past paper Q's Flashcards
(254 cards)
1
Q
what are the 3 defining features of a health economic evaluation?
A
cost both services
benefits both services
comparison of the cost and benefit of the service and alternative service
2
Q
2 features comprising a QALY?
A
number of years
quality of life- i.e. utility
3
Q
what system do health economists use to evaluate disability?
A
dalys- disability adjusted life years
4
Q
define healthcare economic ‘efficiency’
A
getting the max cost/ health benefit outcome from a service
5
Q
what is the term when treatment is given elsewhere because it gives better benefit on another opportunity?
A
opportunity cost i.e the money is spent elsewhere because it gives better benefit on another opportunity
6
Q
what is a SAH?
A
Bleeding into the subarachnoid space- between arachnoid membrane and pia mater
7
Q
why does SAH cause a coma?
A
raised ICP and hydrocephalus
8
Q
causes of coma?
A
hypoglycaemia meningococcal septicaemia trauma SAH hypoxaemia seizures
9
Q
what causes a fixed dilated pupil?
A
3rd nerve palsy (oculomotor)
10
Q
immediate management of SAH?
A
A-E assessment CT scan treat hypertension- nimodipine Intubate and give O2 mannitol-fusion colloid refer for surgery to stem bleed- coiling
11
Q
4 features of brainstem death?
A
- no respiratory effort in reaction to turning off ventilator
- fixed pupils unreactive to light
- no corneal reflex
- no cough reflex
- no response to supra orbital pressure
12
Q
screening by GP for microvascular damage of DM?
A
Retinal screening
kidney U&E- urine albumin and serum creatinine
Foot care screening- monofilament for sensation
ABPI
13
Q
causes of increasing floaters?
A
diabetic retinopathy retinal detachment/tear posterior vitreous detachment trauma recent cataract surgery
14
Q
Ix of floaters in eye?
A
1) Fundus photography Schaffer’s sign- positive when you use a thin beam of bright light without a lens and see fine pigment floating in the anterior vitreous
2) ophthalmoscopy
3) ultrasound- flying angel sign
15
Q
most common cell of bladder cancer?
A
transitional cell
squamous cell is most common
16
Q
risk factors for bladder cancer?
A
FH
smoking
frequent bladder infections
working in a rubber dye factory
17
Q
which artery supplies the superior and inferior vesical arteries?
A
internal iliac
18
Q
what lymph nodes can bladder cancer metastasise to?
A
external iliac
obturator
internal iliac
common iliac
19
Q
2 signs of cauda equina in the following areas?
- perianal skin
- lower limb
- anal and urethral sphincters
A
Perianal skin -paraesthesia, decreased tone
Lower limb -upgoing plantars, pain, altered reflexes
Anal and urethral- decreased tone, incontinence
20
Q
what abnormal heart sound is heart in pericarditis?
A
pericardial rub
21
Q
4 Ix of pericarditis?
A
USS
CXR
bloods
ECG
22
Q
2 treatments for pericarditis?
A
NSAIDS
Steroids
23
Q
triad of cardiac tamponade?
A
raised JVP
BP 90/40
tachycardia
24
Q
causes of pericarditis?
A
recent viral infection recent bacterial infection e.g. TB recent MI Chest trauma Autoimmune disorders Cancer Uraemic pericarditis
25
moat common type of lung cancer?
squamous cell adenoma (non- small cell)
26
common causes of bowel obstruction?
```
adhesions
cancer
constipation
diverticulitis
hernias
```
27
common causes of constipation?
drugs
dehydration
autonomic neuropathy
immobility
28
important things to assess in a fracture?
open/closed
stable/non-stable
neurovascular status
is it displaced
29
what is the salter harris classification of injury to growth plates?
