‘’ Flashcards
If someone presents with vomiting, central chest pain, has mild crepitus in the epigastric region and has alcohol misuse what would we suspect ?
Oesophageal perforation
If someone has a history of progressive fatigue, has a background of type 1 diabetes and has low Hb and high MCV what antibodies should be tested for that would aid a diagnosis ?
Intrinsic factor antibodies
What is the immediate management for an NSTEMI ?
Immediate coronary angiography with percutaneous coronary intervention
What is the first line pharmacological treatment for COPD ?
A SABA or SAMA
What should be given for a patient with bradycardia and showing signs of shock ?
500 mg IV atropine
If someone has an INR of 6.9 and is on warfarin what steps should be put in place ?
Withhold warfarin for 1-2 days and restart at a lower dose
A transjugular intrahepatic portosystemic shunt procedure connects which 2 vessels ?
Hepatic vein and portal vein
Which drugs can cause facial plethora and moon face ?
Steroids such as prednisolone
If there is a patient with a circular red rash which is worse in the centre and edges which illness may be indicated ?
Lyme disease
What feature that may occur in COPD causes a prompt assessment for long term oxygen therapy ?
Ankle oedema
What investigations are done to screen for adult Polycystic kidney disease ?
USS
What is the first line medication for primary biliary Cholangitis ?
Ursoseoxycholic acid
What medications would potentially increase the likelihood of having a C.Difficile infection ?
Antibiotics
What would a right bundle branch block present as on an ECG ?
The ECG will show rSR patterns in V1-3 ( M shaped QRS complexes ).
How would a left bundle branch block present as on an ECG ?
There would be a dominant S wave in V1 ( W shaped ).
Which medications worsen renal function and should be stopped in an AKI ?
ACEi
What medication given could cause drug-induced cholestasis ?
COCP
Flucloxacillin, co-amoxiclav
Fibrates
Sulphonylureas
What medications can cause hepatocellular damage ?
Paracetamol
Sodium valproate
MAOIs
Alcohol
Amiodarone
Nitrofurantoin
What medications can cause liver cirrhosis ?
Methotrexate
Methyldopa
Amiodarone
If there is a strong suspicion of a PE but there is a delay in a CTPA what should happen ?
Give treatment dose Apixaban while waiting for a scan
What findings would you suspect if a HIV patient has pneumocystitis jiroveci pneumonia ?
CD4 count under 200 cells/mm3
What can develop from lithium therapy that would cause excessive drinking and urinating ?
Nephrogenic diabetes insipidus
What is aggravated when taking an SGLT-2 inhibitor and why ?
Recurrent thrush. SGLT-2 inhibitors prevent resorption of glucose from the proximal renal tubule resulting in more glucose secreted in the urine. This is thought to predispose to bacterial growth.
What pathogen is likely causing a chest infection if the FBC shows low WBC and the U&E’s show low sodium ?
Legionella pneumophila infection
What antibiotic is given for an atypical chest infection ?
Macrolides such as clarithromycin
What are some indications for a splenectomy ?
Trauma
Spontaneous rupture ( EBV )
Hereditary spherocytosis or elliptocytosis
Malignancy
What are some complications of a splenectomy ?
Haemorrhage
Pancreatic fistula
Thrombocytosis
Encapsulated bacterial infection
What pathogen can cause 5 days of headache, myalgia and increasing cough ( non - productive ). There is also. A rash made up of target lesions all over his trunk.
Mycoplasma pneumoniae
It is associated with erythema mutliforme
The patient has flu-like symptoms prior to developing pneumonia.
What is the most common complications of mumps ?
Orchiditis
What investigation should be performed for a diagnosis of chlamydia ?
Nucleic acid amplification tests - via swabs or first catch urine
What should be given as prophylaxis for meningococcal meningitis ?
Oral Ciprofloxacin
What are the treatment steps for a campylobacter infection ?
Can be self resolving - no treatment
If severe or symptoms persist - clarithromycin
Ciprofloxacin is second line
What should be given for a HIV patient with a CD4+ count of less than 200/mm3 ?
Prescribe co-trimoxazole as prophylaxis against pneumocystitis jiroveci pneumonia
What improves outcomes in bacterial meningitis ?
Dexamethasone
What is a common side effect of Gliclazide ?
