PM3 Flashcards
1
Q
Allopurinol and which drug increase the risk of myelosuppresion / agranulocytosis? [1]
A
aziothropine and allopurinol
2
Q
Sulphonylureas can cause which electrolyte disturbance and why? [1]
A
Hyponatraemia - due to causing SIADH
3
Q
How can you think of LADA and MODY with regards to how similar they are to DMT1 and DMT2? [2]
A
LADA
- ‘Adult variant-T1DM
- More likely to present with DKA
MODY
- ‘Young variant-T2DM’
4
Q
sore throat + joint pains + pink, ring shaped lesions = ??
A
Rheumatic fever
5
Q
BMI > 35 + prediabetic indicates what treatment? [1]
A
GLP-1 agonist
Ozempic season
6
Q
Prolactinoma = 1st line tx? [1]
A
Cabergoline
7
Q
HIV +Ve patients should avoid which vaccines? [4]
A
Live attenuated vaccines
* BCG
* MMR
* oral polio
* yellow fever
* oral typhoid
8
Q
Aspirin OD < 1hrs ago = Tx? [1]
A
Activated charcoal can be used within an hour of an aspirin overdose
9
Q
You want to prescribe diclofenac. What should you check with a patient before prescribing? [1]
A
Diclofenac is now contraindicated with any form of cardiovascular disease
10
Q
What is important to note about where in the body you’re giving adrenaline? [1]
A
Don’t give in small vessels as causes ischaemia
11
Q
A patient is given aspirin 300 mg after developing an acute coronary syndrome. What is the mechanism of action of aspirin to achieve an antiplatelet effect?
Inhibits the production of thromboxane A2
Inhibits ADP binding to its platelet receptor
Inhibits the production of prostaglandin H2
Glycoprotein IIb/IIIa receptor antagonist
Inhibits the production of prostacyclin (PGI2)
A
A patient is given aspirin 300 mg after developing an acute coronary syndrome. What is the mechanism of action of aspirin to achieve an antiplatelet effect?
Inhibits the production of thromboxane A2
Inhibits ADP binding to its platelet receptor
Inhibits the production of prostaglandin H2
Glycoprotein IIb/IIIa receptor antagonist
Inhibits the production of prostacyclin (PGI2)
12
Q
A 44-year-old man asks for advice. He is due to go on a long bus journey but suffers from debilitating motion sickness. Which one of the following medications is most likely to prevent motion sickness?
Cyclizine
Chlorpromazine
Metoclopramide
Prochlorperazine
Domperidone
Score
A
Cyclizine
13
Q
Jaundice, chest pain radiating to the back. Also a DMT2 patient. Which drug could have caused this?
- Sulfonyurea
- Biguanides
- GLP-1 agonist
- DPP-4 inhibitor
- Insulin
A
Jaundice, chest pain radiating to the back. Also a DMT2 patient. Which drug could have caused this?
- Sulfonyurea
- Biguanides
- GLP-1 agonist
- DPP-4 inhibitor - cause pancreatitis
- Insulin
14
Q
How do you give morphine in an A&E setting? [1]
A
1-2 bolus then titrate
15
Q
Which marker is used to assess the severity of cirrhosis [1] and overall liver function? [1]
A
Cirrhosis: ALT
Liver function: PT
16
Q
A patient has suspect Lymes disease. How do you confirm this suspicion? [1]
A
ELISA test - blood test for serology
17
Q
Give three examples of a unit of alcohol [3]
A
25ml single measure of spirits (ABV 40%)
a third of a pint of beer (ABV 5 to 6%)
half a 175ml ‘standard’ glass of red wine (ABV 12%)
18
Q
An ECG demonstrated torsade de pointes
What electrolyte abnormality is most likely to have caused this deterioration? [1]
A
hypomagnesaemia
19
Q
Which further investigation will confirm if mycoplasma is causing an infection? [1]
A
serology is diagnostic
Sputum microscopy, culture, and sensitivity would be a reasonable investigation to request. It can identify a range of pathogens but is not the preferred investigation for identifying Mycoplasma pneumoniae which is the most likely diagnosis in this instance.
20
Q
HIV presents with malaise and loose stools = ?
