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2B - GRIND > Things I've got wrong > Flashcards

Things I've got wrong Flashcards

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

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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

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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

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4
Q

When might black sputum occur?

A

In chronic coal inhilation e.g. miners

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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

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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)

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7
Q

What do haemagluttin and neuraminidase proteins indicate?

A

Influenza A

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8
Q

How can you identify H. influenzae microbiologically?

A

Gram negative aerobic bacilli which requires factors V and X to grow

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9
Q

What is acetylsalicylic acid?

A

Aspirin

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10
Q

What is streptokinase?

A

A thrombolysis medication

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11
Q

What is chlorpromazine?

A

Anti-psycotic used to treat schizophrenia

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12
Q

What is propylthiouracil?

A

PTU - used to treat hyperthyroidism

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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

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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

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15
Q

What is proctalgia fugax?

A

Idiopathic intense brief stabbing/cramping pain of the rectum which is often worse at night

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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
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17
Q

Which TB drug interacts with the oral contraceptive pill?

A

Rifampicin

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18
Q

What is the best treatment of Parkisons disease?

A

Levodopa and carbidopa (as one pill = co-careldopa)

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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

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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)

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21
Q

What are the most common causative organisms of reactive arthritis?

A 
GI = salmonella, shigella, yersinia
GU = chlamydia, ureaplasma
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22
Q

When should you initiate anticoagulant treatment in AF?

A

CHA2DS2VASc score of 2 or more to prevent stroke

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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

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24
Q

What affect does alcohol have on warfarin?

A

Increases its affect (increases INR)

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25
Q

What is Brudzinski’s sign?

A

Hip and knees flex when the neck is flexed - this is seen in meningism

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26
Q

What medical condition is associated with Lhermitte’s sign and Uhthoffs phenomenom? What are they?

A

MS.
Lhermitte’s sign = electric shock sensation travelling down the back and througth the limbs
Uhtoff’s phenomenom = symptoms becoming worse with heat

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27
Q

What is Rhomberg’s test used for?

A

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

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28
Q

What appears on LP 12 hours post SAH?

A

Xanthochromia (yellow CSF)

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29
Q

What is the first line treatment of eretile dysfunction?

A

Phosphodiesterase inhibitors e.g. viragra

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30
Q

What is Horner’s syndrome?

A

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

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31
Q

What is the first line eczema treatment?

A

Hydrocortisone creme

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32
Q

What will the thyroid function test look like in primary and secondary hyperthyroidism?

A 
Primary = low TSH and raised T4
Secondary = Raised TSH and raised T4.
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33
Q

What is carcinoid syndrome?

A

Hepatic involvement of a carcinoid tumour leading to diarrhoea, flushing, bronchoconstriction and cardiac involvement

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34
Q

What symptoms may help distinguish between UC and CD?

A

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

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35
Q

What are side effects of alpha blockers e.g. tamulosin?

A

Lower vascular resistance so cause postural hypotension, dizziness and syncope

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36
Q

What is leucocytosis?

A

An increase in WBCs seen in conditions e.g. CML

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37
Q

What are the causes of iron deficiency anaemia?

A

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

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38
Q

Define pharmacokinetics and pharmacodynamics?

A 
Pharmacokinetics = action of the body on the drug
Pharmacodyanmics = action of the drug on the body
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39
Q

SEs of amitryptyline?

A

It has anticholinergic properties so inhibits the parasympathetic nervous system.
Causes dry mouth, blurred vision, confusion and urinary retention

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40
Q

What is a phenochromocytoma, how do you treat it?

A

Catacholamine producing tumours found within the adrenal medulla which cause episodic sweating, headaches and tachycardia
Tx with phenoxybenzamine before oporation to remove

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41
Q

What is the first line treatment of osteoporosis?

A

Alendronic acid and AdCal-D3

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42
Q

What is denosumab?

A

Monoclonal antibody to RANK ligand which reduces osteoclast activity. Can be injected every 6 months to treat osteoporosis

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43
Q

What are the first line prophylaxis and acute treatments of migraine?

A 
Prophylaxis = propanolol or topiromate
Acute = triptan and NSAIDs/paracetamol
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44
Q

What are the commonest causes of bacterial meningitis in the UK?

A

Strep. pneumoniae = commonest, N. meningitidis = most severe, Haemophillus influenza type B, E.coli, Listeria monocytogenes (pregnant women) and Strep agalactiae (neonates)

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45
Q

Typical casues of CAP?

A

Strep. pneumonia = commonest, Haemophillus influenzae, Moraxella catarrhalis

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46
Q

Atypical causes of CAP?