Weight gain
Which diabetic medications cause weight loss ?
SGLT2 inhibitors ( canagliflozin )
DPP4 inhibitors ( vildagliptin )
GLP1 agonist ( exenatide )
What is most likely if someone has symptoms of headaches, amenorrhea and visual field defects ?
Prolactinoma ( the secretion of high levels of prolactin from the tumour can lead to hypogonadotropic hypogonadism through suppression of GnRH which can cause amenorrhea and infertility ).
In a DKA what management would be in place in terms of insulin ?
Fixed rate IV insulin and continue injectable long acting insulin only.
Over replacement of thyroxine can increase the risk of what ?
Osteoporosis
What would appear on the synACTHen test for Addisons ?
Low baseline cortisol and no improvement when synthetic ACTH is given.
What visual field defect does a pituitary adenoma cause ?
Bitemporal hemianopia
What should be given if there is a thyroid storm ?
Give corticosteroids, propylthiouracil and propranolol
What will cause impaired hypoglycaemic awareness in a patient with diabetes ?
Neuropathy in the autonomous nervous system
What are the causes of hypoglycaemia ?
Exogenous drugs ( sulfonylureas or insulin )
Pituitary insufficiency
Liver failure
Addison’s disease
Islet cell tumour
Non pancreatic neoplasm
If Metformin is contra-indicated what medications can be given ?
DPP-4 inhibitor
Pioglitazone
Sulfonylurea
SGLT2 inhibitor
What diabetic medication should be given if metformin is contra-indicated and there is established CVD ?
SGLT-2 monotherapy
If there is a small cell lung carcinoma what would the Dexamethasone suppression test show ?
High cortisol and high ACTH
What treatment options are there for hyperthyroidism ?
Carbimazole
Propylthiouracil
Radioactive iodine
What complication of fluid resuscitation for a DKA that causes seizures ?
Cerebral oedema
What are the 3 main features of addisonian crisis ?
Hyponatremia
Hyperkalaemia
Hypoglycaemia
What medication is given if a patient with acromegaly cant have trans-sphenoidal surgery or has residual surgery ?
Octreotide
If a patient has a primary pneumothorax without shortness of breath what is the management ?
Discharge with outpatient chest x ray
What is the next step in management in a COPD patient that is still breathless despite using SAMA/SABA ?
And Salmeterol and Beclometasone bronchodilator therapy
What is a common cause of occupational asthma ?
Isocyanates
What are the indications for surgery in bronchiectasis ?
Uncontrollable haemoptysis
Localised disease in one lobe
What is the most likely cause of an irregular broad complex tachycardia ?
AFIB with bundle branch block
What should the management be following a TIA for AF ?
Prescribe lifelong Apixaban now
What medications should be given for pulseless electrical activity ?
Administer 1mg of IV adrenaline
What hypertensive medication can cause hypocalcaemia ?
Loop diuretics
What are some signs of heart failure ?
Cyanosis
Tachycardia
Elevated JVP
S3 heart sounds
What is the next step in a patient with uncontrolled hypertension already taking an ACEi and a CCB ?
Add a thiazide like diuretic such as Indapamide
What should be given in patients with bradycardia and showing signs of shock ?
IV atropine
What arrest rhythm can a tension pneumothorax cause ?
Pulseless electrical activity
What does pericarditis show on an ECG ?
Saddle shaped ST elevation and PR depression
What is the first line management of acute pericarditis ?
Naproxen
What does a PE usually show on an ECG ?
Sinus tachycardia
Which beta blocker medication has proven to reduce mortality in stable heart failure ?
Bisoprolol
If angina is not controlled with a beta blocker then what should be added ?
A long acting Dihydropyridine CCB
What is the investigation of choice when suspecting an aortic dissection ?
CT angiography thorax, abdomen and pelvis
If someone has breathing difficulties with a clear chest what condition should be assumed ?
PE
Why does acute mitral regurgitation occur after an MI ?
What would be heard and seen in the patient ?
Rupture of the papillary muscle
Widespread systolic murmur, hypotension and pulmonary oedema
What should be given in a patient with radial pulse of 40, cool peripheries and a blood pressure of 80/55 mmHg ?
Give 500 micrograms of atropine due to the signs of shock and bradycardia
What is malignant hypertension ?
