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Practice qs Flashcards

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1
Q

What structure initiates and controls ongoing voluntary movements?

A

basal ganglia

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2
Q

What characteristics of a headache make it likely to be a tension headache?

A

prolonged period of time
NO ASSOCIATED SYMPTOMS
bilateral dull pain

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3
Q

What are the 3 classic symptoms of aortic stenosis?

A

exercise induced chest pain
dyspnoea
presyncope

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4
Q

What are heart sounds and murmurs are a sign of aortic stenosis?

A

high-pitched crescendo decrescendo systolic ejection murmur, radiating to the carotids
2nd heart sound soft
slow-rising carotid pulse

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5
Q

What investigation can diagnose aortic stenosis?

A

echocardiogram

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6
Q

Cardiac muscle only has the capacity to enlarge by what process?

A

hypertrophy

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7
Q

What 2 types of hypertrophy can occur in the heart muscle?

A

pathological eg hypertension (increases cardiac afterload > increases workload > enlarges)
physiological ie in response to exercise

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8
Q

What are the 4 characteristic signs of multiple myeloma?

A

anaemia + hypercalcaemia + renal failure + lytic lesions

+ raised globulin levels

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9
Q

What are the causes of macrocytic anaemia?

A

B12 deficiency, myelodysplastic syndrome

liver dysfunction, alcoholism, hypothyroidism, certain drugs

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10
Q

What are the causes of microcytic anaemia?

A

iron deficiency,

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11
Q

What does the hypoglossal nerve innervate?

A

extrinsic and intrinsic muscle of the tongue

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12
Q

What is the most likely gram +ve cocci cause of meningitis?

A

streptococcus pneumoniae

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13
Q

What are the typical signs of diabetic peripheral neuropathy?

A

uncontrolled diabetes +
bilateral distal symmetrical sensory loss in both feet
burning, paraesthesia, tingling

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14
Q

What is the most specific antibody for rheumatoid arthritis?

A

anti-CCP

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15
Q

When is weakness caused by myasthenia gravis more marked?

A

in the evening or after exertion

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16
Q

What is the most sensitive screening test for LV failure?

A

BNP

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17
Q

What are some characteristic signs of Cushing’s syndrome?

A

HTN
weight gain + bruising (cortisol excess)
abdominal striae
severe > hypokalaemia (activation of mineralcorticoid receptor)

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18
Q

What are some acute infarct markers?

A

creatinine kinase

troponin

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19
Q

What is BNP an indication of?

A

heart failure

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20
Q

What might a LBBB indicate?

A

past infarct

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21
Q

What are the symptoms of Addison’s?

A

adrenal insufficiency > low cortisol + aldosterone
= tanned, tired, tearful, thin, throwing up

fatigue, weakness, weight loss, malaise
\+ hyponatraemia + hyperkalaemia/calcaemia
hyperpigmentation
low mood
thirst
hypotension
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22
Q

Who is diverticulitis likely to affect?

A

elderly

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23
Q

When might nitrates be high?

A

UTI

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24
Q

What can a D-dimer test do in the diagnosis of a DVT/PE?

