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1
Q

What is the most significant risk factor for pelvic inflammatory disease?

A

A history of prior infection with chlamydia or gonorrhoea is the most significant risk factor for PID

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2
Q

What is the treatment for pelvic inflammatory disease?

A

Parenteral cephalosporin + Oral doxycyclin

Adjunct metronidazole

Think: Pelvis or vagina can get fungal infections which have spores, so cephalosporin.
You also use your pelvis to ride a bicycle, so doxycycline
Pelvis has a hole, like metronidahole

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3
Q

Which two gastrointestinal infections cause bloody diarrhoea?

A

Shigella - bloody diarrhoea with vomitting and abdominal pain

Amoebiasis - gradual onset bloody diarrhoea, abdominal pain and tenderness lasting several weeks

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4
Q

Which gastroenteritis presents with a flu-like prodrome, crampy abdo pain, fever and diarrhoea (possibly bloody) and can lead to complications including GBS?

A

Campylobacter

think: camp = cramp

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5
Q

Which gastroenteritis results in severe dehydration and profuse watery diarrhoea?

A

Cholera

think: found in the water in poverty, drink water, loose water

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6
Q

Which gastroenteritis results in severe vomiting?

A

Staph Aureus

think: respiratory pathogen, breath out, vomit out

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7
Q

Which gastroenteritis results in vomiting within 6 hours, diarrhoea after, stereotypically due to rice?

A

Bacillus cereus

think: basmati bacillus

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8
Q

What antibiotic treatment is recommended for invasive diarrhoea (bloody + fever)?

A

Ciprofloxacin

think: Cip and Flux, Sip and Flush out that invasive diarrhoea

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9
Q

What antibiotic is recommended for non-invasive / travellers diarrhoea?

A

Clarithromycin

think: Clear my sins over seas

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10
Q

What is the clinical triad of ARDS?

A

A - Acute onset
R - Ratio <300 (PaO2/Inspired)
D - Density on CXR of duo-lateral opacities
S - Sepsis is a common cause

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11
Q

What are the most common underlying causes of ARDS?

A

Sepsis
Aspiration
Pneumonia

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12
Q

Cardinal symptoms of acute pancreatitis?

A

Sudden onset abdominal pain radiating to the back

Also N&V with anorexia
Tachycardia may result from hypovolaemia.

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13
Q

What investigations may you perform to diagnose coeliacs?

A

FBC - IDA / folate deficiency

IgA transglutaminase (high titre)

Endomysial Antibody (EMA)

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14
Q

What marker should be investigated to anticipate refeeding syndrome?

A

Serum phosphate will be low and indicates refeeding syndrome, with the anticipation of a cardiac arrest

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15
Q

What differences in blood test results may be seen in osteomalacia or vitamin D deficiency?

A

Low Calcium
Low Phosphate
Low Vit D

Raised Alk Phos
Raised PTH

*blood values are normal in osteoporosis

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16
Q

What investigation would you order in suspected myeloma?

What would be the effect on calcium?

A

Serum electrophoresis and a skeletal survey

Hypercalcaemia

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17
Q

What are some organic causes of osteomalacia?

A 
Vitamin D deficiency
Renal failure
Liver disease e.g. cirrhosis
Drug induced e.g. anticonvulsants
Vitamin D resistant; inherited
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18
Q

What are some risk factors and protective factors of ovarian cancer?

A

Ovarian cancer is hormonal. Ovulation increases Ovarian cancer.

Therefore, early menarche and late menopause, HRT and obesity all increase the risk

Pregnancy and the COCP are both protective

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19
Q

What test is done initially in suspected ovarian cancer?

If raised, what is the next step in management?

A

CA125

Urgent USS of abdo / pelvis

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20
Q

What is a cause of relative polycythemia?

A

Dehydration or Diuretics

Plasma volume : Red cell mass
is reduced

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21
Q

What are some secondary causes of polycythemia?

A

COPD (reduced PaO2 simulates EPO)
Altitude
Obstructive sleep apnoea
Excessive EPO

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22
Q

How may you differentiate true (primary or secondary) and relative polycythemia?

A

True: Red Cell Mass is >35ml/kg (M) or >32ml/kg (F). Plasma volume remains same giving a true ratio.

Relative: Plasma volume is reduced giving derranged ratio

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23
Q

What is the step-wise management of chronic SIADH?

A

Fluid restriction
Treat underlying cause
NaCl + Forusemide
Demeclocycline

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24
Q

What is the most common cause of SIADH.