The blood pressure is extremely high and there are potentially life threatening symptoms. These can include : papilloedema, retinal bleeding, heartaches and nausea and difficulty stopping nosebleeds
What can be given as a treatment option for pericarditis ?
Ibuprofen
What medications are contra-indicated in aortic stenosis ?
Nitrates
What ECG changes are seen in acute pericarditis ?
PR depression
What ECG changes on seen in Wolff-Parkinson white syndrome ?
Short PR interval associated with a slurred upstroke - delta wave.
What is needed for an unexplained visible haematuria without UTI ?
Urgent 2 week wait referral
What is a common cause of bilateral carpal tunnel syndrome ?
Rheumatoid arthritis
What is the choice of investigation for a suspected psoas abscess ?
CT abdomen
When should oral antibiotics be given in an acute exacerbation of COPD ?
Presence of purulent sputum
OR
Signs of pneumonia
What is the initial management of carpal tunnel syndrome ?
A trial of conservative treatment - wrist splint +/- steroid injection
What is the most common malignancy seen after a renal transplant ?
Squamous cell carcinoma due to Immunosuppression
What should be suspected if someone presents with headaches, amenorrhoea and visual field defects ?
Prolactinoma
What does hypothermia show on an ECG ?
J waves
What should raise suspicion of acute interstitial nephritis ?
Sterile pyruria and white cell casts
Starts on antibiotic therapy
What is recommended in COPD patients who continue to have infective exacerbations ?
Azithromycin prophylaxis
What may arise in a lung cavity that has developed secondary to pulmonary TB ?
Aspergilloma
What is the immediate management of a recent shoulder dislocation ?
Shoulder reduction without analgesia / sedation
What is the screening test for adult Polycystic kidney disease ?
USS
What does dysplasia on biopsy in Barrett’s oesophagus require ?
Endoscopic intervention
What mediation should be avoided in bowel obstruction ?
Metoclopramide
What is the difference between vestibular neuronitis and labyrinthitis ?
VB has unaffected hearing
What characteristically causes pain when hungry that is relieved when eating ?
Duodenal ulcers
What is associated with painless ulceration ?
Primary syphilis
What joints are commonly affected in the hand in OA ?
Carpometacarpal and distal interphalangeal joint
What is a key differential for abdominal pain and fever in patients with cirrhosis and portal hypertension ?
Spontaneous bacterial peritonitis
What medication alongside methotrexate can cause bone marrow suppression and severe or fatal pancytopenia ?
Trimethoprim
When suspecting acromegaly plus they have raised IGF-1 levels what investigation should be performed to confirm the diagnosis ?
An oral glucose tolerance test with serial GH measurements
What medication should be used when a person as ascites ?
Spironolactone
What is the next step if a patient with suspected polymylagia rheumatica doesn’t respond dramatically to steroids ?
Consider an alternative diagnosis
What is the technique used to stop oesophageal variceal bleeding ?
Variceal band ligation
What can erythema nodosum be caused by ?
Pregnancy
What is consuming undercooked meat / unclean water in developing countries a risk factor for ?
Hepatitis A
Patients with suspected visual loss secondary to temporal arteritis are usually given what ?
IV methylprednisolone
What is the more common organism if there is an infection in a patient with bronchiectasis ?
Haemophilus influenza
What are some features of acute severe asthma ?
PEFR is 33-50% best or predicted
Inability to complete full sentences
RR is more than 25
Pulse is above 110 bpm
How long should you wait before the second dose when using an inhaler ?
30 s
What is the first line management for ankylosing spondylitis ?
Exercise regimes and NSAIDs
What is the standard testing for diagnosing and screening HIV ?
Combination tests ( HIV p24 antigen and HIV antibody )
What are used to induce remission of Crohn’s disease ?
Oral / topical / IV glucocorticosteroids
What advice is given for a patient who has had a pneumothorax ?
Life long ban on deep sea diving
How does nephrotic syndrome affect thyroid function ?
Low total thyroxine levels
What should be performed if a lung abscess is not improving with IV antibiotics ?
Percutaneous drainage
What is a highly specific test for SLE ?
Anti-dsDNA
If someone is bleeding on dabigatran what should be used to reverse it ?
Idarucizumab
How does amiodarone affect the lungs ?
