Past Papers Flashcards
(172 cards)
1
Q
Shoulder and hip girdle pain
Raised inflammatory markers
Not responding to steroids
Possible diagnosis?
A
Rheumatoid arthritis - can present as polymyalgia syndrome before articular features
2
Q
Non convulsive status epilepticus
- investigation findings
A
Usually signs link rapid blinking, twitching, may be confused but will be responsive
Must last more than 30 minutes
Need EEG to confirm, normal lactate usually (nil tonic clonic activity)
3
Q
What do you need to do prior to starting RCHOP?
A
Hepatitis B serology
Rituximab can reactivate
4
Q
Atrial fibrillation
Unable to rate control with beta blocker
A
Diltiazem or digoxin if possible
Remember other agents e.g. amiodarone will cardiovert patient
5
Q
Diagnosis of sleeping sickness
A
Can use serology/lymph node biopsy, ideally LP
Any neurological involvement will need treatment
6
Q
Autoimmune hepatitis
Raised IgG
A
Type 1 Autoimmune Hepatitis
7
Q
Determining salicylate overdose
Management
A
> 450 - moderate overdose, treat IV bicarbonate
> 700 or resistant acidosis/neurological sequale, consider haemodialysis
8
Q
Indication for hyperbaric oxygen in CO poisoning
A
Carboxyhaemoglobin levels >25%
9
Q
Nerve palsy CN III, IV, V
How to determine location of lesion
A
Use which branches of CN V are involved, remember V1 superior orbital fissure, V2 foramen rotundum
If multiple branches involved = cavernous sinus
10
Q
Uniform capillary wall deposits IgG and C3
A
Membranous glomerulonephritis
11
Q
Management of membranous nephropathy
A
BP control with ACE inhibitor
Immunosuppression e.g. oral prednisolone
12
Q
Management of necrobiosis lipodica
A
Topical corticosteroids
13
Q
Secondary prevention in CKD
A
No need for QRISK
Start statin straight away
14
Q
Eccentric
Social isolation
Inappropriate affect
- personality disorder?
A
Schizotypal
15
Q
What do you need to diagnose someone with an insulinoma/begin further investigation?
A
Hypoglycaemic symptoms which coincide with hypoglycaemia
Symptoms improve with raising blood sugar
16
Q
How to differentiate between 1y hyperparathyroidism and familial hypocalciuric hypercalcaemia
PTH levels?
A
PO4- level
1y = low (XS PTH promotes phosphate excretion by the kidneys)
Familial hypocalciruic = normal PO4-, may have normal/high PTH
17
Q
What do you need on renal biopsy of Alport’s syndrome?
A
Electron microscopy
18
Q
CSF results in cryptococcal meningitis
A
Low glucose
Elevated protein
Raised opening pressure
19
Q
Management of gastroparesis
A
Domperidone
Can also use metoclopramide
20
Q
How to manage cisplatin related nephrotoxicity
A
Switch to platinum alternative e.g. carboplatin
21
Q
Management of Takaysau’s arteritis
A
Prednisolone
22
Q
Differentiating between pseudo-Cushing’s and Cushing’s
A
Pseudo = retain diurnal variation of cortisol, check a midnight level
Cushing’s = loss of diurnal, persistently high
23
Q
Management of thyroid eye disease
A
Consider the severity
Mild = nil optic nerve involvement
Artificial tears and smoking cessation
Moderate/severe = steroids
24
Q
When would you use SGLT2 as second line?
A
CVD disease e.g. hypertension
ACR >30
25
Lower limb weakness
Painful paraesthesia
Reduced sensation distally
Absent ankle jerks
Fasciculations
Diabetic Amyotrophy
26
How often should those with cirrhosis be screened for HCC?
Every 6 months
27
Option for xanthelasma management
Topical trichloroacetic acid
28
Likely diagnosis HIT - test you can use to confirm
Serotonin release assay
29
Initial management of diabetes
- metformin contraindicated
If CVD disease - SGLT2 monotherapy
30
Management of Flu A
- immunocompromised
Zanamivir
31
Indication of severe AS - heart sounds
Soft S2
32
What type of amyloidosis is associated with inflammatory conditions?
AA amyloidosis
33
Treatment associated with increased risk of delayed bleeding
Plasma exchange
- depleted of clotting factors etc
34
First presentation of uncal herniation
Ipsilateral CN III palsy
35
What is moraxella seen in association with?
COPD
36
How can you avoid post-LP headache?
By re-inserting the stylet when removing the needle
Volume of CSF removed largely doesn't make a difference
37
How do you manage bone and joint TB?
Same - 2 months RIPE and 4 months rifampicin and isoniazid
37
Biopsy findings in anti-GBM disease
Linear IgG and C3 deposits in the membrane with crescenteric glomerulonephritis
38
Lung nodule follow up
<5mm - no further follow up
5-8mm - CT in three months
>8mm - Brock risk stratification, likely to have PET CT
39
Cardiac arrest
P waves only on monitor
Management?
