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Passmed Questions 2.0 Flashcards

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1
Q

when should you give prophylactic abx for spontaneous bacterial peritonitis? what antibiotic would this be?

A

oral ciprofloxacin
if previous SPB infection
ascitic tap protein 15 or less
child pugh 9 or more
hepatorenal syndrome

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2
Q

what condition would over estimate HbA1c?

A

splenectomy due to long half life of RBC

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3
Q

treatment for hiccups in palliative care

A

chlorpromazine or haloperidol

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4
Q

pathophysiology of primary biliary cholangitis

A

interlobula bile ducts become inflammed –> cholangitis –> cirrhosis

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5
Q

ovarian tumour associated with Meig’s syndrome

A

fibroma
(benign tumour)

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6
Q

most common ovarian tumour found in women of reproductive age?

A

follicular cyst

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7
Q

most common ovarian tumour found in young women < 25 years

A

dermoid cyst (teratoma)

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8
Q

precipitating factors for digoxin toxicity

A

hypokalaemia, hypomagnaesaemia
hypercalcaemia, hypernatraemia
low albumin
hypothermia, hypothyroidism
amiodarone, verapamil, diltiazem, ciclosporin, spironolactone, thiazide and loop diuretics
increasing age, renal failure,

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9
Q

HF medications which may precipitate digoxin toxicity

A

spironolactone
loop diuretics
thiazide like diuretics
verapapmil, diltizem

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10
Q

electrolyte abnormalities which could precipitate digoxin toxicity

A

low K, Mg, temp, albumin, thyroid
high Na, Ca

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11
Q

at what fasting glucose should insulin be started immediately in pregnant patients

A

if fast glucose 7 or higher then start insulin
if > 5.6 but < 7 - lifestyle advice + metformin

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12
Q

cancer with raised AFP and bHCG

A

non-seminoma testicular cancer

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13
Q

cancer with raised 15-3

A

breast cancer

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14
Q

bombesin tumour marker

A

gatsric cancer, neuroblastoma, small cell lung cancer

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15
Q

S-100 tumour marker

A

schwannoma, melanoma

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16
Q

treatment for genital warts

A

multiple, non-keratinized: topical popdophyllum
solitary, keatinized: cryotherapy

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17
Q

what is the target time for thrombectomy and thrombolysis in stroke patients

A

thrombolysis - 4.5 hours
thrombectomy - 6 hours

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18
Q

when should bells palsy have urgent referral to ENT

A

no improvement within 3 weeks

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19
Q

features of herpes simplex encephalitis on CT

A

bilateral temporal lobe hypodensities

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20
Q

features of temporal lobe involvement

A

aphasia
hemiparesis
memory impairment

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21
Q

antiemetic used in parkinsons

A

domperidone
acts as dopamine antagonist but doesnt cross BBB so can safely be used in parkinsons

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22
Q

dose of rectal diazepam in seizure emergency

A

< 1 year - 5mg
2-11 years - 5-10mg
11-17 years - 10mg
adult - 10-20mg
elderly - 10mg

