Things I've got wrong Flashcards
(156 cards)
1
Q
Sx of pagets disease of bone? What is it?
A
Associated with increased activity of osteoclasts and osteoblasts it causes increased bone remodelling.
Deep bone pain, done deformity and enlargement and pathological fractures
2
Q
Dx and Tx of pagets disease of bone?
A
Localized bone enlargement seen on x-ray. ALP is markedly raised
Treat with analgesia and alendronic acid
3
Q
What is pagets disease of breast?
A
Intra-epidermal spread of an intraductal cancer. Looks like eczema - suspect in any red scaly lesion of the nipple
4
Q
When might black sputum occur?
A
In chronic coal inhilation e.g. miners
5
Q
What is Dressler’s syndrome?
A
Reccurrent fever, central chest pain and pleural/pericardial rub occuring 2-10 weeks after MI or heart surgery
6
Q
What is seborrheric dermatitis?
A
A skin disease causing an itchy rash with flaky scales aka dandruff (can also affect the face and chest)
7
Q
What do haemagluttin and neuraminidase proteins indicate?
A
Influenza A
8
Q
How can you identify H. influenzae microbiologically?
A
Gram negative aerobic bacilli which requires factors V and X to grow
9
Q
What is acetylsalicylic acid?
A
Aspirin
10
Q
What is streptokinase?
A
A thrombolysis medication
11
Q
What is chlorpromazine?
A
Anti-psycotic used to treat schizophrenia
12
Q
What is propylthiouracil?
A
PTU - used to treat hyperthyroidism
13
Q
What drugs should be offered as secondary prevention in MI?
A
ACEi, dual anti-platelet therapy (aspirin and clopidogrel/ticagrelor), beta-blocker, statin
14
Q
When should thrombolysis be offered in MI? Give 2 drugs which can be used?
A
In a STEMI when symptoms have occured <12 hours ago but PCI can not be performed within 120mins of presentation
Tenecteplase or streptokinase
15
Q
What is proctalgia fugax?
A
Idiopathic intense brief stabbing/cramping pain of the rectum which is often worse at night
16
Q
Define the foregut, midgut and hindgut?
A
Foregut = oesophagus, stomach, liver, GB, bile ducts, pancreas and proximal duodenum Midgut = distal duodenum - proximal 2/3rds of the transverse colon Hindgut = distal 1/3rd of the transverse colon to the upper anal canal
17
Q
Which TB drug interacts with the oral contraceptive pill?
A
Rifampicin
18
Q
What is the best treatment of Parkisons disease?
A
Levodopa and carbidopa (as one pill = co-careldopa)
19
Q
What is Bell’s palsy?
A
Idiopathic facial nerve palsy.
Abrupt onset complete unilateral facial weakness with ipsilateral numbness and pain around the ear. Patient can NOT wrinkle forehead as LMN pathology
20
Q
What is Ramsay Hunt syndrome?
A
Lantent VZV reactivating in the VII CN ganglion. Leads to a painful rash on the auditory canal and causes Bell’s palsy (ipsilateral facial paralysis)
21
Q
What are the most common causative organisms of reactive arthritis?
A
GI = salmonella, shigella, yersinia GU = chlamydia, ureaplasma
22
Q
When should you initiate anticoagulant treatment in AF?
A
CHA2DS2VASc score of 2 or more to prevent stroke
23
Q
What can cause a low/high INR? What does this mean?
A
Low (blood not thin enough) = hypothyroidism, high vitamin K, nephrotic syndrome and hyperlipidaemia
High (blood too thin) = hyperthryoidism, low vitamin K, diarrhoea, liver disease and HF
24
Q
What affect does alcohol have on warfarin?
A
Increases its affect (increases INR)
25
What is Brudzinski's sign?
Hip and knees flex when the neck is flexed - this is seen in meningism
26
What medical condition is associated with Lhermitte's sign and Uhthoffs phenomenom? What are they?
MS.
Lhermitte's sign = electric shock sensation travelling down the back and througth the limbs
Uhtoff's phenomenom = symptoms becoming worse with heat
27
What is Rhomberg's test used for?
Diagnose the cause of ataxia.
If balance can not be kept with eyes open = cerebellar issues
If balance can be kept with eyes open but not with eyes closed = loss of proprioception due to DCML issues
28
What appears on LP 12 hours post SAH?
Xanthochromia (yellow CSF)
29
What is the first line treatment of eretile dysfunction?
Phosphodiesterase inhibitors e.g. viragra
30
What is Horner's syndrome?
