Passmedicine Questions Flashcards
(186 cards)
1
Q
Electrolyte abnormality associated with thiazide diuretics
A
Hyponatraemia Hypokalaemia Hypomagnesemia Hypercalcaemia Hypocalciuria Hyperglycaemia (impaired glucose tolerance)
2
Q
Example of thiazide diuretic
A
Bendroflumethiazide
3
Q
ABG in diarrhoea
A
Normal anion gap acidosis
4
Q
ABG in vomiting
A
Metabolic alkalosis
5
Q
How do you calculate anion gap
A
(sodium + potassium) - (bicarbonate + chloride)
Range = 10/18 mmol/L
6
Q
ABG in primary hyperaldosteronism
A
Metabolic acidosis - hypernatraemia and hypokalaemia
7
Q
Posterior MI ECG
A
ST depression in V1-V3 and tall R waves in V1 and V2.
8
Q
LBBB ECG findings
A
Broad QRS, dominant S wave in V1, broad monophasic R waves in lateral leads
9
Q
RBBB ECG findings
A
Broad QRS complexes, RSR pattern in V1-V3, wide slurred S waves in lateral leads
10
Q
Complications of thiazide diuretics
A
Gout
11
Q
Levothyroxine interactions
A
Iron / calcium carbonate reduces absorbtion of levothyroxine
12
Q
Management of COPD
A
1st line: SABA (eg. salbutamol) or SAMA (eg. ipratropium).
2nd line: LABA (eg. formoterol, salmeterol) and LAMA (eg. tiotropium) and inhaled corticosteroids (eg. beclomethasone)
13
Q
What condition causes abnormal pigmentation of the large bowel due to the presence of pigment-laden macrophages?
A
Melanosis coli.
Often caused by prolonged laxative abuse.
14
Q
Medication to use in type 2 DM patients who are obese
A
DPP-4 inhibitor
15
Q
DM medications that can cause weight gain
A
Sulphonylurea
Pioglitazone
Insulin
16
Q
How many days before surgery should warfarin be stopped?
A
5 days
17
Q
Mechanism of action of indapamide
A
Thiazide-like diuretic
18
Q
Mechanism of action of candesartan
A
ARB (angiotensin receptor blocker)
19
Q
Common post-MI systolic murmur
A
Mitral regurgitation
20
Q
What does notching of the inferior border of the ribs suggest?
A
Coarctation of the aorta
21
Q
Signs of left ventricular aneurysms post-MI
A
Tiredness
Breathlessness
Persistent ST elevation
22
Q
Ultrasound findings in chronic diabetic nephropathy
A
Large (early disease) / normal sized kidneys (later disease)
23
Q
Ultrasound findings in chronic kidney disease
A
Bilateral small kidneys
24
Q
Diagnosis criteria for AKI
A
Increase in creatinine > 26 umol/L in 48hrs
Increase in creatinine > 50% in 7 days
Decrease in urine output < 0.5 ml/kg/hr for more than 6 hours
25
How does hypertrophic obstructive cardiomyopathy present?
Exertional dyspnoea
| Ventricular hypertrophy on ECG
26
What condition is metoclopramide contraindicated in?
Parkinsonism
27
When is BIPAP useful?
Type 2 respiratory failure. Especially COPD exacerbations
28
When is CPAP useful?
Type 1 respiratory failure. Especially pulmonary oedema
29
Primary pneumothroax management guidelines
Rim of air < 2cm + not short of breath = discharge.
If > 2cm or short of breath = aspiration.
If aspiration is unsuccessful = chest drain
30
Secondary pneumothorax management guidelines
Patient > 50 + rim of air > 2 cm +/- short of breath = chest drain insertion.
Rim of air 1-2cm = aspiration.
If aspiration fails = chest drain.
Rim of air < 1cm = give O2 and admit for 24 hrs
31
What nephritic syndrome develops 1-2 weeks after URTI?
Post streptococcus glomerulonephritis
32
What nephritic syndrome develops 1-2 days after URTI?
IgA nephropathy
33
What are the features of primary hyperaldosteronism?
Hypertension.
| Hypokalaemia.
34
How are primary and secondary hyperaldosteronism differentiated?
Plasma aldosterone/renin ratio.
High ratio = primary
Low ratio = secondary
35
How is primary hyperaldosteronism diagnosed?
Adrenal imaging.
If unsuccessful: adrenal venous sampling.
Differentiates between unilateral adenoma (Conn's syndrome) and bilateral hyperplasia
36
What are the features of aldrenal insufficiency? (Addison's)
Hypotension
Hyponatraemia
Hyperkalaemia
37
What is a raised ACR?
