Practice Questions additional points Flashcards by Joe Rowlands

What are 4 symptoms and 4 signs of hyperthyroid disease?

Sx: Weight loss, diarrhoea. fatigue, irritability, heat intolerance, sweating, increased appetite

Signs: Fine tremour, tachycardia, hair loss, ptosis, exophthalmos, pretibial myxoedema, acropachy, Hypertension

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Risk factors for T2DM?

Hypercholesterolaemia
Obesity
Smoking
Male
Sedentary Lifestyle
Hypertension

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2 Places where alpha adrenoceptors can be found and what they do?

Blood vessels - vasoconstrict
Sphincters - Contract

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How do you avoid a hypertension crisis in phaeochromocytoma?

Phentolamine

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4 short term side effects of chemotherapy treatment?

Sexual Dysfunction
Infection
Anaemia
Infection risk
Nausea and Vomiting
Alllopecia

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What is the treatment for Febrile Neutropenia?

IV
Beta lactam
Piperacillin + Tazobactam (Tazocin)

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What is a potential long term side effect of chemotherapy?

Tumour Lysis Syndrome

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Why are iron studies a limited investigation when looking for iron deficiency anaemia?

Ferritin is an acute phase protein and therefore it will increase with inflammation

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What is a key side effect of ferrous sulphate?

Turns stools black
Nausea and vomiting
Loss of appetite
constipation
diarrhoea

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What are some treatments for haemophillia A?

Desmopressin
IV replacement of Factor VIII

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List 3 signs you may see on an abdominal examination of a patient with a small bowel obstruction?

Abdominal Distension
Tinkling Bowel Sounds
Hyper resonant percussion

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What is seen on an abdominal XRAY in a sigmoid Volvulus?

Coffee Bean Sign

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What are some features seen systemically in a patient with Ulcerative colitis?

Uveitis/Episcleritis
Pyoderma Gangrenosum
Erythema Nodosum
Arthritis

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What tests could you do other than biopsy and FBC/U&E to diagnose UC?

Faecal Calprotectin
P-ANCA

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What are some investigations you would do to rule out other conditions in IBS?

tTg antibodies for coeliac
Faecal Calprotectin for IBD

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What are some common exacerbating factors for IBS?

Stress
Fatty foods
Spicy Foods
Caffeine
Processed Foods

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What are some complications of acute pancreatitis?

Acute Respiratory Distress Syndrome (ARDS)
Sepsis
Hypovolaemic Shock
DIC
Systemic Inflammatory Response Syndrome

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What are some signs that may be found on examination of the hands in chronic liver disease?

Dupytrens Contracture
Palmer Erythema
Leukonychia
Finger Clubbing
Asterixis

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What is the survival rate of pancreatic Cancer?

Very poor Prognosis
<3% 5 year Survival

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What are the causes of Clubbing?

CLUBBING (L has ABCDEF)
C:cyanotic Heart Disease
L: Lung Disease
- Abscesses
- Bronchiectasis
- Cystic Fibrosis
- DONT SAY COPD
- Empyema
- Fibrosis
U: Ulcerative Colitis + IBD (Crohns)
B: Biliary Tract Disease
B: Birth Defects
I: Infective Endocarditis
N: Neoplasm (lung cancer or mesothelioma)
G: Gastrointestinal Malabsorption Syndrome (Coeliac Disease)

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What are the causes of Clubbing?

CLUBBING (L has ABCDEF)
C:cyanotic Heart Disease
L: Lung Disease
- Abscesses
- Bronchiectasis
- Cystic Fibrosis
- DONT SAY COPD
- Empyema
- Fibrosis
U: Ulcerative Colitis + IBD (Crohn’s)
B: Biliary Tract Disease
B: Birth Defects
I: Infective Endocarditis
N: Neoplasm (lung cancer or mesothelioma)
G: Gastrointestinal Malabsorption Syndrome (Coeliac Disease)

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where do diverticula most commonly occur?

Sigmoid colon due to smallest luminal diameter and therefore the highest pressure to cause the mucosal herniation

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What is the most common cause of portal hypertension that is not due to liver cirrhosis?

Schistosomiasis infection

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What are the 2 forms of Fungi?

Yeast - single cells and use budding

Mould - Multicellular and use hyphae or spores

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What are fungi cell walls made from?

Chitin Glucan

What are the targets of antifungal drugs?

Target cell wall: Beta-glucan Echinocandins Target Cell membrane: Ergosterol Polyenes - Amphotericin, Nystain Ergosterol synthetic pathway inhibitors - Azoles

What is candida albicans?

A vaginal or oral yeast infection

What is aspergillus Fumigatus?

A lung Infection

What is the prepatent period?

Interval between infection of a helminth and the appearance of eggs in stools

What is the major helminth of concern? Where is it contracted?

Schistosomiasis Contracted via freshwater swimming or drinking infected water in endemic africa "Medical student comes back from elective, swimming in malawi"

What 2 conditions are related to Schistosomiasis?

Can cause portal hypertension without causing Hepatocellular cirrhosis Can lead to bladder Squamous Cell Carcinoma

Classical presentation of renal stones?

Loin to groin Patient cant lie still Intermittent pain due to peristalsis

What small cell vasculitis presents similarly to IgA nephropathy and post strep glomerulonephritis and will have IgA deposition in extra-nephritic tissue?

