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Progress Tests > Passmed Year 4 > Flashcards

Passmed Year 4 Flashcards

1
Q

What symptoms would suggest a lacunar stroke?

A

Pure motor / sensory / cerebellar symptoms

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2
Q

Symptoms of total anterior circulation stroke

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
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3
Q

Symptom of partial anterior circulation stroke

A

2 of:

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
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4
Q

Symptoms of posterior circulation stroke

A

1 of:

  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia
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5
Q

common causes of acute interstitial nephritis

A

Drugs (eg NSAIDs or abx) are more common

Systemic inflammatory conditions eg SLE

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6
Q

Management of acute interstitial nephritis

A

Stop offending agent

Steroids or dialysis if severe

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7
Q

Symptoms of acute interstitial nephritis

A

rash, fever and eosinophilia
White cells and white cell casts in urine
Mild renal impairment
HTN

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8
Q

Anti platelets in patients with ACS who are taking oral anticoagulant

A

Aspirin and clopidogrel

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9
Q

Anti platelets in patients with ACS who aren’t already on anticoagulants

A

Aspirin and prasugrel

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10
Q

Symptoms of HOCM

A 
Asymptomatic 
Exertional dyspnoea
Angina
Syncope
Sudden death
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11
Q

What cancer is CA15-3 a marker of?

A

Breast

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12
Q

Management of pregnant women colonised with group B strep

A

Prophylactic abx in Labour

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13
Q

Indication for pregnant women having intrapartum abx prophylaxis against group B strep

A

Previous baby with group B strep
Preterm Labour
Pyrexia in Labour

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14
Q

What is a hyatidiform mole?

A

A pregnancy which becomes cancerous early in development

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15
Q

Symptoms of hyatidiform mole

A

Painless PV bleeding in early pregnancy
Uterus is large for date
Hyperemesis
Symptoms of thyrotoxicosis

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16
Q

Diagnosis of hyatidiform mole

A

Ultrasound is highly suggestive (resembles bunch of grapes)

Histopathological examination is diagnostic

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17
Q

What is asherman syndrome?

A

Scar tissue adhesions form in the uterus following surgery leading to amenorrhoea

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18
Q

Aetiology of imperforate hymen

A

Congenital (no hole in hymen from birth)

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19
Q

Management of hydrocele

A

In neonates it may close spontaneously within a few months

If not then surgery

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20
Q

Whooping cough treatment

A

Abx (azithromicin) if presenting in first 21 days

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21
Q

Whooping cough prophylaxis

A

Household contacts

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22
Q

Symptoms of neuroleptic malignant syndrome

A

pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

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23
Q

When does neuroleptic malignant syndrome usually present?

A

Soon after starting antipsychotics

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24
Q

Causes of jaundice in first 24 hours

A

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

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25
Q

Management of polycythemia Vera

A

Aspirin
Venesection
Chemo

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26
Q

Complications of polycythemia Vera

A

Thrombotic events
Myelofibrosis
Acute leukaemia

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27
Q

Symptoms of pityriasis rosea

A 
herald patch (usually on trunk)
followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a 'fir-tree' appearance
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28
Q

Age affected by pityriasis rosea

A

Young adults

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29
Q

Management of pityriasis rosea

A

None needed

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30
Q

Prognosis in pityriasis rosea

A

Good, typically clears up spontaneously in 6-12 weeks

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31
Q

Symptoms of Lyme disease

A 
Bulls eye rash
headache
lethargy
fever
arthralgia
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32
Q

Late features of Lyme disease

A

cardiovascular (heart block, peri/myocarditis)

neurological (facial nerve palsy, radicular pain, meningitis)

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33
Q

Management of Lyme disease

A

Abx

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34
Q

Management of thrush

A

Oral or pessary antifungals

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35
Q

Management of thrush in pregnancy

A

Antifungal pessary

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36
Q

Management of recurrent thrush

A

induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months

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37
Q

Normal resp rate in neonates

A

30-60

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38
Q

Normal heart rate in neonates

A

100-160

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39
Q

Management of PDA

A

indomethacin or ibuprofen
given to the neonate
(inhibits prostaglandin synthesis and closes the connection in the majority of cases)
if associated with another congenital heart defect amenable to surgery then prostaglandin E1 is useful to keep the duct open until after surgical repair

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40
Q

What differentiates gestational hypertension from pre-eclampsia?

A

Gestational hypertension has no proteinuria

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41
Q

NICE criteria for immediate CT head

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture.
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

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42
Q

NICE criteria for CT head within 8 hours

A

age 65 years or older
any history of bleeding or clotting disorders
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury

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43
Q

Site to avoid when cannulating diabetic patient

A

Foot (risk of foot ulcers)

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44
Q

Causes of oligohydramnios

A 
premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia
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45
Q

Treatment of takotsubo cardiomyopathy

A

Supportive

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46
Q

Prognosis of takotsubo cardiomyopathy

A

Good (most patients recover with supportive treatment)

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47
Q

Pathophysiology of takotsubo cardiomyopathy

A

Transient apical ballooning of the heart triggered by stress

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48
Q

What is dermatofibroma?

A

Benign lesion.
Firm elevated nodules.
Usually history of trauma.
Lesion consists of histiocytes, blood vessels and fibrotic changes

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49
Q

What is pyogenic granuloma?

A

Overgrowth of blood vessels.
Red nodules.
Usually follow trauma.
May mimic amelanotic melanoma

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50
Q

Site to avoid when cannulating diabetic patient

A

Foot (risk of foot ulcers)

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51
Q

Causes of oligohydramnios

A 
premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia
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52
Q

Treatment of takotsubo cardiomyopathy

A

Supportive

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53
Q

Prognosis of takotsubo cardiomyopathy

A

Good (most patients recover with supportive treatment)

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54
Q

Pathophysiology of takotsubo cardiomyopathy

A

Transient apical ballooning of the heart triggered by stress

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55
Q

What is dermatofibroma?

A

Benign lesion.
Firm elevated nodules.
Usually history of trauma.
Lesion consists of histiocytes, blood vessels and fibrotic changes

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56
Q

What is pyogenic granuloma?

A

Overgrowth of blood vessels.
Red nodules.
Usually follow trauma.
May mimic amelanotic melanoma

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57
Q

Appearance of CSF fluid in viral meningitis

A

Clear / cloudy

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58
Q

Appearance of CSF fluid in TB meningitis

A

Slightly cloudy

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59
Q

CSF glucose in Bacterial meningitis

A

Low (less than half plasma level)

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60
Q

CSF glucose in viral meningitis

A

Normal (60-80% plasma level)

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61
Q

CSF glucose in TB meningitis

A

Low (less than half of the plasma glucose level)

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62
Q

CSF glucose in fungal meningitis

A

Low (less than half of the plasma level)

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63
Q

CSF protein in bacterial meningitis

A

High

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64
Q

CSF protein in viral meningitis

A

Normal

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65
Q

CSF protein in tuberculosis meningitis

A

High

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66
Q

CSF protein in fungal meningitis

A

High

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67
Q

CSF white cells in bacterial meningitis

A

High polymorphs

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68
Q

CSF white cells in viral meningitis

A

High lymphocytes

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69
Q

CSF white cells in TB meningitis

A

High lymphocytes

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70
Q

CSF white cells in fungal meningitis

A

High lymphocytes

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71
Q

Management of proximal scaphoid fractures

A

Surgical fixation

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72
Q

Management of undisplaced distal scaphoid fracture

A

Splint or cast for 6 weeks

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73
Q

Initial management of scaphoid fracture

A

Immobilise with splint

Orthopaedic follow up with repeat imaging in 7-10 days

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74
Q

How often is adrenaline given in CPR

A

Every 3-5 mins

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75
Q

First line medication and route for medical miscarriage

A

Misoprostol pessary

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76
Q

How long may an expectant miscarriage be trialed for?

A

14 days

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77
Q

Medications in meningitis in child under 3 months

A

Antibiotics

Steroids contraindicated

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78
Q

How long after exposure to text for HIV

A

4 weeks

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79
Q

Management of initial negative HIV test

A

Repeat at 12 weeks after exposure

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80
Q

Investigation for full thickness oesophageal tear

A

CT contrast swallow

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81
Q

What is Boerhaaves syndrome

A

Spontaneous oesophageal rupture due to vomiting

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82
Q

Symptoms of oesophageal rupture

A

Sudden chest pain
Vomiting
Surgical emphysema

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83
Q

Management of oesophageal rupture

A

Surgery

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84
Q

Symptoms of narcolepsy

A

Excessive daytime sleepiness. Cataplexy. Sleep paralysis and hallucinations

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85
Q

Investigation of narcolepsy

A

Multiple sleep latency EEG

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86
Q

Management of narcolepsy

A

Daytime stimulants

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87
Q

Is there a vaccine for Hep A?