> 3 mg/mmol
38
What medication should be commenced if ACR is raised?
ACE-i
39
What electrolyte imbalance can be caused by PPIs?
Hyponatraemia
40
What hormones are reduced by the stress response?
Insulin
Oestrogen
Testosterone
41
What is the commonest cause of mortality in CKD patients on haemodialysis?
Ischaemic heart disease
42
ECG findings in hypokalaemia
Prominent U-waves, best seen in precordial leads.
T waves have a 'sine wave' appearance.
Prolonged QTc > 600ms.
Borderline PR interval.
43
Features of Good Pasture's Syndrome
Haemoptysis
| Haematuria
44
What ACS medication is contraindicated in patients with hypotension?
Nitrates
45
What skull changes are seen in multiple myeloma?
Rain-drop skull (a random pattern of dark spots)
46
What skull changes are seen in primary hyperparathyroidism?
Pepperpot skull
47
What blood results are seen in beta-thalassaemia trait (minor)?
Disproportionate microcytic anaemia - raised haemoglobin A2 (HbA2)
48
What is the correct management if a DVT US is negative?
Stop DOAC and repeat US in a week
49
Causes of a raised APTT
Haemophilia (A,B,C)
Von Willebrand disease
Heparin
50
Casues of a prolonged PT
Liver disease
DIC
Vitamin K deficiency
Warfarin
51
Causes of a prolonged PT and APTT
Vitamin K deficiency - liver disease, malabsorption
DIC
Factor V or X
52
What blood product is the most likely to cause iatrogenic septicaemia with a Gram-positive organism?
Platelets (stored at room temperature)
53
What blood product is the most likely to cause iatrogenic septicaemia with a Gram-negative organism?
Packed red cells
54
What nuclei are seen in Reed-Sternberg cells?
Mirror image nuclei
55
When should a patient with AF + an acute stroke (not haemorrhagic) be started on anticoagulation?
Two weeks after the event
56
What blood results indicate an aplastic crisis?
Severe anaemia and a reduced reticulocyte count
57
What is an ejection systolic murmur heard best on inspiration?
Pulmonary stenosis
58
What is an ejection systolic murmur heard best on expiration?
Aortic stenosis
59
What is a mid-late diastolic murmur heard loudest in expiration?
Mitral stenosis
60
What is a mid-systolic murmur heard loudest in expiration?
Mitral valve prolapse
61
What is a mid / late diastolic murmur heard loudest in inspiration?
Tricuspid stenosis
62
What adjustments should be made to levothyroxine in pregnancy?
Increase levothyroxine by 50%
63
What scale is used to identify obstructive sleep apnoea?
Epworth Sleepiness Scale
64
What is 1st line management for moderate / severe obstructive sleep apnoea?
CPAP
65
What is classified as NYHA class I?
No symptoms
No limitation
66
What is classified as NYHA class II?
Mild symptoms
Slight limitation of physical activity
67
What is classified as NYHA class III?
Moderate symptoms
Marked limitation of physical activity
68
What is classified as NYHA class IV?
Severe symptoms
Unable to carry out any physical activity without discomfort
Symptoms present at rest
69
What ACS medication is contraindicated in pregnany?
Statins
70
What may be seen on a blood film of a patient with functional hyposplenism secondary to coeliac disease?
Howell-Jolly bodies and target cells
71
What is first line treatment for a mild-moderate flare of distal ulcerative colitis?
Topical (rectal) mesalazine
72
What ECG changes are seen in acute pericarditis?
Widespread saddle shaped ST elevation
PR depression
73
What is 1st line treatment for meningitis in young adults?
IV ceftriaxone
74
What is the mechanism of action of loop diuretics?
Inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of Helne
75
What does of atorvastatin is given after an MI?
80mg
76
What is the second line management of hypertension in African-Caribbean patients after a CCB?
ARB
77
What vaccines should be offered to patients with chronic hepatits?
One-off pneumococcal
Annual influenza
78
What ECG changes are seen in hypokalaemia?
Prolonged PR interval and prominent U waves
79
What other condition should patients with type 1 diabetes be screened for on diagnosis?
Coeliac disease
80
What difference is present in the blood results between iron deficiency anaemia and anaemia of chronic disease?
```
IDA = TIBC is high
ACD = TIBC is low / normal
```
81
What tumour marker is associated with colorectal cancer?
Carcinoembryonic antigen (CEA)
82
What condition is superior vena cava obstruction assoicated with?