1- through the growth plate
2- (most common)- through growth plate and metaphysis (proximal)
3- through growth plate and epiphysis (distal)
4- through all 3 elements
5- crush injury of growth plate
30
how does rivaroxaban work?
inhibits factor 10a
31
where does the varicella zoster virus reside?
geniculate ganglion
32
symptoms of ramsey hunt syndrome?
facial palsy
ear: vertigo, ear pain
altered taste, dry mouth, dry eyes
33
3 actions of PTH?
osteoclast activation
stops loss of ca in the urine
increased absorption from GI
34
complications of hypercalcaemia?
cardiac arrhythmias
coma
cardiac arrest- short QT and Osborn wave
35
tx of hypercalcaemia?
fluid
furosemide
bisphosphonates
calcitonin
36
ix of beta thalassaemia?
FBC- microcytic hypochromic anaemia
Haemoglobin electrophoresis
DNA testing
37
what is a complication of treatment for B-thalassaemia?
how is this complication prevented?
iron induced oxidative stress
Liver
Heart
Brain
Iron chelation therapy
38
Ix for rectal bleeding?
Foecal calprotectin
bloods
anti-endomysial antibodies and anti-TTG
colonoscopy and biopsy
39
what is the pathophysiology behind anaphylaxis?
type 1 hypersensitivity reaction- degranulation of mast cells releasing histamine
40
what are the 5 causes for an association?
bias
chance
confounding
reverse causality
41
why isn't there a PSA screening programme in the UK?
```
length time bias- harmess tumours detected
Unnecessary treatment
PSA is unreliable
Causes undue worry
many tumours are slow-growing
```
42
when is it appropriate to do a PSA?
Men above age 50
suspicious PR findings
monitoring treatment and remission of prostate cancer
43
what does an upright CXR exclude in a woman with constipation?
bowel perforation
44
what do the blood findings raised urea, low creatinine and high Na show?
dehydration
45
drug treatments of incomplete miscarriage?
anti-D
| misoprostol
46
RFs of intermittent claudication?
```
smoking
diabetes
hypertension
hyperlipidaemia
lack of exercise
```
47
how to do ABPI?
A blood pressure cuff is inflated around the lower calf muscle above the ankle joint, and a doppler ultrasound probe placed over the dorsalis pedis artery and the posterior tibial artery
- the max cuff pressure at which the pulse can just be heard with the probe is recorded and related to SBP at brachial artery
- lower BP in the legs is an indicator of PAD
48
important physical signs in pre-op assessment?
Mallampati- how much of the soft palate in visible on opening of the mouth
Thyromental and sternomental distance
49
complications seen in RA after routine surgery?
adrenal crisis from stopping prednisolone
RA produces hypercoaguable state- increased VTE risk, infection risk from steroid
Immunosuppression from methotrexate
50
how to differentiate between testicular torsion and epididymo-orchitis?
Prehn's sign- scrotal elevation relieves pain in epididymitis but not torsion
Absent cremasteric reflex- torsion
testicle is higher- torsion
51
differentials of quinsy?
```
epiglottitis
lymphoma
tonsillitis
pharyngitis
craniopharyngioma
glandular fever
```
52
what is the name of the lymph node affected by quinsy?
jugulodigastric lymph nodes
53
what hormone is hypersecreted in Conn's syndrome and where from?
and what hormone is suppressed?
aldosterone (mineralocorticoid) , adrenal cortex
| renin, JG apparatus
54
4 ECG features of hypokalaemia?
U have no POT and no T, but a large PR and a large QT
U waves
small or absent T waves
long PR
long QT
55
imaging in conn's syndrome?
CT adrenal gland
56
where does spironolactone act?
aldosterone antagonist in the cortical collecting duct
| used in ascites
57
2 ECG changes in ischaemia?
ST depression
| T wave inversion
58
how do beta blockers work?
block beta-adrenoreceptors , antagonising the sympathetic NS (reducing NA and adrenaline)
reduces HR and force of contraction
can be cardio-selective or non-cardio selective e.g. propranolol
(can work in sphincters of GI tract- to make them contract)
59
how do nitrates work?
cause NO release which leads to vasodilation and decreased PVR
60
why do you do 3 samples of LP in a SAH?
One for virology, one for microbiology and one for biochemistry
61
what pathological structure causes SAH?
berry aneurysm
62
what causes headaches pre-SAH?