Lower zone lung fibrosis
What movement is classically impaired in adhesive capsulitis ?
External rotation
What imaging modality is used for a suspected Achilles tendon rupture ?
USS
What is a common cause of pneumonia in bird keepers ?
Chlamydia psittaci
In life threatening C. Difficile infections what treatment should be given ?
ORAL vancomycin and IV metronidazole
What medications are first line to prevent angina attacks ?
Beta blocker or CCB
What is used to monitor the treatment of haemochromatosis ?
Ferritin and transferrin saturation
What hand joints are affected in OA ?
Carpometacarpal
Distal interphalangeal
What should be considered if there is an elevated JVP, persistent hypotension and tachycardia despite fluid resuscitation in a patient with chest wall trauma ?
Cardiac tamponade
What should be performed if you suspect a PE and CTPA is negative ?
Proximal leg vein USS if DVT is suspected
what develops in about 10% pf primary sclerosing cholangitis patients ?
cholangiocarcinoma
what antibiotic is a well recognised cause of cholestasis ?
co-amoxiclav
what would an IV drug user with fever, facial spasms and dysphagia make you concerned about ?
tetanus
what is used for emergency reversal of anticoagulation in patients with severe bleeding or a head injury ?
prothrombin complex concentrate
what is used to manage acute flare ups of rheumatoid arthritis ?
intramuscular steroids
what is Raynaud’s phenomenon characterised by ?
exaggerated vasoconstrictive response to the cold
what does a combination of liver and neurological disease point to ?
wilsons disease
in a secondary pneumothorax less than 1 cm what is the management ?
admit and give oxygen for 24 hours and review
Which vitamin if taken in high doses is teratogenic ?
Vitamin A
What is the mainstay treatment for haemochromatosis ?
Venesection
What causes painless ulceration of the genitals ?
Treponema pallidum
What neck lump moves upwards when swallowing ?
Goitre
If someone previously had crushing chest pains and was treated by PCI. What would have the condition been to cause their heart to skip beats 2 weeks later ?
Inferior MI can cause AV block
What is the next step if someone presents with dyspepsia and weight loss ?
2 week wait referral for upper GI endoscopy
What are some clinical features that would indicate polymyositis ?
Proximal muscle weakness
Raised creatine kinase
No rash being present
What does Helicobacter pylori infections have the strongest association with ?
Duodenal ulceration
What is the mechanism of action of rivaroxaban ?
Direct factor Xa inhibitor
What should make you think gastroparesis in a diabetic patient ?
Erratic blood glucose control
Bloating
Vomiting
What is seen during high and low dose Dexamethasone suppression testing in someone with Cushing’s syndrome ?
Low dose - not suppressed
High dose - suppressed
What antibodies would be positive in autoimmune hepatitis ?
Anti-smooth muscle antibodies
What is the first line treatment for ITP ?
Oral prednisolone
What investigation should be given for patients with clinical signs of heart failure and raised BNP greater than 400pg/ml ?
Transthoracic Doppler ECHO within 2 weeks
What should be given for patients with an uncertain tetanus vaccination history with a wound ?
They should be given a booster vaccine + immunoglobulin
What is a key intervention in patients with ascites ?
Reducing sodium intake
What is associated with tear drop poikilocytes on a blood film ?
Myelofibrosis
What treatment is the preferred management fro chronic symptoms of vestibular neuronitis ?
Vestibular rehabilitation exercises
What is the main ECG change in Hypercalcaemia ?
Shortened QT interval
What is the likely complication of acute pancreatitis in a patient struggling with breathing ?
Acute respiratory distress syndrome
What is the most common site of a stress fracture in the foot ?
2nd metatarsal shaft
What can be used to assess a flare up of SLE ?
Complement levels are usually low during active disease
What is the treatment of Paget’s disease ?
Bisphosphonates
What medication can exacerbate plaque psoriasis ?
Beta blockers
What area of the lungs are commonly affected by idiopathic pulmonary fibrosis ?
Lower zones
How is plantar fasciitis best managed ?
Rest
Stretching
Weight loss
How should a haemorrhage 5 - 10 days after a tonsillectomy ?
ENT hospital admission as it is associated with a wound infection and hence therefore should be treated with abx
Hypocalcaemia in the context of an AKI should be managed how ?