Consider ventricular standstill - consider pacing
39
Management of small bowel obstruction 2y to metastatic cancer
Dexamethasone
40
Investigations in acute GBS
Nerve conduction studies may be normal
Will see elevated CSF protein
41
CT findings in normal pressure hydrocephalus
Ventriculomegaly
Normal sized sulci/gyrus
41
What pre-excitation disorders are there?
Wolff Parkinson White - short PR, delta wave
Lown-Ganong-Levine - short PR, no delta wave
41
Features of pseudogout on XR
Calcification of meniscus
Knee - may see calcification of the patellar/quadriceps tendon
41
What can you use in HUS?
Eculizumab
Reduces complement activation which drives the haemolytic process
41
Investigation of choice in MND
Electromyography
42
Investigation of choice in sarcoidosis
Pulmonary function tests
43
Management of lytic bone lesions in myeloma
- isolated
- risk of fracture
Single = denosumab
Fracture risk = radiotherapy
44
Management of Lambert Eaton Syndrome
Amifampridine
= blocks K+ channels to extend action potential, allows Ca2+ channels to be open for a longer duration, more ACh release
45
Management of urinary schistomiasis
Praziquantel
46
Differentiating pituitary tumours
Microadenoma = no visual field defects
Macroadenoma = very high prolactin, often visual field defect
Non-functioning = often see hypopituitarism as a result of compression
47
What can be used to manage delirium in Parkinson's disease?
Lorazepam
48
Multiple transfusions
Hypoxia
Pyrexia
Hypotension
- diagnosis
Transfusion associated lung injury
The pyrexia helps differentiate
49
Management options for remission of membranous nephropathy
Rituximab
Prednisolone + cyclophosphamide (obviously avoid in young people)
50
Management option in IBD resistant to TNFa inhibitor/not suitable for TBFa I
- mechanism of action
Vedolizumab
= integrin antagonist, blocks white cell movement across the intestinal epithelium
51
What renal stones are associated with small bowel overgrowth?
Calcium oxolate
= fat malabsorption associated with increased oxolate absorption
52
What is associated with the best prognosis in cardiac arrest?
Ventricular Tachycardia
53
Multi-infarct dementia - presentation
Various steps in altered cognition
e.g. memory around cooking, then names then items to do
Cardiac risk factors
54
Causes of axonal neuropathy (10)
Diabetes
HIV
B12 deficiency
Hypothyroidism
Uraemia
Chemotherapy
Paraneoplastic
Paraproteinaemia
Tropical spastic paraparesis
Cryoglobulinaemia vasculitis
55
Nerve conduction studies
- reduced amplitude of signals
= axonal neuropathy
Number of axons are less due to damage, results in weaker signal
56
Nerve conduction studies
- decreased signal velocity
= demyelinating neuropathy
57
Pattern of loss in axonal neuopathies
Sensory loss first, distal then proximal
- this is because longer fibres are affected first
Hands affected only when at level of knees
Motor involvement is later
Deep tendon reflexes lost
58
Pattern of loss in demyelinating neuropathies
Motor loss first with motor weakness a prominent feature
Remember some sensory nerves are myelinated - these can be affected by demyelination in multiple sclerosis giving sensory symptoms
59
Reflexes
- UMN lesion
- LMN lesion
Upper = hyper reflexic deep tendon reflexes, absent superficial reflexes
Lower = absent deep tendon reflexes
60
Paraparesis
- UMN lesion
- LMN lesion
Upper = spastic
Lower = flaccid
61
Features of erythroderma
Systemic upset
Bright red
Often associated with recent cessation of PO steroid
62
Contraindication to use of ciclosporin
Chronic kidney disease
63
Differentiating between essential tremor and parkinson's diagnosis
SPECT imaging
64
When would you use rifaximin?
In the prophylaxis of hepatic encephalopathy
No role in acute management
65
Key feature of accelerated idioventricular rhythm
No p waves present
66
Prolonged APTT
What can you use to determine cause?
Results?
Mixing study
If factor deficiency = APTT improves with mixing
If factor inhibitor = nil improvement with mixing, likely acquired Haem A
67
What is a cause of acquired haem A?
Clopidogrel
68
Distinguish between Familial Mediterranean Fever and Behcet's Disease
Both may present with pyrexia, abdominal pain, arthralgia
FMF = NO ulcers, high fever and high CRP
MEFV mutation
Behcet's = ulcers, normal CRP
Pathergy test
69
Low dose dexamethasone suppression test (1mg overnight or two day test)
Result = Cortisol high at end of test
= Cushing's syndrome
Further test to localise - either insulin stress test or high dose dexamethasone test
70
High dose dexamethasone suppression test
- results and diagnosis
Suppress cortisol = Cushing's disease (adenoma)
No suppression of cortisol = ACTH ectopic source
71
Insulin tolerance test - what does it aim to do?