A
Cryptosporidium parvum
21
Q
[] should be avoided in patients with HOCM
ACEin
Loop diuretic
CCB
BB
A
[] should be avoided in patients with HOCM
ACEin
ACE inhibitors can reduce afterload which may worsen the LVOT gradient
22
Q
Bisferiens pulse - caused by? [2]
A
Bisferiens pulse - mixed aortic valve disease & (HOCM may occasionally be associated with a bisferiens pulse)
23
Q
How do you calculate NNT? [1]
e.g. This prevention study for stroke reveals that 20 patients need to be treated to prevent one event.
A
It is calculated by 1/(Absolute risk reduction) and is rounded to the next highest whole number (aka: the NTT is the number of patients needed to be given treatment for a single patient to benefit/ not have a bad outcome.)
- The absolute risk reduction (ARR) may be calculated by finding the absolute difference between the control event rate (CER) and the experimental event rate (EER)
- This prevention study for stroke reveals that 20 patients need to be treated to prevent one event.
- Thus if you treat 1000 patients then you will expect to have 50 fewer strokes.
24
Q
How do you treat alcoholic ketoacidosis? [1]
A
Alcoholic ketoacidosis is managed with an infusion of saline and thiamine
25
**[]** is used in non-falciparum malaria to destroy liver hypnozoites and prevent relapse
**Primaquine** is used in **non-falciparum malaria** to destroy liver hypnozoites and prevent relapse
26
Sickle cell anaemia causing osteomyelitis is usually precipitated by which pathogen? [1]
**Salmonella species**
27
A 9-year-old boy presents to his GP with his father complaining of an itchiness over his scalp. His father has noticed a rash that has grown in size over the past 3 days. The boy feels well in himself and denies any other symptoms. He lives in a smoke-free home with his father, mother, 6-year-old sister and their cat, which sleeps on the boy’s bed.
A set of observations are performed, which reveal:
Temperature 36.9 °C
HR 71 bpm
Oxygen saturation 99% in room air
A photograph of the rash is taken for the boy’s medical records, which is shown below.
What is the best treatment option for him? [1]
**Oral itraconazole and topical ketoconazole**
- This child has presented with** tinea capitis or scalp ringworm**, most likely from exposure from shedding of cat hair contaminated with fungal spores. Oral antifungals are required for treatment of tinea capitis owing to poor penetrance of topical agents through the root of the hair follicle. Adjunct treatment with topical agents can help to reduce spore transmission to family members.
28
ormal valve – Staph A -> [1[]
Abnormal native valve – strep viridans -> [1]
Prosthetic valve – first year after surgery= staph A -> [1], >1 yr after surgery= strep viridans
Native valve – 4 wks, prosthetic – 6 wks
ormal valve – Staph A -> **Flucloxacillin**
Abnormal native valve – strep viridans -> **benzylpenicillin**
Prosthetic valve – first year after surgery= staph A -> **flucloxacillin**, >1 yr after surgery= strep viridans
Native valve – 4 wks, prosthetic – 6 wks
29
Coagulase-negative, Gram-positive bacteria such as **[]** are the most common cause of neutropenic sepsis
Coagulase-negative, Gram-positive bacteria such as **Staphylococcus** **epidermidis** are the most common cause of neutropenic sepsis
30
[] is the intervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma
**Biliary stenting** is the intervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma
31
**[]** gastroenteritis is characterised by a short incubation period and severe vomiting
**Staphylococcus aureus** gastroenteritis is characterised by a short incubation period and severe vomiting
32
Tx for In patients with sigmoid volvulus who have bowel obstruction with symptoms of peritonitis? [1]
In patients with sigmoid volvulus who have bowel obstruction with symptoms of peritonitis, **skip the flexible sigmoidoscopy and treat with urgent midline laparotomy**
33
[] typically presents with flu like illness → brief remission→ followed by jaundice and haematemesis
Y**ellow fever** typically presents with flu like illness → brief remission→ followed by jaundice and haematemesis
34
On examination, there is a widespread urticarial rash.
Which of her medications is the most likely cause?
Amlodipine
Aspirin
Bisoprolol
Losartan
Metformin
On examination, there is a widespread urticarial rash.
Which of her medications is the most likely cause?