A

exclude only

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25
What is a potential complication of a mallory-weiss tear?
significant blood loss/haemorrhage | shock/collapse
26
How is a mallory-weiss tear usually treated?
endoscopic haemostasis
27
What characterises bulimia nervosa?
Recurrent episodes of binge eating followed by inappropriate compensatory behaviour with a sense of lack of control
28
What are the potential complications of bulimia nervosa?
``` kidney failure cardiac symptoms prolonged qt interval dehydration dental problems muscle spasms osteoporosis ```
29
What is the pathophysiology of grave's disease?
autoimmune stimulation of TSH receptors by circulating IgG autoantibodies leading to increased stimulation of the thyroid gland
30
After TFTs, what other investigations can be done to diagnose grave's?
thyroid USS | iodine thyroid scan
31
What are the signs of liver failure?
``` jaundice finger clubbing palmar erythema bruising spider naevi oedema anorexia ```
32
What are the 3 stages of alcoholic liver disease?
1. alcoholic fatty liver 2. alcoholic hepatitis 3. alcoholic cirrhosis
33
What are the complications of liver cirrhosis?
HCC portal HTN oesophageal varices
34
How liver failure lead to ascites?
low albumin produced > oncotic pressure lower than hydrostatic pressure > fluid leaks into abdominal cavity portal HTN > hydrostatic pressure higher than oncotic pressure > fluid leaks into abdominal cavity
35
What are 2 example of anti-epileptic drugs and their side effects?
sodium valproate/carbamazepine | teratogenic (mainly valproate), cognitive disturbance, heart disease
36
Patient has had a recent chest infection and presents with pan- systolic murmur heard at the apex. Doctor suspects infective endocarditis. What might have caused the murmur?
mitral regurgitation
37
What would be seen on the echocardiogram of a pt with infective endocarditis?
vegetations on the heart valves
38
What are the signs of IE?
``` murmur splinter haemorrhages Roth spots Osler's nodes Janeway lesions ```
39
What are the risk factors for IE?
``` elderly IVDU poor dental hygiene cardiac surgery prosthetic heart valves congenital heart disease pacemaker ```
40
What is the diagnostic criteria for giant cell arteritis?
age >50 temporal artery tenderness new headache giant cells/neutrophils on biopsy
41
What is a serious complication of GCA?
acute blindness
42
What is the management for GCA?
corticosteroids eg prednisolone methotrexate monitor and reduce likelihood of osteoporosis
43
Give an example of a 5-alpha-reductase inhibitor?
finasteride
44
What are the risk factors for breast cancer?
``` genetic predisposition late menopause + early menarche never breast fed increasing age HRT never having borne a child/1st child after 30 ```
45
Which genes and their chromosomes increase the likelihood of developing breast cancer?
BRCA1 gene - chromosome 17 | BRCA2 gene - chromosome 13
46
What is the most common type of breast cancer?
ductal carcinoma
47
Where can breast cancer metastasise to?
lung bone brain liver
48
What chemotherapy drugs are used for breast cancer?
tamoxifen (pre-menopause) | anastrozole (post-menopause)
49
What organisms can cause UTIs?
``` staph saprophiticus (gram +ve cocci) e. coli (gram -ve rod, lactose fermenting) klebsiella pneumoniae (gram -ve cocci) ```
50
What antibiotics can be used to treat UTIs?
trimethoprim | nitrofurantoin
51
In GORD pts often suffer from chest pain after eating. What might the differentials be for this?
MI PE pericarditis
52
What are 2 complications of GORD?
peptic stricture | Barrett's oesophagus
53
What are 3 red flag signs for GORD complications?
weight loss haematemesis dysphagia
54
What is chronic bronchitis?
inflammation of the bronchi leading to mucociliary dysfunction and therefore lower ventilation
55
What are the 2 signs of COPD on LFTs?
FEV1/FVC <0.7 | FEV1 < 80% of predicted
56
What is essential HTN?
primary cause unknown
57
How might the size of a kidney change with HTN?
reduced
58
What investigations might be requested and what cause may they show for HTN?
urinalysis > protein/albumin:creatinine/haematuria bloods > creatinine/eGFR fundoscopy/ophthalmoscopy > retinal haemorrhage, papilloedema ECG/echo > left ventricular hypertrophy
59
What hormone changes result in a thyroid storm?
rapid increase in T4
60
What can be the complications of a thyroid storm if not treated?
delirium coma death
61
What factors can precipitate a thyroid storm?
stress infection surgery
62
What medications can be given orally to treat a thyroid storm?
carbimazole propanolol potassium iodide
63
How does hydrocortisone work in the treatment of a thyroid storm?
inhibits peripheral conversion of T4 to T3
64
What type of anaemia occurs in myeloma?
normocytic normochromic
65
Why give bisphosphonates to pts with myeloma?
to reduce fractures and bone pain
66
How much fluid should pts with myeloma drink daily?
3L
67
Name 2 1st line drugs used in the treatment for chronic hepatitis?
``` oral ribavirin (antiviral) SC pegylated interferon alpha A, B ```
68
What type of drug would be prescribed for renal colic?
analgesics eg diclofenac
69
What lifestyle modifications can be made to reduce reoccurrence of kidney stones?
``` reduce BMI normal/low Ca2+ intake low Na+ intake normal dairy low animal protein intake ```
70
Give 3 signs of brainstem compression?
deep/irregular breathing ipsilateral pupil dilation bilateral limb weakness coma
71
How long do SABAs work for?
4hrs
72
Give 2 examples of LABAs?
salmeterol | formoterol
73
What makes LABAs last longer in tissues?
they are lipophilic
74
Name 4 types of melanoma?
nodular superficial spreading lentigo maligna acral
75
Define ulcer
breach of the mucosal surface
76
How long is a normal QT interval?
0.08 - 0.10 seconds
77
What BP reading leads to a diagnosis of stage 1 HTN? and stage 2?
stage 1: >140/90 (>135/85 at home) | stage 2: >160/100 (>150/95 at home)
78
What is the normal cardio-thoracic ratio?
<1:2 | heart is normally less than half the diameter of the chest
79
What are 2 possible causes of acromegaly?
benign pituitary tumour | ectopic carcinoid tumour
80
What investigations should be done to diagnose acromegaly?
glucose tolerance test MRI of pituitary (serum GH not diagnostic > pulsatile and increases due to stress, pregnancy and puberty)
81
Name 3 types of drugs used to treat acromegaly?
somatostatin analogues GH receptor antagonist dopamine agonist
82
A pt has a black curtain coming down vertically into their field of vision in one eye. What is this called and why does it happen?
amaurosis fugax | = involvement of ipsilateral ophthalmic artery
83
What symptoms indicate Bell's palsy rather than stroke?
no forehead sparing ! ``` drooling difficulty speaking dry eyes phonophobia decrease in taste ```
84
What is the key feature of MG?
fatiguability with use
85
What is the key feature of MND?
BOTH UMN and LMN symptoms
86
What signs come first in MG? What is the order of signs after this?
eye signs: ptosis, diplopia then dysphagia + dysarthria then weakness of muscles of facial expression then limb and trunk involvement
87
What are some of the causes of GORD?
``` lower oesophageal sphincter hypotension obesity hiatus hernia rolling/para-oesophageal hiatus gastric acid hyper secretion slow gastric emptying drugs e.g. CCBs, nitrates systemic sclerosis ```
88
What are the symptoms of GORD?
``` heartburn increased belching food/acid regurgitation odynophagia increased salivation chronic cough ```