Sentinel headache due to much smaller lead from the ruptured aneurysm
63
how does salbutamol work?
beta-2 agonist
| relaxation of bronchial smooth muscle, bronchodilation
64
symptoms of SLE?
malaise, fever, abdo pain, weight loss, fatigue, headache
65
signs of SLE?
```
malar rash
discoid rash
photosensitivity
oral ulceration
arthritis
serositis
seizures/psychosis
proteinuria
anaemia
```
66
features of anti-phospholipid syndrome?
```
CLOTS
Coagulation defect
Livedo reticularis
Obstetric (recurrent miscarriage)
Thrombocytopenia
SLE
```
67
what is amoebiasis?
Amoebiasis is caused by Entamoeba histolytica (an amoeboid protozoan) and spread by the faecal-oral route
68
features of amoebiasis?
dysentery- bloody diarrhoea
| Amoebic liver abscess-mass in R lobe, fever, RUQ pain
69
what is found on stool microscopy of amoebiasis?
trophozoites, amoebic cysts
70
tx of amoebiasis?
mentronidazole
71
how do alpha blockers work?
smooth muscle of blood vessels and GI tract
| vasoconstriction of blood vessels and decreased motility in the GI tract
72
where do beta receptors act?
cause smooth muscle relaxation
GI tract
blood vessels
bronchi
73
what is adrenaline produced by?
“chromaffin cells” in the adrenal glands
74
what is phaeochromocytoma
a tumour of the chromaffin cells that secretes unregulated and excessive amounts of adrenaline
caused by MEN 2
75
features of phaeochromocytoma?
```
hypertension
headaches
palpitations
sweating
anxiety
```
76
diagnosis of phaeochromocytoma?
24 hr urinary collection of metanephrines
77
mx of phaeochromocytoma?
Surgery is the definitive management. The patient must first however be stabilized with medical management:
alpha-blocker (e.g. phenoxybenzamine), given before a
beta-blocker (e.g. propranolol)
78
what is the pathophysiology of CML?
Philadelphia chromosome- t(9:22) chromosomal translocation= BCR-ABL gene= excess tyrosine kinase activity
79
tx of CML?
imatinib- tyrosine kinase inhibitor
80
what is the full name of chlamydia?
chlamydia trachomatis
81
what is the formula for fluid correction given to a burns patient?
4 x weight x burn percentage
82
what level of burns is burns with no blistering but reduced pin-prick sensation?
3rd degree, full thickness
83
electrolyte complication of burns?
hyperkalaemia due to lysis of cells
84
name some viral and bacterial causes of hospital acquired infections?
viral- norovirus, rotavirus
| bacterial- campylobacter, staph aureus, E.coli, C.diff
85
possible sources of infection in hospital?
resp droplet/airborne
catheter
bloods/cannulas
food
86
cause of infectious mononucleosis?
EBV
87
causes of pharyngitis and cervical lymphadenopathy other that EBV?
```
CMV
toxoplasmosis
HIV
rubella
mumps
```
88
features of mouth and throat examination of infectious mononucleosis?
```
sore throat
tonsillar enlargement
erythema
uvula oedema
lymphadenopathy
palatal petechiae
pyrexia
```
89
test used to confirm infectious mononucleosis?
Monospot test-hereophil antibody test
| FBC, WCC
90
other features of glandular fever?
splenomegaly- occurs in 50%
hepatitis- transient rise in ALT
lymphocytosis
haemolytic anaemia secondary to cold agglutins
maculopapular pruritic rash common in amoxicillin tx
91
how does serotonin work?
increases synaptic cleft serotonin level
proven to work with depression
less side effects
92
what is the most likely cause of mitral stenosis?
rheumatic fever- think in a patient with a new murmur and arthralgia after sore throat
93
cause of rheumatic fever?
streptococcus pyogenes
94
why do the following happen in mitral stenosis:
- AF
- RV heave
- Raised JVP
AF- increase of left atrial pressure and dilatation
RV heave- RV hypertrophy
Raised JVP- pulmonary hypertension/ right heart failure
95
why does mitral stenosis cause dyspnoea?
increased pressure in the atrium due to stenosis, backlog into pulmonary circulation leading to fluid overload leading to INCREASED HYDROSTATIC PRESSURE causing fluid to shift from vascular to interstitial causing oedema and SOB
96
treatments of COPD after standard medical therapy fails?