Henloch Schonlein Purpura

Suggest some complications of CKD?

CVD Arrhythmias Anaemia Osteodystrophy Neuropathy/Encephalopathy

Give some treatments to help the symptoms of CKD?

Fe Supplements for anaemia Vitamin D supplements Adcal D3 ACEi - blood pressure control Statins

What is the first line treatment for Ankylosing spondylitis?

NSAIDs

How is rheumatoid arthritis disease progression monitored?

ESR and CRP levels

What is a life-threatening complication of Rheumatoid arthritis?

Felty Syndrome: RA Neutropenia Splenomegaly

What are some extra-articular manifestations of RA?

Skin Nodules Sjogren's Pleural Effusions Pericarditis and MI Glomerulonephritis Deranged Blood results in haematology

What is seen on electron microscopy in Diabetic Nephropathy?

Nephrotic Syndrome picture Kimmelsteil Wilson Nodules

What is the lifestyle management for nephrotic syndrome?

Low salt, protein and fat diet Control CVD risk factors Smoking cessation Regular exercise lose weight

Describe the pathogenesis of a subdural haematoma?

Trauma/Deceleration injury causes shearing of Dural venous sinuses or bridging veins

Why must patients with guillain barree syndrome be constantly monitored?

Monitor breathing rate as these patients are at a high risk of respiratory distress

What part of the brain, what pathway and what is the result of Parkinsons diseaes?

Loss of dopaminergic neurones in substantia nigra pars compacta which results in an impaired nigrostriatal pathway and therefore problems initiating movement

What is the spirometry results for an obstructive disease?

FEV1/FVC ratio < 0.7 FEV1<0.8 FVC normal or reduced

What are the common organisms of an infective exacerbation of COPD?

Haemophilus Influenzae Strep. pneumonia

What might you want to ask about in a patients history when diagnosis asthma?

FHx Atopic triad (do they have eczema, hayfever) Drug Hx Diurnal variation Wake up at night coughing

What are some signs of a poorly controlled asthma?

Inhaler > 3x per week regular Exacerbations Hyperinflated lungs Wake up at night coughing

What is the FVC and FEV1/FVC ratio for an asthma attack?

FVC = normal FEV1/FVC = <0.7

What are some risk factors for suicide?

Male gender Alcohol/Drug misuse Depression anxiety Low Socioeconomic status Learning Difficulties Trauma (physical/sexual abuse) Recent Grief

What are some questions to ask a depressed patient as a risk assessment for suicide or self harm?

Ever thought about killing/self harming yourself Have you ever acted on this was it planned or impulsive written suicide notes

Give 4 classes of drugs that can be used as antidepressants

SSRIs - Sertraline SNRIs - Duloxetine TCAs - Amitriptyline MOAis - Selegiline

What inherited condition can show high volumes of HDL and LDL in blood results?

Familial Hypercholesterolaemia

What are some key complications of CF in adulthood?

Diabetes Mellitus Infertility Pancreatic Insufficiency

What bacteria are the main causes of COPD exacerbations?

Haemophilus Influenzae Strep. Pneumonia

What bacteria are the main causes of recurrent Respiratory Tract infections in CF?

Staph. Aureus Pseudomonas. Aeruginosa

How does tension pneumothorax lead to cardiorespiratory distress?

Air cannot escape the pleural space and therefore a large tension PTX can lead to kinking of the mediastinal vessels and reduce air/blood flow.

What is the classical triad for critical limb ischaemia?

Pain at rest Arterial Insufficiency Ulcers Gangrene

What would the diurnal pattern of PEFR be for patients with asthma?

PEFR will be Lower in the morning and Higher in the Evening

What may be seen on blood film in a Macrocytic megaloblastic anaemia?

Hyper segmented neutrophil Polymorphs

What is the protocol for taking blood for IE?

3 cultures from 3 different sites on 3 different occasions

What other blood tests may you do in a Mallory weiss tear?

FBC U&E Coagulation profile LFTs Erect CXR

Name some features of the Glasgow Blatchford score?

Heart Rate Systolic Blood Pressure Hb Urea Gender Melena Hx of Syncope Cardiac Failure Hx

What is the First line management in an Upper GI bleed caused by a MWT if the bleeding is persistent?

Surgical Endoscopy and Clipping OR Thermal Coagulation High Dose PPI

How should bisphosphonates be taken?

First Thing in the morning Empty Stomach Stay upright or standing for 30 mins after With a full glass of water

Give 4 symptoms of a septic infection?

Fever Rigors Night sweats Weight loss Dizzy Confusion Nausea and vomiting

What are some symptoms of delirium tremens?

Ataxia Tremors Confusion Sweating Irritability/agitation/aggression N+V

What are some signs of iron Deficiency anaemia?

Angular Cheilitis Atrophic Glossitis Koilonychia

What kind of bacteria is Staphylococcus Aureus?

Gram Positive Cocci Beta Haemolytic Staphylococcus

What is a possible diet that can reduce the risk of gallstone development?

High grain Diet

What are some factors that can increase the risk of gallstone development?

High fat diet obesity T2DM Rapid weight loss

What blood results are seen on primary hyperparathyroidism?

High PTH High Ca Low Phos

What is the biggest cause of gout?

Underexcretion is the greatest cause so things such as thiazides

What is the biggest risk factor for PSC?

Female Gender (accounts for 90% of the cases)