89
What are the complications of GORD?
barrett's oesophagus | peptic stricture
90
What ECG changes are seen in an MI?
ST elevation/depression Q wave changes inverted T wave
91
How does spironolactone work?
potassium sparing diuretic | inhibits aldosterone receptors in the distal tubules
92
Which CVS condition puts you at very high risk of a stroke? Why?
AF | blood collects in the atria and forms clots
93
What are the 3 key aspects of Conn's?
HTN associated with hypokalaemia HTN <40yrs HTN despite being on 3+ antihypertensives metabolic acidosis
94
What happens to renin and aldosterone levels in primary and secondary hyperaldosteronism?
primary: low renin + high aldosterone (adrenal carcinoma/adenoma/hyperplasia) secondary: high renin + high aldosterone (excess activation of RAAS > low circulating volume, likely to be a renin secreting tumour, renal artery stenosis, HF, pregnancy, cor pulmonale)
95
How do pts with Cushing's present?
``` HTN abdominal striae, bruising moon face buffalo hump, central obesity weight loss in extremities severe > hypokalaemia increased body hair, acne ```
96
How do pts with Addison's disease present?
hyper pigmentation central weight loss hypotension
97
When is a water deprivation test with desmopressin used? How is it done, what does it show?
diagnosing DI > is it a cranial or nephrogenic cause? large amount of water lost in DI due to: decreased production of ADH (cranial) or impaired response to ADH (nephrogenic) deprive pt of water, test pre and post giving desmopressin urine osmolality after des is high > cranial cause low > nephrogenic cause
98
What is the full diagnostic criteria for DM?
Fasting plasma glucose >7mmol/L HbA1c of ≥48mmol/mol Symptoms and random plasma glucose >11mmol/L
99
What rhyme is used to remember to signs and symptoms of hypercalcaemia?
bones, stones, groans and psychiatric moans
100
What ECG changes are seen in hyperkalaemia?
absent p wave, prolonged PR, tall tented T wave, wide QRS
101
What is the classical triad of symptoms associated with Carcinoid syndrome? What is it?
cardiac involvement, diarrhoea and flushing paraneoplastic syndrome > tumour cells produce 5-HT
102
Which antibodies are specific to coeliac disease?
IgA tissue transglutaminase (tTGA) | IgA endomysial antibody (EMA)
103
What investigation should be done if a pheochromocytoma is suspected?
``` plasma metanephrines (breakdown products of adrenaline) 24hr urine catecholamines ```
104
What is the difference between Cushing's syndrome and disease?
Cushing’s syndrome: clinical picture (signs and symptoms) that reflect prolonged abnormal elevation of cortisol Cushing’s disease: a pituitary adenoma secretes excessive ACTH, causing Cushing’s syndrome
105
What is the immediate management for a pt with suspected DKA? What needs to be closely monitored?
IV fluids then IV insulin monitor K+ carefully as can drop dramatically
106
What is the most appropriate investigation to confirm Cushing's?
dexamethasone suppression test dose of dexamethasone (glucocorticoid steroid) at night and measuring cortisol and ACTH in the morning normal = cortisol suppressed cushings = no change at low dose as hypothalamus and pituitary are used to high levels of cortisol, no reaction > try higher dose
107
What electrolyte disturbance would make you think SIADH?
excessive ADH > excessive water is reabsorbed into the blood > dilutes sodium > hyponatraemia
108
What is the 1st line investigation for stable angina?
stress ECG > changes occur when ischaemia is induced
109
What is the 1st line treatment for trigeminal neuralgia? 2nd line?
1st line = carbamazepine | 2nd line = gabapentin
110
Which medication used to treat TB can interact with the OCP?
rifampicin (RIPE)
111
What signs are positive in meningitis?
brudzinski's sign: hips and knees flex in response to neck flexion kerning's sign: flex hip and knees at 90 degrees, then extend the knee up, if painful = +ve
112
A smoker presents with Horner's syndrome and resp symptoms. What is the most likely cause?
pancoast tumour in the apex of the lung
113
What is the 1st line treatment for Parkinson's? What 2 medications is it derived from and why?
co-careldopa (levodopa + carbidopa) levodopa = precursor to dopamine: when used alone, it is broken down peripherally before it has any effect on the basal ganglia > should be used in conjunction with Carbidopa, which prevents its breakdown
114
What is the 1st line treatment for pregnant women with an uncomplicated UTI?
nitrofurantoin (usually would be trimethroprim but this is teratogenic)
115
What happens to TSH and T4 levels in secondary hyperthyroidism? Why?
high TSH + T4 | due to pituitary gland pathology
116
The blockage of what vein could cause a left varicocele? What might the blockage be due to?
left renal vein drains the left gonadal vein from the left testes > congestion in lgv > varicocele could be due to left renal cell carcinoma
117
What kind of diet can lower a pt's INR? Why?
leafy greens - spinach, kale | high in vitamin K > interacts with warfarin and lowers INR
118
Name a protective factor for osteoporosis?
high BMI > puts stress on bones > increases BMD
119
Define cachexia?
extreme weight loss and muscle wasting
120
What is Courvoisier's sign?
painless jaundice + palpable gallbladder > pancreatic/biliary neoplasm until proven otherwise
121
What are the key signs of giant cell arteritis?
sudden blindness scalp tenderness headache
122
What do owl's eye intranuclear lesions in the bowel suggest?
CMV infection
123
What type of crystals are found in the joint aspiration for gout and pseudo gout?
gout > needle shaped negatively birefringent | pseudo (more commonly affects knees) > rhomboid shaped positively birefringent crystals
124
A warm swollen and tender joint is always what until proven otherwise?
septic arthritis
125
What is the 1st line treatment for BPH?
tamulosin: alpha-1 blocker
126
When is a lumbar puncture useful for diagnosing an SAH?
after 12 hrs > as this is when you see xantochromia (yellow CSF)
127
What is seen on a CT head that would indicate SAH?
star sign
128
What is the treatment pathway for T2DM?
1st line = metformin + lifestyle changes + sufonylurea + insulin if no improvement
129
Painless haematuria in the absence of a UTI is what until proven otherwise?
bladder cancer
130
Match the presentation with the haematological condition: a. painless rubbery lump that aches on drinking alcohol b. breathlessness, frequent infections, bleeding c. bone pain, fractures, infection d. infections, bleeding, fever
a. Hodgkin's lymphoma b. AML c. multiple myeloma d. CLL
131
What tests are done to diagnose acromegaly?
IGF-1 test | if +ve > oral glucose tolerance test to confirm
132
What is Rovsing's sign?
palpation of LIF increases pain in RIF > +ve > indicates appendicitis
133
ST elevation in what leads indicates an inferior STEMI?
II, III, aVF
134
What are the key signs of cardiac tamponade?
``` quiet heart sounds cool peripheries bibasal coarse crackles (early pulmonary oedema) hypotension tachycardia history of chest trauma low voltage QRS complexes ```
135
Where does the fluid lie within the testes in a hydrocele?
tunica vaginalis
136
What can cause a hydrocele?
- Patent processus vaginalis - Testis tumour - Trauma - Infection - Testicular torsion - Generalised oedema
137
What are 2 key differential diagnosis of a hydrocele?
testicular torsion | strangulated hernia
138
