider

Answer 19

mechanical clot retrieval - thrombectomy

Question 20

cavitation on XR ->

Answer 20

aspergilloma or TB

Question 21

Long-term atypical antipsychotics can lead to the development of

Answer 21

GLUCOSE DYREG AND DIABETES

Question 22

Painless vg bleeding later in pregnancy

Answer 22

do US to check for PP

Question 23

Placental accreta increases risk of

Answer 23

PPH - home birth is CI

Question 24

The correct position for women who have a cord prolapse is

Answer 24

On all 4s, elbows and knees

Question 25

Suspected PE in pregnant women with a confirmed DVT:

Answer 25

treat with LMWH first THEN investigate to rule in/out

Question 26

HELP syndrome

Answer 26

-haemolysis - elevated liver enzymes - low platelets - serious mainfestation of pre-ec

Question 27

ECV can be attempted up until

Answer 27

amniotic sac rupture

Question 28

BF and AED

Answer 28

Breast feeding is acceptable with nearly all anti-epileptic drugs - EXCEPT barbituates

Question 29

PPH - first like surgical tx

Answer 29

intrauterine Bakri catheter/ balloon tamponade

Question 30

mx of GBS + mother

Answer 30

intrapartum IV benzylpenicillin

Question 31

GBS in pregnancy - monitoring

Answer 31

regular obs for 24 hrs following delivery

Question 32

intrahepatic cholesasis of pregnancy - delivery

Answer 32

induce at 37-38 weeks - c section not necessart

Question 33

key sign to check for with pre-ec as it can precede eclampsia

Answer 33

brisk tendon reflexes

Question 34

Mx of shoulder dystocia

Answer 34

1) Initially, request senior help and ask the mother to hyperflex their legs (also called McRobert's manouvere) and apply suprapubic pressure 2) episotomy 3) then Wood screw manouvre and manipulation of posterior arm 4) last resorts: symphisiotomy and the Zavanelli manouvere

Question 35

A woman at moderate or high risk of pre-eclampsia should take

Answer 35

aspirin 75-150mg daily from 12 weeks gestation until the birth

Question 36

The recurrence rate of postnatal psychosis is

Answer 36

25-50%

Question 37

PPROM mx

Answer 37

- oral erythromycin - steroids - monitor until 37 weeks (delivery usually recommended at 37 weeks unless need for earlier delivery)

Question 38

? is used to investigate suspected placenta praevia

Answer 38

TVUS (DO NOT DO A BIMANUAL)

Question 39

A 26-year-old pregnant woman with type 1 diabetes asks you how often she should test blood glucose levels throughout her pregnancy?

Answer 39

Daily fasting, pre-meal, 1 hr post meal and bedtime

Question 40

RF for pre-ec that should be checked for at booking

Answer 40

- Aged 40 years or older - Nulliparity - Pregnancy interval of more than 10 years - Family history of pre-eclampsia - Previous history of pre-eclampsia - Body mass index of 30kg/m^2 or above - Pre-existing vascular disease such as hypertension - Pre-existing renal disease - Multiple pregnancy

Question 41

Pregnant women ≥ 20 weeks who develop chickenpox are generally treated with

Answer 41

oral aciclovir if they present within 24 hours of the rash

Question 42

screening tool for postnatal depression

Answer 42

Edinburgh

Question 43

Which one of the following results would indicate the need for routine antenatal anti-D prophylaxis to be given at 28 weeks?

Answer 43

rhesus negative mothers who are not sensitised

Question 44

what should be assessed prior to induction of labour

Answer 44

- bishop - Cervical position (posterior/intermediate/anterior) Cervical consistency (firm/intermediate/soft) Cervical effacement (0-30%/40-50%/60-70%/80%) Cervical dilation (<1 cm/1-2 cm/3-4 cm/>5 cm) Foetal station

Question 45

This patient has had a placental abruption. Important signs and symptoms to think about when suspecting placental abruption are:

Answer 45

- continuous abdominal pain shock disproportionate to the amount of blood loss (20% of placental abruptions are 'concealed' - the blood is trapped behind the placenta and does not drain) the uterus may be in spasm and feel firm or 'woody' the fetus may be hard to feel the fetal heart may be hard to auscultate

Question 46

flying in pregnancy

Answer 46

> dont fly after 32 weeks with twins > dont fly after 37 weeks if singleton

Question 47

wood scre manouvre =

Answer 47

describes the action of putting a hand in the vagina and rotating the foetus 180 degrees in attempt to 'dislodge' the anterior shoulder from the symphysis pubis.

Question 48

peuperial pyrexia causes

Answer 48

Puerperal pyrexia may be defined as a temperature of > 38ºC in the first 14 days following delivery. Causes: endometritis: most common cause urinary tract infection wound infections (perineal tears + caesarean section) mastitis venous thromboembolism

Question 49

Mx of endometritis

Answer 49

- refer to hosp for IV ab

Question 50

primary RF for endometritis

Answer 50

caesarean section, which augments the risk by 5-20-fold.

Question 51

sudden collapse occurring soon after a rupture of membranes is suggestive of

Answer 51

amniotic fluid embolisn

Question 52

mx of acute sinusitis

Answer 52

- analgesia + intranasal decongestants or saline - intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days

Question 53

When should oral ab be given for acute sinusitis

Answer 53

- severe presentation - phenoxymethypenicillin 1) - Co-amox is v unwell

Question 54

biggest RF for malignant otitis externa

Answer 54

- diabetes - others: IS

Question 55

cause of malignant otitis externa

Answer 55

pseudomonas

Question 56

diffuse systemic sclerosis vs limited ab

Answer 56

-Limited (central) systemic sclerosis = anti-centromere antibodies - diffuse = anti-Scl70 (70 body areas)

Question 57

mx of reactive arthritis

Answer 57

- oral NSAIDs and paracetamol - oral steroids

Question 58

The most common site of metatarsal stress fractures is

Answer 58

2nd metatarsal shaft

Question 59

hypersensitivity pneumonitis =

Answer 59

type 3 hypersensitivity

Question 60

Which of the following may indicate that his hip pain is in fact referred from his lumbar spine?

Answer 60

positive femoral nerve stretch test

Question 61

blood findings in APS

Answer 61

(paradoxically) prolonged APTT + low platelets

Question 62

Initial vs best imaging for achilles tendon rupture

Answer 62

- US: initial - MRI: best

Question 63

Anterior shoulder dislocations account for

Answer 63

95%

Question 64

? classification system is used to classify neck of femur fractures

Answer 64

garden

Question 65

Osteoporosis in a man - check

Answer 65

testosterone

Question 66

Mx of hip fractures

Answer 66

Question 67

mx of open #

Answer 67

- Urgent IV ab and debridement in theatre - definitive mx delayed until soft tissues have recovered

Question 68

initial improvement of cellulitis with antibiotics but persistent discharge and localised tenderness/swelling ->

Answer 68

abscess formation - surgical drainage and ab

Question 69

In an IVDU with back pain and pyrexia have a high suspicion

Answer 69

osteomyelitis

Question 70

A 22 year man is shot in the back, in the lumbar region. He has increased tone and hyper-reflexia of his right leg. He cannot feel his left leg.

Answer 70

brown sequart

Question 71

malignant tumour that occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure

Answer 71

osteosarcoma

Question 72

Ix for tibial stress syndrome

Answer 72

XR to rule out stress #

Question 73

Any patient presenting with symptoms of intermittent claudication not worsened by increasing exertio

Answer 73

neurogenic not ischaemic

Question 74

Dermatomyositis is associated with the ? ab

Answer 74

anti-Jo 1 (aunt Jo gets rashes)

Question 75

what to do ASAP for an ankle #

Answer 75

reduce - minimise risk of damage to skin

Question 76

mx of scaphoid #

Answer 76

wrist splint and follow up at 7-10 days

Question 77

Meralgia parasthetica can be caused by

Answer 77

sudden WG

Question 78

Burning and tingling sensation over the upper lateral area of the thigh

Answer 78

- meralgia perasthetica - lateral femoral cutaneous nerve affected

Question 79

Tx for AS

Answer 79

1) Oral NSAIDs and physio, encourage reg exercise 2) DMARDs only if peripheral joints 3) anti-TNF

Question 80

Mx of rib #

Answer 80

conservative mx w pain killers

Question 81

Carpal tunnel syndrome: a trial of ? should be tried initially for patients with mild-moderate symptoms

Answer 81

conservative treatment (wrist splint +/- steroid injection)

Question 82

? is the most common mechanism of ankle sprain

Answer 82

foot inversion

Question 83

osteomyelitis on a BG of malaria or sickle cell tends to be causes by

Answer 83

non typhi salmonella - due to haemolysis and iron availability

Question 84

pain on passive stretch ->

Answer 84

cs

Question 85

mx of sciatica

Answer 85

- tx w NSAID and refer for physio - referral for sciatica is appropriate after 4-6 weeks of conservative treatment (analgesia and physiotherapy) has failed

Question 86

initial mx of shoulder dislocation

Answer 86

kocher technique reduction w/o analgesia/ sedation

Question 87

First line for lower back pain

Answer 87

- NSAIDs - co-prescribe PPI

Question 88

5th metatarsal fractures often follow forced

Answer 88

INVERSION of foot and ankle

Question 89

Phalens test

Answer 89

The patient's wrist is held in maximum flexion (reverse prayer sign) for 30-60 second. The test is positive if there is numbness in the median nerve distribution

Question 90

statin dosage for established CVD

Answer 90

80MG 0- high dose regardless of baseline lipids

Question 91

Key features of hypocalcaemia

Answer 91

perioral paraesthesia, cramps, tetany and convulsions

Question 92

most serious comp of AKI

Answer 92

hyperkal

Question 93

hypercalcaemia Mx

Answer 93

1) IV fluids 2) calcitonin - quicker effect than bisphosphonates steroids in sarcoidosis

Question 94

raised ALP in pregnancy

Answer 94

due to placenta

Question 95

cause of syphilis

Answer 95

treponema pallidum - painless ulcer

Question 96

new LBBB is

Answer 96

always pathological

Question 97

syphilis mx

Answer 97

IM benzathine penicillin first line

Question 98

Pregnant women who smoke mx

Answer 98

- give NRT - vareniciline and bupropion are CI

Question 99

Pernicious anaemia predisposes to

Answer 99

Gastric cancer

Question 100

what can CF cause

Answer 100

dm

Question 101

The diagnosis of acute epiglottis is made by

Answer 101

direct visualisation by senior airway trained staff

Question 102

? is the investigation of choice for intussusception

Answer 102

US

Question 103

Which one of the following is least associated with constipation in children?

Answer 103

Addisons -> diarrhoea

Question 104

mx of bronchiolitis

Answer 104

suppotive mx w O2 only

Question 105

Hand, foot and mouth disease is most commonly caused by

Answer 105

coxsackie A16 and enterovirus

Question 106

When is MMR given

Answer 106

- 12-13 m - 3-4 yrs

Question 107

Infant with bilious vomiting & obstruction → ?

Answer 107

intest malrotation (PS DOES NOT CAUSE BILIOUS VOMITING)

Question 108

AT WHAT AGE IS A HIGH FEVER V CONCERNING

Answer 108

A child aged < 3 months with a fever > 38ºC -> send straight to hosp

Question 109

? should be given to all children who have an asthma attack

Answer 109

steroids

Question 110

At what age would the average child acquire the ability to crawl?

Answer 110

9m

Question 111

rb prognosis

Answer 111

90% survive into childhood

Question 112

Time between MMR doses

Answer 112

give MMR then 2nd dose in 3 monhs if missed

Question 113

auto recessive vs dominant inheritance

Answer 113

- Autosomal recessive conditions are 'metabolic' - exceptions: inherited ataxias Autosomal dominant conditions are 'structural' - exceptions: Gilbert's, hyperlipidaemia type II

Question 114

most immediate concern for a child with downs who does sports

Answer 114

atlantioaxial stability - Screen for atlanto-axial instability in people with Down syndrome who participate in sports that may carry an increased risk of neck dislocation (e.g. trampolining, gymnastics, boxing, diving, rugby and horse riding)

Question 115

child under 5 bedwetting

Answer 115

Normal under 5 - reassure

Question 116

croup - admission criteria

Answer 116

moderate or severe croup < 3 months of age known upper airway abnormalities (e.g. Laryngomalacia, Down's syndrome) uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)

Question 117

croup gradinf

Answer 117

Question 118

Pyloric stenosis classically leads to - ABG

Answer 118

elevated bicarb, hypocholoraemic, hypokal alkalosos

Question 119

mx of SUFE

Answer 119

- EMERGENCY - internal fixation accross growth plate

Question 120

Older woman with labial lump and inguinal lymphadenopathy → ?

