QuesMed Corrections Flashcards
(107 cards)
1
Q
What is the 1st line investigation for IBD?
A
Faecal calprotectin (non-invasive)
2
Q
If faecal calprotectin is raised, what is next investigation?
A
Colonoscopy
3
Q
Which type of IBD is a risk factor for gallblabder carcinoma?
A
UC - due to its association with primary sclerosing cholangitis
4
Q
Is MS more common in men or women?
A
Women (typically <50)
5
Q
What type of disease is MS?
A
Demyelinating
6
Q
How can MS present on examination?
A
- Cerebellar ataxia → wide gait
- Poor coordination
- Optic neuritis
- Eye movement abnormalities e.g. double vision, opthalmoplegia
7
Q
Give the stepwise management of mild-moderate UC
A
- Oral mesalazine
- oral prednisolone
- oral tacrolimus
8
Q
Give the stepwise management of acute severe IBD
A
- IV corticosteroids
- IV ciclosporin or surgery
9
Q
What is the main cause of short bowel syndrome?
A
Surgical resection
10
Q
What class of drug is given as 2ary prophylaxis of oesophageal varices
A
Propanolol
11
Q
What type of IBD are peri-anal fistulas more common in?
A
Crohn’s
12
Q
What is a peri-anal fistula?
A
A peri-anal fistula is an abnormal tract between the anal canal and surface of skin.
Is the most common type of fistula and often appears following an abscess.
13
Q
What is paralytic ileus?
A
Neurogenic disruption of the normal peristaltic activity of the bowel
14
Q
Presentation of paralytic ileus vs mechanical bowel obstruction?
A
Presentation similar but lack of intestinal movements in paralytic ileus → silent bowel sounds & lack of colicky pain
15
Q
Risk factors for paralytic ileus?
A
- Obese
- Anticholinergics
- Opiates
- Operation with bowel handling
- Lack of mobilisation post-operatively
16
Q
What 2 classes of drugs are a risk for paralytic ileus?
A
- Opiates
- Antimuscarinics
17
Q
Which 3 Abx leavesa metallic taste in the mouth?
A
- clarithromycin
- metronidazole
- tetracycline
18
Q
What is the 1st line diuretic for ascites in liver cirrhosis?
A
Spironolactone
19
Q
What is the investigation of choice to visualise the bile ducts?
A
MRCP
20
Q
What malignancy can Schistosomiasis predispose to?
A
Bladder cancer (squamous cell carcinoma)
21
Q
Pharmacological agent for acute alcohol withdrawal?
A
Chlordiazepoxide (benzo) → to reduce withdrawal symptoms e.g. seizures
22
Q
Pharmacological agent for chronic alcohol use?
A
Thiamine (B1)
23
Q
What is haemolytic uraemic syndrome?
A
HUS is a rare but serious disease that affects the kidneys and blood clotting functions of infected people. Infection with HUS causes destruction of red blood cells, which can then cause kidney failure.
Can present with haemolytic anaemia, AKI, and thrombocytopenia
24
Q
What infection can HUS occur as a complication of?
A
HUS occurs as a complication of a diarrhoea infection → usually E. coli due to production of Shiga toxin
25
Why are patients with **chronic liver disease** susceptible to **hypoglycaemia**?
as there is an impairment of the liver’s ability to produce **glycogen**
26
What is the definitive investigation for coeliac disease?
duodenal biopsy (healing would be seen after instigation of gluten-free diet)
27
What 3 drugs can cause cholestatic jaundice?
1. Co-amoxiclav
2. Flucloxacillin
3. Nitrofurantoin
28
How does digoxin toxicity affect potassium levels?
hyperkalaemia
29
How can hypokalaemia precipitate digoxin toxicity?
Hypokalaemia can precipitate digoxin toxicity as this increases the Na+/K+ pump due to less competition for digoxin binding
30
Why is verapamil contraindicated in WPW?
contraindicated in **WPW syndrome** as they block the AV node and result in impulses from the atria to be passed to the ventricles via the aberrant pathway
31
How can thiazides affect acid base balance?
Can cause hypokalaemic metabolic alkalosis
32
What type of valves are known to cause non-immune haemolytic anaemia?
Metallic aortic valves are known to cause **non-immune haemolytic anaemia** in some cases (due to shear stress against foreign material of valve).
33
What combination of medications can predispose to complete heart block?
beta blocker + non-dihydropyridine CCB (e.g. verapamil)
34
Rheumatic fever is a delayed reaction to what infection?