A

SCLC

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25
What are the sick day rules regarding diabetes?
Increase frequency of blood glucose monitoring to four hourly or more frequently Encourage fluid intake aiming for at least 3 litres in 24hrs If unable to take struggling to eat may need sugary drinks to maintain carbohydrate intake
26
Which diabetes medication must be stopped in ill patients who are dehydrated?
Metformin due to potential impact on renal function
27
What are some symptoms of hypercalcemia?
Stones, bones, groans and psychiatric overtones Nausea, polydipsia, polyuria, constipation, confusion and weakness
28
What are some causes of spider naevi? What questions should you elicit when in the presence of them?
Are they pregnant? Are they on the COCP? Do they drink alcohol (excessively)? Do they take drugs / medications that harm the liver? Caused by Estrogen levels which is seen in pregnancy and liver damage.
29
Which cancer is associated with the following monoclonal antibodies tumour markers? CA 19-9 CA 125 CA 15-3
CA 19-9 pancreatic cancer (think of the 9 being a backwards p) CA 125 - ovarian cancer (think 5-2+3=4 wives with 4 ovaries) CA 15-3 - Breast cancer (think of the 3 looking like a set of boobies)
30
What cancers are the following tumour antigens associated with? ``` PSA AFP CEA S-100 Bombesin ```
PSA - prostatic AFP - hepatocellular, teratoma CEA - colorectal S-100 - schwannoma, melanoma Bombesin - SCLC, Gastric cancer, neuroBlastoma
31
What is the classical triad of infectious mononucleosis? | What is the most common causative organism?
Sore throat Pyrexia Lymphadenopathy EBV
32
Which test is diagnostic for infectious mononucleosis?
Heterophil antibody test (monospot test)
33
What is the management of chlamydia STI?
Doxycycline 7 day course or Azithromycin SINGLE dose (better concordance)
34
What is the clinical triad of pre-eclampsia?
Pregnancy induced hypertension Proteinuria (>0.3g / 24h) Oedema* (no longer 3rd element due to lack of specificity), including papilloedema
35
At what blood pressure should you treat HTN in pre-eclampsia and what is the first line medication?
>160/110 mmHg Labetalol
36
What is the first line treatment for Onychomycosis?
Oral terbinafine Alternatively oral itraconazole
37
What is the step by step management of DKA?
1. IV fluids with isotonic saline 2. Potassium phosphate to correct hypokalaemia 3. Iv Insulin once potassium is >3.3mmol/L
38
Which organism is responsible for diarrhoea which... Occurs in travellers Sourced from contaminated food Profuse watery / bloody diarrhoea
E.Coli
39
Which organism is responsible for diarrhoea which... Has a history of antibiotic use
C.Diff
40
Which organism is responsible for diarrhoea which... Source usually food and faecally contaminated water Symptoms of nausea, vomiting, fever, diarrhoea, cramping
Salmonella
41
Which organism is responsible for diarrhoea which... Usually occurs in children Watery ==> mucoid and bloody diarrhoea 10 - 12 stools / day
Shigella
42
Which organism is responsible for diarrhoea which... Sourced from undercooked poultry, raw milk, cheese Watery profuse or bloody with mucus Severe CRAMPY
Campylobacter
43
What is the criteria for LTOT in COPD patients?
2x ABG measurements with a PaO2 < 7.3 kPa
44
What is the composition of stag-horn calculus? | Is this visible on xray?
Struvite = Stag-horn calculi forms in alkaline urine Alkaline urine requires ammonia producing bacteria Visible on XRAY
45
Which renal stones appear opaque on imaging?
Calcium oxalate Mixed calcium oxalate / phosphate Triple phosphate (staghorn struvite) Calcium phosphate hint: anything with calcium and phosphate
46
Which renal stones appear radio-lucent?
urate stones Xanthine Hint: Urate, radio-lUcent Hint: Xanthine, xception, radio-luxent
47
Which renal stones appear semi-opaque / ground glass?
Cystine hint: Not quite calcium, but half way there, so semi-opaque.
48
What are two common complications of congenital diaphragmatic hernia?
``` Pulmonary hypolasia Pulmonary hypertension (NOT systemic) ```
49
What is the most common type of congenital diaphragmatic hernia and what two factors indicate a poor prognosis or outcome?
Left sided CHD 1. Liver position (herniated into thoracic cavity) 2. Lung-to-head ratio <1 (small lungs)
50
What is alports syndrome and what are the features?
X-Linked dominant Type IV collagen gene defect Abnormal GBM Renal failure Features are - Presents in childhood - Microscopic haematuria - Progressive renal failure - bilateral sensorineural deficits - Lenticonus: protrusion of lens surface into anterior chamber - retinitis pigmentosa - renal biopsy: splitting of lamina densa