Lung cancer
83
What are the symptoms of superior vena cava obstruction?
```
Dyspnoea
Swelling of the face, arms and neck
Headache : often worse in the mornings
Visual disturbance
Pulseless jugular venous distension
```
84
Can hypothermia cause pancreatits?
Yes
85
What is 1st line management of hydronephrosis?
Urethral catheter
86
What are the symptoms of charcot's cholangitis?
Fever, jaundice, RUQ pain
87
What condition can cause an over-estimated HbA1c on bloods?
Splenectomy
| due to the increased lifespan of RBCs
88
How many stages of renal cell carcinoma are there?
4
89
What organism commonly causes aspiration pneumonia?
Klebsiella
90
What is the ratio of oral to parenteral morphine?
2:1
91
How should a severe flare of ulcerative colitis be treated?
Admit to hospital and give IV corticosteroids
92
What do the results of a dexamethasone supression test show in an adrenal adenoma?
Cortisol is not suppressed by low dose dexamethasone.
Cortisol is not suppressed by high-dose dexamethasone.
ACTH is suppressed by high-dose dexamethasone.
93
What do the results of a dexamethasone supression test show in a pituitary adenoma?
(Cushing's Disease)
Cortisol is not suppressed by low-dose dexamethasone.
Cortisol is suppressed by high-dose dexamethasone.
ACTH is suppressed by high-dose dexamethasone.
Often too small to be detected on pituitary MRI.
94
What do the results of a dexamethasone supression test show in ectopic ACTH syndrome?
(eg. small cell lung cancer)
Cortisol is not suppressed by low dose dexamethosone.
Cortisol is not suppressed by high dose dexamethasone.
ACTH is not supressed by high dose dexamethasone.
95
What condition with weakness and vision blurring is assoicated with thyroid conditions?
Myesthenia Gravis.
96
What is a side effect of adenosine?
Flushing / warmth
97
What analgaesia should be used in renal colic?
IM diclofenac
98
What electrolyte balance can be seen with acute pancreatitis?
Hypocalcaemia
99
What biliary condition is associated with ulcerative colitis?
Primary sclerosing cholangitis
100
What antibodies are assoicated with primary sclerosing cholangitis?
ANCA (anti-neutrophil cytoplasmic antibodies)
Anti-smooth muscle cell antibodies
101
What score is used to determine stroke risk in AF?
CHA2DS2-VASc
102
What is the 1st line anticoagulant used in AF?
DOAC
103
What is a characteristic of Crohn's disease but not UC?
Skip lesions
Increased goblet cells
Granulomas
Bowel obstruction
Fistulae
104
What is a characteristic of UC but not Crohn's?
No inflammation beyond the submucosa
Crypt abscesses
Depletion of goblet cells and mucin
105
What is the imaging of choice in renal colic?
Non-contrast CT KUB
106
How are calcium renal stones prevented?
- High fluid intake
- Low animal protein
- Low salt diet
- Thiazide diuretics
107
How are oxalate stones prevented?
- Cholestyramine
| - Pyridoxine
108
How are uric acid stones prevented?
- Allopurinol
| - Urinary alkalisation eg. oral bicarbonated
109
What is the most common causative organism of spontaneous bacterial peritonitis?
E. coli
110
What medications are used in secondary prevention of CVD?
| peripheral vascular disease
- Clopidogrel 75mg
| - Atorvastatin 80mg
111
What type of anaemia would sickle cell disease cause?
Normocytic
Other findings:
- raised reticulocytes
- Sickle cells on a blood film
112
First line investigation for liver cirrhosis
Transient elastography
113
What is the biochemical pattern on primary hyperparathyroidism?
- Mild hypercalcaemia
- Low serum phosphate
- Raised / normal PTH
114
What is the biochemical pattern of multiple myeloma?
- Hypercalcaemia
- Normocytic anaemia
- Renal failure (raised urea and creatinine)
115
What type of medication is candesartan?
ARB
116
What is the management of HF with a reduced ejection fraction?
- ACE-i (or ARB)
- Beta blocker
2nd line:
- + spironolactone
117
What condition is assoicated with carbimazole use?
Agranulocytosis
118
What is the 1st line insulin regime for newly diagnosed type 1 diabetics?
Basal-bolus using twice-daily insulin detemir
119
Signs of idiopathic intracranial hypertension
Papilloedema.
| 6th nerve palsy
120
Symptoms of riased intracranial pressure
Exacerbation of headache on straining or bending forwards
Nausea
Vomiting
Visual disturbances (including double vision).