Urgent IV calcium gluconate as QTc may be prolonged
What should be added to an ARB or ACEi in people with HFeRF ?
Spironolactone
After colorectal cancer what is the second most common association of HNPCC ?
Endometrial cancer
What criteria should be used for a definitive diagnosis of infective endocarditis ?
Dukes
How long should women be on contraception for after taking methotrexate ?
At least 6 months in men or women
What is the first line treatment for Lyme disease ?
14-21 day course of oral doxycycline
What artery is at risk with duodenal ulcers in the posterior wall ?
Gastroduodenal artery
How is alchoholic ketoacidosis treated ?
Infusion of saline and thiamine
How should acute haemolytic transfusion reactions be treated ?
Generous fluid resuscitation and termination of the transfusion
What is indicated in someone with recurrent chest infections and sub fertility ?
Kartagener’s syndrome
What is the initial management of acute limb ischaemia ?
Analgesia
IV heparin
Vascular review
If a patient has dysphagia of both solids and liquids from the start what should be assumed ?
Achalasia
What is first line for OA in the knee or hand ?
Paracetamol + topical NSAIDs
What is the acute management of a DKA ?
Insulin should be given at a fixed rate whilst continuing regular injected long acting insulin but stop short acting injected insulin
What is irradiated blood products trying to prevent ?
Transfusion - associated graft versus host disease
What can cause galactorrhoea ?
Metoclopramide
What does a widened mediastinum seen CXR indicate ?
Aortic dissection
Following a bone marrow transplant what does a Maculopapular rash indicate ?
It is a common feature of graft versus host disease
What is the first line treatment of a mild-moderate flare up of UC ?
Topical ( rectal ) aminosalicylates
What should be avoided after glandular fever and for how long ?
Contact sports for 4 weeks
What is the most common causative organism of septic arthritis ?
Staphylococcus aureus
What should be performed prior to starting biologics for RA ?
CXR to look for TB as biologics can cause reactivation
What is the treatment of bacterial vaginosis in pregnant women ?
Oral metronidazole
What is a contraindication of for statin therapy ?
Pregnancy
What can PPI’s cause which is seen on U&E’s ?
Hyponatraemia
What can give falsely low HbA1c readings ?
Sickle cell anaemia and other haemoglobinopathies
What acid base balance is seen in addison’s disease ?
Metabolic acidosis with a normal anion gap
Which valve is most commonly affected in infective endocarditis ?
Mitral valve
What is characterised by a positive antiglobulin test ( Coombs’ test ) ?
Autoimmune haemolytic anaemia
If someone has poorly controlled hypertension - already taking ACEi and a thiazide diuretic what should be added ?
CCB
What is the immediate treatment for a DKA ?
Isotonic saline should be initially started even if the patient is severely acidotic
If an INR is between 5-8 what should be given ?
Stop warfarin
Give IV vitamin K 1-3 mg
Restart warfarin when INR is less than 5
Which thyroid cancer shows an excellent prognosis despite tendency to spread to cervical lymph nodes early ?
Papillary thyroid cancer
What should be assumed if someone has tachycardia with tachypnoea with no signs on imaging ?
PE
What is the management of a woman with asymptomatic bacterial vaginosis ?
Don’t require treatment
What is the cause of persistent ST elevation 4 weeks after sustaining a MI, examination reveals bibasal crackles and the presence of a third or fourth heart sound ?
Left ventricular aneurysm
What are some key features of polymyalgia rheumatica ?
Abrupt onset of bilateral early morning stiffness in the over 60s
Which cancer can pernicious anaemia predispose someone to ?
Gastric carcinoma
What are the exercises called that are performed to treat BPPV ?
Brandt-Daroff exercises
What deficiency increases the risk of anaphylactic blood transfusion reactions ?
IgA deficiency
What should every person being treated with insulin have ?
Glucagon kit for emergencies
What causes an ejection systolic murmur heard louder on inspiration ?
Atrial septal defect
What should be performed in a STEMI if primary PCI cant be delivered within 120 mins ?
Fibrinolysis should be offered within 12 hours
What is SLE a risk factor for ?
Acute pericarditis
How should someone with a possible PE be managed ?
A DOAC
What should someone with suspected cauda equina have ?
Urgent MRI spine
What is Beck’s triad for cardiac tamponade ?