A

Yes

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88
Q

Most common site of necrotising fasciitis

A

Perineum

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89
Q

Symptoms of necrotising fasciitis

A

Acute onset pain swelling and redness with pain out of keeping with physical features. Fever and tachycardia later

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90
Q

Causes of neonatal hypoglycaemia

A

Transient hypoglycaemia is normal.

preterm birth (< 37 weeks)
maternal diabetes mellitus
IUGR
hypothermia
neonatal sepsis
inborn errors of metabolism
Beckwith-Wiedemann syndrome
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91
Q

Management of asymptomatic neonatal hypoglycaemia

A

Encourage feeding. Monitor BMs

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92
Q

Management of symptomatic neonatal hypoglycaemia

A

Dextrose infusion

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93
Q

Definition of incarcerated hernia

A

Can’t be reduced

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94
Q

Definition of strangulated hernia

A

Lost blood supply

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95
Q

What differentiates patients with incarcerated and strangulated hernias

A

Patient will be systemically unwell in strangulated hernia

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96
Q

Management of femoral hernia

A

Surgical repair

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97
Q

Typical history of cervical rib

A

A 23-year-old man presents with intermittent symptoms of altered sensation in his arm and discomfort when he uses his hands. He works as an electrician and his symptoms are worst when he is fitting light fixtures.

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98
Q

Conditions caused by high altitude

A

Acute mountain sickness
High altitude pulmonary oedema
High altitude cerebral oedema

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99
Q

Prevention and management of acute mountain sickness

A

Ascend slowly
Acetazolamide is preventative
Treated with descent

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100
Q

Symptoms of acute mountain sickness

A

Headache
Nausea
Fatigue

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101
Q

Treatment of high altitude cerebral oedema

A

Descent

Dexamethasone

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102
Q

Treatment of high altitude pulmonary oedema

A

Descent
Oxygen
Nifedipine or dexamethasone

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103
Q

Management of suspected DVT with negative USS but raised D dimer

A

Repeat USS in 1 week

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104
Q

Management of immunosuppressive drugs patient who has been in contact with chickenpox

A

Check if they have varicella antibodies

If negative, give varicella immunoglobulins

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105
Q

What pneumonia is associated with erythema multiforme

A

Mycoplasma pneumonia

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106
Q

Is minimal change disease nephrotic or nephritic?

A

Nephrotic

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107
Q

Is membranous glomerulonephritis nephrotic or nephritic?

A

Nephrotic

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108
Q

Is focal segmental glomerulosclerosis nephrotic or nephritic?

A

Nephrotic

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109
Q

Management of membranous glomerulonephritis

A

ACE inhibitor
Immunosuppression
Consider anticoagulants

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110
Q

What is a first degree burn?

A

Red and painful. Epidermis is burned

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111
Q

What is a second degree burn?

A

Pink or white. Painful. Blistered. Dermis is burned

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112
Q

What is a third degree burn?

A

White / brown / black. Not painful. Full thickness

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113
Q

What cancer does pernicious anaemia increase risk of?

A

Gastric

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114
Q

Management of hip dislocation

A

Reduction under GA in 4 hours to reduce risk of AVN

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115
Q

First line in superficial vein thrombosis

A

Compression stockings

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116
Q

Where is small cell lung cancer usually found?

A

Centrally

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117
Q

What is lambert eaton syndrome?

A

Associated with SCLC

antibodies to voltage gated calcium channels causing myasthenic like syndrome

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118
Q

What cancer is lambert Eaton syndrome associated with?

A

Small cell lung cancer

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119
Q

Treatment of lung cancer

A

Usually Chemo and radiotherapy. Surgery if very early

Palliative of late

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120
Q

Complications of PBC

A

Liver cirrhosis

Liver cancer

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121
Q

Management of child under 3 presenting with acute limp

A

A&E assessment (high risk of septic arthritis)

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122
Q

History and typical patient in transient synovitis

A

Acute limp
Accompanies viral infection
Child well
Most common in boys 2-12

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123
Q

Management of dyspepsia not responding to high dose PPI

A

Test for H pylori (and treat if present)

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124
Q

What is calcitonin a tumour marker for?

A

Medullary thyroid cancer

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125
Q

Treatment of scabies in close contacts

A

2 doses permethrin a week apart

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126
Q

Symptoms of Bartholin’s cyst

A

Soft painful labial lump

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127
Q

Signs in ALS motor neurone disease

A

UMN and LMN

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128
Q

Signs in primary lateral sclerosis motor neurone disease

A

UMN

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129
Q

Signs in progressive muscular atrophy motor neurone disease

A

LMN affecting diatal muscles first

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130
Q

Symptoms of progressive bulbar palsy motor neurone disease

A

palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei

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131
Q

When to start treatment in subclinical hypothyroidism

A

Symptomatic patients. Younger patients. Very high TSH

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132
Q

What is balanitis xerotica oliberans?

A

Tight foreskin due to lichen sclerosus

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133
Q

What is paraphimosis?

A

Foreskin can’t be returned to it’s original position after being retracted

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134
Q

What is phimosis?

A

Tight foreskin means it can’t be retracted

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135
Q

What is balanitis?

A

Inflammation of the head of the penis

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136
Q

First line investigation in suspected primary hyperaldosteronism

A

Serum aldosterone to renin ratio

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137
Q

Features of primary hyperaldosteronism

A

Hypertension
Hypokalaemia (can cause muscle weakness)
Alkalosis

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138
Q

Patau syndrome features

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

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139
Q

Edwards syndrome features

A

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

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140
Q

Fragile X syndrome features

A 
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
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141
Q

Noonan syndrome features

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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142
Q

Prader Willi syndrome features

A

Hypotonia
Hypogonadism
Obesity

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143
Q

Organophosphate poisoning symptoms

A

Parasympathetic e.g. pupil constriction, sweating, incontinence, hypotension, bradycardia

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144
Q

Opioid toxicity symptoms

A

Pupil constriction, constipation, respiratory depression

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145
Q

Cataract symtpoms

A

Gradual onset blurred vision and reduced colour vision with halos around lights

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146
Q

Surgical procedure in cataracts

A

Lens replacement with artificial lens

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147
Q

Vitreous haemorrhage symptoms

A

Sudden onset unilateral vision loss after trauma. Often associated with a red hue

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148
Q

Causes of optic neuritis

A

multiple sclerosis: the commonest associated disease
diabetes
syphilis

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149
Q

Symptoms of optic neuritis

A

unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma

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150
Q

Management of optic neuritis

A

High dose steroids

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151
Q

Murmurs on which side of the heart are loudest on expiration?

A

Left

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152
Q

Murmurs on which side of the heart are loudest on inspiration?

A

Right

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153
Q

Indications for induction of labour

A

prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
prelabour premature rupture of the membranes, where labour does not start
diabetic mother > 38 weeks
pre-eclampsia
rhesus incompatibility

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154
Q

What is the main complication of induction of labour?

A

Uterine hyperstimulation

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155
Q

Consequences of uterine hyperstimulation

A

Foetal hypoxia

Rarely it can cause uterine rupture

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156
Q

Management of uterine hyperstimulation

A

Remove vaginal prostaglandins
Stop oxytocin infusion
Terbutaline

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157
Q

Management of tachycardia with adverse features (shock, syncope, MI, heart failure)

A

DC cardioversion

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158
Q

Management of regular broad complex tachycardia

A

Amiodarone

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159
Q

Management of regular narrow complex tachycardia

A

Vagal manoeuvres followed by adenosine if unsuccessful

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160
Q

Features of chondromalacia patellae

A

Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy

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161
Q

Features of Osgood-Schlatter disease

A

Seen in sporty teenagers

Pain, tenderness and swelling over the tibial tubercle

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162
Q

Features of osteochondritis dissecans

A

Pain after exercise

Intermittent swelling and locking

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163
Q

Features of patellar subluxation

A

Medial knee pain due to lateral subluxation of the patella

Knee may give way

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164
Q

Features of patellar tendonitis

A

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

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165
Q

Risk factors for pharyngeal pouch

A

Males

Older age

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166
Q

Pharyngeal pouch features

A 
dysphagia
regurgitation
aspiration
neck swelling which gurgles on palpation
halitosis
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167
Q

Pharangeal pouch management

A

Surgery

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168
Q

Symptoms of necrotising enterocolitis

A

Initial symptoms can include feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis.