A

Mycoplasma pneumoniae, Staph. aureus, Legionella species, Chlamydia and Coxiella burnetii

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47
Q

Causes of HAP? - Define HAP?

A

Pneumonia accquired >48 hours after hosptial admission.

Stap.aureus (most common), Pseudomonas, Klebsiella and Clostridia

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48
Q

What is risperidone used for?

A

It is an anti-psychotic used to treat aggression and chorea e.g. in HD

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49
Q

What is gabapentin used for?

A

It is used to treat seizures and neuropathic pain

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50
Q

What is haloperidol used for?

A

It is used to treat psychosis in huntington’s disease

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51
Q

What is the 6-in-1 vaccine?

A

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

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52
Q

Name the causes of clubbing?

A

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)

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53
Q

What conditions cause BHL?

A

Sarcoidosis, infection e.g. TB, malignancy, hypersensitivity pneumonitis and organic dust diseases

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54
Q

What is seen on the X-ray in HF?

A

Alveolar oedema, kerly B lines, Cardiomegaly, Dilated prominent upper lobe veins, pleual Effusions

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55
Q

Describe the MRC dypnoea score?

A 
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
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56
Q

What factors give a better prognosis for patients with MS?

A

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

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57
Q

What is orthostatic hypotension?

A

Postural hypotension

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58
Q

What should you give in an ischaemic stroke that can not be thrombolysed? What is the most important reasons not to thrombolyse?

A

300mg aspirin

Onset of symptoms >4.5hrs ago, active bleed, surgery/major trauma <2 weeks, lumbar puncture <1 week

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59
Q

What is sciatica?

A

Pain that radiates down the path of the sciatic nerve (down the buttocks and through the leg)

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60
Q

Sx of spinal stenosis (spondylosis)?

A

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

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61
Q

What is status epilepticus? How should you treat?

A

Seizures lasting >30mins. If diazepam does not stop seizures give phenytoin

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62
Q

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?

A

Crossed signs implies the lesion is in the brainstem

Facial paralysis always implies that the lesion is above the spinal cord

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63
Q

Which nerves are involved in the pupillary reflex?

A 
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
Q

What does forehead sparring indicate in facial paralysis?

A

UMN lesion e.g. CN VII - this rules out Bells palsy

65
Q

What is the Glabellar reflex/sign?

A

Continuous blinking when the forehead is tapped repeatedly - this is a sign of parkinsons disease

66
Q

What is the Hoffmans sign?

A

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
Q

What does a high APTT indicate?

A

Haemophillia or von Willebrands disease

68
Q

What does a high PT indicate?

A

AKA INR

Liver disease, vitamin K deficiency, DIC and warfarin excess

69
Q

What does prolonged bleeding time indicate?

A

Von Willebrand deficiency, TTP/DIC, thrombocytopenia

70
Q

What if Factor V Leiden?

A

A mutation which causes you to develop clots in the legs and lungs

71
Q

What is aplastic anaemia?

A

When the body fails to produce blood cells in sufficient quantities (low RBCs, WBCs and platelets)

72
Q

Where is B12 absorbed? What condition will commonly lead to B12 deficiency?

A

The terminal ileum

Crohn’s disease and Coeliac’s disease

73
Q

How do you measure iron storage levels? What transports iron?

A

Serum Ferritin = iron storage (increases in inflammation, liver disease and malignancy)
Transferrin = iron transport (increases in iron defficiency)

74
Q

What are schistocytes?

A

Fragments of red blood cells seen in RBC haemolysis. e.g. G6PD deficiency

75
Q

How can you test for sickle cell disease?

A

Metabisulfite test

76
Q

What are the best differentials between ALL and AML?

A

BM biopsy = Auer rods are found in AML but not ALL

Sudan black stains in AML more than in ALL

77
Q

What is Coombs test?

A

It detects autoimmune haemolytic anaemia

78
Q

What is the best initial test to diagnose an acute leukeamia?

A

Direct microscopy of bone marrow cells to look for an increased quantity of blast cells

79
Q

What is Schilling’s test?

A

Detects issues with B12 absorption in pernicious anaemia

80
Q

Define erythrocytosis and thrombocythaemia?

A 
Erythrocytosis = too many RBCs
Thrombocythaemia = too many platelets
81
Q

What are the alarm symptoms for peptic ulcers?

A

ALARMS: Anaemia, Loss of weight, Anorexia, Recent onset/progressive symptoms, Melena/haematemesis, Swallowing difficulties

82
Q

What is the test for Wilson’s disease?