What investigation can be done to diagnose a hydrocele? And 2 tests to exclude a malignant teratoma but confirm the hydrocele?
scrotal US serum alpha-fetoprotein serum hCG
139
What are 2 classes of bronchodilators as an alternative to beta agonists?
muscarinic antagonists | methylxanthines
140
What are the features of a life-threatening asthma attack?
``` cyanosis/PaO2 <8kPa PEFR < 33% silent chest confusion exhaustion bradycardia ```
141
Risk factors for an arterial ulcer?
smoking atherosclerosis DM hypercholesterolaemia
142
What are the signs of an arterial ulcer?
``` small + painful worsened when elevated Punched out ulcer - Cold/ Pale leg - Sharply defined ulcer - Shiny skin - Loss of hair on leg - Absent peripheral pulses - Arterial bruits ```
143
What 2 investigations should be carried out to diagnose an arterial ulcer?
doppler US | ankle brachial pressure index
144
What are the treatment options for an arterial ulcer?
Keep ulcer clean + covered - Analgesic e.g. ibrupofen/ morphine - Vascular reconstruction
145
What are the differences between an arterial and venous ulcer?
``` A vs V Small ulcer vs Large ulcer Punched out ulcer vs Shallow ulcer Painful vs Minimal pain No oedema vs Oedema of lower leg No varicose veins vs varicose veins Absent peripheral pulses vs Peripheral pulses present Cold skin vs Warm skin ```
146
What is the name of the criteria used to diagnose Irritable Bowel Syndrome?
rome III criteria
147
What class of drug can be given to relieve bloating and the associated pain in IBS?
antispasmodics/cholinergics
148
Which microorganisms can cause IE?
Staphylococcus Aureus - Pseudomonas Aeruginosa - Streptococcus Viridans
149
What is the criteria used to diagnose IE?
modified duke's
150
How long are abx given for IE?
4-6wks
151
Signs of IE?
``` ventricular tachycardia fever confusion Splinter haemorrhages on nail beds of fingers - Embolic skin lesions - Osler nodes - Janeway lesions - Roth spots - Petechiae - New valve lesion/ regurgitant murmur - sepsis of unknown origin - haematuria - finger clubbing - embolization of vegetations ```
152
What is the antibody for Goodpasture's syndrome?
anti-GBM
153
Treatment for mild-moderate UC?
mesalazine
154
Known asthma, presents with severe breathlessness, barely able to speak O/E dynamic hyperinflation, severe wheeze throughout both lungs, accessory breathing Sats ?lowish, RR ?28/min, HR ?110/min. Appropriate 1 st -line mgmt.?
24% O2 venturi mask
155
What benign lesion of the colon has a | high risk of malignant transition?
villous adenoma
156
1st line investigation for chronic liver disease, after bloods?
US abdo
157
Acute management of gout?
oral diclofenac | colchicine
158
X-ray shows a mid-shaft fracture of the humerus with posterior displacement. OE he is unable to extend his wrist or fingers. What nerve has he likely damaged?
radial
159
What is Charcot foot?
weakening of the bones/soft tissue due to neuropathy common in diabetics > swelling, change of shape, loss of sensation/circulation, frequent fractures, dislocation, joint destruction
160
What is Paget's disease of bone?
new bone tissue gradually replaces old bone tissue > affected bones become fragile and misshapen commonly affects pelvis, skull, spine and legs
161
What substance is likely to be depleted in myocytes after a STEMI?
ATP
162
A deficiency in which protein produced by the liver is a risk factor for HCC?
alpha-1-antitrypsin
163
What is pretibial myxoedema? What is it seen in?
red, swollen skin on shins, texture like orange peel | Grave's dermopathy
164
What effect does gaining weight and starting smoking have on liver enzymes?
increases them
165
What effect does coeliac, Crohn's and hepatitis have on serum albumin?
coeliac > decrease Crohn's > decrease Hepatitis > increase
166
What is the role of albumin?
synthesised in the liver helps to bind water, cations, fatty acids and bilirubin key in maintaining the oncotic pressure of blood
167
When can albumin levels fall?
Liver disease resulting in a decreased production of albumin (e.g. cirrhosis) Inflammation triggering an acute phase response which temporarily decreases the liver’s production of albumin Excessive loss of albumin due to protein-losing enteropathies or nephrotic syndrome.
168
What conditions can cause a glove and stocking polyneuropathy?
HTN, diabetes, vitamin B12 deficiency, lead poisoning
169
What is a prolactinoma? What is the 1st line treatment?
benign tumour of the pituitary gland, produces excess prolactin initial treatment > bromocriptine (dopamine agonist > inhibits release of prolactin)
170
What is the 1st and 2nd line treatment for primary generalised epilepsy?
1st > sodium valproate (CI IN PREGNANCY) | 2nd > lamotrigine
171
What is the 1st and 2nd line treatment for partial/focal epilepsy?
1st > carbamezapine | 2nd > lamotrigine
172
What is a normal JVP?
<3cm
173
What can cause a high JVP?
Right-sided heart failure: commonly caused by left-sided heart failure/pulmonary HTN (often due to COPD = most common/interstitial lung disease/PE) Tricuspid regurgitation (due to infective endocarditis/rheumatic heart disease Constrictive pericarditis (often idiopathic, possibly RA, TB)
174
How does a pt with cor pulmonale present?
SoB, peripheral oedema, syncope, chest pain, increased breathlessness on exertion > non-specific! usually sx of the underlying lung disease are more apparent
175
What are the signs of cor pulmonale?
Hypoxia Cyanosis Raised JVP (due to a back-log of blood in the jugular veins) Peripheral oedema 3rd heart sound Murmurs (e.g. pan-systolic in tricuspid regurgitation or ejection systolic murmur radiating to the carotids) Hepatomegaly due to back pressure in the hepatic vein (pulsatile in tricuspid regurgitation) Bilateral air entry, inspiratory wheeze
176
How does encephalitis present?
headache fever clouding of consciousness possibly neck stiffness, photophobia, seizures, focal neurology
177
How does psoriatic arthritis present?
psoriasis rash usually precedes arthritis (red, flaky, crusty patches of skin covered with silvery scales) 5 patterns of disease: - asymmetrical oligoarthritis - symmetrical seronegative inflammatory polyarthritis (resembles RA) - spondylitis (sacroiliitis + early cervical spine involvement) - DIPJS involvement only (with nail dystrophy, dactylics) - arthritis mutilans > periarticular osteolysis, bone shortening, destruction of small bones in hands, pencil in cup X-ray changes) HLA-B27 associated
178
What treatment alternative is there for stroke if the 4.5hrs for thrombosis has passed?
thrombectomy
179
Which virus is associated with nasopharyngeal carcinoma?
EBV
180
What is the acute management of AF?
provoking cause treated cardioversion: urgent synchronised DC CV - LMWH to minimise risk of thromboembolism - if DC CV fails, medical CV > IV flecainide, amiodarone ventricular rate control: block the AV node - CCB e.g. verapamil - beta-blocker e.g. bisoprolol - digoxin - anti-arrhythmic e.g. amiodarone
181
What does the NHS diabetes risk assessment tool assess?
risk of developing diabetes type 2 in the next 10 yrs
182
What does FRAX assess?
10-yr probability of fracture
183
What does CHA2DS2VASC assess?
1 yr risk of a stroke in an AF pt
184
What does Wells score assess? What does a score <2 exclude?
probability of a DVT Well's <2 + negative d-dimer > excludes need for US
185
What is the most common type of inherited colorectal cancer?
hereditary non-polyposis colorectal carcinoma (HNPCC)
186
What is a delta wave on ECG? What does it indicate?