LTOT
home nebulisers
pulmonary rehab
CPAP
97
signs of CO2 retention?
```
confusion
asterixis
warm extremities
bounding pulse
morning headache
```
98
what does a low base excess mean? (
there is a lower than normal amount of HCO3- in the blood, suggesting a primary metabolic acidosis or a compensated resp acidosis
99
how can pancreatitis lead to foul smelling, floaty stools?
pancreatic exocrine dysfunction- lack of faecal elastase
100
how are spinal cord compression and cauda equina different?
cauda equina- lower back pain and sciatica- bilateral, saddle anaesthesia, loss of anal tone, urinary retention
spinal cord compression- leg weakness and radicular pain, urinary and bowel incontinence, sensory level
101
treatments of addisons disease?
fludrocortisone
| hydrocortisone
102
causes of addisonian crisis?
- sepsis or surgery causing an acute exacerbation of
- chronic insufficiency (Addison's, hypopituitarism)
- adrenal haemorrhage
- steroid withdrawal
103
mx of Addisonian crisis?
- hydrocortisone 100mg IM or IV
- 1L normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
- continue hydrocortisone 6-hourly until the patient is stable. No fludrocortisone in required because high cortisol exerts weak mineralocorticoid action
- oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
104
signs/symptoms of Addisonian crisis?
shock, confusion, N&V, fever, acute abdo pain, tachycardia
105
causes of confusion in a patient with myeloma?
hypercalcaemia
| uraemia
106
what does a technicium bone scan look at and why is it not suitable in myeloma?
looks at osteoblastic activity
| myeloma causes plasma cells to secrete IL-6 which inhibits osteoblast and stimulates osteoclastic activity
107
Name 2 methods in which patient could get funding for cancer treatments not
recommended by NICE in the NHS
1) individual funding through PCT
2) cancer drug fund (charity)
3) private funding
consultants can apply for funding through NICE if they feel it is appropriate
108
classic clinical features of plague psoriasis skin lesion?
well-dermarcated
silver scaly plaque
erythematous rash
hyperproliferation (thickened)
109
differences between psoriatic and rheumatoid arthritis?
psoriatic arthritis affects distal interphalangeal joints and has nail changes
110
what does COX stand for?
cyclooxygenase
111
what substances do NSAIDs prevent from forming?
thromboxane A2
| prostaglandin
112
mechanism of steroid action in the nucleus and cytoplasm?
steroids are lipid-soluble so pass through cell membrane. They bind to steroid receptors in the cytoplasm where they combine and travel into the nucleus. There they bind to DNA receptors and control protein synthesis and enzymes that regulate vital cell activity.
113
AEs of methotrexate?
```
mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
teratogenic- need to be on contraception
```
114
ECG features of hypokalaemia?
flat inverted T waves, u waves, depressed ST, long QT
115
what are the actions of aldosterone?
Increase sodium reabsorption from the distal tubule
Increase potassium secretion from the distal tubule
Increase hydrogen secretion from the collecting ducts
116
diagnosis of COPD on spirometry?
FEV1 <80%
| FEV1/FVC <0.7
117
RFs for osteoporosis?
Steroids, hyperparathyroidism, alcohol, low testosterone, low BMI, early
menopause, renal failure, erosive, dietary, female sex, Asian/causasian, increasing age,
smoking, non- weight bearing
118
what is a vertebral compression fracture in the spine called?
wedge fracture
119
signs of lower motor neurone disease?
Muscle wasting
Reduced tone
Fasciculations (twitches in the muscles)
Reduced reflexes
120
signs of upper motor neurone disease?
Increased tone or spasticity
Brisk reflexes
Upgoing plantar responses
121
symptoms of bulbar or pseudobulbar palsy?