Answer 120

vulval carcinoma

Question 121

menorrhagia + bulky uterus

Answer 121

Fibroids (Leiomyoma

Question 122

smear after delivery

Answer 122

waiyt till 12 weeks PP (do not do whilst pregnant)

Question 123

Primary amenorrhoea, little or no axillary and pubic hair, elevated testosterone →

Answer 123

AIS - 46XY

Question 124

long-term complication of vaginal hysterectomy with anteroposterior repair.

Answer 124

Vg vault prolapse

Question 125

test for ? in women who have menorrhagia since menarche

Answer 125

coagulation disorder - e.g. VWD

Question 126

Women with suspected PCOS should have the following investigations

Answer 126

: pelvic ultrasound, FSH, LH, prolactin, TSH, testosterone, sex hormone-binding globulin (SHBG

Question 127

Most common cause of postcoital bleeding

Answer 127

- cervical ectropion (linked to COCP) -

Question 128

Recurrent vg thrush ->

Answer 128

Ix for underlying cause: DM, IS, pregnancy, ab or steroid use

Question 129

sig RF for endometrial cancer

Answer 129

obesity

Question 130

SSRIS taken when may help w PMS

Answer 130

either continuously or during the luteal phase

Question 131

? most reliable test to confirm ovulation

Answer 131

PROGESTERONE - 7 days before end of cycle

Question 132

Tx of endometriosis for women trying to conceive

Answer 132

Laparoscopic excision or ablation of endometriosis is recommended for women who are trying to conceive

Question 133

after 3 months pelvic floor exercises ->

Answer 133

consider duloxetine or surgery for SI

Question 134

Fibroid degen =

Answer 134

Fibroid degeneration may develop during pregnancy, presenting with low-grade fever, pain and vomiting.

Question 135

Pregnant women who are < 6 weeks gestation and present with vaginal bleeding and no pain can be

Answer 135

managed expectantly

Question 136

Women with stage IA cervical cancer may be considered ? if they wish to maintain their fertility

Answer 136

for a cone biopsy with negative margins

Question 137

first line for wilsons disease

Answer 137

penicillamine

Question 138

tremor in PD

Answer 138

Asymmetrical resting -> idiopathic PD

Question 139

Symmetrical tremor ->

Answer 139

drug induced PD

Question 140

If there is clubbing with hyperthyroidism, think

Answer 140

GRAVES DISEASE - thyroid acropachy

Question 141

histology of coeliac

Answer 141

villous atrophy, raised intra-epithelial lymphocytes, and crypt hyperplasia

Question 142

what slows disease progression in CKD

Answer 142

Tolvaptan has been shown to reduce the rate of CKD progression in ADPKD (and is approved by NICE)

Question 143

ou wish to screen a patient for hepatitis B infection. Which one of the following is the most suitable test to perform?

Answer 143

HB SURGFACE ANTIGEN

Question 144

Genital wart treatment

Answer 144

- multiple, non-keratinised warts: topical podophyllum MP - solitary, keratinised warts: cryotherapy SC

Question 145

hoffmans sign

Answer 145

- sign of UMN dysfunction - points to disease of CNS (NOT CTS)

Question 146

Multiple painful genital ulcers, sexually active -

Answer 146

GENITAL HERPES

Question 147

what type of fibrosis does tb cause

Answer 147

upper zone (remember TB is aerobic)

Question 148

mx of chlamydia in pregnancy

Answer 148

erythromycin

Question 149

If a patient has a urine output of < 0.5ml/kg/hr postoperatively the first step is to

Answer 149

- give 500ml fluid challenge - if no CI like signs of haemorrhage

Question 150

? is the empirical treatment of choice in native valve endocarditis

Answer 150

IV amoxicillin

Question 151

leg weakness but no face or speech impairment

Answer 151

ACA

Question 152

Red man syndrome

Answer 152

- assoc w rapid infusion of vancomycin - Typical symptoms include redness, pruritus and a burning sensation, predominantly in the upper body (face, neck and upper chest). - severe= hypotension and chest pain

Question 153

mx of red man syndrome

Answer 153

- stop vancomycin infusion until symp resolve then restart at a lower rate

Question 154

All diabetic patients with a urinary ACR of 3 mg/mmol or more should be started on

Answer 154

ACE/ ARB

Question 155

? can cause hypercalcaemia and hypocalciuria

Answer 155

THIAZIDES

Question 156

triceps reflex

Answer 156

c7 and c8

Question 157

In pancreatic cancer, 3 different abdominal masses may be present:

Answer 157

hepatomegaly (metastases) gallbladder (Courvoisier's law) epigastric mass (primary)

Question 158

common cause of tumour lysis syndrome

Answer 158

burkitts lymphoma

Question 159

gram negative rod

Answer 159

e coli

Question 160

reducing the discomfort associated with a painful mouth that may occur at the end of life

Answer 160

Benzydamine hydrochloride mouthwash or spray

Question 161

adrenaline doses

Answer 161

Question 162

Vision worse going down stairs?

Answer 162

trochlear - 4th nerve palsu

Question 163

Lab features suggestive of Pseudomonas aeruginosa include:

Answer 163

- green discharge - Gram-negative rod non-lactose fermenting oxidase positive

Question 164

Lung adeno

Answer 164

- most common type in non-smokers peripheral lesion

Question 165

Sq cell carinoma

Answer 165

- typically central - associated with parathyroid - hormone-related protein (PTHrP) secretion → hypercalcaemia - strongly associated with finger clubbing - hypertrophic pulmonary osteoarthropathy (HPOA)

Question 166

Large cell carcinoma

Answer 166

- typically peripheral anaplastic, poorly differentiated tumours with a poor prognosis may secrete β-hCG

Question 167

further tests for pleural plqaues

Answer 167

none - benign

Question 168

which type of GE is linked to

Answer 168

camp bacter

Question 169

30-40 year old with basal emphysema and abnormal LFTs → ?

Answer 169

AT1D

Question 170

which valve is most commonly affected in IE

Answer 170

tricuspid - tri drugs

Question 171

Multiple myeloma: bone marrow aspirate would show

Answer 171

plasma cells

Question 172

A 60-year-old obese, nulliparous woman presents with vaginal bleeding -

Answer 172

endometrial cancer

Question 173

Cervical cancer screening: if smear inadequate then

Answer 173

repeat in 3 months

Question 174

FGM in uner 18s

Answer 174

report to police

Question 175

fibroid < 3cm

Answer 175

- try medical mx if its < 3cm and not distorting uterine cavity - e.g. (e.g. IUS, tranexamic acid, COCP etc)

Question 176

Raised FSH/LH in primary amenorrhoea - consider

Answer 176

consider gonadal dysgenesis (e.g. Turner's syndrome)

Question 177

EP locations

Answer 177

- isthmus - is bad more likely to rupture - ampulla - most likely - ample space

Question 178

definition of menorrhagia

Answer 178

an amount the woman considers to be excessive

Question 179

Urinary incontinence - first-line treatment:

Answer 179

- urge incontinence: bladder retraining - stress incontinence: pelvic floor muscle training

Question 180

Cervical cancer screening: if 2nd repeat smear at 24 months is now hrHPV -ve →

Answer 180

- return to normall recall - every 3 years if under 50 - every 5 years if over 50

Question 181

diagnosing thrus

Answer 181

- Vaginal candidiasis: Diagnosis does not require a high vaginal swab if the symptoms are highly suggestive - oral antifungal single dose

Question 182

In the case of pregnancy of unknown location, what suggests an ectopic

Answer 182

HCG > 1500

Question 183

use metoclopramide in N and V of pregnancy

Answer 183

do not use for more than 5 days - risk fo EPS

Question 184

Which one of the following is the most common cause of recurrent first trimester spontaneous miscarriage?

Answer 184

APS

Question 185

what is required for diagnosis of premature ovarian insufficiency

Answer 185

- raised FSH - further test at 4-6 weeks

Question 186

Cervical cancer screening: if smear inadequate then repeat in

Answer 186

3m

Question 187

Endometrial hyperplasia is associated with;

Answer 187

Taking oestrogen unopposed by progesterone Obesity Late menopause Early menarche Aged over 35-years-old Being a current smoker Nulliparity Tamoxifen

Question 188

High risk HPV for CC

Answer 188

16, 18, 33

Question 189

Need for contraception after the menopause

Answer 189

- 12 months after the last period in women > 50 years - 24 months after the last period in women < 50 years

Question 190

If analgesia doesn't help endometriosis then

Answer 190

COCP or POP should be tried

Question 191

All patients with secondary dysmenorrhoea need to

Answer 191

be referred to gynae

Question 192

atrophic vaginitis - do

Answer 192

TVUS to rule out endometrial cancer. is a diagnosis of exclusion

Question 193

Miscarriage - expectant management is not suitable if

Answer 193

- evidence of infection or risk of haemorrhage - fever + haem instability -> do surgery e.g. vaccum aspiration

Question 194

Lesbian and bisexual women - CC

Answer 194

AS NORMAL

Question 195

first-line treatment of atrophic vaginitis

Answer 195

Lubricants + moisturisers in addition to topical oestrogen

Question 196

ovarian cyst symptoms

Answer 196

Unilateral dull ache which may be intermittent or only occur during intercourse. Torsion or rupture may lead to severe abdominal pain Large cysts may cause abdominal swelling or pressure effects on the bladder

Question 197

Mifepristone MAO

Answer 197

- progesterone receptor antagonist → weakening of attachment to the endometrial wall + cervical softening and dilation + induction of uterine contractions

Question 198

The classic symptoms of endometriosis are

Answer 198

pelvic pain, dysmenorrhoea, dyspareunia and subfertility

Question 199

HIV positive women - CC

Answer 199

Annual screening

Question 200

mx of vasomotor symptoms w menopause

Answer 200

SSRI

Question 201

Most imp monitoring w Marfans

Answer 201

- regular echo - assoc w dilatation of aortic sinuses and may predispose to aortic dissection

Question 202

Hydroxychloroquine monitoring

Answer 202

visual acuity- retinopathy

Question 203

PMR - no response to steroids

Answer 203

stop steroids and consider alt diagnosis

Question 204

psoriatic arthitis ab

Answer 204

no ab detected - being a seronegative spondyloarthropathies, RF and anti-CCP are negative

Question 205

Septic arthritis mx

Answer 205

IV flucoxacillin 4-6 weeks

Question 206

azathioprine and pregnancy

Answer 206

safe

Question 207

Stills disease

Answer 207

- triad of joint pain, spiking fevers, and a salmon pink bumpy rash - fever rises in late evening

Question 208

if dermatomyositis is suspected

Answer 208

refer urgently to rheum

Question 209

Knee osteoarthritis - first line

Answer 209

topical NSAIDS

Question 210

Anterior ischemic optic neuropathy - fundoscopy typically shows a

Answer 210

swollen pale disc with blurred margins

Question 211

AS XR findings

Answer 211

s: subchondral erosions, sclerosis and squaring of lumbar vertebrae

Question 212

methotrexate monitoring

Answer 212

- FBC, U&E and LFTs need to be regularly monitored. - every 2-3 months

Question 213

WHAT SHOULD BE PRESCRIBED WITH METHOTREXATE

Answer 213

folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose

Question 214

Rheumatoid arthritis: initial management is

Answer 214

- Methotrezate DMARD - often with 2-3 months bridging steroids

Question 215

a measure of disease activity in rheumatoid arthritis

Answer 215

DAS28

Question 216

Reactive arthritis - HLA

Answer 216

b27

Question 217

Normal temporal biopsy with GCA

Answer 217

SKIP LESIONS OCCUR SO A NORMAL BIOPSY IS NOT THAT ABN - continue prednisolone

Question 218

? is a risk factor for pseudogout

Answer 218

hyperparathyroidism -> hypercal -> pseudogout

Question 219

old man, bone pain, raised ALP

Answer 219

Pagets fisease

Question 220

? helps to distinguish pseudogout from gout

Answer 220

chondrocalcinosis

Question 221

temparteritis mx

Answer 221

- urgent high-dose glucocorticoids should be given as soon as the diagnosis is suspected and before the temporal artery biopsy if there is no visual loss then high-dose prednisolone is used if there is evolving visual loss IV methylprednisolone is usually given prior to starting high-dose prednisolone - urgent opthalmology review if visual symptoms

Question 222

cochicine se

Answer 222

gi - diarrhoea

Question 223

highly specific test for SLE

Answer 223

anti dsDNA

Question 224

DRUG INDUCED LUPUS AB

Answer 224

anti-histone = answer in the history

Question 225

Syndesmophytes (ossification of outer fibres of annulus fibrosus) are a feature of

Answer 225

AS

Question 226

WEAKNESS IN PMR

Answer 226

no true weakness of limb girdles in polymyalgia rheumatica on examination. Any weakness of muscles is due to myalgia (pain inhibition)

Question 227

Felty's syndrome

Answer 227

ondition characterized by splenomegaly and neutropenia in a patient with rheumatoid arthritis.