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169
Q

Key investigation in necrotising enterocolitis

A

Abdo X-ray

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170
Q

AXR in necrotising enterocolitis

A

dilated bowel loops
bowel wall oedema
Gas in the peritoneum, bowel walls or portal vein

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171
Q

Test prior to BCG vaccine in patients over 6 years

A

Tuberculin skin test

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172
Q

Diagnosis of boerhaave’s syndrome

A

CT contrast swallow

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173
Q

Symptoms of roseola infantum

A

3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever

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174
Q

Classic rash in roseola infantum

A

Non itchy maculopapular rash starting on the trunk and limbs

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175
Q

First line management of suspected PE in stable patient

A

Rivaroxaban

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176
Q

First line management of unstable suspected PE

A

Alteplase

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177
Q

Investigation of reduced foetal movement

A

Doppler to confirm heartbeat. Ultrasound if it can’t be detected. 20 minute CTG

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178
Q

What is meralgia parasthetica?

A

tingling, numbness and burning pain in the outer part of the thigh, caused by compression of the lateral cutaneous nerve often in obese people

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179
Q

What is Steven-Johnson syndrome?

A

painful erythematous macules evolving to target lesions, with severe mucosal ulceration of at least 2 surfaces (e.g. skin, mouth, urethra).

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180
Q

First line for diagnosis of small bowel bacterial overgrowth syndrome

A

Hydrogen breath test

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181
Q

What is hairy leukoplacia?

A

an EBV-associated lesion on the side of the tongue, and is considered indicative of HIV

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182
Q

What is oral lichen planus?

A

a chronic infection that affects mucosal membranes in the mouth. It appears as white lacy patches, open sores, or red swollen patches. It doesn’t tend to affect the tongue. It is generally very itchy for patients and they may be advised to take antihistamines to provide relief.

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183
Q

When is a tetanus booster needed in a wound?

A

Tetanus vaccine status incomplete or unknown

Last dose over 10 years ago in tetanus prone wound

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184
Q

Management of childhood inguinal hernia

A

Urgent surgery

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185
Q

Management of necrotising fasciitis

A

Surgical debridement and IV abx

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186
Q

Total iron binding capacity in iron deficiency anaemia

A

High

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187
Q

Management of obstetric cholestasis

A

induction of labour at 37-38 weeks
ursodeoxycholic acid
vitamin K supplementation

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188
Q

What is psittacosis?

A

Respiratory illness spread by birds

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189
Q

Dengue fever treatment

A

Symptomatic

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190
Q

First line treatment for ITP in adults

A

Oral prednisolone

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191
Q

Uterine fibroids symptoms

A

may be asymptomatic
menorrhagia (may result in iron-deficiency anaemia)
lower abdominal pain: cramping pains, often during menstruation
bloating
urinary symptoms, e.g. frequency, may occur with larger fibroids
subfertility

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192
Q

Management of asymptomatic uterine fibroids

A

Monitor

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193
Q

Management of symptomatic uterine fibroids

A

Contraception / NSAIDs / TXA to manage menorrhagia
Short term - GnRH agonists
Surgery - myomectomy / endometrial ablation / hysterectomy / uterine artery embolisation

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194
Q

Pathogen in scarlet fever

A

Group A strep e.g. strep pyogenes

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195
Q

Scarlet fever symptoms

A 
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
'strawberry' tongue
rash (sandpaper like fine pinhead rash starting on torso)
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196
Q

Scarlet fever management

A

abx

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197
Q

Age associated with croup

A

6 months to 3 years

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198
Q

Croup symptoms

A

stridor
barking cough (worse at night)
fever
coryzal symptoms

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199
Q

Management of croup

A

Oral dexamethasone
Supportive (usually at home)
Admit if severely unwell or comorbidities

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200
Q

What is Cushing’s disease

A

ACTH secreting pituitary adenoma

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201
Q

What is filgrastim?

A

A granulocyte-colony stimulating factor used in neutropaenia

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202
Q

Cause of neonatal bilious vomiting with double bubble sign on X-ray

A

Duodenal atresia

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203
Q

Treatment of Perthe’s disease

A

Rest and physio. Surgery if severe (more common in older children)

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204
Q

Treatment of slipped upper femoral epiphysis

A

Bed rest. Surgery if severe

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205
Q

Causes of lobar collapse

A

Lung cancer, asthma, foreign body

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206
Q

Symptoms of branchial cyst

A

Asymptomatic neck lump

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207
Q

Most common cause of traveller’s diarrhoea

A

E coli

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208
Q

Symptoms of Shigella diarrhoea

A

Bloody diarrhoea

Abdo pain and vomiting

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209
Q

Symptoms of campylobacter diarrhoea

A

A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody

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210
Q

Management of new onset AF <48 hours

A

Cardioversion (electrical / amiodarone / flecainide)

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211
Q

Management of new AF onset >48 hours

A

Anticoagulate then cardioversion (electrical)

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212
Q

Can breastfeeding continue in mastitis?

A

Yes

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213
Q

Treatment of lactational mastitis

A

abx if systemic illness, nipple fissure, cultures positive, not resolving in 24-48 hrs

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214
Q

Presentation of fat necrosis

A

It tends to present with a firm, round lump in the breast tissue, often following trauma

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215
Q

Symptoms of primary ciliary dyskinesia

A

Recurrent chest infections
Recurrent sinusitis
Subfertility

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216
Q

What drug is added to induce remission in UC if mesalazine unsuccessful?

A

Oral steroids

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217
Q

Indications for high dose folic acid in pregnancy

A 
Maternal or paternal family history of neural tube defects
Anti-epileptics
Coeliac
Diabetes
BMI over 30
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218
Q

Management of pregnant woman with group B strep

A

BenPen in labour

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219
Q

Target HbA1c in patients with only lifestyle advice or metformin

A

48

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220
Q

Target HbA1c in patients on two drugs

A

53

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221
Q

Symptoms of dengue fever

A

retro-orbital headache, elevated fever, rash (usually maculopapular) and thrombocytopenia after returning from a trip abroad. May develop into haemorrhagic fever

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222
Q

Ebola symptoms

A

The first symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding

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223
Q

Symptom of thrombosed haemorrhoid

A

acutely painful and tender blue-black lump originating from the anal margin (and bleeding if it bursts)

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224
Q

Management of thrombosed haemorrhoid

A

Analgesia, stool softeners and ice pack. If presenting within 72 hours consider surgical excision

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225
Q

Test for BPPV

A

Dix-Hallpike test

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226
Q

First line for induction of labour

A

Vaginal prostaglandins

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227
Q

Symptoms of lymphogranuloma venereum

A

stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis

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228
Q

Lesions in Kaposi’s sarcoma

A

Raised purple lesions

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229
Q

First and second line in paediatric constipation

A

Movicol paediatric plain then add senna if ineffective

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230
Q

Symptoms of measles

A

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

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231
Q

Symptoms of mumps

A

Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

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232
Q

Symptoms of rubella

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

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233
Q

Symptoms of erythema infectiosum

A

Lethargy, fever, headache

‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

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234
Q

What virus causes erythema infectiosum?

A

Parvovirus

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235
Q

What is erythema infectiosum also known as?

A

Slapped cheek disease

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236
Q

Symptoms of scarlet fever

A

Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

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237
Q

Symptoms of hand foot and mouth disease

A

Mild systemic upset: sore throat, fever

Vesicles in the mouth and on the palms and soles of the feet

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238
Q

How long before vasectomy is effective?

A

Do semen analysis at 16-20 weeks to check for no sperm

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239
Q

Which renal condition is associated with an “allergic” type picture?

A

Acute interstitial nephritis

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240
Q

Nerve conduction studies in motor neurone disease

A

Normal

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241
Q

Uterine fibroids symptoms

A 
Symptoms of fibroids include:
Menorrhagia
Pain (with torsion)
Subfertility
As fibroids get larger they cause symptoms due to their size such as: dysuria, hydronephrosis, constipation and sciatica.
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242
Q

Uterine fibroids treatment

A

First line treatment is often tranexamic acid, NSAIDs or progesterones as they are used in menorrhagia, but surgery is usually required for troublesome fibroids.

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243
Q

Management of auricular haematoma

A

Urgent ENT referral

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244
Q

Consequence of rapid treatment of hyponatraemia

A

Osmotic demyelination syndrome

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245
Q

Symptoms of vestibular neuronitis

A

acute, severe vertigo, nausea, vomiting and ataxia

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246
Q

How to differentiate vestibular neuronitis from labyrinthitis

A

Vestibular neuronitis won’t have hearing loss

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247
Q

Treatment of vestibular neuronitis

A

Vestibular rehabilitation exercises and anti-emetics

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248
Q

Treatment of asymptomatic fungal nail infections

A

Topical anti fungal for 6-12 months

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249
Q

Treatment of symptomatic fungal nail infections

A

Oral anti-fungal

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250
Q

Bone profile in oseteogenesis imperfecta

A

Normal

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251
Q

Aetiology of osteogenesis imperfecta

A

Autosomal dominant

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252
Q

Antibodies in systemic sclerosis

A

ANA / anti-Scl 70

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253
Q

Treatment of lichen planus

A

Topical steroids

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254
Q

Management of ankle fractures

A

Prompt reduction then typically surgical repair in younger patients or conservative in older patients

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255
Q

What is transposition of the great arteries?

