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1
Q

What must be done within 1 hour of a patient becoming septic?

A

Give 3 Take 3
Give - fluids, high flow oxygen, empirical antibiotics
Take - blood cultures, lactate and urine output

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2
Q

Patient with asthma attack has RR 30, HR 124, sats 93%, PO2 9.1, PCO2 5. What stage of asthma is this and what is the immediate management?

A

Acute severe asthma

Give high flow o2 plus nebuliser ipratropium

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3
Q

Patient presents with muscle cramps after taking too much spironolactone. ECG shows widened QRS and absent p waves. What is the initial management?

A

IV calcium gluconate

Followed by IV insulin and dextrose

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4
Q

What is the management for acute anaphylaxis?

A

ABCD + 100% oxygen + IM adrenaline (0.5mg) + IV steroids + IV antihistamines

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5
Q

38yof investigated for heavy bleeding during routine mole removal. Low platelets, reticulocytes and Auer rods noticed. Dx?

A

AML

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6
Q

4yo w/ bruising and swollen testicles.

A

ALL

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7
Q

75yof w/ raised WCC, asymptomatic but some cervical lymphadenopathy. Smear cells seen on blood film.

A

CLL

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8
Q

25yom w/ neck swelling, pain on alcohol, active disease in hilar and cervical lymph nodes.

A

Hodgkin’s lymphoma

Would see Reed-Sternberg cells on blood film.

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9
Q

35y w/ RTI develops haemoptysis, hx of nosebleeds, microscopic haematuria.

A

Wegener’s granulomatosis (GPA)

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10
Q

65yof w/ fronto-temporal left sided headache, noticed when brushing ahir, also has shoulder pain for 6 months

A

Giant cell arteritis

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11
Q

6yom w/ maculopapular rash, swollen red tongue, fever. Echo shows coronary artery aneurysms

A

Kawasaki’s vasculitis

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12
Q

38yof hx of asthma has SOB. High eosinophils, which Ab would be high?

A

p-ANCA (Churg-Strauss)

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13
Q

45yom with haemoptysis, history of epistaxis and poor renal function. Which ab would be high?

A

c-ANCA (Wegener’s granulomatosis)

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14
Q

Which antibody in microscopic polyarteritis?

A

p-ANCA

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15
Q

Child presents with arthritis, purpura, abdo pain, glomerulonephritis and haematuria

A

IgA vasculitis (Henloch-Schonlein purpura)

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16
Q

HBV+ve patient presents with string of aneurysms in coronary and renal arteries

A

Polyarteritis nodosum

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17
Q

Young female with upper limb claudication and hypertension

A

Takayasu’s vasculitis (large cell)

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18
Q

GCS - eyes (EYES)

A
  1. Eyes shut
  2. Youch! - Responds to pain
  3. Eyes open to voice
  4. Spontaneous opening
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19
Q

GCS - vocal (VOWEL)

A
  1. Voiceless
  2. Obscure words
  3. Way off (inappropriate words)
  4. Erratic (confused words)
  5. Legit (normal conversation)
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20
Q

GCS - motor (OLD BEN)

A
  1. Obeys commands
  2. Localises to pain
  3. Draws away from pain
  4. Bends due to pain
  5. Extends due to pain
  6. No motor response
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21
Q

6 Ps of acute limb ischaemia

A 
Painful
Pale
Pulseless
Perishingly cold
Paraesthesia
Paralysis
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22
Q

5 Ts of Addisons

A 
Thin
Tummy pain
Tanned
Teary
Tired
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23
Q

32yof w/ profuse green diarrhoea and headache for 3d. Returned from Thailand, v lethargic. Pink spots on abdo and tenderness in RUQ and LUQ, pyrexial.