slurring of the upstroke of the QRS complex > associated with wide QRS AP from the SAN is able to conduct to the ventricles very quickly through the accessory pathway > QRS occurs immediately after the P wave indicate of Wolff-Parkinson-White syndrome
187
2ndary preventative treatment of heart failure?
furosemide
188
What are the ECG findings for pericarditis?
widespread saddle-shaped ST elevation in all leads = diagnostic PR depression
189
What is a Mantoux test?
screening for TB +ve > raised hardened area measuring >6mm in diameter where the fluid was injected strongly +ve: >15mm diameter
190
What is Wolff-Parkinson White syndrome? What are the ecg findings?
congenital heart disorder accessory pathway between atria and ventricles > impulses avoid AVN > atrioventricular reentrant tachycardia short PR interval (<120) wide QRS with slurred onset (delta wave) ST segment and T wave changes
191
What can a nucleic acid amplification test be used to test for?
malaria, TB, SARS
192
When might serum lactate levels be raised?
any condition that decreases the amount of oxygen available to the body/increased lactate production e.g. strenuous exercise, systemic shock, acute mesenteric ischaemia
193
What medication if a risk factor for developing gout?
diuretics
194
What is fondaparinux? What is its mechanism of action?
activates antithrombin II = anticoagulant inhibits activated factor X used for DVT prophylaxis
195
Apraxic gait involves what?
magnetic/shuffling gait difficulty getting started often seen in frontal lobe disorders e.g. dementia
196
What is cardiac tamponade?
blood/fluid/pus/gas fills the pericardial space | > reduced ventricular filling > haemodynamic compromise = EMERGENCY
197
Causes of cardiac tamponade?
``` trauma, HIV > young people malignancy, CKD > elderly MI infection e.g. TB connective tissue disease e.g. SLE, RA radiation, drugs ```
198
How does cardiac tamponade present?
anxiety, fatigue, altered mental status, oedema, waxing/waning dyspnoea, tachycardia, tachypnoea, cold/clammy extremities often features of pericarditis
199
What are the signs of cardiac tamponade?
``` PULSUS PARADOXUS distended neck veins, hypotension, tachycardia tachypnoea, hepatomegaly muffled heart sounds pericardial rub increased JVP ``` Beck's triad > jugular venous distension, hypotension + diminished heart sounds
200
What are the signs of haemolytic anaemia?
splenomegaly jaundice, gallstones (excess bilirubin) leg ulcers underlying disease e.g. SLE reduced Hb, increased reticulocyte count presence of schistocytes on blood film high bilirubin, urobiliogen, stercobilinogen MACRCOCYTIC
201
Causes of haemolytic anaemia?
AI, infection, 2ndary to systemic disease roc membrane defects, enzymes defects, thalassaemia, sickle cell
202
When is the posterior sag test used? What is it?
tests for integrity of the PCL pt lies supine, raise leg so knee and hip are at 90o support leg under lower calf observe position of tibia in comparison to femur +ve > posterior drop of tibia -ve > remains straight
203
When is Thomas' test used? What is it?
tests for fixed flexion deformity of the hip e.g. in OA pt lies supine, both hips flexed simultaneously to limit ensure lordosis is obliterated but placing a hand under the spine hold one hip firmly in position, lower other limb +ve > knee unable to rest on couch if flexion deformity present normal flexion: 130o
204
When is the Trendelenburg test used? What is it?
assesses strength of hip abductors (gluteus medius and minimus) pt standing lift each foot off ground in turn (lifts right foot > left hip abd being tested) position hands on pt's iliac crests, does hip on unsupported side lift or droop? +ve > pelvis of unsupported side (lifted leg) sags due to failure of abductors to stabilise hip normal = level/slightly raised
205
When is Buerger's test used? What is it?
assesses adequacy of arterial supply to the leg pt supine, elevate both legs to 45o and hold for 1-2 minutes > observe colour of feet (pallor > ischaemia) poorer the supply > lower the angle the legs need to e raised to become pale sit pt up, hang legs over side of bed at 90o, colour returns to legs skin goes blue (deoxygenated through ischaemic tissue) > red (reactive hyperaemia) done simultaneously, changes most obvious when compared to normal leg
206
When is the Bowstring test used? What is it?
assesses sciatic nerve pathology/lumbar nerve root compression pt supine, raise leg straight slightly flex knee 20o, place on your shoulder apply pressure to the tibial nerve in the popliteal area +ve > pain after popliteal compression indicates tension on sciatic nerve
207
What electrolyte imbalance can spironolactone cause?
potassium sparing > hyperkalaemia other electrolytes may be depleted
208
Side effects of loop diuretics?
inhibits reabsorption from the AL of the LoH inhibits NaKCl2 transporter dizziness hyponatraemia, hypo everything else hyperuricaemia gout, syncope, dehydration
209
Side effects of thiazide diuretics?
hypercalcaemia HYPOnatraemia HYPOkalaemia hyperuricaemia dizziness, blurred vision, headache
210
Nystagmus is most noticeable when looking towards to away from the lesion?
towards
211
Pronator drift is a test of what lesion?
UMN
212
What is rivastigmine used to treat?
acetylcholinesterase inhibitor > Alzheimer's, Parkinson's
213
What type of dementia is usually accompanied by hallucinations?
Lewy body
214
What vaccine do pts with coeliac disease need as part of their management? Why?
pneumococcal vaccine reduced splenic function > increased risk of infection
215
What is INR?
international normalised ratio > how long it takes the blood to form a clot using a PT test determines effects of oral anticoagulants normal = <1.1
216
What can increase INR?
``` vitamin K deficiency warfarin DIC increased alcohol intake major lifestyle changes e.g. changing diet, how much you exercise ```
217
Describe microbe of e.coli?
gram -ve bacilli lactose fermenting (+ve MacConkey agar test, red pink) motile with flagellum > H antigen present
218
How should carotid bruit be investigated?
duplex US
219
What is Romberg's test?
assesses sensory ataxia caused by 2/3 of proprioception (dorsal columns), vestibular dysfunction and vision pt stands 2 feet together, arms by side stand with eyes open then eyes closed and maintain balance dr should stand close to avoid injury scored by counting seconds pt is able to stand with eyes closed
220
How can truncal ataxia be assessed?
pt stands with arms crossed
221
What factors can effect a PEFR reading?
beta-blockers moving house recent travel to polluted area obesity - decreases PEFR
222
Complications of GORD?
oesophageal carcinoma Barrett's oesophagus anaemia benign strictures
223
What is achalasia? What are the sx?
LOS fails to open during swallowing food/drink can't pass into the stomach and gets stuck/regurgitated ``` vomiting undigested food progressive dysphagia - becomes impossible chocking, coughing fits heartburn, chest pain repeated chest infections drooling vomit, saliva gradual significant weight loss ```
224
With what antibiotic, used to treat diverticulitis, is alcohol contraindicated? What are the sx if alcohol is consumed?
metronidazole flushing, headache, vomiting, palpitations
225
Appropriate management in a STEMI? Which surgical intervention is not recommended?
morphine aspirin PCI beta-blocker NOT CABG
226
What should a normal fasting glucose level be? What is the diabetic threshold?
<5.5mmol/L | >7mmol/L = diabetic