Triad of miosis (constricted pupil), partial ptosis (drooping of the upper eyelid) and anhydrosis (ipsilateral loss of sweating).
Due to interuption of the faces sympathetic innervation e.g. in MS
31
What is the first line eczema treatment?
Hydrocortisone creme
32
What will the thyroid function test look like in primary and secondary hyperthyroidism?
```
Primary = low TSH and raised T4
Secondary = Raised TSH and raised T4.
```
33
What is carcinoid syndrome?
Hepatic involvement of a carcinoid tumour leading to diarrhoea, flushing, bronchoconstriction and cardiac involvement
34
What symptoms may help distinguish between UC and CD?
Blood/mucous in stools and tenesmus = UC
Perianal abscess/fistual/skin tags = CD
Mucous in stools implies that the disease is in the large intestine
35
What are side effects of alpha blockers e.g. tamulosin?
Lower vascular resistance so cause postural hypotension, dizziness and syncope
36
What is leucocytosis?
An increase in WBCs seen in conditions e.g. CML
37
What are the causes of iron deficiency anaemia?
Blood loss - menorrhagia, GI bleed e.g. due to peptic ulcers, hiatal hernia and colorectal cancers. NSAIDs commonly cause GI bleeds
Low dietary iron
Inability to absorb iron e.g. coeliacs disease
Pregnancy and hookworm
38
Define pharmacokinetics and pharmacodynamics?
```
Pharmacokinetics = action of the body on the drug
Pharmacodyanmics = action of the drug on the body
```
39
SEs of amitryptyline?
It has anticholinergic properties so inhibits the parasympathetic nervous system.
Causes dry mouth, blurred vision, confusion and urinary retention
40
What is a phenochromocytoma, how do you treat it?
Catacholamine producing tumours found within the adrenal medulla which cause episodic sweating, headaches and tachycardia
Tx with phenoxybenzamine before oporation to remove
41
What is the first line treatment of osteoporosis?
Alendronic acid and AdCal-D3
42
What is denosumab?
Monoclonal antibody to RANK ligand which reduces osteoclast activity. Can be injected every 6 months to treat osteoporosis
43
What are the first line prophylaxis and acute treatments of migraine?
```
Prophylaxis = propanolol or topiromate
Acute = triptan and NSAIDs/paracetamol
```
44
What are the commonest causes of bacterial meningitis in the UK?
Strep. pneumoniae = commonest, N. meningitidis = most severe, Haemophillus influenza type B, E.coli, Listeria monocytogenes (pregnant women) and Strep agalactiae (neonates)
45
Typical casues of CAP?
Strep. pneumonia = commonest, Haemophillus influenzae, Moraxella catarrhalis
46
Atypical causes of CAP?
Mycoplasma pneumoniae, Staph. aureus, Legionella species, Chlamydia and Coxiella burnetii
47
Causes of HAP? - Define HAP?
Pneumonia accquired >48 hours after hosptial admission.
| Stap.aureus (most common), Pseudomonas, Klebsiella and Clostridia
48
What is risperidone used for?
It is an anti-psychotic used to treat aggression and chorea e.g. in HD
49
What is gabapentin used for?
It is used to treat seizures and neuropathic pain
50
What is haloperidol used for?
It is used to treat psychosis in huntington's disease
51
What is the 6-in-1 vaccine?
Given to babies at 8, 12 and 16 weeks.
| It vaccinates against diptheria, hep. B, Hib (Haemophillus influenza type B), polio, tetanus and whooping cough
52
Name the causes of clubbing?
Respiratory - Lung cancer, Lung abscess, Empyema, Bronchiectasis, CF, IPF and Sarcoidosis
Cardiac - IE, Congenital heart disease
GI - UC/CD, Coeliac's disease, Cirrhosis and GI lymphoma
Other - Thyroid acropachy (hyperthyroidism)
53
What conditions cause BHL?
Sarcoidosis, infection e.g. TB, malignancy, hypersensitivity pneumonitis and organic dust diseases
54
What is seen on the X-ray in HF?
Alveolar oedema, kerly B lines, Cardiomegaly, Dilated prominent upper lobe veins, pleual Effusions
55
Describe the MRC dypnoea score?
```
1 = no unusual breathlessness
2 = breathlessness when walking up hill
3 = slow walking and has to stop
4 = has to stop after 100m/few mins on the flat
5 = too breathless to leave the house
```
56
What factors give a better prognosis for patients with MS?
