Vol 4

Question 0

What is type 1 respiratory failure?

Answer 0

Normal co2 - Q is wrong with V/Q. Macroscopically functional lungs.
E.g. PE, pneumonia, pulmonary oedema, VSD

Question 1

What test is used to quantify lumbar flexion by measurement with rulers and marking?

Answer 1

Schober test

Question 2

What are azathioprine, methotrexate and mecaptopurine all examples of?

Answer 2

Immunosuppressive drugs

Question 3

What is Corrigans pulse?

Answer 3

The collapsing/dancing carotid pulse visible in aortic regurgitation

Question 4

What is the Van Graefe sign?

Answer 4

Lid lag in hyperthyroidism (Graves)

Question 5

What is Riddochs sign?

Answer 5

Hitler arm raise (rebound lift) in cerebellar dysfunction/UMNL

Question 6

What is Traubes sign?

Answer 6

Gunshot femoral artery murmur associated with aortic regurgitation

Question 7

What is the recommended treatment for pyelonephritis? What about in pregnant women?

Answer 7

Co-amoxyclav 14 days

Preg women cefalaxin

Question 8

What is Murphy’s sign?

Answer 8

Pain on inspiration of the palpable gallbladder associated with acute cholecystitis

Question 9

What is ciclosporin used for?

Answer 9

Immunosuppression - UC, graft vs host, uveitis

Question 10

What is De Musset’s sign?

Answer 10

Head bobbing in time with heartbeat - aortic regurgitation

Question 11

What is Reynolds pentad?

Answer 11

Indicates ascending cholangitis. Charcot’s triad (fever, jaundice and RUQ pain) + hypotension + altered mental state

Question 12

What is the Bruit de Roger?

Answer 12

Pansystolic low pitched VSD murmur

Question 13

Possible medications for epilepsy?

Answer 13

Sodium valproate
Lamotrigine, carbamazepine
Acute = phenytoin, phenobarbitol
Benzodiazepines

Question 14

What is Quincke’s sign?

Answer 14

Light hold on nails, visible pulsatile blanching and redness

Indicates aortic regurgitation

Question 15

6 things that can cause hypokalaemia?

Answer 15

D+V
Diuretics
Insulin
Poor nutrition
Ileostomy
Bulemia nervosa

Question 16

What changes do you get on ECG in response to hyperkalaemia?

Answer 16

A wide QRS
Prolonged PR
Flattened P waves
T wave tenting
ST depression

Question 17

4Hs and 4Ts of reversible cardiac arrest causes?

Answer 17

Hypo/hyperkalaemia
Hypothermia
Hypoxia
Hypovolaemia
Toxins
Tamponade
Tension pneumothorax
Thrombosis

Question 18

What is the characteristic sign of PE on ECG? What is actually the most common finding?

Answer 18

S1Q3T3

Sinus tachycardia

Question 19

What is Fox’s sign?

Answer 19

Acute pancreatitis - ecchymosis down the inguinal ligaments

Question 20

What is Mullers sign?

Answer 20

Pulsatile uvula visible in aortic regurgitation

Question 21

What is flecainide?

Answer 21

Can treat tachyarrythmias - paroxysmal AF, PSVT, VT

Question 22

What is the Brudzinski neck sign?

Answer 22

Meningism - flexing neck of couch causes reflex hip flexion

Question 23

Discuss primary sclerosing cholangitis PSC?

Answer 23

Has a male link, also strong link to ulcerative colitis
Presents with earlier RUQ pain and pruritis, TATT
Eventually liver cirrhosis

Question 24

Investigations for PSC?

Answer 24

ANCA | IgG

Question 25

4 causes of sacroiliitis?

Answer 25

Ankylosing spondylitis Reiter's syndrome Crohns spondylitis Psoriatic spondylitis

Question 26

What investigation is useful in indicating early sacroiliitis changes?

Answer 26

MRI

Question 27

4 radiological hallmarks of rheumatoid arthritis?

Answer 27

Symmetrical small joint involvement Soft tissue swelling, synovial hyperplasia Periarticular osteoporosis, bony erosion Thinning of joint space

Question 28

What are the characteristic rheumatoid arthritis deformities?

Answer 28

Ulnar deviation Z thumb Boutonnière deformity Swan neck deformity

Question 29

What is the progression of treatment for rheumatoid arthritis?

Answer 29

NSAIDs and physio -> DMARDs (methotrexate, ASAs) -> steroids -> biologics

Question 30

What disease may be indicated in a male with known rheumatoid arthritis, smoking history and chest symptoms?

Answer 30

Diffuse pulmonary fibrosis

Question 31

What defines an exudate found in pleural effusion?

Answer 31

Protein > 30g/L Protein/blood protein > 0.6 LDH/blood LDH > 0.6

Question 32

What additional finding (other than protein/LDH) in pleural tap indicates empyema?

Answer 32

pH < 7.2

Question 33

What are the 3 further investigations that can be done with pleural tap analysis and what are they for?

Answer 33

Histology - cytology (cancer) Biochemistry - proteins, LDH, glucose Microbiology - culture and sensitivity

Question 34

What are 2 signs of chronic hypertensive retinopathy?

Answer 34

AV nicking -> branch retinal vein occlusion BRVO | Copper and silver wiring

Question 35

4 signs of acute hypertensive retinopathy?

Answer 35

Flame haemorrhages Cotton wool spots Hard exudates Papilloedema

Question 36

3 causes of a microcytic anaemia?

Answer 36

IDA SCD Thalassaemia

Question 37

4 stages of diabetic retinopathy?

Answer 37

Mild non-proliferative Moderate non-proliferative Severe non-proliferative Proliferative

Question 38

What characterises mild non-proliferative diabetic retinopathy?

Answer 38

Micro-aneurysms - dot and blot retinal haemorrhages

Question 39

What characterises moderate non-proliferative diabetic retinopathy?

Answer 39

Hard (yellow) exudates - chronic oedema | Cotton wool spots due to micro infarcts

Question 40

What characterises severe non-proliferative diabetic retinopathy?

Answer 40

Macular oedema visible on slit lamp | Venous dilatation

Question 41

What characterises proliferative diabetic retinopathy?

Answer 41

Neovasculature around medulla | Oedema and haemorrhage (-> sudden vision loss)

Question 42

What are the symptoms of a peptic ulcer?

Answer 42

Epigastric pain that may or may not be relieved by eating Bloating, distension, oral flatulence Coffee ground vomit, heartburn, melena

Question 43

What investigations are indicated in peptic ulcer?

Answer 43

Urea breath test FBC OGD and culture biopsies

Question 44

Management of peptic ulcers?

Answer 44

Lifestyle management, NSAID reduction Abs for H pylori PPI/H2RB Endoscopic intervention?

Question 45

What is meant by a fluid challenge in fluid resus?

Answer 45

500ml of 0.9% saline stat

Question 46

What are the 2 components of resus fluid?

Answer 46

Volume replacement | Electrolyte balance

Question 47

What is usually designated as maintenance fluid?

Answer 47

Dexsaline - 5% dextrose, 0.9% saline | Often + 20mmol K+

Question 48

Sx of B12/folate deficiency?

Answer 48

``` Fatigue Paraesthesia, peripheral neuropathies Sore red tongue Weakness Depression and cognitive deficits ```

Question 49

Drugs that can cause B12 folate deficiency?

Answer 49

PPIs | Anticonvulsants