Amlodipine
**Aspirin**
Bisoprolol
Losartan
Metformin
35
Which abx should be avoided in G6PD deficiency? [1]
Macrolides e.g. ciprofloxacin
36
How do you determine between AKI caused by rhabdo vs dehydration? [1]
**Rhabdomyolysis** would give a
**CK of >10,000.**
**Dehydration** causes increased **urea and creatinine ++**
37
Describe some key differences between delerium tremens and Korsakoff's pyschosis
38
What is one aspect with timing that would indicate a person is suffering from renal hypoperfusion c.f. interstitial nephritis? [1]
Interstitial nephritis would normally not appear **until 4-7 days of antibiotic exposure** and is relatively rare.
39
How do you know when to give alendronic vs zolendronic acid? [1]
**Zoledronate** is only administered **intravenously** and is reserved for those intolerant of an oral bisphosphonate.
40
A patient with hypertensio presents with sudden blindness. They say that they also see flashing lights.
What is this pathology and describe why its ocurring
41
If toxicity is suspected, digoxin concentrations should be measured within **[]** to **[]** hours of the last dose
If toxicity is suspected, digoxin concentrations should be measured within **8 to 12** hours of the last dose
42
How do you treat an asymptomatic patient with long term catheter who has grown significant amount of bacteria within catheter? [1]
In the absence of symptoms, antimicrobial therapy is **generally not recommended** except in pregnant patients
43
How do you determine if a patient has klinefetlers or kallmans based off their LH / FSH results? [2]
* FSH/LH Climb in Klinefelter's
* FSH/LH Fall in Kallman's
Climbfelters and Fallmans
44
Patient with green wound - what is the likely infective organsim? []1
green wound = **pseudomnas aerugonisa**.
45
**[]** is recommended after a woman has had a **wide-local excision** as this may reduce the risk of recurrence by around two-thirds
**Whole breast radiotherapy** is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds
46
A patient has DKA.
You notice their P levels are 0.1
How would you correct them? [1]
Continue with current insulin therapy and initiate parenteral phosphate replacement therapy
47
Which organisms need positive serology for Dukes Criteria for IE (which are specific for it) [3]
Coxiella burnetii, Bartonella species or Chlamydia psittaci,
47
Severe cellulitis should be treated with [4]
Severe **c**ellulitis should be treated with **co-amoxiclav, cefuroxime, clindamycin or ceftriaxone**
| C4C
48
Use **rhythm** **control** to treat AF if there is [3]
Use rhythm control to treat AF if there is **coexistent heart failure, first onset AF or an obvious reversible cause**
## Footnote
Immediate DC cardioversion is only recommended when there is life-threatening haemodynamic instability caused by new-onset atrial fibrillation.
49
*IgG and C3 subepithelial deposit spikes*
This would indicate which renal pathology? [1]
**membranous nephropathy**
50
*Subepithelial humps in the glomeruli*
This would indicate which renal pathology? [1]
**post-streptococcal glomerulonephritis.**
51
Rust coloured sputum = which infective organism? [1]
Current jelly coloured sputum = which infective organism? [1]
Rust coloured sputum = **Strep pneumoniae**
Current jelly coloured sputum = **Klebsiella**
52
Hypothyroidism causes what type of anaemia? [1]
**Macrocytic** (non-megaloblastic)
53
what blood components are available for transfusion? when would each be indicated? [4]
**RBC**: haemorrhage, improve oxygenation (e.g. SCA, haemorrhage 30+%/1.5L+, anaemia)
**Plasma**: includes coag factors so indicated for anticoag reversal, or active bleed with INR > 1.6, or prior to surgery for pts on anticoag
**plts**: prevent haemorrhage in pts with thrombocytopenia/plt dysfunction. Contraindicated in TTP and heparin-thrombocytopenia
**cryoPpt**: high concentration factor 8 and fibrinogen. used in hypofibrinogenaemia (i.e. massive haemorrhage/DIC)
54
Describe the pathophysiology of common variable immune deficiency; how does it present on a investigation? [1]
How do patients commonly present? [3]
**Dysregulation of B cells** means that get:
- exhibit low levels of **IgG, IgA, and often IgM.**
Patients are at risk of developing:
- **Infections**
- **Autoimmune** **disorders** (e.g. ITP or AIHA)
- **Malignancies**
55
What are the different classes of anti-arrhythmic drugs? [4]
class 1: Na blockers (lidocaine, flec, procainamide)
class 2: BB (meto, propran)
class 3: K blockers (amiodarone)
clas 4: CCB (verapamil, diltiazem
56
caused by autoAbs against **proteinase 3**? [1]
GPA
57
Which of the following diseases is characterized by autoantibodies to IgG antibodies, and an association with HLA DR4?