Question 228

prior to starting biologics for rheumatoid arthritis DO

Answer 228

A xr - look for TB

Question 229

When starting allopurinol

Answer 229

NSAID or colchicine 'cover' should be used when starting allopurinol

Question 230

Haemochromatosis is a risk factor for

Answer 230

pseudogout

Question 231

methorexate pneumonitis

Answer 231

cough, fever, SOB

Question 232

key investigation in patients with suspected septic arthritis

Answer 232

Synovial fluid analysis

Question 233

Pagets disease tends to affect

Answer 233

the skull, spine/pelvis, and long bones of the lower extremities

Question 234

Moderate/severe psoriatic arthropathy →

Answer 234

methotrexate

Question 235

Poor prognostic features in RA

Answer 235

rheumatoid factor positive anti-CCP antibodies poor functional status at presentation X-ray: early erosions (e.g. after < 2 years) extra articular features e.g. nodules HLA DR4 insidious onset

Question 236

T scores

Answer 236

> -1.0 = normal -1.0 to -2.5 = osteopaenia < -2.5 = osteoporosis

Question 237

Discoid lupus erythematous mx

Answer 237

topical steroids → oral hydroxychloroquine

Question 238

Joint aspirate in rheumatoid arthritis shows

Answer 238

high WBC count, predominantly neurophils. Appearance is typically yellow and cloudy with absence of crystals

Question 239

CFS - symptoms for ? before diagnosis

Answer 239

3 months (3 letters)

Question 240

Septic arthritis in adults is most common in

Answer 240

knees

Question 241

Low serum calcium, low serum phosphate, raised ALP and raised PTH -

Answer 241

osteomalacia

Question 242

best rule out test for lupus

Answer 242

ANA - (im ANA here)

Question 243

positively birefringent rhomboid-shaped crystals

Answer 243

pseudogout

Question 244

Chronic kidney disease is a risk factor for

Answer 244

osteoporosis

Question 245

pyrexia seen in stills didease

Answer 245

Pyrexia in Still's disease has a characteristic pattern. It typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash

Question 246

osteogenesis imperfecta bone profile

Answer 246

djusted calcium, PTH, ALP and PO4 results are usually NORMAL

Question 247

osteogenesis imperfecta

Answer 247

frequent or multiple bone fractures, but also the blue-grey sclera, micrognathia and kyphoscoliosis

Question 247

TB can have which rheum comp

Answer 247

- polyarthritis - > reactiev arthritis

Question 248

most common cause of septi arthritis

Answer 248

staph a

Question 249

? can be used to prevent pathological fractures in bone metastases

Answer 249

- bisphosphonates - denosumab - use if GFR < 30

Question 250

Marfan's syndrome is caused by a mutation in a protein called

Answer 250

fibrillin 1

Question 251

? should be corrected before giving bisphosphonates

Answer 251

hypocalcaemia and vitamin D deficiency

Question 252

A 4-year-old boy is brought to the clinic. He gives a history of difficult, painful defecation with bright red rectal bleeding.

Answer 252

anal fissure

Question 253

A 2-year-old has a history of rectal bleeding. The parents notice that post defecation, a cherry red lesion is present at the anal verge.

Answer 253

juvenile polyps

Question 254

? complication of radiotherapy for prostate cancer

Answer 254

- proctitis - rectal discomfort, increased bowel movement frequency, and rectal bleeding,

Question 255

Zollinger-Ellison syndrome:

Answer 255

- multiple gastroduodenal ulcers causing abdominal pain and diarrhoea. - part of MEN1

Question 256

triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit

Answer 256

intestinal angina or CMI

Question 257

Crypt abscesses

Answer 257

UC

Question 258

Ongoing diarrhoea, lethargy, bloating, flatulence, steatorrhoea, weight loss +/- recent travel → ?g

Answer 258

Giardiasis

Question 259

? may cause marked right iliac fossa pain mimicking appendicitis

Answer 259

camplobacter jejuni

Question 260

inducing remission of crohns

Answer 260

steroids

Question 261

Diarrhoea, fatigue, osteomalacia → ?

Answer 261

coeliac disease

Question 262

? is used first-line to maintain remission in patients with Crohn's

Answer 262

azathioprine or mercaptopurine

Question 263

JVP rise in inspiration

Answer 263

In constrictive pericarditis, the JVP will rise on inspiration; this is known as Kussmaul's sign

Question 264

standard for the diagnosis and screening of HIV

Answer 264

Combination tests (HIV p24 antigen and HIV antibody)

Question 265

Bilateral, mid-to-lower zone patchy consolidation in an older patient → ?

Answer 265

legionella

Question 266

Flash pulmonary oedema can occur after

Answer 266

acute mitral valve regurg due to MI

Question 267

when should tetracyclines like lymecycline be avoided

Answer 267

pregnant & BF, children < 12

Question 268

mx of severe papules and pustules rosacea

Answer 268

oral doxy + topical ivermectin

Question 269

mx of undisplaced patella #

Answer 269

- if intact extensor mechanism: consv mx with knee mmobilisation - failure to extend: ORIF

Question 270

When is ORIF indicated for a patella #

Answer 270

indicated when there is failure of the extensor mechanism, open fractures or fracture displacement.

Question 271

Widened QRS or arrhythmia in tricyclic overdose - give

Answer 271

IV bicarb

Question 272

PD dementia

Answer 272

MOTOR SYMPTOMS THEN DEMENTIA AFTER 1 YEAR

Question 273

PDD vs LBD

Answer 273

PDD= Parkinsonian symptoms for atleast a year then dementia symptoms (neuropsychiatric) DLB= Neuropsychiatric + dementia symptoms for a year then parkinsonism

Question 274

Seizure Mx

Answer 274

Tonic-clonic = Levetiracetam or Lamotrigine (tonic-clonic is 2 words so there's an option of 2 treatments), Men = valproate Myoclonic (longer word) = levetiracetam (longer drug name) Atonic (shorter word) = Lamotrigine (shorter drug name)/ or sodium valproate if male Focal= lamotrigene or levetiracteam

Question 275

when should clopidogrel be stopped before surgery

Answer 275

7 days

Question 276

how is caortid artery stenosis diagnosed

Answer 276

duplex US carotids

Question 277

A 32 year male with leukaemia attends the day unit for a blood transfusion. Five days after the transfusion he attends A&E with a temperature of 38.5, erythroderma and desquamation.

Answer 277

G v H disease

Question 278

Surgery / metformin on day of surgery:

Answer 278

OD or BD: take as normal TDS: miss lunchtime dose assumes only one meal will be missed during surgery, eGFR > 60 and no contrast during procedure

Question 279

GFR < 60 and metformin & surgery

Answer 279

avoid metformin for 48 hrs before surgery

Question 280

? is associated with Takayasu's arteritis

Answer 280

renal artery stenosis

Question 281

LMWH monitoring

Answer 281

Factor Xa

Question 282

hypodense =

Answer 282

dark

Question 283

Massive PE + hypotension ->

Answer 283

thrombolyse - usually alteplase

Question 284

Waldenstrom's macroglobulinaemia,

Answer 284

- type of lymphoma that produces IgM - presents with bone marrow infiltration, splenomegaly and sometimes lymphadenopathy.

Question 285

HIV + proctitis ?

Answer 285

Lymphogranuloma venereum

Question 286

DCM initial step

Answer 286

refer to spinal surg

Question 287

Pulling the patient's thumb with ulnar deviation and longitudinal traction over the left radial styloid reproduces the patient's pain.

Answer 287

de quervains tensyonvitis

Question 288

TIA definition

Answer 288

The definition of a TIA is now tissue-based, not time-based: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction

Question 289

the appearance of ground-glass hepatocytes on light microscopy can point towards a diagnosis of

Answer 289

chronic he B

Question 290

3,4-methylenedioxymethamphetamine in urine

Answer 290

Ecstacy -> hyponatreamia

Question 291

bechets disease =

Answer 291

The classic triad in Behcet's is oral ulcers, genital ulcers and uveitis. Venous thromboembolism is also seen.

Question 292

when to shock a pt with tachycardia

Answer 292

Patients with tachycardia and signs of shock, syncope, myocardial ischaemia or heart failure should receive up to 3 synchronised DC shocks

Question 293

essential investigation when investigating a PE

Answer 293

CXR

Question 294

OM + post auricular swelling ->

Answer 294

mastoiditis - same day hosp admission

Question 295

A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination -

Answer 295

VSD (Left to right shunt on echo)

Question 296

Following a surgical abortion, an ? can be inserted immediately after evacuation of the uterine cavity

Answer 296

IUD/ IUS

Question 297

Normal anion gap acidosis

Answer 297

rta

Question 298

BV and trichomonas vaginalis pH

Answer 298

> 4.5

Question 299

biceps reflex

Answer 299

c5-c6

Question 300

Korsakoffs syndrome

Answer 300

complication of Wernicke's encephalopathy. It's features include: anterograde amnesia, retrograde amnesia, and confabulation

Question 301

mx of hypospadius

Answer 301

- refer to specialist - surgery usually around 12m - do NOT curcumcise

Question 302

Pneumonia with lymphopenia, hyponatraemia & deranged LFTs → ?

Answer 302

lEGIONALLA

Question 303

he presence of heart block alongside malaise, arthralgia ->

Answer 303

TEST FOR BORDIELLA - LYME DISEASE

Question 304

SLE, recurrent miscarriages → check for

Answer 304

Anticardolipin ab

Question 305

abdominal pain, bloating and vomiting following bowel surgery → ?

Answer 305

post op ileus

Question 306

? n is required prior to surgery for patients taking prednisolone

Answer 306

give IV hydrocortisone during induction of anaesthesia

Question 307

what can cause deranged LFTs

Answer 307

TPN

Question 308

Neuropathic pain drugs

Answer 308

used as monotherapy i.e. if not working then drugs should be switched, not added

Question 309

Diabetes sick day rules: when unwell, If a patient is on insulin

Answer 309

If a patient is on insulin, they must not stop it due to the risk of diabetic ketoacidosis. They should continue their normal insulin regime but ensure that they are checking their blood sugars frequently

Question 310

NSTEMI management: patients with a GRACE score > 3% should have

Answer 310

coronary angiography within 72 hrs of admission

Question 311

TACO

Answer 311

C -> Hypertension - raised HVP - afebrile - S3 present

Question 312

TRALI

Answer 312

- hypotension - L for Low - prexia - normal JVP

Question 313

bells palsy sx

Answer 313

lower motor neuron facial nerve palsy → forehead affected in contrast, an upper motor neuron lesion 'spares' the upper face patients may also notice post-auricular pain (may precede paralysis) altered taste dry eyes hyperacusis

Question 314

UC flares

Answer 314

Question 315

An unexplained persistent sore throat is an indication for

Answer 315

2 WWW for oral surgery

Question 316

normal post void volumes

Answer 316

< 50ml in < 65 < 100ml in > 65

Question 317

ALS - amiodarone dose

Answer 317

300mg

Question 318

mx of sinusitis

Answer 318

- consv: analgesia - intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days oral antibiotics are not normally required but may be given for severe presentations - phenoxymethylpenicillin first

Question 319

fused podocytes on EM

Answer 319

minimal change

Question 320

Metabolic side effects of antipsychotics include

Answer 320

dysglycaemia, dyslipidaemia, and diabetes mellitus

Question 321

mx of malignant hyperthermia

Answer 321

IV dantrolene

Question 322

which ab class causes light sensitivity

Answer 322

tetracyclibes

Question 323

tachycardia and tachypnoea with no signs: think

Answer 323

PE

Question 324

When do diabetics need to temporarily surrender their license

Answer 324

Patient with diabetes who have had two hypoglycaemic episodes requiring help needs to surrender their driving licence

Question 325

mx of adernal hyperplasia -> hyperaldosteronism

Answer 325

spironolactone

Question 326

mx of adrenal adenoma -> hyperaldosteronism

Answer 326

surgery

Question 327

what can be done to improve effectievness of mcroberts in SD

Answer 327

suprapubic pressure

Question 328

which drug should be given for SAH due to aneurysm

Answer 328

nimodepine (Fhx - Nimra)

Question 329

testing for diabetic nephropathy

Answer 329

measure urinary ACR on spot urine sample. If abn results repeat with a first pass morning urine sample

Question 330

? key investigation in patients with suspected encephalitis

Answer 330

CSF PCR

Question 331

What classifies a life threatening C diff infection

Answer 331

f hypotension, shock, or intestinal obstruction

Question 332

Pearl index

Answer 332

number of women using this form of C who would become pregnant per 1000 per year

Question 333

renal colic imaging

Answer 333

NON CONTRAST CT-KUB

Question 334

Initial mx of OCD

Answer 334

exposure and response prevention

Question 335

QT interval: Time between

Answer 335

start of q wave and end of T wave

Question 336

stridor and swelling at op site following thyroidectomy

Answer 336

contained haematoma -> resp distress

Question 337

mechanical hip replacement VTE prophylaxis

Answer 337

TED stockings and LMWH 6 hrs after surgery

Question 338

nappy rash with flexural sparing

Answer 338

irritant dermatitis - flexural sparing (as these areas are less likely to be in contact with irritants).