Being female, being under 25 at presentation, >1 year between relapses, initial symptoms of optic neuritis/sensory disturbances rather than cerebellar issues e.g. ataxis and few lesions seen on MRI
57
What is orthostatic hypotension?
Postural hypotension
58
What should you give in an ischaemic stroke that can not be thrombolysed? What is the most important reasons not to thrombolyse?
300mg aspirin
| Onset of symptoms >4.5hrs ago, active bleed, surgery/major trauma <2 weeks, lumbar puncture <1 week
59
What is sciatica?
Pain that radiates down the path of the sciatic nerve (down the buttocks and through the leg)
60
Sx of spinal stenosis (spondylosis)?
Spinal claudication = pain worse when the spine is extended e.g. on walking downhill but better when the spine is flexed e.g. walking up hill or sitting
61
What is status epilepticus? How should you treat?
Seizures lasting >30mins. If diazepam does not stop seizures give phenytoin
62
If you have facial paralysis on one side of the body and limb paralysis on the other but only one lesion where will the lesion be?
Crossed signs implies the lesion is in the brainstem
| Facial paralysis always implies that the lesion is above the spinal cord
63
Which nerves are involved in the pupillary reflex?
```
CNII = detect the presence of light
CNIII = causes pupillary constriction (direct = in the eye with the light being shone into, consensula = in the other eye)
```
64
What does forehead sparring indicate in facial paralysis?
UMN lesion e.g. CN VII - this rules out Bells palsy
65
What is the Glabellar reflex/sign?
Continuous blinking when the forehead is tapped repeatedly - this is a sign of parkinsons disease
66
What is the Hoffmans sign?
Contraction of the thumb and index finger when flicking the middle finger - this indicates UMN lesion leading to coritcospinal dysfunction (often due to cord compression)
67
What does a high APTT indicate?
Haemophillia or von Willebrands disease
68
What does a high PT indicate?
AKA INR
| Liver disease, vitamin K deficiency, DIC and warfarin excess
69
What does prolonged bleeding time indicate?
Von Willebrand deficiency, TTP/DIC, thrombocytopenia
70
What if Factor V Leiden?
A mutation which causes you to develop clots in the legs and lungs
71
What is aplastic anaemia?
When the body fails to produce blood cells in sufficient quantities (low RBCs, WBCs and platelets)
72
Where is B12 absorbed? What condition will commonly lead to B12 deficiency?
The terminal ileum
| Crohn's disease and Coeliac's disease
73
How do you measure iron storage levels? What transports iron?
Serum Ferritin = iron storage (increases in inflammation, liver disease and malignancy)
Transferrin = iron transport (increases in iron defficiency)
74
What are schistocytes?
Fragments of red blood cells seen in RBC haemolysis. e.g. G6PD deficiency
75
How can you test for sickle cell disease?
Metabisulfite test
76
What are the best differentials between ALL and AML?
BM biopsy = Auer rods are found in AML but not ALL
| Sudan black stains in AML more than in ALL
77
What is Coombs test?
It detects autoimmune haemolytic anaemia
78
What is the best initial test to diagnose an acute leukeamia?
Direct microscopy of bone marrow cells to look for an increased quantity of blast cells
79
What is Schilling's test?
Detects issues with B12 absorption in pernicious anaemia
80
Define erythrocytosis and thrombocythaemia?
```
Erythrocytosis = too many RBCs
Thrombocythaemia = too many platelets
```
81
What are the alarm symptoms for peptic ulcers?
ALARMS: Anaemia, Loss of weight, Anorexia, Recent onset/progressive symptoms, Melena/haematemesis, Swallowing difficulties
82
What is the test for Wilson's disease?
24 hour urinary copper excretion test, diagnose with liver biopsy
83
How do you take alendronic acid?
Take it first thing in the morning on ana empty stomach (before other medications), swallow the tablet whole with a large galss of water, stay upright for 30mins after taking the tablet
84
What is vitamin B1?
Thiamine
85
What are the commonest bacterial causes of COPD exacerbations?
Haemophilus influenzae (most common cause), Streptococcus pneumonia and Moraxella catarrhalis
86
How long should each of the TB drugs be taken for?
Rifampicin and Isoniadid = 2 months intensive, 4 months continuation
Pyrazinamide and Ethambutol = 2 months intensive
87
What are the W and the M in WiLLiaM MaRRoW?
```
W = slurred S wave
M = R wave
```
88
What are the complications of GORD?
Oesophagitis, ulcers, benign strictures, iron deficiency, Barrett's oesophagus
89
What are the risk factors for oesophageal cancer?