A

aorta leaves the right ventricle

pulmonary trunk leaves the left ventricle

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256
Q

Signs in transposition of great arteries

A

Cyanosis, tachypnoea, load S2, prominent right ventricular impulse

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257
Q

Management of transposition of great arteries

A

Supportive then surgery

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258
Q

Management of otitis externa

A

Topical antibiotic and steroid

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259
Q

Emergency treatment of severe croup

A

Oxygen and nebulised adrenaline

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260
Q

Reactive arthritis symptoms

A

Urethritis + arthritis + conjunctivitis

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261
Q

Reactive arthritis treatment

A

Symptomatic : NSAIDs, analgesia, intra-articular steroids

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262
Q

Lead poisoning symptoms

A 
abdominal pain
peripheral neuropathy (mainly motor)
fatigue
constipation
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263
Q

What is the time window from symptom onset for thrombolysis in stroke?

A

4.5 hours

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264
Q

What is the time window from symptom onset for thrombolysis in stroke?

A

6 hours

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265
Q

How long for IUD to be effective contraception

A

Immediately

266
Q

How long for IUS to be effective contraception

A

7 days

267
Q

Adverse effect of IUD

A

Periods longer, heavier, more painful

268
Q

What is mittelschmertz?

A

Mid cycle pelvic pain due to fluid released in ovulation. Systemically well and pain resolves

269
Q

First line in acute pericarditis

A

NSAID and colchicine

270
Q

Aetiology of osteopetrosis

A

Recessive

271
Q

Management of thyroxine in pregnancy

A

Increase dose (typically by up to 50% in first 4-6 weeks

272
Q

What is galactocele?

A

Painless breast lump after stopping breast feeding due to milk build up

273
Q

Symptoms of allergic btonchopulmonary aspergillosis

A

bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
bronchiectasis (proximal)

274
Q

Symptoms of allergic btonchopulmonary aspergillosis

A

bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
bronchiectasis (proximal)

275
Q

Management of type B aortic dissection

A

Control BP then supportive

276
Q

Indication for abx in mastitis

A

Systemically unwell
Fissure
Symptoms for over a day
Bacteria on culture

277
Q

Symptoms of breast engorgement

A

Bilateral breast pain worse before feed. May be red. May have difficulty feeding. Typically a few days after birth

278
Q

Symptoms of breast engorgement

A

Bilateral breast pain worse before feed. May be red. May have difficulty feeding. Typically a few days after birth

279
Q

Management of breast engorgement

A

Hand expression

280
Q

Complications of breast engorgement

A

Blocked ducts
Mastitis
Difficulty feeding

281
Q

Symptoms of raynauds disease of the nipple

A

Breast pain and cyanosis or redness during or after feeding

282
Q

Management of Raynaud’s disease of the nipple

A

Heat packs
Stop smoking
Reduce caffeine

283
Q

Most common cause of erythema multiforme

A

HSV

284
Q

VSD murmur

A

Pansystolic murmur in lower left sternal border

285
Q

Coarctation of aorta murmur

A

Crescendo-decrescendo murmur in the upper left sternal border

286
Q

PDA murmur

A

Diastolic machinery murmur in the upper left sternal border

287
Q

Pulmonary stenosis murmur

A

Pulmonary stenosis Ejection systolic murmur in the upper left sternal border

288
Q

Causes of HUS

A

classically Shiga toxin-producing Escherichia coli (STEC) 0157:H7 (‘verotoxigenic’, ‘enterohaemorrhagic’). This is the most common cause in children, accounting for over 90% of cases
pneumococcal infection
HIV
rare: systemic lupus erythematosus, drugs, cancer

289
Q

Features of HUS

A

acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia

290
Q

Investigations in HUS

A 
full blood count: anaemia, thrombocytopaenia, fragmented blood film
U&E: acute kidney injury
stool culture
looking for evidence of STEC infection
PCR for Shiga toxins
291
Q

Management of HUS

A

Mostly supportive

292
Q

Management of contacts of person with measles

A

Unvaccinated contacts offered MMR

293
Q

Encephalitis symptoms

A

fever, headache, psychiatric symptoms, seizures, vomiting

focal features e.g. aphasia

294
Q

CSF in encephalitis

A

lymphocytosis, raised protein

295
Q

ALS guideline pulseless electrical activity

A

Non-shockable. Give IV adrenaline

296
Q

What heart rhythms are shockable

A

VF / Pulseless VT

297
Q

What heart rhythms are non-shcokable

A

Asystole, Pulseless electrical activity

298
Q

Cardiac arrest causes

A 
Hypoxia
Hypovolaemia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders
Hypothermia
Thrombosis (coronary or pulmonary)
Tension pneumothorax
Tamponade – cardiac
Toxins
299
Q

What is a Whipple’s procedure?

A

Removal of pancreas and duodenum

300
Q

Investigation of carcinoid syndrome

A

Urinary serotonin

301
Q

Bells palsy treatment

A

Oral prednisolone and artificial tears

302
Q

What is Bells palsy?

A

acute, unilateral, idiopathic, facial nerve paralysis

303
Q

Risk factors for Bells palsy

A

20-40 or pregnant

304
Q

Bells palsy symptoms

A

Unilateral facial weakness (including forehead). Patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis

305
Q

Bells palsy prognosis

A

Mostly resolves in a few months

306
Q

What do seborrheic keratoses look like?

A

They are typically described as well-circumscribed plaques or papules with a ‘stuck on’ appearance, and most commonly affect the torso or face. The colour of the lesions can vary, but they are most commonly grey-brown or black.

307
Q

Management of seborrhoeic keratoses

A

Reassuarnace

308
Q

Prognosis in seborrhoeic keratoses

A

Good, they are benign

309
Q

What is erythema ab igne

A

Erythema ab igne is a skin disorder caused by over exposure to infrared radiation. Characteristic features include reticulated, erythematous patches with hyperpigmentation and telangiectasia.

310
Q

What is an osteoma?

A

Benign bone growth, often on skull

311
Q

What is osteochondroma?

A

Cartilage covered bone tumour most common in young males

312
Q

What is osteosarcoma?

A

Most common primary bone tumour seen mainly in children and teens in the metaphysis

313
Q

What is Ewing’s sarcoma?

A

Bone tumour seen in children and teens

314
Q

What is chondrosarcoma?

A

Malignant tumour of cartilage most commonly seem in middle age in the axial skeleton

315
Q

Hirsutism management

A

Healthy weight
Cosmetic e.g. waxing
Consider COCP

316
Q

Investigation of reduced foetal movements

A

Initially handhold doppler. If heartbeat is found then CTG. If no heartbeat is found then USS

317
Q

Presentation of cephalohaematoma

A

Swelling on head a few hours after birth that doesn’t cross suture lines

318
Q

Management of typical endometrial hyperplasia

A

Progesterone and watch and wait

319
Q

Management of atypical endometrial hyperplasia

A

Hysterectomy and bilateral salpingo-opherectomy

320
Q

High PTH, high calcium, low phosphate

A

Primary Hyperparathyroidism

321
Q

High PTH, low calcium and phosphate

A

Osteomalacia

322
Q

High PTH, normal calcium, low phosphate

A

CKD

323
Q

Vestibular neuronitis symptoms

A

recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus

324
Q

Treatment of severe hyponatraemia

A

Hypertonic saline

325
Q

Where to check pulse in paediatric BLS

A

Femoral or brachial

326
Q

Primary hyperparathyroidism treatment

A

Surgery

327
Q

Management of suspected DVT but doppler negative

A

Stop anticoagulant and repeat scan in 7 days

328
Q

Wells score cut off in DVT and actions

A

2 or more DVT likely start anticoagulation (DOAC) and arrange doppler USS
1 or less DVT unlikely do D-dimer

329
Q

Uterine fibroids symptoms

A

may be asymptomatic
menorrhagia
may result in iron-deficiency anaemia
lower abdominal pain: cramping pains, often during menstruation
bloating
urinary symptoms, e.g. frequency, may occur with larger fibroids
subfertility

330
Q

Uterine fibroids age range

A

Pre-menopausal

331
Q

Amoebiasis treatment

A

abx

332
Q

Bacteria that causes pneumonia following influenza

A

Staph aureus

333
Q

Which fingers are affected by cubital tunnel syndrome?