51
What are the two most common causative organisms for cellulitis and what antibiotic is first line for managing this condition (mild to moderate and severe)?
Strep Pyogens Staph Aureus Mild-Moderate: Oral Flucoxacillin Clarithromycin / Clindamycin if allergic to penecillin Severe: IV B.Penecillin + Flucoxacilllin
52
What are the key diagnostic factors of antiphospholipid syndrome?
History of venous / arterial / microvascular thrombosis History of pregnancy loss (>=3 losses @ <10 weeks gestation)
53
What is the clinical triad of Nephrotic Syndrome?
Proteinuria (>3.5g/24h) Hypoalbuminaemia (<30g/L) Peripheral Oedema (despite heavy proteinuria and lipiduria, urine contains little cells or casts, which is contrasting to Nephritic Syndrome)
54
What is the clinical triad of nephritic syndrome?
AKI (renal dysfunction) Hypertension (reduced GFR with salt and water retention results in systemic HTN) Red cells and casts
55
What is amyloidosis and what is the clinical triad? What may you see on immunofixation of serum and urine?
Amyloid tissue deposition disease Weight loss Fatigue Diuretic resistant Oedema Immunofixation confirms monoclonal light bands
56
What is the most common cause of Nephrotic Syndrome in children? What is the first line treatment for this condition?
Minimal change disesae corticosteroid therapy
57
What is the most common cause of Nephrotic syndrome in adults?
Membranous nephropathy GBM thickening is seen with deposits.
58
What cases may result in secondary membranous nephropathy?
Hep B Autoimmune Malignancy Adverse drug reactions including Gold, Penecillamine and NSAIDs
59
Which medications increase the risk of VTE?
COCP (3rd gen more than 2nd) HRT (Prog+Oes > Oes only) Raloxifene and Tamoxifene Antipsychotics (esp Olanzapine)
60
What is the diagnostic investigation for VISIBLE haematuria and mild proteinuria after an URTI or GI-Infection?
Renal biopsy Diagnosis most likely IgA nephropathy
61
What is the management of IgA nephropathy?
Depends on risk of progression and amount of protienuria. <0.5g/dL - observe >0.5g/dL or HTN - ACEi or ARB >1g/dL - ACEi/ARB + Fish oil + Pred
62
What is the management of Von Willebrand's disease?
Tranexamic Acid for bleeding Desmopressin (DDAVP) to raise levels of vWF Factor VIII concentrate
63
Which nerve may be affected from loss of pronation of forearm + weakness of long flexors of thumb and index finger?
anterior interosseus nerve (branch of median nerve)
64
What are the rules of Diabetes Mellitus and DVLA?
Must inform DVLA if - Risk of hypoglycaemia - On hypoglycaemia medication To drive, must be - Free of severe hypo for 12 months - Regular monitoring 2x a day relevant to driving - No visual impairment No need to inform if - Diet controlled alone - On tablets or exenatide - Gestational diabetes taking insulin for <3 months - Temporary treatment for <3 months
65
What dose of adrenaline should be administered to a 1. <6 month 2. 6 month - 6 year 3. 6-12 year 4. Adult and child (>12 yr)
1 and 2 = 150mcg (0.15ml 1 in 1000) 3 = 300mcg (0.3ml 1 in 1000) 4 = 500 mcg (0.5ml 1 in 1000)
66
What is Acanthosis nigricans?
a sign of insulin resistance, also associated with type 2 diabetes mellitus.
67
What is the clinical triad of Bartter's syndrome?
Hypokalemia Met Alkalosis Normal-low BP Presents in children, polyuria, dehydration, mimics loop diuretic
68
What is the clinical triad of renal cell carcinoma?
Haematuria Loin pain Abdominal mass
69
What testicular issue arises from renal cell carcinoma?
Varicocele due to occlusion of left testicular vein
70
What endocrine effects may arise from a renal cell carcinoma?
Secretion of erythropoietin (polycythemia) PTH (hypercalcaemia) Renin ACTH
71
What is the treatment for an overdose of... Heparin
Protamine sulfate
72
What is the treatment for an overdose of... Salicylate
Urinary Alkalinization (CI if cerebral / puolmonary oedema) Haemodialysis
73
What is the treatment for an overdose of... Benzodiazepines
Flumazenil
74
What is the treatment for an overdose of... Antifreeze / Ethylene Glycol or Methanol
Fomepizole Or alcohol / ethanol
75
What is the treatment for an overdose of... Cyanide
Hydroxocobalamin
76
What risks are increased with antipsychotic use in the elderly?
Increased risk of STROKE | Increased risk of VTE
77
What are some risk factors and extra-intestinal manifestations of UC?