A

24 hour urinary copper excretion test, diagnose with liver biopsy

83
Q

How do you take alendronic acid?

A

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
Q

What is vitamin B1?

A

Thiamine

85
Q

What are the commonest bacterial causes of COPD exacerbations?

A

Haemophilus influenzae (most common cause), Streptococcus pneumonia and Moraxella catarrhalis

86
Q

How long should each of the TB drugs be taken for?

A

Rifampicin and Isoniadid = 2 months intensive, 4 months continuation
Pyrazinamide and Ethambutol = 2 months intensive

87
Q

What are the W and the M in WiLLiaM MaRRoW?

A 
W = slurred S wave
M = R wave
88
Q

What are the complications of GORD?

A

Oesophagitis, ulcers, benign strictures, iron deficiency, Barrett’s oesophagus

89
Q

What are the risk factors for oesophageal cancer?

A

Diet, alcohol excess, smoking, achalasia, reflux oesophagitis, Barrett’s oesophagus, obesity, hot drinks

90
Q

Where are the majority of colon cancers found?

A

Descending colon

91
Q

What are the common cause of diverticulum? Where do the majority of diverticulum occur?

A

Low fibre diet, Obesity, NSAIDs, Smoking

Mostly within the sigmoid colon

92
Q

Name the complications of PKD?

A

Hypertension leading to cardiovascular disease, Kidney stones, Polycystic liver disease, Berry aneurysms leading to Subarachnoid haemorrhage

93
Q

Tx of thrombotic thrombocytopenic purpura?

A

Urgent plasma exchange

94
Q

What is the target cell of rituximab?

A

CD20

95
Q

What are the treatments of malaria?

A 
P.falciparum = quinine
Non-P.falciparum = chloroquinine
Complicated = IV artesunate
96
Q

Define hypertrophy and hyperplasia?

A 
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
Q

Which WBCs are most present in acute inflammation, chronic inflammation and alleric reactions?

A 
Acute = neutrophil polymorphs
Chronic = macrophages, B/T lymphocytes
Alergic = marcophages and histamine release (not a WBC)
98
Q

Causes of peripheral neuropathies?

A

DM, SLE, Sjogrens sydrome, Alcoholism, HCV, HIV, dyptheria, leprosy and lyme’s disease (risk of catching all diseases is higher in immunocompromised patients)

99
Q

What is the time window for thrombolysis treatment?

A

Must be given within 4.5 hours of symptoms developing

100
Q

What are the thresholds for a life threateneing asthma attack?

A

Silent chest, confusion, exhaustion, cyanosis, SpO2 <92%, bradycardia, PEF <33%

101
Q

What is the score used to calculate annual risk of stroke in AF patient?

A

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
Q

What does QRISK2 calculate?

A

The 10 year risk of having a cardiovascular event in patients who do not already have heart disease.

103
Q

Which clotting factor is deficient in haemophillia b?

A

Clotting factor 9

104
Q

What is the treatment pathway of asthma?

A

SABA, low dose ICS, LABA, increased dose ICS/LTRA, refer!!!

105
Q

Which lung cancers are most strongly associated with smoking?

A

Squamous cell (a NSCLC) and SCLC

106
Q

Where do lung cancers commonly metastasise to?

A

Adrenal glands, bone, brain, liver and lymph nodes

107
Q

Name the main 3 causes of atypical pneumonia?

A

Mycoplasma pneumonia, chlamydiophila pneumonia and legionella pneumonia

108
Q

Tx of syphyllis?

A

Benzatine penicillin

109
Q

What are the cardinal symptoms of a cerebllar stroke?

A

Ataxia, headache, vertigo and vomiting

110
Q

What is CA 19-9 a marker of?

A

Pancreatic cancer

111
Q

When does neutrophillia occur? What is it?

A

Infection, inflammation (e.g. appendicitis) and trauma (e.g. MI)
High neutrophils

112
Q

Which clotting factor is defficient in haemophillia B?

A

9

113
Q

Which is the most common type of renal cell carcinoma?

A

Clear cell

114
Q

What are the parameters for a UTI to be classed as complicated?

A

Male, Pregnant, Child, Reccurent UTIs, Immunocompromised, structual abnormalities (anywhere in the KUB tract)

115
Q

What is Wolf-Parkinson-White syndrome? How does it appear on ECG?

A 
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
Q

Which cancers most commonly metastasise to the brain?

A

Lung, breast, skin, bowel and kidney

117
Q

What is the most common cause of viral hepatitis in travellers?