Strep A (most commonly S. pharyngitis)
35
What is the most common valvular defect following rheumatic heart disease? What murmur does this cause?
Mitral stenosis → mid-diastolic murmur heard over the apex
36
Pathophysiology of an aortic dissection?
Tear in tunica intima of wall of aorta, creating a false lumen which fills with large volumes of blood
37
What may be seen on the CXR of a patient with aortic dissection?
Widened mediastinum
38
Which antiarrhythmic increases the risk of **statin-induced rhabdomyolysis**?
Amiodarone (class III)
39
Which artery most likely supplies the AV node?
Right coronary artery
40
What is heart failure with preserved ejection fraction typically caused by?
ventricular stiffness 2ary to long-standing HTN or ventricular hypertrophy
41
Describe ECG changes in hypokalaemia
* ST segment depression
* U waves
* Small or absent T waves (occasionally inversion)
42
Describe ECG changes in hyperkalaemia
* Small or absent P waves
* Tall, tented T waves
* Broad bizarre QRS complexes
43
Describe the murmur heard in aortic regurgitation
Early diastolic heard in the aortic area (get patient to lean forwards)
44
Give 2 major causes of aortic regurgitation?
1. Infective endocarditis
2. Aortic dissection
45
How do nitrates affect **intracellular** calcium?
Nitrates cause a **decrease** in intracellular calcium.
46
How do NSAIDs affect the anti-hypertensive effects of ACEi?
**NSAIDs _reduce_ the anti-hypertensive effects of ACEi.**
47
Combined use of PPIs and thiazide diuretics can lead to which electrolyte abnormality?
Severe hyponatraemia
48
Which diuretics can predispose to gout?
1. Thiazide/thiazide-like
2. Loop
49
Give 3 possible signs seen in PE
1. Sinus tachycardia (most common)
2. Signs of right heart strain
3. T wave inversion in anterior leads
50
Why does warfarin have a small volume of distribution
protein bound
51
How do antacids affect the absorption of ACEi?
Reduce
52
What is Dressler's syndrome?
A 2ary pericarditis that usually occurs 1-6 weeks post MI
53
Management of Dressler's?
High dose aspirin
54
Stepwise management of SVT?
1. Vagal manoeuvres
2. Verapamil
3. Adenosine (if no contraindications e.g. asthma)
55
What is P pulmonale? What condition does it indicate?
A tall, peaked p wave on an ECG trace - reflects **right atrial enlargement** seen in cor pulmonale
56
Oral hypoglycaemics vs insulin in DKA
Oral hypoglycaemic drugs (e.g. sulfonylureas) class of drugs) have **no** **role** in the treatment of DKA.
Insulin is the mode of treatment.
57
Which ECG leads represent the lateral view of the heart?
V5-6
58
What class of medication is amiloride?
K+ sparing diuretic
59
How will the INR be affected in liver damage?
Raised - due to reduced clotting factors (blood will clot more slowly)
60
How does levofloxacin affect the P450 system?
It is an enzyme inhibitor
61
How does the body correct acidosis if kidney function is poor?
Hyperventilation
62
What is the most common cause of clubbing?
Lung cancer
63
What is a dermoid cyst?
Dermoid cysts occur when tissue collects under the skin and may contain hair, teeth or nerves. The often form on your head and neck.
64
What is a sebaceous cyst also known as?
Epidermoid cyst
65
What is an epidermoid cyst?
Sebaceous cysts fill with sebum and form within sebaceous glands, which are part of the skin and hair follicles. They often have a ‘**punctum**’ (small dark-coloured **comedone** opening on the surface).
66
Which cyst has a ‘punctum’?
Epidermoid
67
What GI disease can show **discrete** areas of inflammation in the bowel with a nodular cobblestone appearance?
Crohn's disease
68
What is atrial dilatation commonly associated with?
Pressure and/or volume overload e.g. HTN, mitral valve dysfunction
69
What arrhythmia is atrial dilatation associated with?
AF
70
What is the likely site of pathology if there is sudden loss of vision in the **left** visual field of both eyes but central vision is good?
Right occipital lobe → occipital lobe lesions cause **homonymous hemianopia with macular sparing**
71
Who's duty is it to issue the MCCD (medical certificate for confirmation of death)?
the doctor who has attended in the last illness to issue the MCCD i.e. a doctor who has cared for the patient **during the illness that led to death** and is familiar with their PMH.
72
If no doctor who cared for the patient can be found, who is the death referred to?
Coroner
73
Within how many days prior to death must the doctor have see the patient to issue the MCCD?