Diet, alcohol excess, smoking, achalasia, reflux oesophagitis, Barrett's oesophagus, obesity, hot drinks
90
Where are the majority of colon cancers found?
Descending colon
91
What are the common cause of diverticulum? Where do the majority of diverticulum occur?
Low fibre diet, Obesity, NSAIDs, Smoking
| Mostly within the sigmoid colon
92
Name the complications of PKD?
Hypertension leading to cardiovascular disease, Kidney stones, Polycystic liver disease, Berry aneurysms leading to Subarachnoid haemorrhage
93
Tx of thrombotic thrombocytopenic purpura?
Urgent plasma exchange
94
What is the target cell of rituximab?
CD20
95
What are the treatments of malaria?
```
P.falciparum = quinine
Non-P.falciparum = chloroquinine
Complicated = IV artesunate
```
96
Define hypertrophy and hyperplasia?
```
Hyperplasia= Increased size of a tissue due to increase in number of constituent cells
Hypertrophy= Increased size of a tissue due to increase in size of constituent cells
```
97
Which WBCs are most present in acute inflammation, chronic inflammation and alleric reactions?
```
Acute = neutrophil polymorphs
Chronic = macrophages, B/T lymphocytes
Alergic = marcophages and histamine release (not a WBC)
```
98
Causes of peripheral neuropathies?
DM, SLE, Sjogrens sydrome, Alcoholism, HCV, HIV, dyptheria, leprosy and lyme's disease (risk of catching all diseases is higher in immunocompromised patients)
99
What is the time window for thrombolysis treatment?
Must be given within 4.5 hours of symptoms developing
100
What are the thresholds for a life threateneing asthma attack?
Silent chest, confusion, exhaustion, cyanosis, SpO2 <92%, bradycardia, PEF <33%
101
What is the score used to calculate annual risk of stroke in AF patient?
CHA2DS2VASc:
CCF (1), Hypertension (1), Age 65-74 (1), >74 (2), Diabetes (1), preivous Stroke/TIA/thromboembolism (2), Vascular disease(1), Sex (female = 1)
102
What does QRISK2 calculate?
The 10 year risk of having a cardiovascular event in patients who do not already have heart disease.
103
Which clotting factor is deficient in haemophillia b?
Clotting factor 9
104
What is the treatment pathway of asthma?
SABA, low dose ICS, LABA, increased dose ICS/LTRA, refer!!!
105
Which lung cancers are most strongly associated with smoking?
Squamous cell (a NSCLC) and SCLC
106
Where do lung cancers commonly metastasise to?
Adrenal glands, bone, brain, liver and lymph nodes
107
Name the main 3 causes of atypical pneumonia?
Mycoplasma pneumonia, chlamydiophila pneumonia and legionella pneumonia
108
Tx of syphyllis?
Benzatine penicillin
109
What are the cardinal symptoms of a cerebllar stroke?
Ataxia, headache, vertigo and vomiting
110
What is CA 19-9 a marker of?
Pancreatic cancer
111
When does neutrophillia occur? What is it?
Infection, inflammation (e.g. appendicitis) and trauma (e.g. MI)
High neutrophils
112
Which clotting factor is defficient in haemophillia B?
9
113
Which is the most common type of renal cell carcinoma?
Clear cell
114
What are the parameters for a UTI to be classed as complicated?
Male, Pregnant, Child, Reccurent UTIs, Immunocompromised, structual abnormalities (anywhere in the KUB tract)
115
What is Wolf-Parkinson-White syndrome? How does it appear on ECG?
```
SVT due to an AV nodal re-entery tachycardia.
Wide QRS (normally 0.12), short PR interval (normally 0.12-0.2) and a delta wave
```
116
Which cancers most commonly metastasise to the brain?
Lung, breast, skin, bowel and kidney
117
What is the most common cause of viral hepatitis in travellers?
Hep A
118
Sx of pernicious anaemia?
Anaemia symptoms, peripheral neuropathy, lemon-tinged skin, mouth ulcers, depression and dementia
119
How is CKD diagnosed?
2 measurments at least 3 months apart of an eGFR of <60
120
What does an eGFR of <15 indicate?
End stage renal failure (requires dialysis)
121
How can you localise a MI on ECG?
```
Changes in:
V1/2 = septal
V3/4 = anterior
V5/6, I and aVL = lateral
II, III and aVF = inferior
```
122
Describe how to localise which vessel is affected by MI?