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23
Q

does cushings reflex cause wide or narrow pulse pressure

A

wide pulse pressure

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24
Q

what blood test is used to check response to treatment in hashimotos

A

TSH

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25
tear drop poikilocytes on blood film
myelofibrosis megaloblastic anaemia thalassaemia
26
fist line treatment for ITP
oral prednisolone
27
blood film feature of DIC
schistocytes
28
what type of cancers are at increased risk with the COCP?
breast and cervical
29
Monomorphic rash with punched out erosions - diagnosis? causative organism? treatment?
eczema herpeticum HSV 1 or 2 admit for IV aciclovir
30
indications for high dose folic acid in pregnancy
taken 3 months prior to conception to 12 weeks pregnancy either partner has NTD, previous pregnancy with NTD or family history of NTD diabetes, thalassaemia, coeliac, antiepileptic medications obsese (BMI 30 or higher)
31
features on fundoscopy and condition they are found in; - drusen - cotton wool spoots - flame haemorrhages - AV nicking - cupping of optic disc
drusen - age related macular degeneration cotton wool spots - HTN, diabetic retinopathy flame haemorhages - HTN AV nicking - HTN - cupping of optic disc - glaucoma
32
cancers associated with dermatomyositis
ovarian and lung cancer
33
cancer associated with - migratory thrombophlebitis - necrolytic migratory erythema - pyoderma gangrenosum - tylosis
pancreatic glucaganoma myeloproliferative disorders oesophageal
34
live attenuated vaccines
BCG MMR oral polio yellow fever oral typhoid
35
treatment for heart block post MI
no treatmet if asymptomatic transcutaneous pacing if symptomatic +/or elderly
36
drugs that can induce erythema nodosum
penicillin sulphonadmides COCP
37
38
good prognostic factors for SCC
well circumscribed lesion < 20mm diameter <2mm deep no associated disease
39
surgical margins for excision of SCC
if < 20mm then 4mm margin if > 20mm then 6mm margin
40
what cancer are renal transplant patients at risk of
SCC
41
treatment for antiphospholipid syndrome during pregnancy
aspirin + LMWH (LMWH usually continued 6 weeks post partum or until oral anticoagulant can be restarted)
42
whats the most common cardiac abnormality found in downs syndrome
AVSD (endocardial cushion defect)
43
wells score criteria
bed bound >3 days or recent major surgery in past 12 weeks leg swelling >3cm previous DVT/PE tachycardia (HR > 100) active cancer collateral superficial veins entire leg swollen pitting oedema tenderness along deep venous system differential diagnosis unlikely if > 2 then USS if < 2 then d-dimer
44
medication used to prevent; - calcium stones - urate stones - oxalate
calcium stones - thiazide like diuretics urate stones - allopurinol oral bisophosphonate oxalate - pyridoxine, cholestyramine
45
1st line treatment for renal stones
<5mm and asymptomatic - watch and wait 5-10mm - shockwave lithotripsy 10-20mm - SWLT or ureteroscopy > 20mm - percutaneous nephrolithotomy if pregnant --> SWLT contraindicated
46
1st line treatment for ureteric stones
<10mm - SWLT +/- alpha blockers 10-20mm - ureteroscopy
47
acute heart failure with hypotension management
1st line - HDU for inotropic support 2nd line - vasopressors 3rd line - mechanical circulatory assistance i.e. intra aortic balloon counterpulsation or LVAD
48
treatment for magnesium sulphate induced respiratory depression
calcium gluconate
49
most common congenital heart disease in new born and at 1-2 months age
new born - transportation of great arteries if 1-2 months of age - tetralogy of fallot
50
mode of action of bupropion
used for smoking cessation norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist
51
mode of action of varenicline
used for smoking cessation partial nicotinic receptor agonist
52
colorectal screening
FIT test every 2 years people aged 50-74 in scotland ,60-74 years in england
53
when do you refer patients with sciatica +/- known disc prolapse to neurosurgery
after 4-6 weeks of conservative management
54
most common infective organism in bronchiectasis
H. influenzae
55
indications for surgery in bronchiectasis
uncontrollable haemoptysis localised disease
56
rules for pregnancy women unvaccinated against Rubella during pregnancy
MMR live attenuated so not given during pregnancy can be given in post-natal period advise to keep away from people who may have rubella
57
breast lump with green discharge
mammary duct ectasia
57
irregular breast lump in obese lady with skin tethering
fat necrosis
58
discrete, non-tender lump in breast of 20 year old
fibroadenoma
59
lumpy tender breasts which may become painful during menstruation
fibroadenosis (fibrocystic disease)
60
breast lump associated with bloody stained nipple discharge
ductal pappiloma
61
night blindness and tunnel vision?
retinitis pigmentosa
62
how should you alter long acting insulin on the day of surgery
reduce dose by 20%
63
what is an acceptable level of PSA post prostatectomy?
undetectable any level of PSA should require urgent referral to oncology
64
1st line management in paediatrics with constipation?
advice on diet and exercise + movicol paediatric plain
65
drug causes of lung fibrosis
amiodarone bleomycin, busulphan sulfasalazine, MTX cabergoline, bromocriptine, pergolide nitrofurantoin
66
whats the most appropriate test to confirm h.pylori eradication after completing treatment
urea breath test
67
main indication for placing chest drain in pleural infections
purulent discharge growth of organisms PH < 7.2
68
1st, 2nd and 3rd line treatment for anal fissure
1st: increase dietary fiber, bulk forming laxatives or lactulose if not tolerated 2nd: topical GTN, topical diltiazem if GTN not tolerated 3rd: if fails after 8 weeks of treatment the consideration of referral for surgical management - sphincterectomy or botulinum toxin
69
pregnant and exposed to chickenpox. Not symptomatic. Dont know if they have previously had chickenpox. What do you do?
check varicella IgG Ab
70
pregnant and exposed to chickenpox. Symptomatic. What do you do?
discuss with Obs and Gynae
71
pregnant and exposed to chickenpox. Asymptomatic. Previously had chickenpox. What do you do?
Reassure
72
1st, 2nd, 3rd and 4th degree perineal tears
1st degree: superficial no muscle involvement 2nd degree: injury to perineal muscle 3rd degree: tear of the anal sphincter complex 4th degree: tear of anal sphincter complex and rectal mucosa
73
WHO categories of obese on BMI ranges
BMI 30 - 34.9 obese type I BMI 35-39.9 obese type II BMI 40 and above obese type III
74
what type metabolic abnormality does cushings cause
hypokalaemia metabolic alkalosis
75
XR features of perthes disease
early: widened joint space late: flattening of the femoral head
76
firm painless lump in the eyelid and management
chalazion (meiboman cyst) resolve spontaneously but sometimes require surgical drainage
77
treatment for stye
hot compress antibiotics if there is associated conjunctivitis
78
treatment for gatsroenteritis in severe cases +/or immunocompromised patients
ciprofloxacin
79
causative organism of keratitis found in contact lens wearers?
pseudomonas staph aureus if not contact lens wearer
80
treatment for keratitis
stop wearing contacts until resolves topical quinolone
81
what is the antidepressant of choice in a breast feeding woman?
sertraline or paroxetine
82
what medication should be given in patient with subarachnoid haemorrhage
nimodipine to prevent vasospasm
83
features of pesticide poisoning
increase in parasympathetic acitivity i.e. drooling bradycardia small pupils (miosis)
84
whats the earliest time external cephalic version can be offered in nuliparous and multiparous women?
nuliparious - 36 weeks multiparous - 37 weeks
85
what chromosomes are BRCA 1 and BRCA 2 located on?
BRCA 1 - chromosome 17 BRCA 2 - chromosome 13
86
what cancers does BRCA 2 put men at risk of
breast and prostate
87
when is the anomaly scan done
18-20 weeks
88
pigmented laded macrophages suggestive of melanosis coli. what is the cause of this
laxative abuse
89
what antiemetic is recommended in patients with mirgaine
prokinetic such as metoclopramide
90
what type of laxative is first line in patients with IBS
bulk forming laxative such as isphagula husk
91
what type of hearing test is done at the newborn screening
otoaccoustic emission test
92
what type of hearing test is done at school entry age
pure tone audiometry
93
treatment for recurrent c.diff infection within 12 weeks of prev infection
oral fidaxomicin

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