28
74
What lung condition is being a heating engineer a risk factor for?
asbestos
75
What is a seroma?
A seroma is a build-up of clear fluid inside the body that happens most often after surgery. Seromas typically appear 7-10 days after surgery when drainage tubes have been removed.
76
How long after surgery does lymphoedema develop
Within 3 years
77
What type of anaemia do blood thinners increase your risk of?
Iron-deficiency anaemia
78
Presentation of ischaemic colitis?
GI bleeding
Severe abdominal pain
79
Which Abx is indicated in Giardia?
Metronidazole
80
What risk factor can 15% of OA cases be directly traced back to?
injury e.g. fractures, breaks
81
What is fibromyalgia?
Fibromyalgia is a condition that causes **widespread pain** and **extreme** **tiredness**. It can also cause **sleep**, **memory** and **mood** **issues**. It can start after a stressful event like an injury, illness, or death of a loved one.
82
How does excess ADH affect plasma sodium?
Causes hyperkalaemia
83
What is Sjogrens syndrome?
Sjögren's syndrome is a condition that affects parts of the body that produce fluids, like tears and spit (saliva).
84
What condition is Sjogren's syndrome associated with?
Rheumatoid arthritis
85
Ocular manifestations of myasthenia gravis?
Ocular myasthenia gravis only affects the muscles that move the eyes and eyelids.
Symptoms include double vision trouble focusing, and drooping eyelids (symptoms worse later in day).
86
WHhat is the most common tumour of the cerebellopontine angle?
Acoustic neuroma
87
What is an acoustic neuroma? What are the most common presenting complaints?
It is a benign tumour that develops on the vestibular or cochlear nerves. The most common presenting symptoms are **unilateral** **hearing** **loss**, **tinnitus** and **imbalance**.
88
What is vestibular neuronitis?
A disorder characterised by **sudden onset attacks of vertigo** and **nystagmus** caused by **inflammation of the vestibular nerve**.
Hearing is NOT affected.
89
What does vestibular neuronitis typically follow?
Viral URTI
90
Which 2 CCBs can cause bradycardia
Non-dihydropyridine calcium-channel blockers → **diltiazem and verapamil**
91
Which 2 drug classes should not be used together due to risk of bradycardia/arrest?
Beta blockers + non-dihydropyridine CCBs
92
How does fludrocortisone increase BP?
Fludrocortisone works to increase BP in postural hypotension by retaining sodium which can lead to water retention and swelling.
93
Which scan is used to assess the risk of fractures?
DEXA bone density scan
94
What vitamin deficiency are associated with reduced muscle strength?
Vitamin D → Low serum levels of vitamin D are associated with **reduced** **muscle** **strength** which can lead to **muscle** **atrophy**. **Back** **pain** can also be a symptom of low vitamin D levels.
95
Best imaging for bony mets?
MRI
96
What imaging modality is 1st line in assessing the extent of spinal trauma?
CT scans
97
What combination of medications can lead to complete heart block?
beta blocker + non-dihydropyridine CCB (e.g. verapamil)
98
ECG features in SVT vs VT
SVT:
* Absent p waves
* Ventricular rate \>100
* Regular rhythm
* **Narrow** **QRS** complexes
VT:
* Regular rhythm
* **Wide QRS** of equal amplitude (monomorphic)
* Absent p waves
99
Explain the FEV1/FVC ration in **restrictive lung disease**
Reduced FVC **and** FEV1 resulting in a **normalised FEV1/FVC ratio**
100
What type of cancer are most Pancoast tumours?
NSCLC - most commonly squamous cell cancers
101
SCLC can cause SIADH. How may this present?
Hyponatraemia → headache, drowsiness, seizures, coma
102
How does sodium affect seizures?
Low sodium → increased risk of seizures
103
What does high bicarbonate in a hypercapnic patient indicate?
Chronic retention of COPD
104
The diagnosis of T2DM depends on whether the patient is **symptomatic** or not. If the patient is **symptomatic**, what is required for diagnosis?
only **_one_ positive HbA1c**, **fasting glucose**, or **random glucose** is needed for diagnosis
105
The diagnosis of T2DM depends on whether the patient is **symptomatic** or not. If the patient is **asymptomatic**, what is required for diagnosis?
**two _separate_ readings** are required for diagnosis (NICE recommends the same modality that was used for the original test is used e.g. 2x separate HbA1c readings)
106
How does hypocalcaemia present?
paraesthesia, muscle spasms, seizures
107
What is the most common type of thyroid cancer?
**Papillary** thyroid cancer (80%) → occurs more frequently in females