121
Acute adverse effects of phenytoin
| used for seizures
```
Acute:
Initially:
- dizziness
- diplopia
- nystagmus
- slurred speech
- ataxia
Later:
- confusion
- seizures
```
122
Chronic adverse effects of phenytoin
Common:
- gingival hyperplasia
- hirsutism
- coarsening of facial features
- drowsiness
- Megalblasic anaemia
- Peripheral neuropathy
- osteomalacia (enhanced vitamin D metabolism)
- lymphadenopathy
- dyskinesia
123
What is the most common cause of viral meningitis in adults?
Enteroviruses eg. coxsackie B
124
What are the lumbar puncture signs of viral meningitis?
- lymphocytosis
- raised protein
- normal glucose
- normal opening pressure
- clear CSF
125
What are the lumbar puncture signs of bacterial meningitis?
- Elevated protein
- Reduced glucose
- Cloudy / turbid appearance
- Raised opening pressure
126
What is a common causative organism of bacterial meningitis?
Neisseria meningitidis
127
What are concerning signs of raised intracranial pressure?
Cushing's triad:
- Widening pulse pressure
- Bradycardia
- Irregular breathing
Also:
- Hypertension
128
What medication can be used as prophylaxis for prevention of rebleeding following a variceal bleed?
A non-cardioselective beta blocker eg. propanolol
129
What medications are used in an acute variceal bleed?
- Fluid resucitation
- Correct clotting: FFP, vitamin K
- Terlipressin.
- Ceftriaxone IV (prophylactic antibiotic which reduces mortality in patients with liver cirrhosis)
- Endoscopy and variceal band ligation
- Seng-staken-Blakemore tube if uncontrolled haemorrhage
- Transjugular intrahepatic portosystemic shunt if all other measures fail
130
Prophylaxis of variceal haemorrhage
Endoscopic variceal band ligation - every two weeks until all varicies eradicated.
PPI cover is given to prevent EVL-induced ulceration
131
What is a cause of liver failure following cardiac arrest?
Ischaemic hepatitis
132
What is a complication of carbimazole?
Agranulocytosis
133
What can cause a false negative mantoux test?
```
TB
AIDS
Long-term steroid use (eg. in UC)
Lymphoma
Sarcoidosis
Extremes of age
Fever
Hypoalbuminaemia
Anaemia
```
134
What is the commonest type of lymphoma in the UK?
Diffuse large B cell lymphoma
135
What system is used for staging non-Hodgkin's lymphoma?
Ann Arbor system
Stage 1 - one node affected
Stage 2 - more than one node affected on the same side of the diaphragm
Stage 3 - nodes affected on both sides of the diaphragm
Stage 4 - extra-nodal involvement eg. spleen, bone marrow, CNS
136
What complication can occur after bilateral adenectomy for Cushing's?
Nelson's syndrome
137
Acute seizure management
Rectal diazepam 10-20mg for adults - can be repeated once after 10-15 minutes
Midazolam oromucosal solution 10mg in adults
138
STEMI ECG findings
- Q waves
- ST elevation
- Inverted T waves
139
Posterior MI ECG findings
- Tall R waves in V1-V3
- ST depression in V1-V3
- Upright T-waves
140
What causes a tender thyroid goitre?
De Quervain's thyroiditis
141
What is Conn's syndrome?
Primary hyperaldosteronism
142
What are the features of primary hyperaldosteronism?
- Hypertension
- Hypokalaemia (eg. muscle weakness)
- Alkalosis
143
What investigations should be done in primary hyperaldosteronism?
1st line:
- plasma aldosterone/renin ration
- Results: high aldosterone, low renin
If postive:
- CT abdo and adrenal vein sampling (differentiate between unilateral and bilateral sources of aldosterone excess)
144
What is the management of primary hyperaldosteronism?
Adrenal adenoma: surgery
Bilateral adrenocortical hyperplasia: aldosterone antagonist eg. spironolactone
145
Heart failure drug management
1st line:
- ACE-i + Beta blocker
2nd line:
- aldosterone antagoist (eg. spironolactone, elperenone)
3rd line: (by a specialist)
- Ivabradine
- Sacubitril-valsartan
- Digoxin
- Hydralazine in combination with nitrate
- Cardiac resynchronisation therapy
146
Management of abdominal aortic aneurysms
< 3cm = normal
3 - 4.4 cm = small (rescan every 12 months)
4.5 - 5.4 cm = medium (rescan every 3 months)
>= 5.5 cm = large (refer within 2 weeks for surgical intervention (EVAR))
Symptomatic / rapidly enlarging aneurysms (>1cm a year) = EVAR
147
When should COPD patients be assessed for oxygen therapy?