A

4th and 5th

334
Q

Cubital tunnel syndrome management

A

Avoid aggravating activity
Physiotherapy
Steroid injections
Surgery in resistant cases

335
Q

Pernicious anaemia management

A

B12 replacement

336
Q

Myocarditis symptoms

A

usually young patient with an acute history
chest pain
dyspnoea
arrhythmias

337
Q

Myocarditis causes

A

Infection / autoimmune / other

338
Q

Myocarditis investigations

A 
bloods
↑ inflammatory markers in 99%
↑ cardiac enzymes
↑ BNP
ECG
tachycardia
arrhythmias
ST/T wave changes including ST-segment elevation and T wave inversion
339
Q

Myocarditis treatment

A

Treat underlying cause (e.g. abx)

Supportive

340
Q

Myocarditis complications

A

Arrhythmias, heart failure

341
Q

Torsades de pointes management

A

Magnesium sulphate

342
Q

Anticoagulation after stroke (first and second line)

A

Clopidogrel first line
Aspirin and dipyridamole second line
Apixaban if AF

343
Q

Symptoms of posterior dislocation

A

The affected leg is shortened, adducted, and internally rotated

344
Q

Management of hip dislocation

A

ABCDE
Analgesia
Reduction within 4 hours (under general anaesthetic)
Physio

345
Q

Complications of hip dislocation

A

Sciatic or femoral nerve injury
Avascular necrosis
Osteoarthritis: more common in older patients.
Recurrent dislocation: due to damage of supporting ligaments

346
Q

Management of cord prolapse

A

Push presenting part back in vagina
Patient on all fours
Tocolytics to stop contractions
Caesarean delivery

347
Q

Treatment of deQuervains thyroiditis

A

Self resolving. NSAIDs if thyroid pain

348
Q

Management of extrinsic allergic alveolitis

A

Avoid trigger

349
Q

Mild croup treatment

A

Stat dose dexamethasone

350
Q

Severe croup treatment

A

Nebulised adrenaline

351
Q

Croup symptoms

A

stridor
barking cough (worse at night)
fever
coryzal symptoms

352
Q

Acute TB test gold standard

A

Sputum culture

353
Q

Treatment of rosacea

A

Topical metronidazole

Oral doxycycline

354
Q

Management of slipped capital femoral epiphysis

A

Surgical fixation

355
Q

PSC antibodies

A

pANCA

356
Q

PSC investigation

A

ERCP / MRCP

pANCA

357
Q

Pericarditis treatement

A

NSAIDs and colchicine

Treat underlying cause

358
Q

What is significant postural hypotension?

A

Drop more than 20 systolic
Drop to below 90 systolic
Drop more than 10 diastolic with symptoms

359
Q

Medication for severe postural hypotension not responding to conservative measures

A

Fludrocortisone

360
Q

What is Takayasu’s arteritis?

A

Takayasu’s arteritis is a large vessel vasculitis. It typically causes occlusion of the aorta and questions commonly refer to an absent limb pulse. It is more common in females and Asian people

361
Q

Symptoms of Takayasu’s arteritis

A

systemic features of a vasculitis e.g. malaise, headache
unequal blood pressure in the upper limbs
carotid bruit
intermittent claudication
aortic regurgitation (around 20%)

362
Q

Aetiology of otoscelrosis

A

Autosomal dominant

363
Q

Otosclerosis age of onset

A

20-40

364
Q

Reflux nephropathy investigation

A

Micturating cystourethrogram

365
Q

Drug for prophylaxis of hepatic encephalopathy

A

Rifaximin

366
Q

Management of sudden onset sensorineural hearing loss

A

ENT referral
Steroids
Investigate cause

367
Q

Biliary atresia symptoms

A

Jaundice
Hepatomegaly with splenomegaly
Abnormal growth

368
Q

What is Guttate psoriasis?

A

Psoriasis with small plaques over the body 2-4 weeks after an infection

369
Q

Guttate psoriasis prognosis

A

Clears in a couple of months

370
Q

Necrotising enterocolitis symptoms

A

feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis

371
Q

necrotising enterocolitis treatment

A

Gut rest with total parenteral nutrition

Surgery for perforation

372
Q

PDA management

A

Indomethacin or ibuprofen

373
Q

Rhabdomyolysis management

A

IV fluids

374
Q

What nerve is used for corneal reflex

A

V1

375
Q

Jaw jerk reflex nerve

A

V3

376
Q

BPH first line

A

alpha agonist e.g. tamsulosin

377
Q

What hormones are in the implant?

A

Progesterone

378
Q

Implant effect on periods

A

Heavy

379
Q

Epidydimal cyst examination findings

A

separate from the body of the testicle

found posterior to the testicle

380
Q

Epidydimal cyst diagnosis

A

Confirmed on USS

381
Q

Epidydimal cyst treatment

A

Management is usually supportive but surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts

382
Q

Keratoacanthoma appearance

A

initially a smooth dome-shaped papule

rapidly grows to become a crater centrally-filled with keratin

383
Q

Keratoacanthoma management

A

Usually regress within 3 months

Remove if suspicious for BCC / SCC

384
Q

Cervical myelopathy investigation

A

MRI spine

385
Q

Cervical myelopathy treatment

A

Decompressive surgery

386
Q

What is MODY?

A

development of type 2 diabetes mellitus in patients < 25 years old

387
Q

Treatment of MODY

A

As per type 2 DM

388
Q

Aetiology of MODY

A

Genetic

389
Q

Management of Bowen’s disease

A

Topical 5-flurouracil
Surgery
Cryotherapy

390
Q

Sarcoidosis symptoms

A

erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia, dyspnoea, non-productive cough, malaise, weight loss, skin rash hypercalcaemia

391
Q

What is pituitary apoplexy?

A

Haemorrhage or infarction of pituitary adenoma

392
Q

Pituitary apoplexy symptoms

A

sudden onset headache similar to that seen in subarachnoid haemorrhage
vomiting
neck stiffness
visual field defects: classically bitemporal superior quadrantic defect
extraocular nerve palsies
features of pituitary insufficiency
e.g. hypotension/hyponatraemia secondary to hypoadrenalism
Seen in person with pituitary pathology

393
Q

Pituitary apoplexy treatement

A

urgent steroid replacement due to loss of ACTH
careful fluid balance
surgery

394
Q

Restless leg syndrome management

A

simple measures: walking, stretching, massaging affected limbs
treat any iron deficiency
dopamine agonists are first-line treatment (e.g. Pramipexole, ropinirole)

395
Q

How long should a second febrile convulsion be before ambulance called?

A

5 mins

396
Q

Malrotation symptoms

A

Distended abdomen

Bilious vomiting

397
Q

Malrotation investigation

A

Upper GI contrast study and USS

398
Q

Malrotation treatment

A

Surgery

399
Q

Drug induced lupus antibodies

A

Anti-histone antibodies

400
Q

Clubfoot management

A

Splinting and progressive casting

401
Q

First line investigation in stable angina

A

CT coronary angiogram

402
Q

What is mesothelioma

A

Cancer of pleura caused by asbestos exposure

403
Q

What is an aspergilloma?

A

An aspergilloma is a mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to tuberculosis, lung cancer or cystic fibrosis)

404
Q

Anticoagulants used in patients who will have PCI

A

Aspirin and prasugrel

405
Q

Normal pressure hydrocephalus symptoms

A

dementia, ataxia and urinary incontinence

406
Q

Toxic shock syndrome symptoms

A

fever
hypotension
diffuse rash
involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)

407
Q

Toxic shock syndrome management

A

removal of infection focus (e.g. retained tampon)
IV fluids
IV antibiotics

408
Q

Acromioclavicular degeneration symptoms

A

popping, swelling, clicking or grindings and a positive scarf test

409
Q

Subacromial impingement symptoms

A

pain on overhead activities and demonstrate a painful arc of abduction on examination - worse between 90 and 120 degrees. There may also be popping, snapping or grinding.

410
Q

Rotator cuff tear symptoms

A

weakness as well as pain and there may be muscle wasting and tenderness on palpation. There may be a painful arc of movement and weakness of the affected muscle.

411
Q

Frozen shoulder risk factors

A

Diabetes

412
Q

Frozen shoulder symptoms

A

external rotation is affected more than internal rotation or abduction
both active and passive movement is affected
patients typically have a painful freezing phase, an adhesive phase and a recovery phase
bilateral in up to 20% of patients
the episode typically lasts between 6 months and 2 years

413
Q

Frozen shoulder treatment

A

NSAIDs, physio, steroid injections

414
Q

Pharyngeal pouch treatment

A

Surgery

415
Q

Gingival hyperplasia causes

A

phenytoin, ciclosporin, calcium channel blockers and AML

416
Q

Idiopathic intercranial hypertension risk factors

A

obesity
female sex
pregnancy
drugs (COCP, steroids, tetracyclines, vitamin A, lithium)

417
Q

Idiopathic intercranial hypertension symptoms

A 
headache
blurred vision
papilloedema (usually present)
enlarged blind spot
sixth nerve palsy may be present
418
Q

Idiopathic intercranial hypertension treatment

A 
weight loss
diuretics e.g. acetazolamide
topiramate
repeated lumbar puncture
surgery: optic nerve sheath decompression (prevent damage to the optic nerve) or shunting
419
Q

Patellar fracture management

A

Non-displaced and extensor function in tact: Knee brace

Displaced or extensor function impaired: Surgery

420
Q

Toxic epidermal necrosis causes

A

Usually drug reaction

421
Q

Toxic epidermal necrosis treatment

A

Supportive including fluids
Steroids
Immunoglobulin

422
Q

How long after emergency contraception before restarting hormonal contraception?