FHx positive HLA-B27 (Ank Spond, PA, EA) Infection NSAID use Uveitis and episcleritis Arthritis
78
What are some risk factors and extra-intestinal manifestations of Crohn's Disease?
FHx White Age < 40yr Smoking Erythema Nordosom
79
What signs may differentiate Crohn's and UC?
Chron's is non bloody UC is bloody Chrons has perianal involvement with rectal sparing UC affects rectum but no perianal or oral lesions Chrons affects the whole GI UC usually affects the colon and rectum
80
What are the causes of acute pancreatitis?
GET SMASHED G - Gall stones E - Ethanol T - Trauma S - Steroids M - Mumps A - Autoimmune (e.g. polyarteritis nordosa) S - Scorpion Venom H - Hypertriglyceridaemia, hypercalcaemia, hypothermia E - ERCP D - Drugs
81
Which drugs cause acute pancreatitis?
Azathioprine Mesalazine* (7x more than sulfasalazine) Didanosine Bendroflumethiazide Forusemide Pentamadine (Pneumocystis jirovecii) Steroids Sodium Valproate
82
How soon after implantation can IUD vs IUS be relied upon for contraception?
IUD - Immediately (Dependable) | IUS - after 7 days (Seven)
83
What are some problems of IUD vs IUS?
IUD - Periods are heavier, longer and more painful IUS - Initial frequent uterine bleeding and spotting - Later, intermittent light menses, less dysmenorrhoea and some become amenorrhoeic think: IUD - disasterous but dependable think IUS - spotting, sometimes, seldom, seven
84
What medications should be supplied to COPD patients who incur frequent exacerbations?
Home supply of - Prednisolone - Antiotic
85
What are the features of Cor Pulmonale and what is the management?
RHF as a result of pulmonary hypertension Features include - Peripheral oedema (give loop diuretics) - Raised JVP - Systolic parasternal heave, loud P2 Consider LTOT, diuretics for edema
86
What are the adverse effects of phenytoin?
PHENYTOIN ``` P - P450 interactions H - Hirsutism E - Enlarged gums N - Nystagmus Y - Yellow-browning of skin T - Teratogenicity O - Osteomalacia I - Interference with B12 metabolism (megaloblastic) N- Neuropathies (inc vertigo, ataxia and headache) ```
87
What are the features of a vulval carcinoma?
Lump or ulcer on labia majora | Itching or irritation
88
What are the features of a Nasal Septal Haematoma and how may you differentiate it from a deviated septum? How do you manage this condition? What complication may arise if this is not treated?
Can occur from a minor injury Sensation of nasal obstruction Pain and rhinorrhoea Bilateral, red swelling from nasal septum Haematomas are BOGGY whereas deviated septums are firm. ``` Surgical draining (urgent ENT) IV Antibiotics ``` If untreated - IRREVERSIBLE SEPTAL NECROSIS - SADDLE NOSE DEFORMITY
89
What are the long-term complications of polycystic ovarian syndrome?
Subfertility (ovaries are fucked) Diabetes Mellitus (increased weight) + Acanthosis Nigricans Stroke & TIA (increased weight) Coronary artery disease (increased weight) Obstructive sleep apnoea (increased weight) Endometrial cancer (increased estrogen)
90
What is the effect of polycystic ovarian syndrome on LH:FSH ratio?
Raised
91
What are people who work in farms, around animals, in sewers or in abattoir (slaughter house) likely to be infected by? What is the management?
Leptospirosis a.k.a Weil's Disease (a more severe form associated with Juandice) High dose benzylpenecilin or doxycyline
92
What are the two most common cause of pulmonary hypoplasia?
Oligohydramnios (deficiency in amniotic fluid) | Congenital diaphragmatic hernia
93
In what situations should oxygen therapy not be used if there is no evidence of hypoxia?
MI and ACS Stroke Obstetric emergencies Anxiety related hyperventilation
94
What investigation is performed in suspected phaechromocytoma? What is the definitive management of this condition?
24 hr urinary collection of METANEPHRINES ``` Surgery. MUST stabilise prior with medical management - Alpha-blocker (phenoxybenzamine) or - Beta-blocker (propanolol) ```
95
Name 3 common causes of lobar collapse? What are the general signs on XRAY?
Lung CANCER - most common cause in older adults ASTHMA - due to mucous plugging FOREIGN BODY Xray - Tracheal deviation towards side of collapse - Mediastinal shift towards side of collapse - Elevation of hemidiaphragm
96
What is the management for Idiopathic Intracranial Hypertension?
Weight loss Diuretics e.g. acetazolamide Topiramate
97
What findings are present in SIADH with reference to urine and plasma osmlality, and serium sodium?
High urine osmolality Low plasma osmolality Low serum sodium

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