LAD = septal and anterior - V1-V4
Left circumflex = lateral - V5/6, I and aVL
Right anterior descening = inferior - II, III and aVF
123
What is the classic presentation of aortic stenosis?
Syncope following periods of angina, narrow pulse pressure and evidence LV hypertrophy. Also ejection systolic murmur!
124
What are the S3 and S4 heart sounds?
```
S3 = ventricular gallop = mitral valve opening and passive LV filling
S4 = forceful atrial contraction
```
125
Where do the diuretics work?
Loop = ascending loop of henle
Thiazide = DCT
K+ sparring = DCT and is an aldosterone receptor antagonist
126
Lesions to which nerve root cause foot drop?
L4-L5
127
Which group of patients are silent MIs most commonly seen in?
Diabetics
128
Which conditions can result in pleuritic chest pain?
Pneumonia, PE, pneumothorax and rib fracture
129
What are Ghon focuses and Ghon complexes?
Radiological features of TB
130
What is prinzmetal/variant angina?
Coronary artery vasospasm. Pain may occur late at night or early in the morning (when at rest) and is relieved by GTN. There will be ECG ST elevation
131
What radiological features are seen in bronchiectasis?
Tramline opacites and ring shadows
132
How do you identify C.difficile?
Gram positive anaerobic bacilli - often causes non-bloody diarrhoea after antibiotic treatment
133
What are the causes of lung crackles?
COPD (chronic bronchitis and emphysema), bronchiectasis, pulmonary oedema, fibrosis, lung abscess and pneumonia
134
Which nerve is likely to be damaged in an anterior shoulder dislocation? How can this present?
Axillary nerve (C5-C6) - weakness in abduction
135
How do hypo- and hyper- kalaemia present on ECG?
```
Hypo = small inverted T waves, ST depression, prominet U waves and a long PR interval
Hyper = tall tented T waves, small p waves and wide QRS and a long PR interval - may develop VF
```
136
Which artery is most likely to be affected by a posterior duodenal ulcer?
Gastroduodenal
137
What organism causes whooping cough?
Bordetella pertussis
138
What are the RFs for aspiration pneumonia?
Stroke, intubation, GORD, achlasia, poor oral hygiene, decreased consiousness, myasthenia gravis and bulbar palsies
139
What antibodies are seen in hashimotos thyroiditis?
Anti TPO
140
Below what angle in the beurgers test is critical ischaemia declared?
Below 20 degrees
141
When are mallory bodies seen?
alcoholic liver disease
142
What speen should ECG be set at?
25mm/s
143
What is the commonest cause of mitral stenosis?
Rheumatic heart disease
144
What is the least cardioselective Beta blocker?
Propanolol
145
What is the difference between spinal cord compression and corda equina syndrome?
Cord compression = LMN symptoms at the level of the lesion and UMN symptoms below the lesion
Cauda equina = LMN symptoms only with saddle parasthesia, reduced anal tone and sphincter disturbances
146
What is the go to antiplatelet therapy for stroke and TIA?
300mg aspirin for 2 weeks and then SWITCH to clopidogrel
147
What is the second line treatment when initial anti-hypertensive treatment has failed in the over 55s/afro-carribeans?
CCB AND ACEi/ARB
148
How do you treat carcinoid crisis?
Somatostatin analogue and surgery
149
What does stony dull percussion always indicate?
Pleural effusions
150
What antibodies are found in GPA?
C-ANCA
151
What is the inheritance pattern of haemophillia A and VWb disease?
Haemophillia A = X-linked recessive
| VW disease = AD
152
What does translocation of Ch 9 to Ch 22 indicate?
Philadelphia chromosome
153
Define how to localise focal seizures?
```
Frontal = Jacksonian march and post-ictal todd's palsy
Occipital = visual disturbances
Parietal = senosry disturbances
Temporal = prodome (e.g. aura, hallucinations and de ja vu), motor automatisms and post-ictal confusion
```
154
Give examples of the 4 types of hypersensitivity reactions?
1 (IgE) = Anaphylaxis, hayfever, food allergy
2 = Goodpasture's syndrome, MG, Graves and haemolytic anaemia
3 = Hypersensitivity pneumonitis, SLE and post-streptococcal glomerulonephritis
4 = T1DM, MS, contact dermatitis
155
When are delta waves seen on ECG?
Wolff-Parkinson White syndrome (also short PR interval)
156
Wernicke's vs Broca's area?
```
Wernicke's = speech comprehension (parietal and temporal lobe)
Broca's = speech production (frontal lobe)
```