```
slurred speech
Dysphagia,
labile mood,
nasal regurgitation,
weak wasted fasciculating tongue.
Loss of gag reflex.
Jaw jerk affected.
```
122
what will happen to sensitivity and PPV if the prevalence of a disease increases?
sensitivity will stay the same
PPV will increase as there are less false positives (NPV will decrease as there are more false negatives for every true negative
123
Ix for suspected crohn's
high foecal calprotectin
colonoscopy
ESR/CRP
rectal biopst
124
inducing remission drugs and maintaining remission drugs in crohns?
inducing remission- glucocorticoids e.g. prednisolone, budesonide, 5-ASA drugs (e.g. mesalazine) 2nd line
maintaining remission- azathioprine or mercaptopurine
125
mx of erythema nodosum?
```
best rest
analgesia
NSAIDs
venous compression therapy
steroids if malignancy and infection ruled out
```
126
If there is hearing loss + facial weakness, where is the acoustic neuroma located
intracranially?
cerebellopontine angle
127
what are the features of an acoustic neuroma?
cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
128
name some biochemical abnormalities of nephrotic syndrome/
hypoalbuminaemia
hyperlipidaemia- a consequence of increased synthesis of lipoproteins as a direct
consequence of low plasma albumin.
129
pathological change of basement membrane in diabetic nephropathy?
basement membrane thickening
130
name some risk factors for PE and how they increase risk?
Virchow's triad= stasis, hypercoagulability, endothelial damage
immobility= increased stasis
malignancy= pro-thrombotic state
prev DVT= increased risk of embolus
COCP- oestrogen increases pro-thrombotic state
131
name some thromboprophylaxis methods?
```
TED stockings
encourage mobilisation
dalteparin DC
leg elevation
flowtron- intermittent compression device
```
132
how does LMWH work?
activates antithrombin which prevents conversion of prothrombin to thrombin
133
how does clopidogrel work?
P2Y12 inhibitor- stops ADP binding to platelet receptor= platelets can't aggregate
134
how do DOACs work?
rivaroxaban= factor Xa inhibitor
135
signs of down's syndrome?
```
single palmar crease
sandal gap
flat nasal bridge
small, low set ears
upsloping palpebral fissures
epicanthic folds
protruding tongue
brush field spots in eyes
```
136
what is the most important risk factors for down's syndrome?
maternal age for non-disjunction
prev down's baby
translocation carrier
137
2 genetic mutations for down's syndrome?
non-disjunction/translocation/mosaic- trisomy 21
138
2 GI malformations for down's syndrome?
hirschsprungs disease
| duodenal atresia
139
risks to child with down's syndrome?
```
low IQ
early onset alzheimers
epilepsy
cataracts
leukaemia
```
140
RFs for melanoma?
UV exposure
multiple moles
family history
pale skin
141
which lymph nodes are melanoma of the lower leg likely to spread to?
superficial inguinal
| external/internal iliac
142
RFs for lack of vitamin D?
```
dietary
protective clothing
housebound
renal/liver disease
malabsorption e.g. coeliac
```
143
how is vitamin D absorbed?
through the intestine to liver to become 25(OH)D to go to the kidney
- increases calcium and phosphate from the intestine
- increases bone resorption
144
how does PTH work?
BONE- works on bone to increase osteoclastic activity so there is more calcium in the bloodstream
KIDNEY- increases vit D activation and calcium resorption from the distal convoluted tubule and increased phosphate excretion
145
why does lack of vitamin D cause demineralisation of bone?
lack of Vit , reduces calcium, and increasing PTH which increases osteoclastic activity
146
4 things to do for Vitamin D deficiency?
Vit D + calcium supplements (Adcal), increase sunlight exposure, avoid using sunblock, avoid covering, diet (fish and milk), bisphosphonate (prevents osteoclastic activity)
147
triggers of gout?