Question 339

AD - CT

Answer 339

Atrophy of the cortex and hippocampus

Question 340

Young man with AF, no TIA or risk factors,

Answer 340

CHADVASC 0 - no Tx

Question 341

method of assessing for joint hypermobility

Answer 341

Beighton score

Question 342

which conditions display anticipation

Answer 342

- Trinucleotide repeat disorders, including Huntington's disease and Myotonic dystrophy

Question 343

subretinal fluid on fundoscopy is a key finding suggestive of

Answer 343

Wet AMD

Question 344

Stopping food and drink before surgery

Answer 344

stop food 6 hrs before stop drink 2 hrs before

Question 345

What is the most common endogenous cause of this clinical presentation?

Answer 345

pituitary adenoma

Question 346

mx of genital herpes in T3

Answer 346

oral aciclovir until delivery and delivery by C section

Question 347

painful third nerve palsy

Answer 347

posterior comm artery aneurysm

Question 348

ulceration above medial malleolus

Answer 348

venous

Question 349

burn + lack of pain

Answer 349

FULL THICKNESS

Question 350

Burn depths

Answer 350

Question 351

superificial vs deep dermal burns

Answer 351

superficial: blistering + blanching erythema Deeper dermal: non-blanching due to dermal vessel damage and extravasation of bloo

Question 352

triad of sudden onset abdominal pain, ascites, and tender hepatomegaly

Answer 352

budd chiari

Question 353

The major risk factors for SIDS are:

Answer 353

prone sleeping parental smoking bed sharing hyperthermia and head covering prematurity

Question 354

definitive surgical treatment for ulcerative colitis that has failed medical management

Answer 354

Panproctocolectomy with end ileostomy

Question 355

mainstay of imaging for staging Hodgkin's lymphoma

Answer 355

PET/CT

Question 356

Avoid metoclopramide in

Answer 356

Bowel obst

Question 357

tx of choice for BPPV

Answer 357

EPLEY

Question 358

K and Mg replacement

Answer 358

Replace magnesium before correcting hypokalaemia. Hypomagnesemia prevents potassium absorption

Question 359

IPF - CT findings

Answer 359

initially ground glass -> honeycombing

Question 360

Suspected bac meningitis on a background of prolonged/multiple antibiotic use or travel to areas with highly resistant pneumococci

Answer 360

ADD IV VANCOMYCIN

Question 361

INCUBATION PERIOD FOR EBOLA

Answer 361

2-21 DAYS

Question 362

Insulin rate to Tx DKA

Answer 362

fixed rate intravenous insulin infusion of 0.1 units/kg/hour is recommended to treat diabetic ketoacidosis.

Question 363

? should be used first-line for acute stress disorders

Answer 363

TRAUMA FOCUSED CBT. EYE MOVEMENT DENSENITSATION FOR PTSD

Question 364

Long-term oxygen therapy should not be offered to COPD patients who are

Answer 364

ACTIVE SMOKERS

Question 365

well-demarcated, smooth, round or oval patches of hair loss without any visible inflammation, scaling, or scarring of the underlying skin.

Answer 365

ALOPECIA AREATA

Question 366

DIPs on XR in osteo

Answer 366

look like sombreros

Question 367

isolated thrombocytopenia characteristic of

Answer 367

ITP

Question 368

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

Answer 368

CENTRAL RETINAL VEIN OCCLUSION

Question 369

Mx of HOCM

Answer 369

Refer to cardiology for insertion of ICD - to reduce the risk of sudden cardiac death in HOCM

Question 370

First line test in phaechromocytoma

Answer 370

- a triad of sweating, headaches, and palpitations in association with severe hypertension - plasma and urinary metanephrines

Question 371

? are not elevated in temporal arteritis

Answer 371

CK

Question 372

? are a red flag for patients with chronic rhinosinusitis

Answer 372

unilateral sx

Question 373

CN6 palsy manifesting as diplopia could be the first sign of

Answer 373

Brain mets

Question 374

A 54-year-old man is noted to have papilloedema on examination. Which one of the following may be responsible?

Answer 374

hypercapnia - why is why Hyperventilation to induce hypocapnia may be used in the emergency setting to reduce intracranial pressure

Question 375

? is used to treat pityriasis versicolor

Answer 375

topical ketoconazole

Question 376

? an be a presenting symptoms of nasopharngeal cancer

Answer 376

unilateral middle ear effusion

Question 377

Lump on scrotum which is felt separate from the right testicile

Answer 377

epididmyal yst

Question 378

Renal stones > 20 mm should be managed using

Answer 378

percutaneous nephrolithomotomy

Question 379

thiazides and calcium

Answer 379

decrease urinary calcium excretion by enhancing calcium reabsorption in the distal convoluted tubule. This can lead to hypercalcaemia,

Question 380

VT and adverse signs ->

Answer 380

DC SHOCK - e.g. shock (systolic BP of <90), syncope, myocardial ischemia and heart failure.

Question 381

The table below shows the Keith-Wagener classification of hypertensive retinopathy

Answer 381

Question 382

Kaposi's sarcoma - caused by

Answer 382

HHV-8

Question 383

Suspected optic neuritis: IMAGING

Answer 383

MRI BRAIN AND ORBITS WITH CONTRAST

Question 384

Insulin-dependent diabetics must check their blood glucose

Answer 384

BEFORE DRIVING AND EVERY 2 HOURS WHEN DRIVING REGARDLESS OF FOOD

Question 385

The universal donor of fresh frozen plasma is

Answer 385

AB RhD negative

Question 386

TURP syndrome

Answer 386

- due to irrigation with glycine -> hyponatreamia

Question 387

flaky skin, itch, and hair loss

Answer 387

Tinea capitis - scalp ringworm

Question 388

The management of acute chest syndrome in sickle cell disease includes:

Answer 388

pain relief oxygen therapy antibiotics transfusion

Question 389

if ? is given to a pt with pneumothoraz it can become a tension P

Answer 389

NO

Question 390

X-ray changes of osteoarthritis

Answer 390

LOSS Loss of joint space Osteophytes forming at joint margins Subchondral sclerosis Subchondral cysts

Question 391

A 34-year-old female at 24 weeks gestation complains of reduced foetal movements. An ultrasound scan reveals that the foetus is hydropic. Her 4-year-old child recently had a febrile illness and an associated erythematous rash on the face with circumoral pallor. What is the most likely infectious agent?

Answer 391

Parovirus b19

Question 392

bdominal pain and mucopurulent discharge, associated with generalised inflammation and increased frequency. ->

Answer 392

chlamydia

Question 393

which type of cyst contain cholesterol crystals

Answer 393

branchial

Question 394

chemotherapy induced N and V

Answer 394

ondansteron

Question 395

Intercranial causes of N and V

Answer 395

Haloperidol for intracranial causes (raised ICP, direct effect of tumour)

Question 396

mx of vestibular vs GI causes of N and V

Answer 396

- Prochlorperazine for vestibular causes Metoclopramide for gastrointestinal causes

Question 397

mneumonic for N and V at EOL

Answer 397

Ondansetron from you Oncologist Haloperidol for causes in your Head Prochlorperazine for when you feel Peculiar (i.e. dizzy) Metoclopramide for things attached to the Mesentry

Question 398

Primary open angle glaucoma IOP > 24 ->

Answer 398

SLT first line

Question 399

back pain + history of cancer ->

Answer 399

immediate referral to ortho

Question 400

fetor hepaticus is a sign of

Answer 400

ALI - sweet and fecal breath

Question 401

In AF with decompensation the correct management is

Answer 401

Synchornised DC cardioversion

Question 403

hese two markers are the most useful in detecting recurrence of testicular teratoma.

Answer 403

AFP and bHCG - hcg for teratoma testicular cancer because if a guy did a pregnancy test and it was positive he'd be TERAfied

Question 404

Most children with non-IgE-mediated cow's milk protein allergy will be milk tolerant by

Answer 404

3 yrs

Question 405

Patients with MI secondary to cocaine use should be given

Answer 405

IV benzos as part of ACS tx

Question 406

Investigation for diabetes insipidus -

Answer 406

water depriv test

Question 407

gas gangrene

Answer 407

clostridium perfringes - air bubbles in the tissues.

Question 408

? is used to suppress nausea and vomiting with intracranial tumours

Answer 408

dex

Question 409

when is US required for a lipoma

Answer 409

> 5cm

Question 410

Melanosis coli is usually due to

Answer 410

laxative abuse

Question 411

mx of tarive diskinesia

Answer 411

Ttetrabenazine

Question 412

Renal transplant + infection ?

Answer 412

CMV

Question 413

Gummas in syphilis

Answer 413

tertiary - granulomatous lesions that occur in varipis organs

Question 414

A central scotoma is a feature of

Answer 414

ON

Question 415

The corrected age of a premature baby is the

Answer 415

The corrected age of a premature baby is the age minus the number of weeks he/she was born early from 40 weeks

Question 416

Opthalmia neonatorum

Answer 416

- refer same day to O/P - simplymeans infection of the newborn eye

Question 417

most common sx of kaposi sarcoma in kids

Answer 417

generalised lymphadenopathy

Question 418

For cardioversion of AF: patients must

Answer 418

For cardioversion of AF: patients must either be anticoagulated or have had symptoms for < 48 hours to reduce the risk of stroke.

Question 419

Age-related macular degeneration is associated with

Answer 419

charles bonnet syndrome

Question 420

distortion of straight lines and reduced acuity ->

Answer 420

ARMD

Question 421

Charles bonnet syndrome

Answer 421

characterised by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis). Insight is usually preserve

Question 422

An 8-year-old child presents with enlarged tonsils that meet in the midline and are covered with a white film that bleeds when you attempt to remove it. He is pyrexial but otherwise well.

Answer 422

acute bacterial tonsillitis

Question 423

A 10-year-old child presents with enlarged tonsils that meet in the midline. Oropharyngeal examination confirms this finding and you also notice peticheal haemorrhages affecting the oropharynx. On systemic examination he is noted to have splenomegaly.

Answer 423

infective mono

Question 424

If fetal movements have not yet been felt by ? weeks refer to fetal med

Answer 424

24 weeks

Question 425

Infants with congenital diaphragmatic hernia (CDH) have associated

Answer 425

pulm hypoplasia

Question 426

STi + Microscopy demonstrates that the responsible organism is an obligate intracellular bacterium.

Answer 426

chylamydia

Question 427

most appropriate investigation for patients with increased urinary cortisol and low plasma ACTH levels

Answer 427

ct adrenals

Question 428

Which procedure carries the greatest risk of haemorrhage in the newborn?

Answer 428

prolonge ventouse delivery - The high pressure exerted by the vacuum during a ventouse delivery can cause bleeding in the neonate.

Question 429

acute graft rejection

Answer 429

- within 6 months - usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria - The diagnosis can only be confirmed with biopsy of the transplanted kidney.

Question 430

chronic graft rejection

Answer 430

after 6 months (transplant) - dteriorating renal function

Question 431

Contralateral homonymous hemianopia with macular sparing and visual agnosia -

Answer 431

PCA lesion

Question 432

features of meigns syndrome

Answer 432

: Benign ovarian tumour, ascites, and pleural effusion.