A

Typhoid

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24
Q

IVDU w/ fever, new onset pan systolic murmur, splenomegaly

A

Staph aureus causing infective endocarditis

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25
38yof 1w hx of diarrhoea with belching and flatulence. Stool microscopy shows cysts and trophozoites. Dx + Tx?
Giardia | Give metronidazole
26
50yom has bloody diarrhoea after attending a wedding, microscopy shows gram negative spiral shaped bacteria
Campylobacter jejuni
27
78yo being treated for pneumonia develops abdo pain and bloody diarrhoea. Cytopathic toxin detected in stool and axr shows gross dilation of colon
C diff
28
Student has diarrhoea and vomiting after eating Chinese takeaway a few hours ago, stool microscopy shows gram positive rods
Bacillus cereus
29
42yof collapsed, had profuse ‘rice water’ diarrhoea for 2 days, recently returned from Bangladesh. Stool microscopy shows gram negative comma shaped bacilli
Cholera
30
Best opioid for renal colic?
Diclofenac
31
Antidote to benzodiazepines?
Flumazenil (blocks binding site at GABAa)
32
Antidote to TCAs?
Sodium bicarbonate
33
Antidote to warfarin?
Vitamin K
34
Antidote to heparin?
Protamine sulphate
35
Antidote to organophosphates (insecticides)?
Pralidoxime + atropine
36
Antidote to digoxin?
Digiband
37
Antidote to calcium channel blockers?
Glucagon
38
Antidote to lead?
Dimercaprol, penicillamine, edetate calcium
39
Antidote to copper?
Penicillamine
40
Side effects of too much digoxin?
Palpitations, nausea, vomiting, diarrhoea, blurry yellow vision, SVT
41
Side effects of too much spironolactone?
Muscle cramps, gynaecomastia, hyperkalaemia (wide QRS, absent p waves)
42
Side effects of too much phenytoin?
Gingival hyperplasia, nystagmus, cytochrome p450 inducer
43
TB antibiotics
``` RIPE Rifampicin Isoniazid Pyrazinamide Ethambutol ```
44
What is found in seretide?
Fluticasone + salmeterol (steroid + LABA)
45
Antibiotic for upper UTI/pyelonephritis?
Ciprofloxacin
46
Antibiotic for lower UTI?
Nitrofurantoin or trimethroprim
47
Treatment for H pylori
PPI + amoxicillin + clarithromycin or metronidazole
48
Treatment for pneumocystitis carnii?
Co-trimazaxole
49
Tx for MRSA?
Vancomycin
50
Tx for aspiration pneumonia?
IV ciprofloxacin + metronidazole
51
Side effects of SABAs?
Tremor, hypokalaemia
52
47yom w/ soft lumpy swellings on upper left side of scrotum. Not painful or symptomatic
Varicocoele
53
24yom w/ hard smooth swelling on right testes. Testes were late in descending when he was a baby. Not tender, doesn’t transilluminate, no cough impulse. Raised aFP and bhCG
Testicular cancer - teratoma as both afp and bhcg are raised (only bhcg raised in seminoma)
54
35yom back from work trip w/ fever and painful lumps in groin. Pyrexial, yellow discharge from penis, inguinal lymphadenopathy, swelling and tenderness of spermatic cord and testes
Epididymoorchitis (chlamydia or gonorrhoea cause) | - Give ceftriaxone and azithromycin
55
74yof has sudden urges to urinate 10xday, unsteady on feet, difficult memory, wide based shuffling gait, 21/30 on MMSE, Ct shows enlarged ventricles
Normal pressure hydrocephalus Presents as wet, wobbly, wacky - urine incontinence, unsteady on feet, cognitive changes
56
Criteria for AKI?
Rise in creatinine >26um/l in 48h or 1.5x baseline | Urine output 6 consecutive hours
57
17yom w/ periorbital oedema, throat infection 3w ago, urine +ve for protein and blood
Post-strep glomerulonephritis, presenting with nephritic syndrome
58
Findings in nephritic syndrome? (5)
++ protein, ++ haematuria, AKI, oedema, high BP
59
Findings in nephrotic syndrome? (4)
+proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia
60
Risk factors for nephrotic syndrome?
Diabetes, SLE, amyloid, viral hepatitis
61
Risk factors for nephritic syndrome?
Post strep, vasculitis, SLE, anti-GBM disease, cryoglobunlinaemia
62
53yom suffers aortic aneurysm. 1d after sx he becomes oliguric with high urea and creatinine. After 1w urine output increases but GFR remains low
Acute tubular necrosis due to hypovolaemia
63
17yo student sore throat and flu like symptoms, frank haematuria, swelling of ankles and poor urine output
IgA nephropathy
64
84yof collapsed, has AKI
Rhabdomyolysis
65
79yom has deranged U&Es and raised creatinine. Hx of back pain and v tired recently
Myeloma
66
10yof irritable, abdo pain, reduced urine output, diarrhoea
Haemolytic uraemic syndrome (diarrhoea -> e.coli)
67
Clinical features of myeloma - CRABI
Calcium high Renal failure (high urea, high creatinine) Anaemia Bone - osteolytic bone lesions, spinal cord compression Infection
68