Falling BP
Rising JVP
Muffled heart sound
People with an abdominal aorta diameter more than 5.5cm hound have what ?
Seen by a vascular specialist within 2 weeks of diagnosis
Other than pancreatitis what can cause a rise in amylase ?
Small bowel obstruction
What are some features that indicate a bleeding peptic ulcer ?
Hypotension
Melaena
What should be performed for patients with increased urinary cortisol and low plasma ACTH levels ?
CT adrenal glands
What is the first line test for acromegaly ?
Serum IGF-1 levels
What is the treatment for Gonorrhoea ?
IM ceftriaxone
What is the diagnostic test for obstructive sleep apnoea ?
Polysomnography
What is the eradication therapy for H. Pylori ?
PPI + amoxicillin + clarithromycin
PPI + metronidazole + clarithromycin
What is given to patients with polycythaemia vera to reduce risk of thrombotic events ?
Aspirin
What are some key features of hypocalcaemia ?
Perioral Paraesthesia
Cramps
Tetany
Convulsions
How is trichomonas vaginalis treated ?
Oral metronidazole
Other than heart failure what can raise BNP ?
Renal dysfunction - eGFR less than 60
If heart failure is not responding to treatment what should be started ?
CPAP
When should anti coagulation be started in patients with atrial fibrillation ?
Men = CHA2DS2-VASC more than 1
Women = CHA2DS2-VASC more than 2
What are the first line drugs for preventing angina attacks ?
Beta blockers or CCB
What is used to treat Torsades de pointes ?
IV magnesium sulfate
What heart related problem is associated with Polycystic kidney disease ?
Mitral valve prolapse
What are the factors for CHA2DS2-VASc score ?
Congestive heart failue
Hypertension
Age ( 75 + ) = 2 points
Diabetes
Previous stroke, TIA or VTE = 2 points
Vascular disease
Age ( 65 - 74 )
Sex ( female )
What is rapidly progressive glomerulonephritis ?
A term used to describe a rapid loss of renal function associated with the formation of epithelial crescents in the majority of glomeruli.
What are some causes of rapidly progressive Glomerulonephritis ?
Goodpastures
Wegener’s granulomatosis
SLE
Microscopic polyarteritis
What are some features of rapidly progressive Glomerulonephritis ?
Haematuria with red cell casts
Proteinuria
Hyeprtension
Oliguria
( Nephritic )
What is used as a vitamin D supplement in end stage renal disease ?
Alfacalcidol as it doesn’t require activation in the kidneys
How do you differentiate between ATN and prerenal uraemia ?
In prerenal uraemia the kidneys hold onto sodium to reserve volume
What does IgA nephropathy result from ?
Immune complex deposition in the glomerulus
What does the use of 0.9% sodium chloride for fluid therapy in patients rewearing large volumes put them at risk of ?
Hyperchloraemic metabolic acidosis
What is an indication for haemodialysis in a patient with an AKI ?
Pulmonary oedema
What renal condition is HIV associated with ?
Focal segmental glomerulosclerosis
How does calcium gluconate work ?
It stabilises the myocardium and does not lower potassium levels
What does acute tubular necrosis have a poor response to ?
Fluid challenge
What is used for non-falciparum malaria and why ?
Primaquine is used to destroy liver hyponozoites and prevent relapse
What features indicate dengue fever ?
Retro-orbital headache
Fever
Facial flushing
Rash
Thrombocytopenia
Returning traveller
What are some features of yellow fever ?
Flu like illness
- remission -
Followed by jaundice and haematemesis
What are some features that suggest leptospirosis ?
Bilateral conjunctivitis
Bilateral calf pain
High fever
‘ sewage worker ‘
What should be suspected in a man returning from a trip abroad with maculopapular ras and flu like illness ?
HIV seroconversion
What is used for prophylaxis of meningococcal meningitis ?
Oral ciprofloxacin
What is the treatment choice for Gonorrhoea ?
IM ceftriaxone
What is the first line for a mild/moderate flare up of UC ?
Topical ( rectal ) aminosalicylates
What is given for severe alcoholic hepatitis ?
Corticosteroids
What is the investigation of choice fo primary sclerosing cholangitis ?
ERCP / MRCP
What are varicoceles associated with ?
Infertility
Which nerve is at risk during a total hip replacement ?