Induce hypoglycaemia to see whether there is a ACTH/cortisol response
72
Insulin tolerance test
Result: hypoglycaemia + high ACTH/cortisol
Pseudo-Cushing's
73
What is a metallo beta-lactamase?
CPE
74
Antibiotic options for CPE?
Colistin
Tigecycline
Fosfomycin
Gentamicin
75
What anti-emetic is of use in delayed phase emesis?
Dexamethasone
76
Shortness of breath
Purulent cough
Macular rash on face
Atypical pneumonia
Psittacosis
77
How does methylene blue work?
Reduction of Fe3+ to Fe2+
78
Option for nausea in long QT syndrome
Aprepitant
79
What is the chance of focal segmental glomerulosclerosis going into spontaneous remission?
<10% chance
80
Livedo reticularis - associations (3)
Anti-phospholipid syndrome
Cholesterol embolism
Polyarteritis nodosa
81
Management of chicken pox
- immunocompromised
IV aciclovir
- can use oral if nil systemic upset
- if symptomatic too late for immunoglobulin
82
Modest CK elevation
Muscle weakness
Anti-TPO antibodies
Hypothyroidism
- can be associated with CK elevation in untreated disease
83
Acute hepatitis - associated with HIV seroconversion?
NO
84
Hypertension
Hypokalaemia
Raised renin and aldosterone
- diagnosis?
Fibromuscular dysplasia
= reduced renal perfusion, activates RAAS system
85
Hypertension
Hypokalaemia
Low renin and raised aldosterone
- diagnosis
Conn's syndrome
86
Management of T2 N1 NSCLC (ipsilateral hilar node)
Pneumonectomy if well
87
Distinguish between Becker and Myotonic
Largely age - myotonic longer life expectancy
88
+VE edrophonium test
Myaesthenia gravis
89
What are the stages of treatment of prostate cancer?
Bicalutamide - androgen antagonist, blocks receptors in tumour and prevents tumour flare with use of GnRH agonist (Gosrelin)
90
Polymyositis - extra-muscular mainfestations
ILD
91
Can you use warfarin in pregnancy?
No - contraindicated
92
Management of BPH
Finasteride - good option, takes a while to get to therapeutic effect
Doxazosin - gives immediate improvement to symptoms, relaxes the smooth muscle
93
Electrical management of HF + EF low and broad QRS
Usually CRT-P
CRT-D if there has been evidence of ventricular arrhythmia
94
Management of malaria
Uncomplicated = artemether + lumefantine
Complicated
e.g. significant parasetaemia
= IV artesunate, bolus initially
95
VT vs SVT
All complexes in the chest leads should be uniform (i.e. not a mixture of broad and narrow) in VT
If V1-V3 broad consider SVT with RBBB
96
Achalasia - weight?
Can remain stable
97
Management of hepatorenal syndrome
Type 1 = rapid decline of renal function
1st - terlipressin to promote splanchnic vasoconstriction, increase circulating volume
2nd - TIPSS
98
Initiation of NIV
- nil improvement after 1 hour
Consider elective intubation and ventilation
99
1st line investigation of hypoadrenalism
Short synacthen test
100
How many PVCs are you allowed a day?
<10%
= approx 10'000 per day
101
Management option in digoxin toxicity
Digoxin immune Fab
= fragments of antibodies
102
What is CLL associated with? Increased risk?
Autoimmune haemolytic anaemia
Increased risk with fludarabine
103
What is the mechanism behind hyperchloraemic metabolic acidosis following DKA correction?
Plasma volume expansion
(not excessive replacement)
104
Confused
Nausea
Initial dialysis
- diagnosis
- management?
Dialysis dysequilibrium syndrome
Sodium modelling - can use a button on the machine to change the sodium content of the dialysate
105
Option for behavioural issues in Alzheimer's Disease
Atypical antipsychotic
e.g. risperidone
106
Management of histoplasmosis
Itraconazole
107
Confirmation of brain stem death
Apnoea testing
108
Hoarding and self-neglect
- diagnosis
- management
Diogenes syndrome
CBT
109
Management of VTE
- what do you need to consider?
Renal impairment - then LMWH not suitable
Use unfractionated instead
110
Vertebral dissection
- investigation of choice
MRI head + MRA
111
What can you see high levels of post seizure?
Hyperprolactinaemia
The epileptic activity propagates to the hypothalamus and triggers excessive prolactin release from the pituitary gland
112
Management of chronic paroxysmal hemicrania
Indomethacin
Can be used to aid diagnosis - should have excellent response
113
What is a cause of transient conjugated hyperbilirubinaemia?