Question 433

history of asthma + nasal polyps ->

Answer 433

churg strauss syndrome -pANCA

Question 434

On examination you an erythematous cervix with pinpoint areas of exudation.

Answer 434

STRAWBERRY CERVIX - TRICHOMONAS - TREAT WITH METRONIDAZOLE

Question 435

grey coating surrounding the tonsils, fever, and cervical lymphadenopathy are classic symptoms of

Answer 435

DIPTHERIA

Question 436

What falsely decreases hba1c

Answer 436

anything that decreases lifespan of blood e.g. sickle cell

Question 437

hazy cornea and dilaed pupil

Answer 437

closed angle glaucoma

Question 438

G- First-line treatment in a patient with a history of heart block

Answer 438

lantoprost

Question 439

G - Causes pupillary constriction, blurred vision and headaches

Answer 439

pilocarpine

Question 440

Features of WE

Answer 440

Confusion Ataxia Nystagmus Ophthamoplegia PEripheral Neuropathy CAN OPEN a beer

Question 441

If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA

Answer 441

- Admit immediately to CT to rule out haemorrhage

Question 442

A high voiding detrusor pressure with a low peak flow rate is indicative of

Answer 442

Bladder outflow obst

Question 443

Patients with an uncertain tetanus vaccination history should be

Answer 443

given a booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old

Question 444

mx of anastamotic leak

Answer 444

take to theatre ASAP

Question 445

PTHrP is a paraneoplastic syndrome associated with

Answer 445

sq cell carcinoma

Question 446

COPD severity

Answer 446

COPD severity (FEV1): 20-30-20-30 Stage 1 (Mild): >80% Stage 2 (Moderate): 50-79% Stage 3 (Severe): 30-49% Stage 4 (Very severe): <30%

Question 447

autoimmune hep LFTS

Answer 447

- ALT & AST> ALP raised - AMA negative

Question 448

pneumococal vaccine & splenectomy

Answer 448

give 2 weeks before at least

Question 449

A raised CRP in a patient with known SLE may indicate

Answer 449

underlying infection (CRP IS NOT NORMALLY RAISED IN LUPUS)

Question 450

Symptoms of central pontine myelinosis

Answer 450

brainstem damage, such as spastic quadriparesis, pseudobulbar palsy, and emotional lability (i.e. pseudobulbar affect).

Question 451

COPD standby medication:

Answer 451

NICE recommend offering a short course of oral corticosteroids and oral antibiotics to keep at home

Question 452

cheese and tomato pizza appearance on fundoscopy

Answer 452

central retinal vein occlusion - very hungru

Question 453

which type of burn does not req IV fluids

Answer 453

first degree - superificial, epidermal burns

Question 454

When are fluids needed for burns

Answer 454

dermal burns or thicker covering > 15%

Question 455

Answer 455

cherry red spot - central retinal artery occlusion

Question 456

? is an early x-ray feature of rheumatoid arthritis

Answer 456

juxta-articular osteoporosis/ osteopenia

Question 457

RA XR - SOLD

Answer 457

Soft tissue swelling Osteopenia juxtarticular Loss of joint space Deformity of the joint + Periarticular erosions

Question 458

most common cause of septic arthritis in young adults

Answer 458

gonorrhoea

Question 459

mx of legionella

Answer 459

macrolides like clarith

Question 460

central vs peripheral lung cancers

Answer 460

Squamous and Small cell are Sentral and associated with Smoking LA is on the coast (Large cell and Adenocarcinoma are peripheral)

Question 461

A 2-week-old infant with a small chin, posterior displacement of the tongue and cleft palate

Answer 461

pierre robin

Question 462

Supravalvular aortic stenosis is found in a 3-year-old boy with learning difficulties

Answer 462

williams syndrome

Question 463

Lactational amenorrhoea is a reliable method of contraception as long as

Answer 463

amenorrhoeic, baby <6 months, and breastfeeding exclusively

Question 464

Acoustic neuromas are best visualized by

Answer 464

MRI of cerebellopontine angle

Question 465

Campylobacter infection is characterised by a prodrome,

Answer 465

prodome, abdominal pain and bloody diarrhoea

Question 466

hoarseness persistenting for ? should be urgently ref to ENT

Answer 466

MORE THAN 3 WEEKS

Question 467

What is the gold standard investigation for diagnosing CT

Answer 467

ECHO

Question 468

Codeine to morphine - divide by

Answer 468

10 - morphine is 10x stronger than codeine

Question 469

dyspepsia: if symptoms have resolved following test and treat

Answer 469

no need to check h pylori eradication

Question 470

mx of constipation in kids

Answer 470

1) movicol paed plain 2) senna

Question 471

ebsteins anomaly

Answer 471

- lithium use - sults in low insertion of the tricuspid valve resulting in a large right atrium and small right ventricle causing tricuspid incompetence. -> atrialisation of RV

Question 472

IF fluorescein eye stain shows a dendritic ulcer

Answer 472

herpes simplex kertaitis

Question 473

fine bilateral tremor, worse when holding the arms out against gravity (postural tremor).

Answer 473

lithium (coarse tremor in toxicity)

Question 474

In a non-urgent scenario, a unit of RBC is usually transfused over

Answer 474

90-120min

Question 475

tIx of melanoma

Answer 475

excisional biopsy

Question 476

bilateral facial nerve palsy after insect bites

Answer 476

borriella burgdoferi - lyme disease

Question 477

1st line imaging in suspected multiple myeloma

Answer 477

whole body MRI

Question 478

BY WHICH AGE CAN A CHILD PASS OBJECTS FROM ONE HAND O ANOTHER

Answer 478

6 MONTHS - PALMAR GRASP

Question 479

aki - poor response to fluid challenge

Answer 479

ATN

Question 481

cardiac areest adrenaline doses

Answer 481

1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

Question 482

diabetic neuropathy =

Answer 482

Lower limb numbness followed by neuropathic pain (pain described as burning or shooting) in a patient taking multiple type 2 diabetes medications

Question 483

diabetic neuropathy pattern

Answer 483

numbness and pain tend to ascend up the limbs starting distally and moving proximally in a 'glove and stocking' distribution, as longer nerves are affected most first.

Question 484

erysipelas mx

Answer 484

- Superficial cellulitis - same as cellulitis: fluclox

Question 485

DVT and HRT

Answer 485

use topical HRT - not CI

Question 486

CI to HRT

Answer 486

UNEXPLAINED VG BLEEDING

Question 487

cyclical vs combined HRT

Answer 487

Topical cyclical HRT (LIKE PERIODS ) if perimenopausal, Topical continuous HRT if menopausal.

Question 488

visual loss of macular degeneration

Answer 488

central

Question 489

Wellen's syndrome

Answer 489

- critical stenosis of LAD - self resolving chest pain on a background of IHD - deep inverted T waves V2-V3 with limited/ no ST elevation

Question 490

Mx of renal comps from systemic sclerosis

Answer 490

ACEi

Question 491

Mx of psoriasis

Answer 491

- emollients 1) topical steroids + vitamin D 2) vit D analogue 2x a day 3) potent steroid x2 or coal tar

Question 492

cafe au lait spots & bilateral SN hearing loss

Answer 492

Bilateral vestibular schwannomas -> NF II

Question 493

cyst with an epithelial defect and central puntcum

Answer 493

sebaceous cyst

Question 494

swollen disc ad blurred margins on fundocscopy

Answer 494

anterior ischemic optic neuropathy

Question 495

Mx of complex perianal fistulae in CD

Answer 495

seton placement to drain pus

Question 496

What herniates in a surgical 3rd nerve palsy

Answer 496

trans-tentroail herniation (temp lobe)

Question 497

mx of hypocalcaemia

Answer 497

IV calcium gluconate

Question 498

Mx of CF

Answer 498

- Lumacaftor - Ivacaftor - used in people homozygous for dF508 mutation

Question 499

mx of nasal septum haematoma

Answer 499

ENT refer -> incision and drainage

Question 500

Metoclopramide MAO

Answer 500

dopamine antagonist

Question 501

antihistamines in hayfever MAO

Answer 501

- H1 antagonist: - H2: more gastric

Question 502

ix in IE for a haem stable patient

Answer 502

3x sets of blood cultures

Question 503

first line Ix for Lyme disease w/o erythema migricans

Answer 503

Blood test for serology - ELISA

Question 504

RF for asystole in bradycardia

Answer 504

- transvenous pacing - complete HB with broad QRS - recen asystole - mobitz type 2 block - ventricular pause > 3 seconds

Question 505

Dexamethasone suppression test with ectopic ACTH

Answer 505

both cortisol and ACTH NOT suppressed

Question 506

imp side effects of thiazde like diuretics

Answer 506

e.g. indapemide - sexual dysfunction

Question 507

Mx of incomplete miscarrage

Answer 507

Vaginal misoprostol (uterine contractions)

Question 508

diltiazam - remember

Answer 508

is rate limitng. Do not give w BB

Question 509

What taken in high doses can cause tinnitus

Answer 509

aspirin and other NSAIDs

Question 510

Angiodema ->

Answer 510

ACEi

Question 511

Monitoring lupus flares

Answer 511

- complement levels - C3,C4 are usually low during active disease - complement used to monitor flares

Question 512

inhaled foregin objects

Answer 512

- inhaled object: right main bronchus - aspiration pneumonia: R LL

Question 513

paracetamol OD: what is not assoc w toxicity

Answer 513

ACUTE alcohol use

Question 514

wHAT IS ASSOC W POOR PROGNOSIS IN LYMPHOMA

Answer 514

B symptoms

Question 515

pleural effusion fluid protein/ serum protein ratio

Answer 515

> 0.5 = exudate

Question 516

Mx of von wilebrands disease

Answer 516

desmopressin

Question 517

tx of choice for chronic rhinosinusitis

Answer 517

trial of nasal irrigation with saline solution

Question 518

how long is a patient infectious in shingles

Answer 518

until all vesicles crusted over usually 5-7 days following tx

Question 519

pyoderma gangernosum

Answer 519

his typically presents initially with a small blood blister or red bump before progressing to a large deep violaceous ulcer, commonly affecting the lower limb

Question 520

Mx of PG

Answer 520

oral steroids 1)

Question 521

what is PG assoc w

Answer 521

- CD and UC - RA - SLE - some leukemias

Question 522

Tx for bownens and AK

Answer 522

topicL 5-FU

Question 523

Spider naevi can be differentiated from telangiectasia by

Answer 523

Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge

Question 524

In patients with alopecia areata, it is important to screen for

Answer 524

Other autoimmune diseases - thyroid, diabetes, perinicious anaemia

Question 525

broken exclamation mark hairs and alopecia

Answer 525

alopecia areata

Question 526

bow legged in a child under 3

Answer 526

Bow legs in a child < 3 is a normal variant and usually resolves by the age of 4 years

Question 527

HSV positive mum delivery

Answer 527

elective c section at 37 weeks

Question 528

A 50-year-old female presents with bilateral parotid gland swelling and symptoms of a dry mouth. On examination she has bilateral facial nerve palsies. This improved following steroid treatmen

Answer 528

sarcoif

Question 529

An 18-year-old boy presents with pancreatitis. He has bilateral painful parotid enlargement.

Answer 529

measles - In a young adult with parotid swelling and pancreatitis/orchitis/reduced hearing/meningoencephalitis suspect mumps.

Question 530

hip # vs dislocation

Answer 530

= short and ext rotated leg dislocation = short and internall rotated I in dIslocation

Question 531

A 35-year-old male presents to the emergency with an acute onset painless red eye. On examination, his fundoscopy is normal and there is no RAPD. He has a past medical history of constipation.

Answer 531

subconjunctival haemorrhage

Question 532

paraoxical embolisation from DVT

Answer 532

- normally causes a PE - can cause a stroke if ASD or eismengers

Question 533

First line management of acute pericarditis involves combination of

Answer 533

NSAIDs and colchicine

Question 534

At the booking appointment, pregnant women will be checked for risk factors. If present, they will be screened for gestational diabetes via an oral glucose tolerance test (OGTT) at 24-28 weeks. Risk factors include:

Answer 534

BMI above 30 kg/m² Previous macrosomic baby weighing 4.5 kg or more Previous gestational diabetes Family history of diabetes (first-degree relative with diabetes) An ethnicity with a high prevalence of diabetes

Question 535

thyroid scintigraphy in de quervains

Answer 535

In De Quervain's thyroiditis there is globally reduced uptake of iodine-131 during thyroid scintigraphy

Question 536

Cushing's syndrome ABG

Answer 536

hypokalaemic met alk

Question 537

addisons ABG

Answer 537

hyperkalaemic metabolic acidosis

Question 538

Primary hyperparathyroidism is most commonly due to

Answer 538

Solitary parathyroid adenoma

Question 539

APGAR stands for:

Answer 539

appearance (colour) - pulse rate - grimace - activity - resp rate

Question 540

? should be used as the first-line treatment in opioid detoxification

Answer 540

methadone or buprenorphine

Question 541

used to identify patients at risk of pressure sores

Answer 541

waterlow score (low on the bed)

Question 542

Which of the below results is most likely in a patient taking Warfarin?