```
chemo
acute illness
alcohol
surgery
diuretics
```
148
what type of drug is
1. colchicine
2. allopurinol
1. plant alkaloid
2. xanthine oxidase inhibitor- reduces serum uric acid levels (can precipitate an acute attack so don't start straight away)
149
why does gout favour small distal joints?
distal blood supply is cooler so crystals more likely to precipitate i.e. uric acid
150
where are transitional cells found?
renal pelvis, ureter, urethra, bladder
151
blood supply for bladder and nodal clearance?
internal iliac -> superior and inferior vesicle arteries
nodes- external iliac, common iliac
152
coeliac antibodies?
anti-TTG
anti- endomysial
anti-gliadin
153
advice before coeliac biopsy?
eat a gluten diet
154
histology of coeliac?
crypt hyperplasia, villous atrophy, intraepithelial lymphocytes
155
what do vitamin A and E deficiencies cause?
A- night blindness
| E- peripheral neuropathy
156
cancer risk of coeliac?
T call lymphoma of small bowel
157
skin rash of coeliac?
dermatitis herpetiformis
158
define economic evaluation?
Assessment of cost effectiveness - comparative study of the costs and benefits of a health care intervention. Costs and benefits need to be compared to at least two other interventions
159
define efficiency
Allocation of resources between activities on order to maximise benefit
160
what is opportunity cost?
to spend resources on one activity means a sacrifice in terms of lost opportunity elsewhere – benefits foregone from not allocating resources to the next best activity
161
prophylaxis and protective measures for malaria?
malarone
doxycycline
wearing protective clothing, DEET spray
162
3 reasons for malaria prophylaxis failure?
1. non compliance
2. resistance to meds
3. inappropriate med for species
163
diagnosis of malaria?
thick and thin blood film – need to take 3 films on 3 subsequent occasions
thick – detection of parasite
thin – detection of species
Rapid diagnostic test to look for antigen/enzymes of parasite
164
symptoms of cerebral malaria?
Confusion, coma, seizures, encephalopathy
165
symptoms of severe malaria?
seizures, AKI, ARDS, DIC, sepsis,
| hypoglycemia
166
treatment of malaria?
ACT – artemisinin combination
| therapy
167
treatment of complicated malaria?
IV artesunate
168
2 things to regularly test in lithium treatment?
eGFR- renal function
| TFTs
169
signs of lithium toxicity?
tremor, confusion, ataxia, restlessness, hypertonicity, myoclonic jerks
170
what is an apical lung tumour called?
Pancoast Tumor
171
3 features of horner's syndrome?
ptosis
miosis
anhydrosis
caused by sympathetic fibres
172
why do people with lung cancer get shoulder and scapula involvement?
involvement of brachial plexus
173
when nerve root causes wasting of thenar eminence?
supplied by median nerve- C8-T1
174
what nerve causes a hoarse voice?
recurrent laryngeal nerve
175
different features of hypertensive retinopathy on fundoscopy?
1. Arteriolar narrowing
2. AV nipping
3. Flame haemorrhages, blot haemorrhages, cotton wool spots, exudates
4. Papilloedema
176
findings on slit lamp examination of anterior uveitis?
Cell and Flare (turbidity in aqueous humour), Keratic Precipitates, Hypopyon
177
cause of eczema herpeticum?
HSV 1 and 2
178
pathophysiology of lupus nephritis?
immune complex deposition on basement membrane.
179
name some SLE treatments and class of drug?
Methotrexate – immunosuppressant
Corticosteroid – prednisolone
NSAID – naproxen
Hydroxychloroquine
180
signs of examination on ascites?
Shifting dullness, fluid thrill
181
signs in hands of chronic liver disease?
Palmar erythema, spider naevi, clubbing, leukonychia (white spots on nails), dupuytrens contracture,
asterixis/liver flap. Other – jaundice, gynaecomastia
182
complications of chronic liver disease?
```
varices
cirrhosis
liver failure
hepatocellular carcinoma
hepatic encephalopathy – raised ammonia
itching
bruising – decreased production of clotting factors
```
183
pathophysiology of pleural effusion?
increased vascular permeability causes fluid to move into pleural space
184
is a pleural fluid protein of 55 a transudate or exudate?
exudate a >30g/L
185
how to diagnose TB?
microscopy – acid-fast bacilli on Ziehl-Neelson stain,
186
why does an AKI cause tachypnoea?
metabolic acidosis caused by raised urea
| trying to blow off C02 to compensate
187
risk factors for T2DM?