AS
colitic arthropathy
reactive arthritis
RA
SLE
Which of the following diseases is characterized by autoantibodies to IgG antibodies, and an association with HLA DR4?
AS
colitic arthropathy
reactive arthritis
**RA**
SLE
58
AIHA is which type of HS?
Type 1
Type 2
Type 3
Type 4
AIHA is which type of HS?
Type 1
**Type 2** - IgG or IgM mediated
Type 3
Type 4
59
When do you use embolectomy or angioplasty in ALI? [2]
60
A 27 year old patient being treated for lymphoma goes to a party, and subsequently develops a cough and coryza. A viral throat swab is positive for influenza A. It is decided to treat this with an anti-viral drug.
Which one of the following drugs would be suitable?
acyclovir
valgancyclovir
lamivudine
oseltamivir
ribavirin
A 27 year old patient being treated for lymphoma goes to a party, and subsequently develops a cough and coryza. A viral throat swab is positive for influenza A. It is decided to treat this with an anti-viral drug.
Which one of the following drugs would be suitable?
acyclovir
valgancyclovir
lamivudine
**oseltamivir**
ribavirin
61
Name three ECG changes that would suggest sick sinus syndrome [3]
1. **Sinus bradycardia**
2. **Sinus pause > 3 secs AND escape rhythm**
3. **Tachy-brady** (usually bradycardia followed by SVT like AF)
62
How do you diagnose Brugada syndrome?
Diagnosis depends on a **characteristic ECG finding AND clinical criteria.**:
- **Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave.**
- AND
- **Documented ventricular fibrillation (VF)** or **polymorphic ventricular tachycardia (VT).**
- **Family history of sudden cardiac death at < 45 years old **.
63
What is the definitive tx of Brugada? [1]
Definitive treatment = ICD.
64
What is the definitive treatment of TDP? [1]
**ICD**
65
When do you give amodiarone and shock in VT? [1]
pulseless VT - shock
pulse & VT in amadiarone
66
When do you usually give ICD vs pacemakers? [1]
67
Name the different classes of anti-arrhtyhmics and give examples [+]
**Class 1: Na**
- Flecainade
- Lidocaine
- Phenytoin
**Class 2: BB**
- Propranolol
**Class 3: K**
- Amiodarone
- Sotalol
**Class 4: CCB**
- D&V
68
A patient has Bowen's disease of the breast.
This is what type of cancer
Bowen's disease is a form of **intraepidermal** (in situ) **squamous cell carcinoma (SCC)** of the skin
- can develop near / around breast / areola.
69
When should you instruct patients to take metformin? [1]
Why? [1]
When is modified release metformin taken? [1]
After their meals to reduce GI effects
**Modified release**
- Usually taken once daily with the evening meal. This formulation is designed to release the drug slowly, which can help reduce side effects.
70
Describe the ECG changes seen in posterior MI [+]
Horizontal ST depression in V1-3
Tall, broad R waves (> 30ms) in V2-3
Dominant R wave (R/S ratio > 1) in V2
Upright T waves in V2-3
71
Which ECG abnormality can be seen here.
What causes this? [2]
**J wave**
- Hypothermia
- Hypercalcaemia
- SAH
72
What makes up the CENTOR score? [4]
When do you treat? [[3]
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
Give abx if patients with acute sore throat/acute pharyngitis/acute tonsillitis when **3 or more Centor criteria are present**
73
Non-bloody diarrhoea x vomiting in a healthcare institution = ? [1]
Norovirus is notorious for causing outbreaks of non-bloody vomiting and diarrhoea in healthcare institutions.
74
A patient has WPW and also atrial fib or flutter.