Patient presents with macroscopic haematuria, oliguria and haemoptysis. Dx and which antibody?
Good pasture's disease | Autoantibody to type 4 collagen (part of GBM in kidney and lung)
69
Patient with haematuria after URTI
IgA nephropathy (most common glomerulonephritis)
70
Patient with ++blood, ++protein 2 weeks after throat infection
Post-strep glomerular nephritis
71
ST elevation in leads V1-V4
Left anterior descending artery infarct
72
ST elevation in leads V5, V6, I, aVL
Lateral MI - circumflex artery
73
ST elevation in leads II, III, aVF
Inferior MI - right coronary artery
74
ST elevation in V1-V6
Left main stem
75
65yom presents with easy bruising. Bloods show pancytopenia and abnormal cell maturation
Myelodysplastic syndrome
76
What is polycythaemia rubra vera and how does it present?
Donal proliferation of myeloid cells and reduced haematopoeitic efficiency. JAK2 mutations are seen. Presents age 45-60 with headacSOB, tinnitus, hyper viscosity symptoms, pruritus (typically after a hot bath), night sweats, thrombosis, choreiform movements, peptic ulcer disease
77
Management of sickle cell, acute and chronic?
Acute - oxygen, fluids, opiates, antibiotics. May require exchange transfusion in severe crises. Chronic - penicillin prophylaxis, hydroxyurea, folic acid.
78
What is an aplastic crisis?
Infection with B19 parvovirus leading to temporary cessation of erythropoeisis
79
What is the triad of haemolytic uraemia syndrome?
Microangiopathic haemolytic anaemia, acute renal failure and thrombocytopenia. See fragmented red blood cells. TTP includes fever and fluctuating CNS signs.
80
Risk factors for HUS?
``` E.coli Shigella HIV OCP Ciclosporin 5-fluorouracil Malignant HTN Pregnancy SLE Scleroderma ```
81
Presence of Auer rods?
AML
82
Presence of BCR-ABL (philadelphia chromosome)
CML
83
Reed-sternberg cells?
Hodgkin's lymphoma
84
Paraprotein, Bence Jones protein
Multiple Myeloma
85
6yom presents with large haemarthrosis on knee after minor injury. Hx of this.
haemophilia
86
6yom with gum bleeding. Low factor 8
von Willebrand disease
87
60yom tx for sepsis – deteriorates – high APTT and PT, low fibrinogen, high fibrin degradation products
DIC
88
40yof pregnant, acute SOB, took OCP
PE
89
46yom w/ recurrent nosebleed, telangiectasia around lips and mouth
Hereditary telangiectasia AKA Osler-Weber-Rendu syndrome
90
Vitamin K dependent factors?
2, 7, 9, 10 (extrinsic pathway)
91
What does a positive schilling test indicate?
Pernicious anaemia Used in patients with B12 deficiency
92
What is the first line tx for CML?
Imatinib
93
What test can be used to distinguish between AML and ALL?
Sudan black test - stains myeloblasts but not lymphoblasts
94
What happens to EPO in polycythaemia rubra vera?
EPO is reduced in PRV
95
What is seen in beta thalassemia trait?
Mild microcytic anaemia and increased HbA2
96
Factor V Leiden affects which protein?
Factor V Leiden causes resistance to protein C, leading to hypercoaguability > increased risk of DVT
97
What is seen in von Willebrand disease?
Superficial bleeding and bruising + long bleeding time and APTT, but normal PT
98
What should be measured to give an accurate reflection of the body's iron stores?
Serum ferritin
99
Which chromosome is affected in AML?
t(15;17)
100
Which chromosome is affected in CML?
t(9;22) - Philadelphia chromosome
101
Patient presents with oral and genital ulcers, erythema nodosum and arthritis. Which syndrome may they have?
Behcet's Systemic vasculitis of unknown cause – oral and genital ulcers, ocular lesions, cutaneous lesions e.g. erythema nodosum, arthritis, diarrhoea, encephalitis
102
Patient notes they have gotten taller and their head appears bigger. What is the condition?
Paget's disease of bone - involves remodelling of the spine, skull, pelvis, femur and tibia
103
Which antibody is most specific for SLE?
Anti-dsDNA
104
Which antibodies are most specific for RA?
Anti CCP
105
Which joints are spared at the onset of RA?
Distal interphalangeal joints (DIP)
106
Where are Heberdens nodes and Bouchards nodes found?
Heberdens - DIPs | Bouchards - PIPs
107
Patient has a painful neck and presents with hyperthyroid symptoms. 4 weeks later they are hypothyroid. What is the underlying condition?
De Quervains thyroiditis Hyperthyroidism plus acute neck pain - hypothyroid - euthyroid
108
Male presents with hypogonadism, late puberty and cannot smell anything - what is underlying condition?
Kallman's
109
What is the first investigation if Conn's is suspected?
24h ambulatory blood pressure
110
Most appropriate investigation for gallstones/pancreatitis?
Abdominal USS
111