Answer 542

APTT normal Prolonged PT

Question 543

What effect does legionalla have on lymphocyres

Answer 543

lymphophenia

Question 544

? can reduce the sperm count of patients taking it for rheumatoid arthritis.

Answer 544

sulfasalazine

Question 545

Hormonal contraception can be started immediately after using ? for EC

Answer 545

LEVONESTROGEL

Question 546

Kyphosis spirometry

Answer 546

FEV1/FVC raised TLCO reduced Transfer coeffiient increased

Question 547

According to ICD-10 criteria, how long must symptoms last to be classified as a depressive episode

Answer 547

2 weeks

Question 548

? shows a lag in decreasing in comparison to the white cell count in treatment of acute bacterial infection

Answer 548

CRP

Question 549

HIV, neuro symptoms, multiple brain lesions with ring enhancement

Answer 549

toxoplasmosis

Question 550

? is important in patients with symptomatic caustic ingestion

Answer 550

endoscopy

Question 551

asymptomatic bleach ingestion

Answer 551

observe (endoscopy when symptomatuc)

Question 552

Switching from fluoxetine to another SSRI -

Answer 552

withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low dose of the alternative SSRI

Question 553

mx of OAB (BPH background)

Answer 553

add AM like tolterodine

Question 554

A cystic ovarian mass in a middle-aged woman is most likely a

Answer 554

serous cystadenoma

Question 555

? will cause finger abduction weakness

Answer 555

T1 lesions

Question 556

reducing VTE risk with nephrotic syndrome

Answer 556

LMWH

Question 557

A 60 year-old male presents with clumsy hands. He has been dropping cups around the house. His wife complains he doesnt answer his mobile as he struggles to use it. His symptoms have been gradually deteriorating over the preceding months.

Answer 557

DCM - Hoffmans sign

Question 558

first-line in the management of nausea & vomiting in pregnancy/hyperemesis gravidarum

Answer 558

AH like cylizine

Question 559

which drug can trigger EM

Answer 559

CO-AMOX

Question 560

Answer 560

PROLIFERATUVE RETINOPATHY

Question 561

Raised ALP in the presence of normal LFT's should raise suspicion of

Answer 561

malignancy. Particularly bone cancer/ metastases

Question 562

An outbreak of genital herpes should be treated with

Answer 562

ORAL ACICLOVIR

Question 563

MX OF HERPES ZOSTER OPTHALMIUS

Answer 563

ORAL ACICLOVIR

Question 564

HERPES ZOSTER MX

Answer 564

Herpes zoster ophthalmicus: Oral acyclovir Herpes simplex keratitis: Topical acyclovir Herpes zoster oticus (Ramsay-Hunt syndrome): Oral acyclovir 7 days, oral prednisolone 5 days Essentially, shingles = oral.

Question 565

cellulitis with haemorrhagic bullae - think

Answer 565

NEC FAS - IV AB AND SURGERY

Question 566

Valves affected in IE

Answer 566

overall most common: Mitral Drugs: tricuspid

Question 567

Carpal tunnel syndrome causes action potential

Answer 567

prolongation in both sensory and motor axons

Question 568

STEMI long term drugs

Answer 568

ACE inhibitor + beta-blocker + statin + aspirin + ticagrelor. F

Question 569

common cause of bacterial otitis media

Answer 569

haem influenza

Question 570

Contact lens wearers who present with a red painful eye should be referred to

Answer 570

Contact lens wearers who present with a red painful eye should be referred to eye casualty to exclude microbial keratitis

Question 571

amiodarone and digoxin

Answer 571

Amiodarone may cause precipitation of digoxin toxicity - if starting amiodarone on a patient taking digoxin the dose should be reduced

Question 572

Etomidate may result i

Answer 572

adrenal suppression (etomidate sounds like intimidate which in turn suppresses your adrenaline = adrenal suppression)

Question 573

hypothermia ECG

Answer 573

J waves

Question 574

Binocular vision post-facial trauma is suggestive of depressed

Answer 574

depressed # of zygoma

Question 575

Meningitis in children < 3 mo

Answer 575

IV amox and IV CEFOTAXIME DO NOT GIVE CEFTRIAXONE LIKE ADULTS AS CI DUE TO BILIRUBIN DISPLACEMENT

Question 577

The symptoms of fever, hypotension and rash with desquamation (peeling) of the palms and soles of feet are characteristic of

Answer 577

staph toxic shock

Question 578

The combination of renal impairment and bloody diarrhoea in a child point to a diagnosis of

Answer 578

HUS

Question 579

Babies with absent or weak femoral pulses at 6-8 week baby check should be

Answer 579

DIscussed immediately w paeds

Question 580

monitorung lithium

Answer 580

Lithium levels are normally measured one week after starting treatment, one week after every dose change, and weekly until the levels are stable. Once levels are stable, levels are usually measured every 3 months. Lithium levels should be measured 12 hours post-dose.'

Question 581

Acute closed-angle glaucoma presents with a

Answer 581

fixed dilated pupil with conjunctival injection

Question 582

Breastfeeding is a contraindication to the COCP if

Answer 582

< 6 weeks PP only 3 weeks if not BF

Question 583

Which one of the following medications would increase insulin sensitivity?

Answer 583

Pioglitazone - PPAR agonists reducing peripheral insulin resistance - Glitazones, help get insulin into the zone

Question 584

HUS blood film

Answer 584

schistocytes

Question 585

? has been shown to reduce the rate of CKD progression in ADPKD (and is approved by NICE)

Answer 585

tolvaptan

Question 586

Aortic regurgitation typically causes a

Answer 586

an early diastolic murmur

Question 587

Before the induction of anaesthesia, the following must have been checked (Sign in)

Answer 587

Patient has confirmed: Site, identity, procedure, consent Site is marked Anaesthesia safety check completed Pulse oximeter is on patient and functioning Does the patient have a known allergy? Is there a difficult airway/aspiration risk? Is there a risk of > 500ml blood loss (7ml/kg in children)?

Question 588

A macrocytic anaemia in the presence of hyper-segmented neutrophil polymorphs on the blood film is likely to be

Answer 588

megaloblastic anaemia

Question 589

CSF findings consistent with subarachnoid haemorrhage

Answer 589

bilirubin and xanthorchromia - normal or raised opening pressure

Question 590

limit age for walking

Answer 590

18m

Question 591

oral SE of methotrexate

Answer 591

mucositis - oral ulers

Question 592

First line treatment for most patients with a pituitary tumour causing acromegaly

Answer 592

surgery - bring your A game to surgery

Question 593

TOF findings

Answer 593

VSD, right ventricular hypertrophy (as seen on the ECG as right axis deviation), pulmonary stenosis, and an overriding aorta.

Question 594

Asthma: adults not controlled on moderate-dose MART - if FeNO level or blood eosinophil raised then if either of these is raised →

Answer 594

refer to resp specialist

Question 595

treatment of choice of early stage (T1N0M0) oesophageal cancer

Answer 595

surgical resection

Question 596

pupil in syphylis

Answer 596

argyll roberston pupil

Question 597

Killip classification

Answer 597

Question 598

Rotatory nystagmus is indicative of a

Answer 598

positive dix hallpike manouvre

Question 599

Lachman tests for

Answer 599

ACL

Question 600

lung cancer + hyponatreamia

Answer 600

small cell

Question 601

OCD vs psychosis

Answer 601

insight

Question 602

comp of discitis

Answer 602

epidural abscess - persistent back pain following ab

Question 603

Tall R waves V1-V2

Answer 603

POSTERIOR MI

Question 604

When is there a higher platelet transfusion threshold

Answer 604

Platelet thresholds for transfusion are higher (maximum < 100 x 10 9) for patients with severe bleeding, or bleeding at critical sites, such as the CNS

Question 605

The presence of an elevated prolactin level along with secondary hypothyroidism and hypogonadism is indicative of

Answer 605

The presence of an elevated prolactin level along with secondary hypothyroidism and hypogonadism is indicative of stalk compression is consistent with a non-functioning pituitary adenoma

Question 606

The first line treatment in amoebiasis is:

Answer 606

metronidazole

Question 607

double pulse indicates

Answer 607

bisferiens pulse - mixed aortic valve disease

Question 608

ischaemic hepatitis

Answer 608

Ischaemic hepatitis is often characterised by marked elevation in aminotransferase liver enzymes (AST and ALT) which peak 1-3 days after the insult. There is often a significant rise in lactate dehydrogenase (LDH) which is sensitive for ischaemic hepatitis compared to other causes of liver injury.

Question 609

'Clusters' of cluster headaches typically last from

Answer 609

4 - 12 weeks

Question 610

Diabetic maculopathy describes

Answer 610

any structural abn due to diabetes affecting the macula - blurry vision or blindspot in the center of the vision

Question 611

causes of OM

Answer 611

Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis

Question 612

Mx of DCM

Answer 612

Cervical decompressiv surgery

Question 613

A 53-year-old lady presents with a creamy nipple discharge. On examination she has discharge originating from multiple ducts and associated nipple inversion.

Answer 613

duct ectasia

Question 614

A 52-year-old lady presents with an episode of nipple discharge. It is usually clear in nature. On examination the discharge is seen to originate from a single duct and although it appears clear, when the discharge is tested with a labstix it is shown to contain blood. Imaging and examination shows no obvious mass lesion.

Answer 614

intraductal papilloma

Question 615

Contraceptive patch regime:

Answer 615

wear one patch a week for three weeks and do not wear a patch on week four

Question 616

Basal atelectasis

Answer 616

- it should be suspected in the presentation of dyspnoea and hypoxaemia around 72 hours postoperatively - mx: positioning the patient upright chest physiotherapy: breathing exercises

Question 617

shoulder/arm pain, small pupil and lagging eyelid ->

Answer 617

pancoast tumour

Question 618

Diabetic ketoacidosis: once blood glucose is < 14 mmol/l ->

Answer 618

start infusion of 10% dextrose at 125ml/hr

Question 619

ABG in prolonged diarrhoea

Answer 619

met acidosis with hypokalaemia

Question 620

CS -> AKI

Answer 620

CS -> rhabdo -> deposition of myoglobin in renal tubules

Question 621

temp arteritis mx

Answer 621

oral pred if visual changes: IV METHYLPRED

Question 622

most effective management option in renal cell carcinoma

Answer 622

- radical nephrectomy - RCC resistant to chemo or radio - RCC > 7cm → radical nephrectomy RCC < 7cm → partial nephrectomy

Question 623

common complication in subarachnoid haemorrhages

Answer 623

hyponatreamia - siADH

Question 624

immediate mx of orbital CS

Answer 624

canthotomy

Question 625

inducing remission in crohns

Answer 625

steroids

Question 626

first-step in the management of patients with raised ICP

Answer 626

head elevation to 30 degrees

Question 627

analgesia with severe renal impairment

Answer 627

Buprenorphine or fentanyl

Question 628

A rare, but important, side effect of DPP4-inhibitors is

Answer 628

panc

Question 629

ottowa ankle rules

Answer 629

bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular) bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia) -inability to walk four weight-bearing steps immediately after the injury and in the emergency department

Question 630

Intensity of the murmur is increased by the handgrip manoeuvre

Answer 630

aortic regurg = early diastolic

Question 631

, the injected vessels are mobile when gentle pressure is applied on the sclera.

Answer 631

episcleritis

Question 632

NICE recommend the following regarding postoperative wound cleansing:

Answer 632

Use sterile saline for wound cleansing up to 48 hours after surgery. Advise patients that they may shower safely 48 hours after surgery. Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus.

Question 633

mx of septic arthritis

Answer 633

fluclox

Question 634

HbA2 is raised in patients with

Answer 634

beta thalassemia major

Question 635

A baby born at 35 weeks gestations via normal vaginal delivery is found to be irritable 48 hours after birth and suffers a convulsion. There is no obvious head trauma or swellings. Which one of the following cranial injuries is most likely to have occurred?