Which drugs are CI and why? [1]
WPW that develop atrial fibrillation or flutter - **antiarrhythmic medications (beta blockers, calcium channel blockers, adenosine)** are CI as they increase the **risk of polymorphic wide complex tachycardia by reducing conduction** through the AV node and therefore promoting conduction through the accessory pathwa
75
What is the most common cause of:
- small bowel obstruction? [1]
- large bowel obstruction? [1]
Small - adhesions
Large - cancer
76
What are the different stages of AKI? [3]
Stage 1 = all the 1’s: 1.5-1.99x
Stage 2 = all the 2’s: 2-2.99x
Stage 3 = all the 3’s: 3x plus
77
What platelet levels do you give a platelet transfusion for:
- most patients [1]
- high risk bleed [1]
- surgery at critical site [1]
> 50—109/L for most patients
50-75—109/L if high risk of bleeding
>100—109/L if surgery at critical site
78
**[]** improves outcomes (by reducing neurological sequelae) in the treatment of bacterial meningitis
**Dexamethasone** improves outcomes (by reducing neurological sequelae) in the treatment of bacterial meningitis
| Give + ceftriaxone
79
creen
49. A 45-year-old is admitted with a history of central chest pain and being diagnosed as having pericarditis.
Which one of the following features of chest pain is most suggestive of pericarditis?
pain eased with leaning forward
pain eased with lying down
pain remains constant with changing position
pain worsened with expiration
pain worsened with leaning forward
creen
49. A 45-year-old is admitted with a history of central chest pain and being diagnosed as having pericarditis.
Which one of the following features of chest pain is most suggestive of pericarditis?
**pain eased with leaning forward**
80
At a diagnostic endoscopy, a 62-year-old man is found to have Barrett’s oesophagus.
Which one of the following statements regarding Barrett’s oesophagus is true?
has a 30-fold increase risk of adenocarcinoma of the oesophagus
has a 30-fold increase risk of squamous cell carcinoma of the oesophagus
is more common in females
occurs only in the >55 year age group
typically involves a segment less than 3 cm in length
**has a 30-fold increase risk of adenocarcinoma of the oesophagus**
81
**[]** describes a localised accumulation of fluid beneath the skin surface. They most commonly occur 7–10 days after breast surgery
**seroma**
*Lymphoedema describes the progressive build-up of lymphatic fluid, leading to swelling within a region of the body. While this can occur following breast surgery with lymph-node clearance, it **typically develops slowly over a period of 18–24 months post-surgery***
82
How to differentiate between the causes of warm and cold AIHA?
**Cold**:
- infection and malignancy
**Warm**:
- Autoimmune conditions (systemic lupus erythematosus and lymphoma)
83
When would you expect pigment stones causing RUQ pain? [1]
If a patient has a strong risk factor for **chronic haemolysis**:
- **G6PD deficiency**
84
What is the appropriate management for an infected wound? [1]
**Removal of sutures, washout of the wound and wound left open**
Closing an infected wound --> Gas gangrene risk
85
Burkitt's lymphoma is associated with which genetic change? [1]
Burkitt's lymphoma - **c-myc gene translocation**
86
The gene encoding the **low-density lipoprotein (LDL)** receptor is mutated in familial hypercholesterolaemia
The gene encoding the **[]** receptor is mutated in familial hypercholesterolaemia
87
A patient has a haemothorax. What would indicate a thoracostomy? [1]
**loss of blood > 1.5L**
88
89
The X-ray shows a number of features consistent with **left lower lobe collapse**. Firstly, the 'sail sign' is visible. This describes the triangular opacity in the medial aspect of the left lung with the apex pointing towards the left hilum. Secondly, a 'double cardiac contour' is visible. The cardiac silhouette can be seen separately to the edge of the collapsed left lower lobe. Lastly, the medial aspect of the left hemidiaphragm is obscured by the collapsed lobe. Lobar collapse occurs when the bronchus supplying that lobe is obstructed. Gas that is distal to the obstruction is absorbed into the bloodstream causing the lung volume to decrease, resulting in a lobar collapse. There are a number of different causes of lobar collapse: in children, it is most commonly caused by an inhaled foreign body; whereas in adults and the elderly, causes include infection, inflammation and malignancy. Given this patient's history, it is most likely that a lung cancer is the cause of his left lower lobe collapse.
54% of users selected this answer.
90
Where is the pneumonia? [1]
This chest X-ray could be mistaken for a right lower lobe pneumonia but, when taking into consideration the anatomy of the right lung lobes, **a right middle lobe pneumonia is the most likely diagnosis**
91
What is the Luftsichel sign (lungs)? [1]
The luftsichel sign is seen in some cases of left upper lobe collapse and refers to the frontal chest radiographic appearance due to hyperinflation of the superior segment of the left lower lobe interposing itself between the mediastinum and the collapsed left upper lobe.
92
Normal anion gap? [1]
The normal range = 10-18 mmol/L