A

5 days

423
Q

Nasal septal haematoma symptoms

A

the sensation of nasal obstruction is the most common symptom
pain and rhinorrhoea
bilateral, red swelling arising from the nasal septum

424
Q

Nasal septal haematoma treatment

A

Drainage

IV abx

425
Q

What is sick euthyroid syndrome?

A

Low T4 in acute illness

426
Q

FSGS age group

A

Typically young adults

427
Q

FSGS management

A

Steroids and consider immunosuppression

428
Q

What symptom suggests mastoiditis as a complication of otitis media?

A

Post auricular swelling

429
Q

Umbilical hernia management

A

Often resolve spontaneously
If large or symptomatic repair aged 2-3
If asymptomatic repair aged 5

430
Q

Management of oesophageal dysplasia seen on endoscopy

A

Endoscopic resection or ablation

431
Q

What condition causes slapped cheek rash?

A

Erythema infectiosum

432
Q

When to consider surgery in aortic stenosis

A

Symptomatic

433
Q

Facial nerve lesion symtpoms

A

flaccid paralysis of the upper and lower face, loss of taste, hyperacusis and loss of corneal reflex

434
Q

Trigeminal nerve lesion symptoms

A

trigeminal distribution pain, loss of corneal reflex, loss of facial sensation, paralysis of mastication muscles and deviation of the jaw to the weak side

435
Q

Lichen sclerosus management

A

Topical steroids and emollients

436
Q

Pityriasis versicolour symptoms

A

most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus

437
Q

Pityrisasis versicolour treatment

A

Topical antifungals

438
Q

Management of anti-phospholipid syndrome

A

Prophylactic aspirin if no history of VTE

Warfarin if history of VTE

439
Q

Androgen insensitivity syndrome presentation

A

Genotypically male. Phenotypically female.
Primary amenorrhoea
Often have inguinal hernias due to undescended testes

440
Q

Hand foot and mouth disease treatment

A

Symptomatic as it is self limiting

441
Q

S1 lesion symptoms

A

Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

442
Q

L3 compression symptoms

A

sensory loss over the anterior aspect of the thigh, weakness of the quadriceps with a reduction in the knee reflex on the affected side. Finally, pain can be elicited in the anterior thigh when performing the femoral stretch test

443
Q

L4 compression symptoms

A

weakness of the quadriceps, a reduced knee reflex and a positive femoral stretch test. Reduced sensation over anterior knee

444
Q

L5 compression symptoms

A

sensory loss on the dorsum aspect of the foot with weakness of the foot and big toe dorsiflexion. L5 nerve compressions will also result in a positive sciatic nerve stretch test but the reflexes are normally unaffected.

445
Q

Prolapsed disc management

A

similar to that of other musculoskeletal lower back pain: analgesia, physiotherapy, exercises
if symptoms persist e.g. after 4-6 weeks) then referral for consideration of MRI is appropriate

446
Q

Hypospadias management

A

Surgery at 12 months

447
Q

Genital warts management

A

topical podophyllum or cryotherapy are commonly used as first-line treatments depending on the location and type of lesion. Multiple, non-keratinised warts are generally best treated with topical agents whereas solitary, keratinised warts respond better to cryotherapy
imiquimod is a topical cream which is generally used second line

448
Q

Small bowel bacterial overgrowth syndrome risk factors

A

neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus

449
Q

Small bowel bacterial overgrowth syndrome investigations

A

hydrogen breath test
small bowel aspiration and culture: this is used less often as invasive
clinicians may sometimes give a course of antibiotics as a diagnostic trial

450
Q

Small bowel bacterial overgrowth syndrome management

A

correction of underlying disorder

antibiotic therapy: rifaximin is now the treatment of choice due to relatively low resistance

451
Q

Small bowel bacterial overgrowth syndrome symptoms

A

Similar to IBS

452
Q

Cluster headache prophlyaxis

A

Verapamil

453
Q

PMS treatment

A

Conservative. COCP. SSRIs if severe

454
Q

Slipped capitol femoral epiphysis symptoms

A

hip, groin, medial thigh or knee pain
loss of internal rotation of the leg in flexion
bilateral slip in 20% of cases

455
Q

Slipped capitol femoral epiphysis management

A

Internal fixation surgery

456
Q

Newborn BLS

A

Dry baby
Assess tone, HR and RR
If not breathing, 5 rescue breaths
If still not breathing, CPR at 3:1 ratio

457
Q

Bartholin’s cyst age

A

Reproductive age

458
Q

Gonorrhoea treatment

A

Single dose IM ceftriaxone

459
Q

Asymptomatic bacteriuria in catheterised patient treatment

A

None

460
Q

Postnatal depression screening scale

A

Edinburgh depression scale

461
Q

Neuroleptic malignant syndrome blood tests

A

Raised CK
May have leukocytosis
May have hyperkalaemia due to muscle damage

462
Q

Neuroleptic malignant syndrome management

A

stop antipsychotic
IV fluids to prevent renal failure
dantrolene may be useful in selected cases
bromocriptine may also be used

463
Q

What rash has a herald patch?

A

Pityriasis rosea

464
Q

Pityriasis rosea treatment

A

Self limiting

465
Q

Does warfarin affect PT or APTT?

A

PT

466
Q

Alcoholic hepatitis management

A

Steroids in a flare

467
Q

First line to maintain remission in Chrons

A

Azathioprine or mercaptopurine

468
Q

Stevens johnsons syndrome symptoms

A

Flu like prodrome

Rapid onset painful red blistering rash

469
Q

Stevens johnsons syndrome treatment

A

Stop drug

Admit for IV fluids

470
Q

What is syringomyelia?

A

Syringomyelia (‘syrinx’ for short) describes a collection of cerebrospinal fluid within the spinal cord that gradually expands over time

471
Q

Syringomyelia symptoms

A

Slowly progressive neurological symptoms:
loss of temperature sensation in upper limbs
spastic weakness (predominantly of the lower limbs)
neuropathic pain
upgoing plantars
autonomic features e.g. Horner’s syndrome or bladder and bowel dysfunction

472
Q

Syringomyelia diagnosis

A

MRI

473
Q

Bells palsy management

A

Prednisolone and eye care

474
Q

Epidermoid cyst symptoms

A

Common and affect face and trunk
They have a central punctum, they may contain small quantities of sebum
The cyst lining is either normal epidermis (epidermoid cyst) or outer root sheath of hair follicle (pilar cyst)

475
Q

Dermatofibroma symptoms

A

Solitary dermal nodules
Usually affect extremities of young adults
Lesions feel larger than they appear visually
Histologically they consist of proliferating fibroblasts merging with sparsely cellular dermal tissues

476
Q

Pheochromocytoma first line investigation

A

Plasma and urine metanephrines

477
Q

Acromegaly first line investigation

A

Serum IGF-1

478
Q

What is pompholyx eczema?

A

Blistering eczema of hands and feet triggered by warm temperatures

479
Q

Mesenteric adenitis treatment

A

Self limiting

480
Q

What is mesenteric adenitis?

A

Mesenteric adenitis is inflamed lymph nodes within the mesentery. It can cause similar symptoms to appendicitis and can be difficult to distinguish between the two. It often follows a recent viral infection and needs no treatment

481
Q

Meniere’s disease treatment

A

ENT referral. Prochlorperazine in acute attack. Antihistamine and vestibular rehabilitation as prophylaxis

482
Q

Meniere’s disease symptoms

A

recurrent episodes of vertigo, tinnitus hearing loss lasting minutes to hours

483
Q

Anti phospholipid syndrome antibodies

A

Anti-phospholipid syndrome antibodies are lupus anticoagulant (LA) and anti-cardiolipin antibodies (aCL)

484
Q

Entamoeba hystolytica symptoms

A

dysentery, liver abscesses, colonic abscesses, or inflammatory masses in the colon

485
Q

Amoebiasis treatment

A

Metronidazole

486
Q

Acute intermittent porphyria symtpoms

A

abdominal, neurological and psychiatric symptoms

487
Q

Acute intermittent porphyria demographic

A

Young females

488
Q

Acute intermittent prophyria investigation finding

A

Urine turns dark red when left

489
Q

Acute intermittent porphyria management

A

Haematin / haem arginate in a flare. Avoid triggers

490
Q

Shaken baby syndrome symptoms

A

Retinal haemorrhages, subdural haematoma and encephalopathy

491
Q

What is Osgood Schlatter disease also known as?