Answer 635

interventricular haemorrhage

Question 636

may be used to treat Chlamydia in pregnancy

Answer 636

Azithromycin, erythromycin or amoxicillin

Question 637

first line of raynaurds

Answer 637

CCB - nidedipine

Question 638

abnormally large drop in BP during inspiration

Answer 638

CT - pulsus paradoxus

Question 639

SIADH and cerebral salt wasting are differentiated by

Answer 639

fluid status

Question 640

Hypercalcaemia with suppressed PTH is highly suspicious for

Answer 640

malignancy

Question 641

resp alkalosis ->

Answer 641

hypocalcaemia with normal phosphate

Question 642

MODY vs LADA

Answer 642

- MODY: T2DM in a young person - LADA: T1DM later in life

Question 643

Blood results in myeloma

Answer 643

Raised calcium Normal or high phosphate Normal alkaline phosphate

Question 644

pain after drinking ->

Answer 644

hodgkins lymphoma

Question 645

diagnosing H vs NHL

Answer 645

H: excision biopsy NHL: needle core biopsy

Question 646

most common site of thrombosis with NS

Answer 646

RENAL VEIN - Nephrotic syndrome is associated with a hypercoagulable state due to loss of antithrombin III via the kidneys

Question 646

WHAT TO DO FIRST WITH HYPERKALAMIA

Answer 646

- ECG if under 6.5 - if over 6.5 = treat immediately

Question 647

SGLT2 and weight

Answer 647

weight loss

Question 648

Diabetic ketoacidosis: if the ketonaemia and acidosis have not been resolved within 24 hours then

Answer 648

arrange senior endocrinology review

Question 649

differentiating conns vs bilateral adrenal hyperplasia

Answer 649

AVS

Question 650

Increased risk of osteonecrosis with

Answer 650

steroids

Question 651

prophylactic ? is required for nephrotic syndrome

Answer 651

LMWH e.g. enoxaparin

Question 652

transfusion thresholds

Answer 652

70 with no CS 80 with ACS (AC sounds like 80)

Question 653

hyperchloraemic, normal anion gap metabolic acidosis

Answer 653

renal tubular acidosis

Question 654

low serum iron, low TIBC but raised ferritin

Answer 654

anaemia of CD

Question 655

most useful initial diagnostic test in haemolytic uraemic syndrome

Answer 655

BLOOD FILM

Question 656

fluids in in patients with suspected hypovolemic hyponatraemia

Answer 656

isotonic normal saline NOT hypertonic

Question 657

urea: creatine ratio in pre-renal AKI

Answer 657

urea / (creatine divided by 1000) - do the divide by 1000 so its same units >100 - pre renal cause <100 - ATN

Question 658

Fever, abdominal pain, hypotension during a blood transfusion →

Answer 658

acute haem reaction

Question 659

tx of choice in toxic mulrinodular goitre

Answer 659

radioactive iodine

Question 660

Factor 5 leiden

Answer 660

Activated factor V is inactivated much more slowly by activated protein C. -> clotting risk - RESISTANCE TO ACTION OF PROTEIN C

Question 661

Reversal agents

Answer 661

AndeXanet alfa - ApiXaban, RivaroXaban InDArucizaumab - DAbigatra

Question 662

AKPD is associated with enlarement of

Answer 662

liver due to cysts

Question 663

Myxoedema coma typically presents with

Answer 663

confusion and hypothermia

Question 664

most common inherited thrombophilia

Answer 664

activated protein c resistance - factor V leiden

Question 665

most common inherited bleeding disorder

Answer 665

VWD

Question 666

Serum osmolality can be estimated using

Answer 666

2 * Na+ + glucose + urea

Question 667

Each one of the following is a recognised complication of blood transfusion, except:

Answer 667

hypokalaemia - cell lysis causes hyperkalamia

Question 668

cause of euvolaemic hyponatreamia

Answer 668

hypothyroid

Question 669

HBA1C target in T1DM

Answer 669

48

Question 670

high MetHb on ABG

Answer 670

Nitrates, including recreational nitrates such as amyl nitrite ('poppers') may cause methaemoglobinaemia E.G. amyl nitrate

Question 671

Hyperthyroid in T1

Answer 671

PTU (pregnancy) - carbimazole = foetal malformation

Question 672

CLL

Answer 672

- Smear cells - crushed little lymphocytes -> recurrent infections

Question 673

should be used to assess for diabetic neuropathy in the feet

Answer 673

10g monofilament

Question 674

diabetes target in t2

Answer 674

48 53 only if sig hypo risk like sulfonylurea

Question 675

The best initial investigation for phaechromoytoma

Answer 675

urinary metanephrines

Question 676

AOCD bloods

Answer 676

low iron, high ferritin, low transferrin

Question 677

ITP =

Answer 677

- isolated low platelet count with normal BM function - Tx: oral pred

Question 678

kussmal - raised anion gap

Answer 678

K - ketones u - uraemia s - sepsis s - salicylate m - methanol a - aldehyde l - lactic acidosis

Question 679

Addison's disease/adrenal insufficiency can cause

Answer 679

hyperkalaemic met acidosis

Question 680

DI is characterised by

Answer 680

high plasma osmolaity and low urine osmolality

Question 681

diagnostic criteria for DM

Answer 681

: fasting > 7.0, random > 11.1 - if asymptomatic need two readings

Question 682

ckd -> ? hyperparathyroidism

Answer 682

secondary

Question 683

polycythemia transformation

Answer 683

AML

Question 684

Mirror image nuclei

Answer 684

hodgkins lymphoma

Question 685

IgA def increases risk of

Answer 685

anaphylactic reactions

Question 686

what should addisons pts be given for adrenal crises

Answer 686

hydrocortisone injection kit

Question 687

cause of cranial DI

Answer 687

haemachromatosis

Question 688

low platelets + raised fibrin degredation

Answer 688

DIC

Question 689

FIRST LINE TEST FOR ACROMEG

Answer 689

serum IGF-1

Question 690

Insulinoma features

Answer 690

Whipple's triad of symptoms of 1) hypoglycaemia with fasting or exercise, 2) reversal of symptoms with glucose, and 3) recorded low BMs at the time of symptoms is hallmark for an insulinoma

Question 691

Haemarthrosis without trauma is typically a feature of

Answer 691

haemophilia A and B

Question 692

cancer DVT MX

Answer 692

6 months DOAC

Question 693

Mx of polycythemia

Answer 693

- aspirin - VTE risk - venesection - chemo: hydroxyuria and P32

Question 694

In type 1 diabetics, blood glucose targets:

Answer 694

5-7 mmol/l on waking and 4-7 mmol/l before meals at other times of the day

Question 695

warm haem anaemia Mx

Answer 695

steroids and rituximab

Question 696

Tests in acromegaly

Answer 696

- IGF-1 1) - then OGTT and serial GH to confirm

Question 697

Answer 697

lyme disease

Question 698

cushings ABG

Answer 698

hypokalaemic metabolic alkalosis Kushings (hypoKalaemic metabolic alKalosis)

Question 699

most common cause of type 2 necrotising fasciitis

Answer 699

Strep pyogenes (think striptococcus grow in strips/ chains)

Question 700

C-peptide production does NOT fall on exogenous insulin injection in patients with

Answer 700

insulinoma

Question 701

most common type of hodgkins lymphoma

Answer 701

nodular sclerosing

Question 702

NHL types

Answer 702

Most Common = Nodular Sclerosing Best Prognosis = Lymphocyte Predominant Worst Prognosis = Lymphocyte Depleted

Question 703

how should trax acid be given in haemorrhage

Answer 703

IV bolus followed by slow infusin

Question 704

most common neuro complication with HIV

Answer 704

cerebral toxoplasmosis

Question 705

most likely cause of burtkitts lymphoma

Answer 705

ebv infetion

Question 706

Platelet transfusion for thrombocytopenia before surgery/ an invasive procedure. Aim for plt levels of:

Answer 706

> 50×109/L for most patients 50-75×109/L if high risk of bleeding >100×109/L if surgery at critical site

Question 707

aplastic anaemia can be aused by

Answer 707

phenytoin

Question 708

pneumonia and GBS symptoms

Answer 708

think mycoplasma

Question 709

Latent tuberculosis treatment options:

Answer 709

3 months of isoniazid (with pyridoxine) and rifampicin, or 6 months of isoniazid (with pyridoxine)

Question 710

Klinefelter's syndrome causes

Answer 710

high LH low testosterone

Question 711

insulin for DKA

Answer 711

, insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin

Question 712

How many units of insulin in 1ml

Answer 712

100 units

Question 713

Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis

Answer 713

lymphogranuloma venerum

Question 714

Men who have sex with men should be offered immunisation against

Answer 714

hep A

Question 715

Lemierre's syndrome presents with

Answer 715

thrombophlebitis of the internal jugular vein following an anaerobic oropharngeal infection.

Question 716

LIVE ATTENUATED VACCINES

Answer 716

MMR Influenza (intranasal) BCG Oral polio Oral rotavirus Typhoid Yellow Fever MIBOOTY

Question 717

Subclinical hypothyroid Mx

Answer 717

Subclinical hypothyroidism with TSH level of level is 5.5 - 10mU/L: offer patients < 65 years a 6-month trial of thyroxine if TSH remains at that level on 2 separate occasions 3 months apart and they have hypothyroidism symptoms

Question 718

use can result in a false negative Mantoux test

Answer 718

LT steroids

Question 719

unrecordable BS + abdo pain

Answer 719

DKA

Question 720

Yellow fever typically presents with

Answer 720

flu like illness → brief remission→ followed by jaundice and haematemesis

Question 721

alternative to metronidazole for patients with bacterial vaginosis

Answer 721

topical clindamycin

Question 722

False positive VDRL/RPR:

Answer 722

SomeTimes Mistakes Happen' (SLE, TB, malaria, HIV)

Question 723

recommended rate for potassium infusion

Answer 723

10mmol/ hr

Question 724

cotard syndrome

Answer 724

pt believes they are dead, usually seen in severe depression

Question 725

Ongoing diarrhoea in Crohn's patient post-resection with normal CRP →

Answer 725

cholestyramine (bile acid malabs can occur)

Question 726

diabetes and BP targets

Answer 726

- blood pressure target of < 140/90 mmHg for type 2 diabetics, the same as for patients without diabetes. - 130/80 for t1 diabetes has albuminuria or 2 or more features of metabolic syndrome,

Question 727

temp arteritis is associated with

Answer 727

PMR

Question 728

SN hearing loss

Answer 728

- MN - acoustic neuroma

Question 729

how can alcohol -> hypernatreamia

Answer 729

Alcohol bingeing can lead to ADH suppression in the posterior pituitary gland subsequently leading to polyuria

Question 730

Urinary incontinence + gait abnormality + dementia =

Answer 730

normal pressure hydrocephalus - wet ad wobbly

Question 731

Grave's disease, orange peel shin lesions -

Answer 731

pretibial myxoedema

Question 732

Oesophageal cancer may cause hoarseness

Answer 732

advanced tumours, especially in the upper third, may invade or compress the recurrent laryngeal nerve

Question 733

periuriteric fat stranding can indicate

Answer 733

Periureteric fat stranding may indicate recent stone passage, if a ureteric calculus is not present.

Question 734

stroke location leading to aphasia

Answer 734

Dominant hemisphere middle cerebral artery strokes cause aphasia

Question 735

itubation for surgery in a trauma context

Answer 735

use ketamine - does not drop BP

Question 736

intubation - lack of end tidal CO2 ->

Answer 736

always means oesophageal intubuation until otherwise

Question 737

? cause of stridor in the first few weeks of life

Answer 737

laryngomalacia

Question 738

tx of SIADH

Answer 738

FLUID RESTRICTION

Question 739

First line for HTN in P

Answer 739

labetolol -> nifedipine -> methyldopa

Question 740

Sydenham's chorea

Answer 740

late comp of rheumatic fever

Question 741

when do we need to do transvenous pacing for bradycardia

Answer 741

Risk factors for asystole in bradycardia (? needs transvenous pacing) complete heart block with broad complex QRS recent asystole Mobitz type II AV block ventricular pause > 3 seconds

Question 742

which type of rash in pregnancy spares the periumbilical region

Answer 742

polymorphic eruption

Question 743

investigation of choice for suspected carcinoid tumours

Answer 743

urinary 5-HIAA

Question 744

Mx of weber A #

Answer 744

patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot

Question 745

Treatment of asymptomatic hyperuricaemia in an attempt to prevent gout

Answer 745

NOT recommended by NICE

Question 746

Palpitations should first be investigated with

Answer 746

Holter monitoring after bloods/ ECG

Question 747

When should we do US for achilles tendinopathy

Answer 747

only when diagnostic uncertainty or failure to respond to Tx (do not routinely do, just treat w NSAIDS)

Question 748

When switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI

Answer 748

DIRECT SWITCH IS POSSIBLE

Question 749

Proteinuria + AKI ->

Answer 749

INTRINSIC

Question 750

the chorionic villi invade in to the myometrium but not through to the perimetrium

Answer 750

Placental increta

Question 751

first line in LS

Answer 751

topical potent steroids like betamethasone valerate

Question 752

Subacute unilateral visual loss, eye pain worse on movements → ?