227
Which cancers most often lead to bone metastasis, in order of incidence?
``` prostate breast kidney lung thyroid ```
228
What is acute angle-closure glaucoma?
drainage in eye blocked > fluid pressure inside eye rises quickly = SERIOUS! sudden severe eye pain red eye reduced/blurred vision N&V, headache
229
What is Wernicke's encephalopathy? What triad of sx is it characterised by?
thiamine (vit B1) deficiency > affects PNS + CNS, life-threatening! common in alcoholics + malabsorption characterised by opthalmoparesis with nystagmus, ataxia + confusion
230
What will LFTS show in acute liver failure?
raised bilirubin and PT | reduced albumin
231
What are the TLco levels in asthma?
raised and increase with bronchodilator treatment
232
What factors can increase TLco?
polycythaemia asthma increased pulmonary blood volume e.g. in exercise, L heart failure
233
When is TLco decreased?
any condition that affects the effective alveolar surface area e.g. restrictive lung disease, COPD, PE, cardiac insufficiency, pulmonary HTN, heart failure, anaemia
234
What are the long term medications used for rate control and rhythm control in AF? What is their target INR?
rate control - warfarin (AV nodal slowing + anticoagulant) - beta-blocker - CCB - if these fail, try digoxin, then amiodarone rhythm control - for younger, symptomatic, fit pts - cardioversion + beta-blockers (suppress arrhythmia) - pharmacological cardioversion: fleicainide/amiodarone - warfarin (reduce TE risk) target INR = 2-3
235
Acute and chronic management of heart failure?
Acute: 100% O2, nitrates, IV opiates, IV furosemide, consider inotropic drug Chronic: ACEi (if not, ARB) beta-blockers (all pts on ACEi and beta-blockers) loop diuretic
236
Does the trachea deviate towards or away from a collapsed lung?
towards
237
What are the pre-hepatic causes of jaundice?
increased rate of haemolysis: malaria, sickle cell, thalassaemia, haemolytic anaemia, blood transfusion
238
What are the intra-hepatic caused of jaundice?
reduced ability of the liver to metabolise + excrete bilirubin ``` hepatitis A, B, C, AI alcoholic liver disease cirrhosis glandular fever drug misuse primary biliary cirrhosis gilberts HCC ```
239
What are the post-hepatic causes of jaundice?
obstruction of biliary system gallstones Ca of head of pancreas biliary cancer pancreatitis
240
What are the effects on stools, urine and LFTs in each type of jaundice?
pre-hepatic: all normal, isolated raised bilirubin, no itching hepatic: normal stools, dark urine, raised bilirubin in urine, abnormal LFTs post-hepatic: pale stools, dark urine, no urobilinogen in urine, abnormal LFTs
241
No cause identified of a stage 2 AKI. Investigation after FBC, U&Es, LFTS are done?
renal US
242
What is haemochromatosis? What gene mutation is it caused by?
secondary iron overload increased intestinal iron absorption > iron deposits in joints, liver, pancreas, heart, pituitary, adrenals, skin > fibrosis > organ failure HFE gene mutation on chromosome 6, autosomal recessive
243
What are the signs of haemochromatosis?
classic triad = bronze skin, hepatomegaly + diabetes hypogonadism secondary to pituitary dysfunction > erectile dysfunction, reduced libido arthralgia (2nd + 3rd MCP joint, hands, knee) liver > cirrhosis, lethargy heart > dilated cardiomyopathy, heart failure
244
Investigations for haemochromatosis?
RAISED FERRITIN + iron, transferrin saturation >45%, TIBC reduced blood glucose > DM? HFE genotype Liver + cardiac MRI > detects iron overload liver biopsy/ecg/echo
245
Treatment for haemochromatosis?
venesection needed for life consider desferrioxamine if not tolerated HCC surveillance, treat diabetes
246
When an troponin be raised?
PE, heart failure, MI, sepsis
247
1st line investigation for restrictive lung disease?
CT scan
248
What is Hashimoto's thyroiditis? What effect does it have on thyroid hormones?
AI destruction of the thyroid gland by lymphocytes/thyroid autoantibodies > hypothyroidism can lead to myxoedema coma > extreme hypothyroidism > life-threatening elevated TSH, decreased T4, normal/low T3
249
What auto-antibodies are found in the blood in pts with Hashimoto's thyroiditis?
anti-TPO antibodies (thyroid peroxidase) sometimes TgAB (antithyroglobulin)
250
What is Chvostek's sign?
test of hypocalcaemia tap skin over the facial nerve about 2cm anterior to the EAM +ve = ipsilateral contraction of the facial muscles (graded response: mouth > nose > eye) due to hyper excitability of the nerve
251
What is Trousseau's sign?
test of hypocalcaemia (more specific than Chvostek's sign) blood pressure cuff on pt's arm and inflate to 20mmHg above systolic BP for 3-5 mins = increases irritability of nerves +ve > flexion of wrist, MCPJs and thumb (carpal spasm) with extension of IPJs induced by ischaemia
252
Mechanism of corticosteroids?
Up-regulate anti-inflammatory genes and down-regulate pro-inflammatory genes
253
Causes of pancreatitis?
``` Idiopathic Gallstones Ethanol Trauma Steroids Mumps/malignancy Autoimmune Scorpion sting Hypertryglicerides/calcaemia ERCP Drugs e.g. diuretics, antimicrobials, immunosuppressants, anti-convulsants ```
254
What are the contraindications to thrombolysis?
``` clotting disorders haemorrhage, IC bleed onset of Sx >4.5hrs ago/unknown time of onset trauma BP > 185/110 peptic ulcer ```
255
What will the urine dipstick of a pt with a UTI show?
raised wbc +ve nitrites blood
256
When is an urgent endoscopy indicated?
``` dysphagia anaemia weight loss, anorexia recent onset meleana, haematemesis ```
257
Alternative investigation to diagnose a hiatus hernia if endoscopy is contraindicated?
barium swallow
258
2nd line treatment for hiatus hernia?
histamine 2 receptor antagonist e.g. ranitidine
259
2nd line investigation for SAH, if CT does not show a bleed?
LP 12hrs later to look for xanthochromia (yellow CSF)
260
What eye symptoms do pituitary adenomas cause?
bitemporal hemianopia | causes compression on the optic chiasm
261
A pt presents with foot drop. To which spinal cord root does the motor defect localise?
due to weakness in ankle dorsiflexion | L4-5 root > peroneal nerve > innervates tibialis anterior muscle
262
What type of CT is 1st line for stroke imaging?
non-contrast | if confirmed, may have contrast added through angiography to visualise vessels
263
1st line medication foe depression?
citalopram (SSRI)
264
Haematemesis + hx of excess alcohol?
ruptured oesophageal varices
265
1st line treatment for eczema?
emollient cream
266
1st line treatment for acute relapse of MS?
methylprednisolone
267
What virus is shingles caused by?
reactivation of varicella zoster virus
268
What is methylprednisolone?
corticosteroid suppression of inflammatory and allergic disorders, cerebral oedema associated with malignancy
269
Acute management of meningitis while waiting for transfer to hospital?
IM benzylpenicillin
270
In herpes zoster opthalmicus, there is reactivation of the herpes zoster virus in which CN?
``` HZO = shingles involving the eye trigeminal nerve (V1) ```
271
What is cardiac syncope?
Sudden collapse into unconsciousness due to a disorder of heart rhythm in which there is a slow or absent pulse
272
Black racoon eyes + clear fluid on otoscopy is indicative of? 1st line investigation?
base of skull fracture | CT head
273
What occurs with a lesion in Broca's area compared to Wernicke's area?
Broca: non-fluent, motor, frontal lobe, speech is slow and broken = aphasia Wernicke's: fluent, sensory, temporal lobe, speech normal and excessive but makes little sense