A

Hep A

118
Q

Sx of pernicious anaemia?

A

Anaemia symptoms, peripheral neuropathy, lemon-tinged skin, mouth ulcers, depression and dementia

119
Q

How is CKD diagnosed?

A

2 measurments at least 3 months apart of an eGFR of <60

120
Q

What does an eGFR of <15 indicate?

A

End stage renal failure (requires dialysis)

121
Q

How can you localise a MI on ECG?

A 
Changes in:
V1/2 = septal
V3/4 = anterior
V5/6, I and aVL = lateral
II, III and aVF = inferior
122
Q

Describe how to localise which vessel is affected by MI?

A

LAD = septal and anterior - V1-V4
Left circumflex = lateral - V5/6, I and aVL
Right anterior descening = inferior - II, III and aVF

123
Q

What is the classic presentation of aortic stenosis?

A

Syncope following periods of angina, narrow pulse pressure and evidence LV hypertrophy. Also ejection systolic murmur!

124
Q

What are the S3 and S4 heart sounds?

A 
S3 = ventricular gallop = mitral valve opening and passive LV filling
S4 = forceful atrial contraction
125
Q

Where do the diuretics work?

A

Loop = ascending loop of henle
Thiazide = DCT
K+ sparring = DCT and is an aldosterone receptor antagonist

126
Q

Lesions to which nerve root cause foot drop?

A

L4-L5

127
Q

Which group of patients are silent MIs most commonly seen in?

A

Diabetics

128
Q

Which conditions can result in pleuritic chest pain?

A

Pneumonia, PE, pneumothorax and rib fracture

129
Q

What are Ghon focuses and Ghon complexes?

A

Radiological features of TB

130
Q

What is prinzmetal/variant angina?

A

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
Q

What radiological features are seen in bronchiectasis?

A

Tramline opacites and ring shadows

132
Q

How do you identify C.difficile?

A

Gram positive anaerobic bacilli - often causes non-bloody diarrhoea after antibiotic treatment

133
Q

What are the causes of lung crackles?

A

COPD (chronic bronchitis and emphysema), bronchiectasis, pulmonary oedema, fibrosis, lung abscess and pneumonia

134
Q

Which nerve is likely to be damaged in an anterior shoulder dislocation? How can this present?

A

Axillary nerve (C5-C6) - weakness in abduction

135
Q

How do hypo- and hyper- kalaemia present on ECG?

A 
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
Q

Which artery is most likely to be affected by a posterior duodenal ulcer?

A

Gastroduodenal

137
Q

What organism causes whooping cough?

A

Bordetella pertussis

138
Q

What are the RFs for aspiration pneumonia?

A

Stroke, intubation, GORD, achlasia, poor oral hygiene, decreased consiousness, myasthenia gravis and bulbar palsies

139
Q

What antibodies are seen in hashimotos thyroiditis?

A

Anti TPO

140
Q

Below what angle in the beurgers test is critical ischaemia declared?

A

Below 20 degrees

141
Q

When are mallory bodies seen?

A

alcoholic liver disease

142
Q

What speen should ECG be set at?

A

25mm/s

143
Q

What is the commonest cause of mitral stenosis?

A

Rheumatic heart disease

144
Q

What is the least cardioselective Beta blocker?

A

Propanolol

145
Q

What is the difference between spinal cord compression and corda equina syndrome?

A

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
Q

What is the go to antiplatelet therapy for stroke and TIA?

A

300mg aspirin for 2 weeks and then SWITCH to clopidogrel

147
Q

What is the second line treatment when initial anti-hypertensive treatment has failed in the over 55s/afro-carribeans?

A

CCB AND ACEi/ARB

148
Q

How do you treat carcinoid crisis?

A

Somatostatin analogue and surgery

149
Q

What does stony dull percussion always indicate?

A

Pleural effusions

150
Q

What antibodies are found in GPA?

A

C-ANCA

151
Q

What is the inheritance pattern of haemophillia A and VWb disease?

A

Haemophillia A = X-linked recessive

VW disease = AD

152
Q

What does translocation of Ch 9 to Ch 22 indicate?

A

Philadelphia chromosome

153
Q

Define how to localise focal seizures?

A 
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
Q

Give examples of the 4 types of hypersensitivity reactions?

A

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
Q

When are delta waves seen on ECG?

A

Wolff-Parkinson White syndrome (also short PR interval)

156
Q

Wernicke’s vs Broca’s area?

A 
Wernicke's = speech comprehension (parietal and temporal lobe)
Broca's = speech production (frontal lobe)

2B - GRIND (11 decks)

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