Sciatic nerve
What cancer is schistosomiasis a risk for ?
Squamous cell carcinoma of the bladder
What is the treatment choice for biliary colic ?
Elective laparoscopic cholecystectomy
How long should a PSA test be delayed after prostatitis ?
1 month
What is a common complications of radical prostatectomy ?
Erectile dysfunction
What medication is a cause of erectile dysfunction ?
Beta blockers
What is the diagnostic investigation for small bowel obstruction ?
CT abdomen
Why would spinal anaesthesia be used over general anaesthesia ?
Lower cost
Better post-operative pain scores
Allergy to general anaesthesia
Contraindications to general anaesthesia - COPD
Name the 2 anatomical layers in which spinal anaesthesia is injected in between ?
Arachnoid mater and pia mater
What are some cancers that obesity is a risk factor for ?
Bowel
Breast
Ovarian
Endometrial
What are 4 findings on an X-ray for RA ?
Narrowing of joint space
Peri-articular osteopenia
Juxta-articular bony erosions
Soft tissue swelling
Subluxation
What are some extra-articular features of RA ?
Dry eyes
Scleritis
Dry mouth
Pericarditis
Interstitial lung disease
What are some classes of monoclonal antibodies given for RA ?
Anti-TNF
Anti-interleukin 6 receptor
What is the most appropriate first line treatment for functional constipation ?
Macrogol
What are some features from a history that indicate poorly controlled asthma ?
Difficulty sleeping because of symptoms
Need to use salbutamol regularly - more than normal
Decreasing PEFR in home monitoring
What are 4 management options for better asthma control ?
Smoking cessation
Review asthma technique
Step up management
Patient self management plan
What further questions would you ask in a history if someone presented with heavy painful periods ?
Sexual history
Pattern of pain - onset, timing and character
Bloating or mood changes ?
Other abnormal bleeding
What are some contra-indications for COCP ?
Migraine with aura
Previous history of thrombosis
Obesity
How does the COCP prevent pregnancy ?
Acts to inhibit ovulation
Effects the endometrium and cervical mucus
What is the specific test for BPPV and explain how it is performed ?
Hallpike test
Sit up straight and focus on something straight ahead.
Bring the head and torso level to the bed
Keep eyes open
Move head downwards below level of bed and turn left or right
Watch for nystagmus for 30 - 60 seconds
What is the underlying mechanism of BPPV ?
Small fragments of debris - calcium carbonate crystals - are deposited in the inner ear.
When your head is still the fragments sit at the bottom of the canal.
However on movement of the head the fragments can be swept along the fluid filled canal which sends confusing messages to the brain causing vertigo
What procedure is used if BPPV doesn’t self resolve ?
Epley manouevre
What are some risk factors for peripheral arterial disease ?
Smoking
Hyperlipidaemia
Lack of exercise
Family history
What process in the arterial tree may allow improvement of peripheral arterial disease ?
Development of collateral vessels
What is the pharmacological mechanism and therapeutic action of aspirin ?
Irreversible cyclo-oxygenase inhibitor
Prevents platelet aggregation
Where is rest pain mostly felt in the lower leg ?
Toes
Foot
Forefoot
At what ABPI level is rest pain felt ?
0.5
After standing up why is a leg with peripheral arterial disease more red than the other leg ?
Severe ischaemia leads to release of local vasodilators that increase perfusion of the ischaemic foot.
What is a difference between pain caused by peritonitis and ureteric colic ?
Pain in peritonitis is exacerbated by movement whereas ureteric colic causes the patient to move around
What is the the most diagnostic investigation for ureteric colic ?
CT KUB
What is the radiological intervention for hydronephrosis ?
Percutaneous nephrostomy
Following an infective exacerbation of COPD what should a GP do ?
Annual flu vaccine
Give the pneumococcal vaccine
Offer pulmonary rehab
Regular COPD review
Give a rescue pack
What are the 2 main causes of pancreatitis in the UK ?
Alcohol
Gallstones
What score is used to assess the severity of pancreatitis ?
Galsgow
What investigations should be started before a DOAC is started ?
FBC - anaemia
Clotting screen - as baseline
What is a side effect of Pyrazinamide ?
Hepatitis
Joint pain
What is a side effect of ethambutol ?
Visual loss