274
What is Charcot-Marie-Tooth disease?
inherited, damage the peripheral nerves presents with: - distal muscle weakness and sensory loss/tingling, proximal progression over time - awkward gait - highly arched/very flat feet
275
What is the HAS-BLED score?
Estimates risk of major bleeding for patients on anticoagulation to assess risk-benefit in AF care ``` HTN Abnormal liver/renal function Stroke history - Bleeding hx/predisposition Labile INR Elderly >65 Drugs/alcohol ``` 0-2 > low risk of bleeding 3+ > high risk of bleeding
276
When might lungs be hyper-resonant in an asthmatic pt?
acute asthma attack > lungs become hyper-inflated
277
What is the most common type of lung cancer in non-smokers and associated with asbestos exposure?
adenocarcinoma
278
Which type of lung cancer is most strongly associated with cigarette smoking?
squamous cell carcinoma
279
What are the common sites for lung cancer to metastasise to?
``` adrenal glands bone brain liver lymph nodes ``` (breast uncommon)
280
What bacteria can cause atypical pneumonia?
mycoplasma pneumonia chlamydophila pneumonia legionella pneumonia > not detectable on gram stains, can't be cultured using standard methods
281
What is the most common community acquired cause of pneumonia?
strep pneumonia
282
What is the most common hospital acquired cause of pneumonia?
staph aureus
283
Side effects of all RIPE medications?
Rifampicin > red/orange urine (r = red) Isoniazid > neuropathy Pyrazinamide > arthralgia Ethambutol > optic neuritis (e = eyes)
284
Which chromosome is affected in CF?
7 | CFTR protein
285
What is the 1st line treatment for syphilis?
benzathine penicillin
286
What is the difference between primary, secondary and tertiary prevention?
primary > reduce initial occurrence of disease e.g. immunisation, NHS health check secondary > treat disease asap to halt disease progression and prevent long term problems e.g. anti platelet therapy after MI tertiary > aim to reduce impact of ongoing problem and improve quality of life e.g. diabetic eye screening
287
What does a cerebellar stroke present with?
ataxia headache vertigo vomiting
288
Most common cancers to spread to the brain?
``` lung breast skin kidney bowel ```
289
What enzyme is raised in temporal arteritis?
ALP
290
Which spinal cord roots does the median nerve originate from?
C5-T1
291
What are the features of RA on x-ray?
Loss of joint space Erosions Soft tissue swelling Soft bones (osteopenia)
292
What does the Glasgow-Blatchford score calculate?
upper GI bleed
293
What medication is used to treat ACUTE attacks of gout?
colchicine
294
How do alcoholism/chronic liver disease affect MCV?
increase it
295
Most common cause of hepatitis in travellers?
A - faecal-oral route - does not cause chronic liver disease
296
What type of antigen/antibody implies current infection of hepatitis? How do you determine if it is acute or chronic?
surface antigen e.g. HBsAg Acute <6mo Chronic >6mo
297
What is Meig's syndrome?
triad of benign ovarian tumour + ascites + pleural effusion
298
What is the typical gallstones pt?
Fat, female, forty, fertile | OCP also a RF
299
What is neutrophilia? What infection can unusually cause this?
high neutrophil count | AIDS - targets immune system > neutropenia
300
How does pernicious anaemia present?
common in women around 60yrs ``` anaemia sx peripheral neuropathy lemon tinged skin (jaundice + pallor) mouth ulcers depression dementia ```
301
How does acute lymphoblastic leukaemia present?
commonly found in children, associated with Down's anaemia, bleeding, infection hepatosplenomegaly peripheral lymphadenopathy complications > CNS involvement, SVC obstruction
302
What is a key sign of DIC?
distinct trigger e.g. sepsis, major surgery, trauma
303
What is polycythaemia?
increase in rbc production
304
Myeloma is incurable but can be managed with a combination of what?
chemotherapy steroids thalidomide (immunomodulatory) bisphosphonates, radiotherapy
305
What medication is used to treat hypocalcaemia?
calcium gluconate
306
Renal stones smaller than what will pass their own?
<5mm | only need to be managed with analgesia
307
What is a nucleic acid amplification test used for?
test urine for STIs
308
What eGFR measurements are needed to make a diagnosis of CKD?
normal >90 2 measurements >3mo apart with an eGFR<60 <15 = end stage renal failure > dialysis, await transplant
309
Ototoxicity is a potential SE of what antibiotic?
gentamicin
310
What is the most common type of renal cell carcinoma?
clear cell
311
Name a drug and its class used in the treatment of prostate cancer?
goserelin - GnRH agonist
312
Management of acute pulmonary oedema?
``` high flow O2 IV furosemide IV morphine/GTN notify senior, urgent CXR then consider escalating for CPAP ```
313
What makes a UTI complicated?
being male, pregnant, a child or immunocompromised, recurrent UTIs, structural abnormality
314
What hormones are produced by the anterior and posterior pituitary?
anterior: (GHRH +/somatostatin -) > GH > (bones, muscles, organs) (GnRH) > FSH > (testes/ovaries > testosterone/oestrogen) (GnRH) > LH (TRH) > TSH > (thyroid > thyroid hormones) (PRH +/dopamine -) > prolactin > (breasts) (CRH) > ACTH > (adrenal cortex > cortisol) posterior: ADH > (kidney) oxytocin > (breasts/uterus)
315
What are the key signs of hyperparathyroidism?
signs of hypercalcaemia | = bones, (renal) stones, (abdominal) groans, psychiatric moans (depression, anxiety) , thrones (polyuria)
316
What are the PTH, calcium and phosphate levels in primary, secondary and tertiary hyperparathyroidism?
primary (e.g. PT adenoma) > raised PTH and Ca, low phosphate > removal of adenoma secondary (hyperplasia in response to hypocalcaemia, usually in CKD) > raised PTH, low Ca and phosphate > correct hypocalcaemia tertiary (autonomous hyperplasia) > raised PTH, Ca and phosphate > parathyroidectomy
317
Acute management of hypercalcaemia?
IV fluids bisphosphonates measurement of U&E/Ca prednisolone
318
What is myxoedema coma?
hypothyroid emergency | altered mental state, hypothermic, hypotensive, bradycardia
319
How is Addison's treated?
hydrocortisone + fludrocortisone replacement | treat cause
320
1st line medications to treat HF?
b-blocker + acei improve prognosis
321
What leads are affected in a inferior, lateral, anterior and septal STEMI?
inferior: II, III, aVF lateral: I, aVL, V5, 6 anterior: V3, 4 septal: V1, 2
322
Complications of MI?
``` Death Arrhythmias Rupture (septum, papillary muscles) Tamponade Heart failure ``` ``` Valve disease Aneurysm of ventricle Dressler's syndrome Embolism Recurrence/mitral regurgitation ```
323
How do statins work?
HMG-CoA reductase inhibitors
324
Coeliac disease on endoscopy?
villous atrophy lymphocytic infiltration crypt hyperplasia
325
What is pyoderma gangrenosum?
rare, inflammatory skin disease with painful pustules/modules that become ulcers that progressively grow
326
What is ranitidine?
H2 receptor blocker
327
What it Truelove and Witt's criteria? What does it include?
severe flare-up of UC ``` >6 stools passed in 1 day + 1 of: HR >90 Temp >37.5 Hb<10,5 ESR >30 > Iv steroids in hospital ```
328
Most common cause of sudden cardiac death in <30s?
hypertrophic cardiomyopathy
329
What does an S4 heart sound mean?
forceful atrial contraction due to stiff/hypertrophic ventricles
330
What is a silent MI? Who is most likely to suffer from one?