- FEV1 < 30% predicted
- Cyanosis
- Polycythaemia
- Peripheral oedema
- Raised JVP
- O2 sats < 92%
148
What patients should be offered long term oxygen therapy in COPD?
- Patients with pO2 < 7.3
| - Patients with pO2 7.3-8 + secondary polycytaemia / peripheral oedema / pulmonary hypertension
149
How is prostate cancer staged?
Gleason Score
150
What is the first line management of sinus bradycardia?
Atropine 500mg IV
151
What type of oesophageal cancer is related to GORD and barrett's oesophagus?
Adenocarcinoma
152
What is the most likely lung cancer in smokers?
Squamous cell carcinoma
153
What type of cancer may develop after exposure to asbestos?
Mesothelioma
154
What is the most common lung cancer in non-smokers?
Adenocarcinoma
155
What medication can lead to gout?
Thiazide diuretics
| decrease uric acid excretion from the kidneys
156
What is a side effect of thiazide-like diuretics?
Erectile dysfunction
Hypokalaemia
157
What is a side effect of calcium channel blockers?
Ankle swelling
158
How long before a surgery should you stop taking the combined oral contraceptive pill?
4 weeks
159
What medications increase the risk of C.diff?
Cephalosporins
Clindamycin
PPIs
160
How is C.diff diagnosed?
C. diff toxin in the stool
161
How is C.diff managed?
Oral metronidazole for 10-14 days
If severe then vancomycin can be used
162
What are the ECG changes seen in PE?
Sinus tachycardia
or
S1Q3T3
163
What are the signs of acute tubular necrosis?
Worsening renal function + muddy brown casts
Associated with compartment syndrome following trauma (production of myoglobinuria)
164
What is a common cause of acute interstitial nephritis?
Drug toxicity
165
What is the daily requirement of glucose?
50-100g a day
166
What is the management of minimal change glomerulonephritis?
Prednisolone
- If doesn't respond: cyclophosphamide
167
What might be seen on urine microscopy of patients taking loop diuretics?
Hyaline casts
168
What is a side effect of spironolactone?
Gynaecomastia
169
What does hypocalcaemia indicate in renal disease?
The renal disease is chronic
170
What are some signs of chronic renal failure?
- Shrunken kidneys
- Secondary hyperparathyroidism
- Hypocalcaemia (reduced levels of D/1,25(OH)2D - which results in reduced reabsorption of calcium from the kidneys)
171
What urine tests indicate acute tubular necrosis?
- High sodium
- Low urine osmolarity
- Brown casts
172
What is seen on renal biopsy in membranous nephropathy?
- Thickened basement membrane on light microscopy
| - sub-epithelial spikes on silver staining
173
How is membranous nephropathy managed?
Conservative + ACE-i + statin + prophylactic anticoagulation
174
What are features of ADPKD?
```
Hypertension
Recurrent UTIs
Abdominal pain
Renal stones
Haematuria
Chronic kidney disease
```
175
What variables is eGFR calculated from?
CAGE
- Creatinine
- Age
- Gender
- Ethnicity
176
What is the intitial intervention in hyperkalaemia?
IV calcium gluconate
177
What is the most common infection in patients with solid organ transplants?
Cytomegalovirus
178
What is the most common causative organism in patients with peritonitis secondary to peritoneal dialysis?
Staphylococcus epidermis
179
How is anion gap calculated?
(Na + K) - (Cl + HCO3)
180
What does a raised anion gap indicate in metabolic acidosis?
Diabetic ketoacidosis
181
What does a normal anion gap indicate in metabolic acidosis?
GI bicarbonate loss due to diarrhoea
182
What medication can cause diabetes insipidus?
Lithium
183
Which patients would fibromuscular dysplasia be suspected in?
Young females who develop AKI after initiation of an ACE-i
184
What is the treatment for hyperacute transplant rejection?
There is no treatment available - the rejected graft must be removed
185
What medications commonly cause acute interstitial nephritis?
NSAIDs, penicillins, sulphur-based medicines, PPIs, ciprofloxacin, allopurinol
186
How is stable angina managed?
1st line:
- beta blocker OR calcium channel blocker
2nd line:
- beta blocker + calcium channel blocker
If both drugs are not tolerated use one of:
- a long-acting nitrate
- ivabradine
- nicorandil
- ranolazine