A

Tibial epophysitis

492
Q

Osgood Schlatter disease symptoms

A

Seen in sporty teenagers

Pain, tenderness and swelling over the tibial tubercle

493
Q

Vestibular schwannoma symptoms

A

vertigo, hearing loss, tinnitus and an absent corneal reflex

494
Q

What is atopic eruption of pregnancy

A

Common itchy eczematous skin condition in pregnancy

495
Q

What is polymorphic eruption of pregnancy?

A

Itchy rash in last trimester. Treated with emollients or topical steroids

496
Q

What is pemphigoid gestationis

A

Vesicular rash in second half of pregnancy

497
Q

Acute anal fissure management

A

Laxatives, analgesia, lubricants

498
Q

Chronic anal fissure management

A

Laxatives, analgesia, lubricants, topical GTN, surgery considered second line

499
Q

Postpartum thyroiditis treatment

A

Propranolol

500
Q

Strawberry naevus presentation

A

erythematous, raised and multilobed tumours often on face, scalp or back that develops quickly in the month after birth then regresses in a few years

501
Q

Unilateral nasal polyp management

A

Urgent ENT referral

502
Q

When can someone fly after pneumothorax?

A

1 week after CXR shows it has cleared

503
Q

When can someone dive after pneumothorax?

A

Ideally never

504
Q

What is malignant hyperthermia?

A

Hyperthermia and muscle rigidity after general anaesthetic

505
Q

Malignant hyperthermia treatment

A

Supportive and dantrolene

506
Q

What vaccine should people with coeliac get?

A

Pneumococcal

507
Q

Pyoderma gangrenosum treatment

A

Steroids

508
Q

Management of displaced intracapsular hip fracture

A

Internal fixation if fit or hemiarthroplasty if unfit

509
Q

Hyperhidrosis treatment

A

Topical aluminium chloride first line. Botox second line. Surgery third line

510
Q

Iliopsoas abscess symptoms

A

Fever
Back/flank pain
Limp
Weight loss

511
Q

Iliopsoas abscess investigation

A

CT

512
Q

Iliopsoas abscess treatment

A

Antibiotic and drainage

513
Q

Joint aspiration in RA

A

Yellow with high WBCs

No bugs or crystals

514
Q

NF1 symptoms

A

Cafe au lait spots

Some tumours

515
Q

NF2 symptoms

A

Schwannomas

516
Q

Von Hippel Lindau symptoms

A

Cysts and benign tumours

517
Q

Are antibiotics given prior to surgery in appendicitis?

A

Yes

518
Q

Pagets disease of the bone treatment

A

Bisphosphonates

519
Q

SSRI discontinuation syndrome symptoms

A

Mood change, restlessness, insomnia, sweating, GI symptoms

520
Q

Paediatric inguinal hernia management

A

Surgery

521
Q

How to distinguish viral labyrinthitis from vestibular neuronitis

A

Labyrinthitis has hearing loss

522
Q

What is a sequestration crisis?

A

A sequestration crisis is when blood pools in organs due to sickling occurring, and this can cause worsening of anaemia due to loss of blood in the vasculature

523
Q

Tuberous sclerosis symptoms

A 
Depigmented skin lesions
Roughened skin lesions
Developmental delay
Epilepsy
Cysts
524
Q

What does low haptoglabin indicate?

A

Intravascular haemolysis

525
Q

Medication for bile acid malabsorption

A

Cholestyramine

526
Q

Autoimmune hepatitis antibodies

A

Anti-smooth muscle or ANA

527
Q

Guttate psoriasis symptoms

A

‘Tear drop’, scaly papules on the trunk and limbs

528
Q

Guttate psoriasis management

A

Most cases resolve spontaneously within 2-3 months

Topical agents as per psoriasis

529
Q

Pityriasis rosea symptoms

A

Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions.

May follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance

530
Q

Pityriasis rosea management

A

Self limiting

531
Q

When to increase frequency of AAA screening

A

Over 3 cms

532
Q

Treatment of threadworms

A

Single dose mebendazole

533
Q

CXR in transient tachypnoea of the newborn

A

Hyperinflation

Fluid in horizontal fissure

534
Q

What is a hartmans procedure?

A

Sigmoid Colectomy and stoma formation

535
Q

Chronic pancreatitis first line imaging

A

CT abdo (look for calcification)

536
Q

Most common lymphoma

A

Diffuse large B cell lymphoma

537
Q

What subtype of melanoma is more aggressive?

A

Nodular

538
Q

Pheochromocytoma management

A

Alpha blocker e.g. phenoxybenzamine
Then beta blocker e.g. propranolol
Then surgery

539
Q

Paediatric umbilical hernia managment

A

Watch and wait

540
Q

Umbilical granuloma symptom

A

small, red growth of tissue is seen in the centre of the umbilicus in first week of life. May leak fluid

541
Q

Umbilical granuloma management

A

Salt. Cautery with silver nitrate

542
Q

What is omplailitis?

A

Infection of umbilicus

543
Q

Polyarteritis nodosa symptoms

A

Systemic vasculitic symptoms

544
Q

Drug induced lupus antibodies

A

Anti-histone

545
Q

Chagas disease complications

A

Cardiomyopathy, GI issues

546
Q

Chagas disease management

A

Anti-fungal. Monitor for complications e.g. echo

547
Q

Screening for diabetic nephropathy

A

Urine albumin creatinine ratio yearly

548
Q

Most common cause of bitemporal hemianopia with predominately the lower quadrants being affected

A

Craniopharyngioma

549
Q

Hypospadias management

A

Surgery at 12 months

550
Q

Forms of systemic sclerosis

A

Limited cutaneous: Mostly on digits. May have CREST syndrome.
Diffuse cutaneous: Mostly on trunk. May have other organ involvement.
Scleroderma: Tightening of skin without organ involvement.

551
Q

What can CLL transform to?

A

Lymphoma

552
Q

Ramsey Hunt syndrome symptoms

A

auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

553
Q

Ramsey Hunt syndrome treatment

A

Steroids and acyclovir

554
Q

Mild rosacea first line

A

Topical metronidazole

555
Q

What is Charcot joint?

A

A badly disrupted joint due to loss of sensation

556
Q

Symptoms of Charcot joint

A

Red swollen warm slightly painful joint often in daibetics

557
Q

Unilateral undescended testicles referral and management

A

Refer at 3 months. Surgery at 1 year

558
Q

Bilateral undescended testes referral and management

A

Refer immediately for endocrine and genetic tests

559
Q

Haemochromatosis iron studies

A

Transferrin high
Ferritin high
TIBC low

560
Q

Leishmaniasis symptoms

A

Skin lesions or mouth / nasal ulcers.

May have systemic symptoms

561
Q

What virus causes aplastic crisis in sickle cell?

A

Parvovirus

562
Q

Acute bronchitis symptoms

A

Cough (usually non-productive initially then productive)
Rhinorrhoea and sore throat
May have low grade fever
May have wheeze

563
Q

Acute bronchitis treatment

A

Symptomatic. Abx if systemically unwell

564
Q

Newborns to mothers with lupus are at increased risk of what?

A

Arrhythmias

565
Q

Toxoplasmosis symptoms

A

Usually asymptomatic in immunocompetent people. May have low grade malaise symptoms

566
Q

Haemochromatosis inheritance

A

Autosomal recessive

567
Q

Latent autoimmune diabetes of adulthood presentation

A

Slow onset type 1 diabetes symptoms

568
Q

Scalp psoriasis first line

A

Topical steroids

569
Q

Post thrombotic syndrome management

A

Compression stockings

570
Q

Management of bradycardia if atropine fails

A

Transcutaneous pacing

571
Q

Duct ectasia symptoms

A

Nipple retraction and milky discharge

572
Q

First line in ITP

A

Steroids

573
Q

What does India ink stain for?

A

Cryptococcus

574
Q

Pagets age

A

More common in older age

575
Q

First line for multiple genital warts

A

Topical podophyllum

576
Q

Guttate psoriasis treatment

A

As per normal

577
Q

Management of immunosuppressed patients exposed to chickenpox

A

Immunoglobulin if no antibodies

578
Q

Management of whooping cough

A

Abx is presenting within 21 days
Notify public health
Abx for household contacts

579
Q

Meralgia paraesthetica age

A

30s - 40s

580
Q

Which lung cancer is associated with gynaecomastia?

A

Adenocarcinoma

581
Q

What is Lemierre’s syndrome?