heart attack with few/no sx or sx not recognised as signs of an MI > can go unnoticed common in diabetic pts
331
What is Prinzmetal angina? | Sx, ECG findings, due to and triggered by?
chest pain always occurs at rest, usually between midnight and early morning quick response to nitrates clustered attacks of 2 or 3 causes ST elevation due to coronary artery spasm can be triggered by stress, cold, smoking, drugs, alcohol, hyperventilation
332
What is the Sepsis 6?
``` Bloods culture + septic screen Urine output - monitor hourly Fluid resuscitation Antibiotics IV Lactate measurement O2 - keep stats >94% ```
333
Tx for hepatic encephalopathy?
oral lactulose + neomycin/rifaximin
334
What is the difference between bacterial and viral meningitis?
Bacterial: cloudy, very high WBC, very high protein (>200), low glucose Viral: clear, raised wbc (predominantly lymphocytes), normal-high protein (<200), normal glucose
335
What is the most commonly affected area of the bowel in Crohn's?
terminal ileum
336
What does the painful arc test for? How is the test done?
impingement of supraspinatus arm outstretched in front and actively elevate and bring arm back down +ve = pain between 60-120o
337
What does Jobe's/empty can test look for? How is the test done?
supraspinatus pathology arm outstretched at 90o, thumb down as if pouring a can apply downward force on arm, pt tries to resist +ve = pain or arm gives way
338
What does Gerber's lift off test look for? How is the test done?
subscapularis pathology dorsum of hand on mid-lumbar spine pt tries to lift hand away from back, give resistance to test for strength +ve = inability to lift hand off/
339
What does the Scarf test look for? How is the test done?
test acromioclavicular joint fro frozen shoulder (adhesive capsulitis) flex elbow to 90o and place pt's hand on opposite shoulder push pt's arm further into adduction +ve = pain
340
What is Phalen's test?
hold both hands in palmar flexion (reverse prayer sign) | +ve = pain, numbness, tingling in medial nerve distribution = carpal tunnel syndrome
341
Anterior vs middle vs posterior cerebral stroke symptoms?
Middle: CHANGE - CL paralysis + sensory loss of face, arms, legs - Homonymous hemi/quadrantopia - Aphasia, dysarthria - Neglect - Gaze towards side of lesion Anterior: - CL paralysis + sensory loss of leg - cognitive/personality changes Posterior: 4Ds - Diplopia - Dizziness - Dysphagia - Dysarthria
342
What is a pneumothorax? What is the difference between a simple and tension PT?
air enters pleural space due to disease/injury > loss of -ve pressure > partial/complete collapse = spontaneous or traumatic can progress to a tension PT > life-threatening - sudden onset dyspnoea, ipsilateral chest pain, diminished breath sounds, hyper-resonance, hypoxia, hypotension
343
What signs in a breast exam are red flags for breast cancer?
peau d'orange puckering and tethering new inversion of the nipple visible mass that moves with pectoral muscle contraction (hands on hips) normal for young women to have dense lumpy breast tissue
344
What is a Ghon focus? What disease are they found in? | What is a Goon complex?
granuloma in lung from previous TB infection seen on CXR parenchymal granuloma + involved hilarious lymph node on same side = Ghon complex
345
When is a narrow base gait found? What is this gait called?
associated with diplegic gait | caused by cerebral palsy
346
What is the most commonly injured rotator cuff muscle?
supraspinatus
347
What is Schober's test?
tests for decrease in lumbar spine flexion = sign of ankylosing spondylitis pt standing, mark both PSIS, draw line at centre of these marks 2nd line marked 5cm below this and 3rd line 10cm above pt flex forward as if attempting to touch toes remeasure distance between lines whilst fully flexed = should increase from 15cm to 20cm
348
On CXR, tramline opacities and ring shadows are found. What are they and what are they indicative of?
bronchiectasis tramline opacities: mucus build up in airways perpendicular to XR beam ring shadows: dilated airways
349
What organism is linked to antibiotic treatment? What GI SE can it have? What does the gram stain look like?
clostridium difficile causes GI illness including non-bloody diarrhoea gram +ve anaerobic bacillus
350
Unilateral acute testicular pain with active sexual hx?
epididymis-orchitis | secondary to chlamydia trachomatis infection
351
What test is used to differentiate between testicular torsion and epididymo-orchitis?
Prehn's test lift affected testicle > relieves pain of epidiymitis, doesn't relieve testicular torsion
352
What is Meniere's disease? What test is likely to be +ve in Meniere's?
condition of inner ear cause sudden attacks of vertigo, tinnitus, pressure felt deep inside ear, hearing loss Romberg's test likely to be +ve
353
Anterior dislocation of shoulder - what nerve injury may occur? How will this present?
axillary nerve | weakness in abduction
354
What is costochrondritis?
inflammation of the cartilage of the sternum | can mimic a heart attack
355
What is tiotropium?
LAMA
356
Causes of pericardial effusion?
``` cancer, metastasis infection inflammation e.g. from a heart attack, surgery/injury AI e.g. RA, SLE aortic dissection ```
357
Presentation of pituitary gland vs adrenal adenomas?
adrenal > non-functioning (don't produce hormones) | pituitary > massive endocrine dysfunction, headaches, visual changes
358
What autoantibodies are often present in primary sclerosis cholangitis?
anti-endothelial cell ab | pANCA
359
What is L'Hermitte's sign? What is it indicative of?
sudden electric shock sensation passing down the back of the neck radiating into the limbs in MS
360
What is Uhthoff's phenomenon? What is it indicative of?
worsening of symptoms with heat | in MS
361
What is Lambert Eaton syndrome? It is associated with what kind of tumours?
AI attack on the voltage-gated Ca2+ channel at NMJs muscle weakness, aching muscles, difficulty lifting/walking up stairs, drooping eyelids/dry eyes/blurred vision, dysphagia, dizziness on standing, dry mouth associated with small cell lung cancers
362
In Buerger's test, what is the angle below which a +ve result indicates critical ischaemia?
20o
363
Do UMN and LMN lesions in the facial nerve cause facial palsy on the ipsilateral or contralateral side?
LMN: ipsilateral UMN: contralateral
364
What tumours is MG associated with?
thymic tumours
365
What is tolvaptan?
ADH V2-receptor antagonist | for ADPKD, hyponatraemia 2ndary to SIADH
366
Which is the only valve you would need the bell to listen to?
mitral
367
What is bromocriptine?
dopamine agonist | pituitary tumours, PD
368
Mallory bodies on biopsy?
alcoholic liver disease
369
Which antibody would highly suggest Goodpasture's?
anti-GBM
370
What raised, hardened, purplish skin lesions seen on the nose, ears, cheeks, lips and forehead are pathognomonic for sarcoidosis?
lupus pernio
371
What CHA2DS2-VASC score usually required anticoagulation?
2 | any score should be considered apart from gender alone
372
1st line treatment for pheochromocytoma?
phenoxybenzamine treats HTN and heavy sweating = alpha-blocker
373
Which types of renal calculi are radiolucent on XR?
uric acid stones | cysteine, unless they contain Ca
374
Least cardioselective beta-blocker?
propanolol
375
Indications for emergency dialysis in a pt with AKI?
severe metabolic acidosis refractory pulmonary oedema severe uraemia refractory hyperkalaemia

Phase 2a (5 decks)

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