Answer 752

optic neuritis

Question 753

murmur in VSD

Answer 753

Pansystolic (usually seen in association w congenital abn)

Question 754

anterior uveitis mx

Answer 754

steroid and cycloplegic eye drops

Question 755

muscle relaxant of choice for rapid sequence induction for intubation

Answer 755

suxamethonium

Question 756

red, swollen, and tender testicle not relieved by elevation

Answer 756

TT - immediate bilateral orhidopexy

Question 757

prehns sign

Answer 757

relief with elevation of testicles - NOT torrsion

Question 758

Risk malignancy index (RMI) prognosis in ovarian cancer is based on

Answer 758

CA125, menopausal status, US findings

Question 759

mx of acute relapse of MS

Answer 759

High dose steroids

Question 760

units =

Answer 760

volume (ml) * ABV / 1,000

Question 761

? one of the strongest risk factors for future suicide completion

Answer 761

prev suicide attempt

Question 762

when is a laryngeal mask airway CI

Answer 762

Laryngeal mask airway provides poor control against reflux of gastric contents therefore is unsuitable in non fasted patients

Question 763

central scrotoma is a feature of

Answer 763

optic neuritis

Question 764

Lithium toxicity can be precipitated by

Answer 764

thiazides

Question 765

pack years =

Answer 765

Pack-years = (Cigarettes per day / 20) x (Years smoked)

Question 766

mx of bleeding w nexplanon

Answer 766

COCP 3 months

Question 767

contraindication to having a cochlear implant

Answer 767

- chronic infective OM - OTHER: tympanic membrane perforation, cochlear aplasia, mastoid cavity infections, and lesions to the vestibulocochlear nerve (cranial nerve 8) or the brainstem.

Question 768

Tx of keloid scarring

Answer 768

intra-lesional steroid injections

Question 769

where should the implant be sited

Answer 769

subdermal non dominant arm

Question 770

time out of WHO checklist

Answer 770

before first skin excision is made

Question 771

erythema ab igne

Answer 771

caused by infrared radiation and is commonly associated with hot water bottles or open fires

Question 772

reflex tachy + dizziness and palpitations from an antiHTN

Answer 772

nifedipine - vasodilation whih leads to tach

Question 773

Sudden popping sound during athletic activity → knee pain. swelling and instability ?

Answer 773

ACL injury

Question 774

SJS rash

Answer 774

a rapid onset of a painful red skin rash which starts on the trunks and extends abruptly onto the face and limbs. - rash rarely affects the scalp, palms or soles.

Question 775

common trigger of SJS

Answer 775

lamotrigine

Question 776

TIA + bleeding risk

Answer 776

immediate CT non contrast to rule out haemorrhage

Question 777

Mx of mastoiditis

Answer 777

admission and IV antibiotics

Question 778

pANCA mneumonic

Answer 778

P for pump (pANCA) needed in asthma = eosinophilic granulomatosis

Question 779

mx of subtrochanteric hip #

Answer 779

Extracapsular hip fracture (subtrochanteric fracture) - intramedullary device

Question 780

Pigmented gallstones are associated with

Answer 780

sickle cell - red cell haemolysis

Question 781

dyskinetic CP

Answer 781

- writhing movements - from damage to BG and SN

Question 782

Start IV fluid resuscitation in children or young people with

Answer 782

10ml/kg over less than 10mins

Question 783

young people with new onset chest pain with a recent history of viral illness

Answer 783

myocarditis

Question 784

coarctation of aorta

Answer 784

acute circulatory collapse at 2 days of age when the duct closes- heart failure & absent femoral pulses. Systolic murmur heard under the left clavicle and over the back

Question 785

In trauma, to test if the fluid draining from the nose or ear is CSF, check for

Answer 785

glucose

Question 786

? is associated with a firm, smooth, tender and pulsatile liver edge

Answer 786

right heart failure

Question 787

Post stroke AC

Answer 787

No AF: clopidogrel AF: DOAC

Question 788

Do not use corticosteroids in children younger than?with suspected or confirmed bacterial meningitis

Answer 788

3 months

Question 789

Mx of TIA at GP

Answer 789

- aspirin - urgent assessment within 24 hrs - if symptoms over 7 days ago, then refer to stroke specialist within 7 days

Question 790

symptoms triggered by sudden change in head position

Answer 790

BPPV - DOES NOT OCCUR IN MN

Question 791

mirtazapine MAO

Answer 791

noradrenergic and specific serotonergic antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors

Question 792

Paget's disease of the bone is treated with

Answer 792

Bisphosphonates

Question 793

A relative afferent pupillary defect is when

Answer 793

-the affected and normal eye appears to dilate when light is shone on the affected eye - right retina or optic nerve when the both pupils dilate when shing a light into right eye

Question 794

investigation of choice for reflux nephropathy

Answer 794

MCUG

Question 795

drugs -> PF

Answer 795

- Antibiotics - especially nitrofurantoin Amiodarone Chemotherapy Methotrexate

Question 796

An increase in serum creatinine ? from baseline is acceptable when initiating ACE inhibitor treatment

Answer 796

up to 30%

Question 797

features of autonomic neuropathy (diabetes)

Answer 797

1. Postural hypotension 2. Loss of respiratory arrhythmia 3. Erectile dysfunction

Question 798

pericarditis + AKI

Answer 798

shows uraemia -> haemodialysis

Question 799

mx of renal stone > 20mm

Answer 799

perctuaneous nephrolithomotmy if > 2cm

Question 800

Answer 800

episcleritis - increased presence of conjunctival blood vessels confined to a well-circumscribed area, appearing bright red or pink.

Question 801

most common site for nasal bleeidng

Answer 801

anterior nasal septum - Littles area

Question 802

herpes simplex keratitis

Answer 802

- presents as a dendritic ulcer - Mx: topical acilovir

Question 803

lung abscess not responding to ab

Answer 803

arrange CT guided drinage

Question 804

Lung abscess

Answer 804

swinging fevers, night sweats, pleuritic chest pain, dyspnoea, and cough.

Question 805

AOCD vs IDA

Answer 805

Question 806

ORBIT scoring

Answer 806

Question 807

where should adrenaline be injected

Answer 807

anterolateral aspect of the middle third of the thigh

Question 808

When stopping a SSRI the dose should be gradually reduced over

Answer 808

a 4 week period

Question 809

methanol poisoning mx

Answer 809

fomepizole or ethanol haemodialysis

Question 810

If a perforated tympanic membrane does not heal by itself a

Answer 810

myringoplasty may be performed - perf should normally heal itself within 6-8 weeks

Question 811

biceps tendon rupture

Answer 811

A sudden 'pop' or tear either at the shoulder (long tendon), or at the antecubital fossa (distal tendon) which is followed by pain, bruising and swelling Rupture of the proximal tendon causes 'Popeye' deformity; this is when the muscle bulk results in a bulge in the middle of the upper arm. Seen more easily in muscular individuals and less obvious in overweight or cachectic patien

Question 812

? TAKEN IN BF -> REYES SYNDROME

Answer 812

ASPIRIN

Question 813

typically presents with knee pain after exercise, locking and 'clunking'

Answer 813

Osteochondritis dissecans

Question 814

Most sig RF for placental accreta

Answer 814

prev C sections

Question 815

A transvaginal ultrasound demonstrating a crown-rump length greater than 7mm with no cardiac activity is diagnostic of

Answer 815

miscarriage

Question 816

Widened QRS or arrhythmia in tricyclic overdose - give

Answer 816

IV sodium bicarb

Question 817

most common hereditary sensorimotor neuropathy

Answer 817

charcot marie tooth disease

Question 818

CMT symptoms

Answer 818

- There may be a history of frequently sprained ankles - Foot drop - High-arched feet (pes cavus) - Hammer toes - Distal muscle weakness - Distal muscle atrophy - Hyporeflexia - Stork leg deformity

Question 819

Rheumatoid arthritis: patients have an increased risk of

Answer 819

ihd

Question 820

RF for DDH - oligohydramnios

Answer 820

Oligohydramnios can lead to DDH as it restricts foetal movement and thus normal development of the hip joint.

Question 821

preferred method of induction of labour if the Bishop score is ≤ 6

Answer 821

vg PGE2 or oral misoprostiol

Question 822

NICE advise that, as PSA levels may be increased, testing should not be done within at least:

Answer 822

- 6 weeks of a prostate biopsy - 4 weeks following a proven urinary infection - 1 week of digital rectal examination - 48 hours of vigorous exercise - 48 hours of ejaculation

Question 823

first step for pleural effusionimm

Answer 823

pleural aspiration

Question 824

croup - audible stridor at rest ->

Answer 824

immediate admission to hosp

Question 825

tall R waves V1-2

Answer 825

posterior

Question 826

The first-line management of SVT is vagal manoeuvres:

Answer 826

Valsava manouvre or carotid sinus massage (NOT BILATERAL)

Question 827

'Young' stroke blood tests include

Answer 827

thrombophilia and autoimmune screening - performed in those under 55 with no obvious cause of a stroke

Question 828

Perioral dermatitis can be made worse by

Answer 828

topical steroids

Question 829

gastric lymphoma mx

Answer 829

H pylori eradication - omeprazole, metronidazole, clarithromycin

Question 830

how should amiodarone be given

Answer 830

should ideally be given into central veins to reduce the risk of injection site reactions - common cause of thromophlebitis

Question 831

Surgery / diabetes: once-daily insulin dose should generally be reduced b

Answer 831

by 20% on the day before and the day of surgery

Question 832

Raynaud's disease (i.e. primary) presents in

Answer 832

presents in young women with bilateral symptoms

Question 833

Non-seminoma germ cell testicular tumours (e.g. teratomas) are associated with

Answer 833

raised hCG and AFP

Question 834

Acute onset of tear-drop scaly papules on trunk and limbs → ?

Answer 834

- guttate psoriasis - emollients and reassurance

Question 835

most commonly sprained ligament in inversion injuries of the ankle

Answer 835

anterior talofibular ligament

Question 836

isoniazid and warfarin ->

Answer 836

bleeding

Question 837

wernickes vs brocas

Answer 837

Wernicke's sounds like 'What?' as the patient doesn't understand a command. Broca sounds like 'broken' as the patient's word-flow is broken.

Question 838

visual comp in temporal arteritis

Answer 838

ant ischaemic optic neuropathy

Question 839

when are ACEi CI

Answer 839

contraindicated in patients with renovascular disease E.G. renal artery stenosis

Question 840

what causes increased nuchal translucensy

Answer 840

- CHD - Downs

Question 841

how does cocaine -> myocardial ischaemia

Answer 841

spasm of coronary arteries

Question 842

mx of acute OM with perforation

Answer 842

5-7 day course of amox

Question 843

quinine toxicity

Answer 843

- hypotension - ECG changes - met acidosis - hypoglycaemia - tinnitus, flushing and visual disturbance

Question 844

allergic contact derm is a type ? HN

Answer 844

4

Question 845

early x-ray feature of rheumatoid arthritis

Answer 845

Juxta-articular osteoporosis

Question 846

left homonymous hemianopia with some macula sparing.

Answer 846

occipital cortex

Question 847

early blindness + tunnel vision

Answer 847

retinitis pigmentosa - affects the retina

Question 848

mx of suspected urethral injury following pelvic #

Answer 848

suprapubic catheter

Question 849

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

Answer 849

CRVO

Question 850

Which a should be used in caution with epilepsy

Answer 850

ciproflox - lowers seizure threshild

Question 851

retinal detachment

Answer 851

cause of sudden painless loss of vision. It is characterised by a dense shadow starting peripherally and progressing centrally

Question 852

young + HTN + hypokal

Answer 852

hyperaldosteronism - do plasma renin and alds

Question 853

which AP reduces seizure threshold, making seizures more likely

Answer 853

clozapine

Question 854

GCS - need to record

Answer 854

best action done by the pt