A

Lemierre’s syndrome presents with thrombophlebitis of the internal jugular vein following an anaerobic oropharngeal infection

582
Q

Chronic subdural haematoma management

A

If asymptomatic, conservative

If symptomatic, burr holes

583
Q

Primary hyperparathyroidism most common cause

A

Solitary adenoma

584
Q

Primary hyperparathyroidism treatment

A

Total parathyroidectomy. If asymptomatic and Ca not too high and older patient may do nothing

585
Q

Ramsey Hunt treatment

A

Oral acyclovir and steroids

586
Q

Thyroglossal cyst age

A

Teen or young adult

587
Q

Cystic hygroma age

A

Newborn or babies

588
Q

Branchial cyst age

A

Young adults

589
Q

Acute intermittent porphyria age

A

Young adults

590
Q

Acute intermittent porphyria symptoms

A

Abdo pain
Neuropsychiatric
Red urine

591
Q

Acute intermittent porphyria management

A

Avoid triggers

Haem arginate in a flair

592
Q

Subacute combined degeneration of the cord symptoms

A

Loss of vibration and proprioception

UMN and LMN signs (e.g. brisk knee reflexes, absent ankle reflexes)

593
Q

Medical miscarriage drug

A

Vaginal misoprostol

594
Q

Tetralogy of fallot murmur

A

ejection systolic

595
Q

Gestation to offer external cephalic version

A

36 weeks

596
Q

How to check thrombolysis has worked in STEMI

A

repeat ECG in 60-90 minutes and transferring for urgent PCI if ST-elevation has not resolved

597
Q

lichen planus management

A

Topical steroids

598
Q

Hypercalcaemia ECG

A

Short QT

599
Q

What is Argyle Robertson pupil?

A

Small fixed pupil
No light reflex
Accommodation reflex in tact

600
Q

Gestational diabetes management at diagnosis

A

If BM less than 7, lifestyle and diet advice and then metformin if BM still high in 2 weeks
If BM over 7, start insulin

601
Q

Otitis media bacteria

A

Haemophilus influenzae

602
Q

Average age of orbital cellulitis

A

Children

603
Q

Orbital cellulitis management

A

IV abx

604
Q

Blepharitis management

A

Hot compresses and lid hygiene

605
Q

Management of non-retractable foreskin

A

Watch and wait until 2 years as often resolves

After 2 years consider surgery

606
Q

What do muddy brown casts indiate?

A

ATN

607
Q

What do white cell casts indicate?

A

Acute interstitial nephritis

608
Q

Angle closure glaucoma management

A

Eyedrops of pilocarpine, beta blockers and alpha blockers
IV acetazolamide
Laser ididotomy

609
Q

Open angle glaucoma symptoms

A

peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping

610
Q

Scalp seborrheic dermatitis management

A

OTC shampoos e.g. head and shoulders
Topical ketoconazole
Topical steroids if severe

611
Q

Face seborrheic dermatitis management

A

Topical ketoconazole

Topical steroids

612
Q

Hereditary haemorrhagic telangectasia symptoms

A

epistaxis
telangiectases (multiple at characteristic sites e.g. lips, oral cavity, fingers, nose)
visceral lesions with or without bleeding (e.g. GI telangiectasia, pulmonary AVM, hepatic AVM, cerebral AVM, spinal AVM
family history

613
Q

Management of dysplasia on endoscopy

A

Endoscopic treatment

614
Q

What is Kartagener syndrome also known as?

A

Primary ciliary dyskinesia

615
Q

FSGS age

A

Young adults

616
Q

UTI treatment near delivery

A

Amoxicillin

617
Q

Internuclear ophthalmoplegia symptoms

A

impaired adduction of the eye on the same side as the lesion

horizontal nystagmus of the abducting eye on the contralateral side

618
Q

Internuclear ophthalmoplegia cuases

A

MS

Vascular

619
Q

Leprosy symptoms

A

Patches of pale skin

Sensory loss

620
Q

What type of vision is a risk factor for angle closure glaucoma?

A

Hypermetropia (long sighted)

621
Q

Trigeminal neuralgia first line

A

Carbemazepine

622
Q

CRAO symptoms

A

Painless vision loss

623
Q

CRAO on ophthalmoscopy

A

Pale retina with cherry red spot

624
Q

CRVO symptoms

A

Painless vision loss

625
Q

CRVO on ophthalmoscopy

A

Retinal haemorrhages

626
Q

Vitreous detachment symptoms

A

Flashers and floaters

Vision loss starting peripheral and moving centrally

627
Q

Vitreous haemorrhage symptoms

A

Dark spots over vision

628
Q

Hypocalcaemia ECG

A

long QT

629
Q

Eczema herpeticum treatment

A

IV antivirals

630
Q

What is thoracic outlet syndrome?

A

a disorder involving compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet. TOS can be neurogenic or vascular; the former accounts for 90% of the cases

631
Q

Thoracic outlet syndrome demographic

A

Young thin women

632
Q

Neurogenic thoracic outlet syndrome symptoms

A

painless muscle wasting of hand muscles, with patients complaining of hand weakness e.g. grasping
sensory symptoms such as numbness and tingling may be present
if autonomic nerves are involved, the patient may experience cold hands, blanching or swelling

633
Q

Vascular thoracic outlet syndrome symptoms

A

subclavian vein compression leads to painful diffuse arm swelling with distended veins
subclavian artery compression leads to painful arm claudication and in severe cases, ulceration and gangrene

634
Q

Thoracic outlet syndrome investigations

A

chest and cervical spine plain radiographs to check for any obvious osseous abnormalities e.g. cervical ribs, exclude malignant tumours or other differentials e.g. cervical spine degenerative changes
other imaging modalities may be helpful e.g. CT or MRI to rule out cervical root lesions
venography or angiography may be helpful in vascular TOS

635
Q

Thoracic outlet syndrome management

A

conservative management with education, rehabilitation, physiotherapy, or taping is typically the first-line management for neurogenic TOS
surgical decompression is warranted where conservative management has failed
in vascular TOS, surgical treatment may be preferred

636
Q

What sort of childhood neck lump is multiloculated and heterogenous on imaging?

A

Dermoid cyst

637
Q

What is thromboangiitis obliterans also known as?

A

Buerger disease

638
Q

Buerger disease symptoms

A

extremity ischaemia (intermittent claudication and / or ischaemic ulcers)
superficial thrombophlebitis
Raynaud’s phenomenon

639
Q

Leptospirosis risk factors

A

sewage workers, farmers, vets or people who work in an abattoir

640
Q

Leptospirosis symptoms

A 
flu-like symptoms
subconjunctival redness / haemorrhage
acute kidney injury
hepatitis
aseptic meningitis
641
Q

Leptospirosis management

A

Abx

642
Q

What is Li-Fraumenni syndrome?

A

Autosomal dominant

High incidence of malignancies particularly sarcomas and leukaemias

643
Q

What is Gardeners syndrome?

A

FAP variant

644
Q

Interstitial cystitis symptoms

A

lower urinary tract symptoms and suprapubic pain

645
Q

Interstitial cystitis investigation

A

Bladder cystography. Will see red area, small blood vessels and granulomas which may bleed

646
Q

Termination of pregnancy options

A

less than 9 weeks: mifepristone (an anti-progestogen, often referred to as RU486) followed 48 hours later by prostaglandins to stimulate uterine contractions
less than 13 weeks: surgical dilation and suction of uterine contents
more than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)

647
Q

What suggests Korsakoff syndrome rather then Wernicke’s encaphalopathy?

A

Anterograde / retrograde amnesia and confabulation

648
Q

What is hyphaema?

A

Blood in anterior chamber

649
Q

Management of hyphaema

A

Strict bed rest

650
Q

Management of BP over 180/120

A

Admit for same day assessment if signs of organ failure (retinal haemorrhage, papilloedema, confusion, chest pain, heart failure, AKI)
If not investigate for organ failure and review in 1 week

651
Q

Medication to offer with CBT in moderate - severe OCD

A

SSRI

652
Q

Management of bleeding a few hours after tonsillectomy

A

Theatre

653
Q

Management of bleeding a few days after tonsillectomy

A

Abx

654
Q

Hip dislocation management

A

Reduction under anaesthetic within 4 hours

655
Q

What is enteropathic arthritis?

A

Asymmetric seronegative arthritis associated with IBD

656
Q

First line in open angle glaucoma

A

Prostaglandin analogue eye drop eg lantoprost

657
Q

What is Kallman syndrome?

A

Hypogonadotropic hypogonadism

658
Q

LH and FSH in Kallman syndrome

A

Low / inappropriately normal

659
Q

De Quervain’s tenosynovitis management

A

analgesia
steroid injection
immobilisation with a thumb splint (spica) may be effective
surgical treatment is sometimes required

660
Q

Cervical degenerative myelopathy management

A

Decompressive surgery

661
Q

Mammary duct ectasia risk factors

A

Perimenopausal

Smoker

662
Q

Mammary duct ectasia findings on mammogram

A

Microcalcifications

Progress Tests (17 decks)

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