Dubin-Johnson Syndrome
- all other causes are unconjugated
114
Management of cystinuria
Pencillamine
115
What can interact with diltiazem?
Ciclosporin
116
HIV medication + renal complication
Atazanvir
Associated with crystal nephropathy
Manage with hydration
117
Eosinophilia
Penicillin based antibiotics
Proteinuria
Haematuria
Acute tubular necrosis
118
What is the mechanism of action of dobutamine?
Increased inotropic action
119
Diagnosis of obesity hypoventilation syndrome
Raised BMI
Day pCO2 >6
Nil alternative cause identified
Remember OSA not a clinical diagnosis
120
Assessment of ?airway obstruction
Flow volume loop
121
Management of legionella
Levofloxacin
122
Bilateral PERIPHERAL infiltrates
Hard to control asthma
Raised IgG and ESR
Chronic eosinophilic pneumonia
123
Melanosis coli
Laxative abuse - specifically SENNA
124
Management of relapsing/remitting MS
Dimethyl fumarate
125
Progressive visual loss
Hypertension
Central vein occlusion
126
Test to confirm medullary thyroid cancer
Pentagastrin stimulation
127
What can insulin trigger?
Ventricular failure - promotes salt and water retention
128
Contraindication for furosemide
Pregnancy
= reduced placental perfusion
129
Management of cholera
Erythromcyin
130
Fibrate
How to manage in line with renal function?
Need to reduce dose in eGFR <60
131
Jaundice
Hepatomegaly
Abnormal LFTs
Liver transplant
- diagnosis
- management
Acute graft VS host disease
Hepatic US/doppler US
132
Pupil in Horner's syndrome
Constricted pupil
Will NOT respond to atropine
133
Cause of hyperprolactinaemia
CKD
Urea reduces dopamine release
= increased release of prolactin
134
Risk of immune checkpoint inhibitors
Colitis
Treat with IV steroids
135
Mechanism behind GORD in systemic sclerosis
Oesophageal dysmotility
CCB and prokinetics superior to PPI
136
How often should people with Peutz-Jegher's get a colonoscopy?
Every 3 years
137
Management of Familial Mediterranean Fever
Colchicine
138
Wrist dorsiflexion =
Wrist extension
139
Foreign travel
Transient non-erythematous swellings
Loa Loa
140
Management of latent TB
3 months RIP
or
6 months IP
141
What can reduce iron absorption?
Calcium/zinc/magnesium supplements
142
Management of Kawasaki's Disease
IVIg and aspirin
143
Management of asbestosis
Nil specialist management, conservative
144
CSF in HSV encephalitis
Raised protein
Raised WCC - lymphocyte predominant
Normal glucose
145
What types of malaria are prone to relapsing?
Vivax
Ovale
146
Indications for CMV negative blood
Neonates
Pregnant women
Intrauterine transfusions
147
Serum electrophoresis VS serum free light chains
Different things
Sometimes serum free light chains can detect what electrophoresis cannot
148
Differentiating between 11 and 21 hydroxylase deficiency
11 = hypertension
21 = normotension
149
What does disulfiram do?
Unpleasant side effects when continue to drink
Nausea, vomiting, flushing, arrhythmias
150
Large volume of stool in spite of fasting
= secretory diarrhoea
e.g. VIPoma
151
Management of Mobitz II and third degree heart block
DDD pacemaker - need to pace atria and ventricles
152
Absence seizures - management
Levetiracetam or lamotrigine
153
MS management - what to consider?
Don't need IV steroids if not having a flare
Likely need to refer to MDT for decision about drug modifying treatment
154
VTE
Pancytopaenia
Urine Hb not haematuria
- diagnosis
Paroxysmal nocturnal haemoglobulinuria
155
TB drugs - drug-induced lupus?
Isoniazid
156
Management of body dysmorphia
Exposure and response prevention therapy
157
Meningitis
Immunsuppressed
Ependymal enhancement
CSF = increased protein, decreased glucose, mild rise in opening pressure
CMV meningoencephalitis
158
Cause of low HDL and raised trigylcerides
Diabetes
159
Mucocutaneous lesions
Breast cancer
FH colon cancer
- diagnosis
- genetics
Peutz Jegher's syndrome
STK11
160
Dark pink lesions on shin with orange peel appearance
Pretibial myxoedema
161
Features of Grave's Disease
Pretibial myxoedema
Acropachy
162
Can you have Grave's Eye Disease with normal TFTs?
Yes
163
What suggests increasing severity in mitral stenosis?
Increased duration of murmur
164
Digoxin toxicity and VT
IV lidocaine/lignocaine
165
Diagnostic test of Lambert Eaton Syndrome
NCS and EMG
166
What is the mechanism of action of oseltamivir
Neuroaminidase inhibitor