```
Overweight
age
FH
ethnicity
hypertension
gestational diabetes
heart disease or stroke
depression
PCOS
```
188
signs of inflammatory arthritis?
Pain in the morning
Systemic features
Raised inflammatory markers
189
signs of hyperthyroidism?
Irregularly, irregular pulse
pretibial myoedema
thyroid acropatchy- clubbing
inappropriate dressing
190
signs of psoriatic arthritis?
nail pitting
| alopecia
191
which 2 places to ask to check in psoriatic arthritis?
behind ears
| base of spine
192
tx of PVD?
Stents
| bypass surgery
193
causes of poor ulcer healing?
poor perfusion
decreased mobility
malnutrition
194
what is insertion of tendon to bone called?
enthesis
195
symptoms of T2DM?
```
polydipsia
polyuria
abdo pain
ED
recurrent UTI
thrush
```
196
RFs for angina?
```
smoking
DM
hypertension
age
FH
obesity
hyperlipidaemia
```
197
secondary care ix of angina?
CT coronary angiography
| exercise tolerance test with ECG
198
drugs for angina?
everyone has GTN, statin and aspirin
| BB e.g. bisoprolol or CCB nifedipine (if combined with BB)
199
indicators for legionella pneumonia?
low sodium
travel history
bradycardia
dry cough
200
6 Ix for haematuria?
```
urine dipstick
urine culture
bloods- clotting, FBC, LFT
flexible cystoscopy
CT KUB?
XR/ CT
```
201
most common type of renal cell cancer?
clear cell
202
inherited risk factor for RCC?
Von- Hippel Lindau
203
4 side effects of chemotherapy?
alopecia
nausea
constipation
peripheral neuropathy
204
tx of neutropenic sepsis?
tazocin IV- penicillin (piperacillin) with beta-lactamase inhibitor (tazobactam)
205
complications of chemo?
immunosuppression
cardiomyopathy
renal failure
206
complications of MI
```
heart failure
pericarditis
dressler's syndrome
mitral regurgitation
LVH
```
207
immediate management of HF
Loop diuretics
O2
Opiates
Nitrates
208
drugs of glaucoma
BB- timolol
prostaglandin analogue- lantoprost
carbonic anhydrase inhibitors- dorzolamide
oral/iv acetazolamide
pilocarpine drips (mydriatic)- constrict pupil
prevent recurrence- laser iridotomy
209
why can asthma cause cushings syndrome?
exogenous steroids
210
what is a confounder?
when an apparent association between an exposure and an outcome is actually the result of another factor e.g. office workers seem to be more likely to get lung cancer, but in fact more of them smoke
211
features on a DRE that could point to prostate disease?
tender, boggy= prostatis
smooth, enlarged= BPH
craggy, irregular, enlarged= prostate cancer
212
diagnosis of prostate cancer?
TRUSS biopsy
213
what is passivity
were someone feels they are controlled by another person e.g. commanding a mother to kill their baby
214
mx of puerperal psychosis?
atypical antipsychotic- risperidone, olanzapine
CBT
talking therapy
215
immediate treatments for liver failure?
lactulose- prevent hepatic encephalopathy
| vitamin K/ beriplex- to increase clotting factors
216
hormone blood tests done in a sexual health disorder?
```
testosterone and SHBG and albumin
LH/FSH
oestrogen
day 21 progesterone
free androgen index
prolactin
TFTs
semen analysis
```
217
four complications you might see in this RA patient after a routine surgical procedure?
adrenal crisis from stopping prednisolone
infection from steroid
hypercoagulable state- increased VTE risk
immune suppression from methotrexate
218
what is included in PESI score?