What is the first investigation if cushings is suspected?
Free urinary cortisol
112
What is the most definitive investigation if Cushings is suspected?
Low dose dex suppression test followed by high dose dex suppression (if high dose fails to suppress cortisol, the source of cortisol is likely to be an ACTH secreting tumour e.g. small cell lung carcinoma)
113
What is the most common cause of nephrotic syndrome in children/young adults?
Minimal change glomerulonephritis
114
Which drugs can cause drug-induced liver cirrhosis?
Amiodarone, methyldopa and methotrexate
115
Which part of the small intestine is responsible for absorbing vitamin B12?
The terminal ileum
116
What tumour marker is present in hepatocellular carcinoma (and testicular cancer)?
AFP
117
What type of anaemia is seen in alcoholic liver disease?
Macrocytic anaemia
118
Which antibodies are found in coeliac disease?
Anti-TTG
119
Which cancer is primary sclerosing cholangitis a risk factor for?
Cholangiocarcinoma
120
What other condition is primary sclerosing cholangitis associated with?
Ulcerative colitis
121
What is the triad of Budd-Chiari syndrome?
Ascites, hepatomegaly and acute abdominal pain
122
What is the definition of Barrett's oesophagus
Lower third of the oesophagus changes (metaplasia) from squamous epithelium to columnar cells
123
Most appropriate investigation for gallstones?
Abdominal USS
124
What is the most important risk factor for stroke?
Hypertension
125
Patient has AF and suffers painless unilateral vision loss caused by retinal artery emboli
Amaurosis fugax
126
Patient has lower back pain and sciatica on walking, pain worse when walking downhill and better walking uphill
Spinal claudication/stenosis
127
Patient has seizure. 1st line tx?
Rectal diazepam - 2 times 10 mins apart
128
2nd line tx of seizure
Phenytoin loading
129
3rd line tx of seizure
Call ITU - anaesthesia
130
Patient presents with left facial droop, nasolabial fold flattened, slightly weak eye closure - forehead wrinkles when raising eyes. Diagnosis?
Right middle cerebral artery stroke causing CNVII lesion
131
What is Lambert Eaton syndrome and what other disease is it associated with?
Like MG but improves on exercise - assoc w/ small cell lung cancer as is paraneoplastic
132
How does Neurofibromatosis type 1 present?
Cafe au lait spots, axillary freckling, neurofibromas
133
70yom presents with change in behaviour, negative symptoms e.g. loss of interest, withdrawal, gradual progression. What type of dementia?
Frontotemporal dementia
134
Patient presents with loss of vision in lower right quadrant - where is lesion?
Left parietal lobe
135
First line treatment of T2dm?
Diet and lifestyle
136
If HbA1c rises above 6.5%, what is second line management of T2DM?
Metformin/modified release metformin. Aim for 6.5%.
137
If HbA1c rises above 7.5%, what is third line management of T2DM?
Dual therapy - Metformin + DPP-4i (gliptins) or pioglitazone (not in heart failure) or sulfonylurea. Aim for 7%.
138
If HbA1c rises above 7.5%, what is fourth line management of T2DM?
Triple therapy - metformin + DPP-4i + SU or metformin + pioglitazone + SU or metformin, pioglitazone/SU + SGLT2i. Add insulin. Aim for 7%.
139
5th line management of T2DM if triple therapy + insulin not effective?
Metformin, SU + GLP-1 mimetic
140
What are the major criteria of rheumatic fever?
``` ACCNE (alice can copy notes easily) Arthritis Carditis Chorea Nodules Erythema Marginatum ```
141
Which heart murmur is characteristic of rheumatic fever?
Mitral stenosis
142
What sort of murmur is mitral stenosis?
Mitral stenosis is a mid diastolic murmur, loudest at the apex. Presents with a tapping, non displaced apex and malaria flush.
143
What type of murmur is aortic stenosis?
Ejection systolic, loudest over aortic area, radiates to carotids. Has slow rising pulse.
144
What type of murmur is aortic regurgitation?
Aortic regurgitation is mid/early diastolic. Presents with characteristic signs such as water hammer pulse, quinckes sign, de mussets sign (pulsating), dyspnea orthopnea chest pain palpitations
145
What type of murmur is mitral regurgitation?
Mitral regurg is pan systolic
146
What type of murmur is tricuspid regurgitation?
Tricuspid regurg is pan systolic. Assoc w/ raised JVP.
147
What effect does atrial fibrillation have on JVP?
Absent a waves
148
What effect does pulmonary hypertension have on JVP?
Large a wave
149
What can cause cannon a waves in the JVP?
Complete heart block, arrhythmias
150
What effect does tricuspid regurgitation have on the JVP?
Raised, large v waves

3rd year revision (1 decks)

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