```
30 day outcome in PE
male
malignancy
heart failure
chronic lung disease
tachycardia
hypotension
etc
```
219
what causes compartment syndrome?
increased pressure in the tissue in an anatomical area leads to necrosis and compression of structures
due to an increase in fluid building up pressure so tissue pressure is higher than capillary pressure
220
drugs that contraindicate with warfarin?
any drug that prolongs QT
| e.g. amiodarone, haloperidol, bendroflumethazide
221
what is serotonin syndrome?
cognitive impairment
autonomic dysfunction
neuromuscular hyperactivity
tx= benzodiazepine
222
mx of status epilepticus
buccal midazolam-> IV lorazepam -> contact anaesthetist -> phenytoin, sodium valproate, phenobarbitol
remember to do a blood glucose to exclude hypoglycaemia
223
drug for alcohol withdrawal?
chlordiazepoxide
224
Ix in addisons
Short synacthen test- cortisol doesn't increase in problem with adrenals
CT adrenals
adrenal auto-antibody
225
mx of addisonian crisis?
stress-dose hydrocortisone -> saline -> dextrose (and normal dose hydrocortisone)
226
how to prevent addisonian crisis?
steroid sick days
increase in exercise
compliance
medical alert bracelet
227
signs of a deteriorating baby?
```
firm fontanelle
dry mucous membranes
no response
cyanosed
tachycardia
floppy
reduced urine output
not feeding properly
```
228
bloods of paediatric sepsis?
```
FBC
CRP
Coagulation screen
blood cultures
ABG
BG
lactate
```
229
paediatric sepsis 6?
```
O2
IV or IV Abx
IV fluids
get senior help
inotropes e.g. DA
```
230
what class of drug is cyclophosphamide?
alkylating agent
231
well's score for PE?
```
signs and symptoms of DVT
alternative diagnosis less likely
tachycardia
immobilisation
prev DVT/PE
haemoptysis
maligancy
```
232
signs of PE?
```
haemoptyis
dyspnoea
tachycardia
fever
crackles
chest pain
```
233
differentials for dysphagia?
cancer
pharyngeal pouch
MND
achalasia
234
side effects of over treating with levothyroxine?
```
thyrotoxicosis
AF
worsening of angina
palpitations
altered mental state
tremor
```
235
mx of leg injury in ambulance?
```
IV access
gas and air
morphine
immobilise
ice and elevate to prevent compartment syndrome
```
236
surgical mx of burns?
escarotomy
| fasciotomy
237
why do sickle cell pts have increased risk of gallstones?
haemolysis causes increased bilirubin-> stones
238
prophylactic surgery of sickle cell?
splenectomy
239
drug mx of sickle cell?
hydroxycarbamide (increases foetal Hb)
| its an anti-metabolite
240
signs of opioid withdrawal?
restlessness, pupil dilatation, insomnia, sweating, N&V, diarrhoea
241
signs of opioid toxicity?
```
hypotensive
tachycardia
pupil constriction
resp depression
constipation
```
242
mx of IVDU addict?
sexual health screen
needle exchange
immunisation
243
causes of intra-abdominal sepsis?
staph aureus- anaerobe
E.Coli- gram-negative
Enterococcus
244
why does lactate go up in intra-abdominal sepsis?
hypoxia causes anaerobic respiration which causes lactate production
sign of increased mortality
245
2 features of cauda equina in perianal area?
anal wink, saddle anaesthesia
246
features of quinsy?
deviated uvula, purulent tonsils, trismus, painful swallowing
247
UMN signs? (L1 and above)
```
upgoing plantars
hypertonia
brisk reflexes
weakness
retention
```
248
what is efficiency?
max benefit from resource allocation
249
cerebral complications of malaria?
confusion, coma, seizures
250
severe complications of malaria?
seizures, AKI, DIC, sepsis, hypoglycaemia
251
2 things to test before lithium
eGFR, TFT
252
what causes horner's syndrome?
sympathetic nerve fibres
253
features of bulbar palsy?
LMN
| dysarthria, dysphagia, drooling, absent gag reflex, fasciculating tongue
254
differentials of facial nerve palsy?
bells palsy, ramsey-hunt syndrome, parotid tumour
