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1 Flashcards

1
Q

Three embryonal layers and one organ from each

A

Ectoderm - CNS, epidermis, lens of eye
Endoderm - GI tract, lungs, thryoid
Mesoderm - Muscle, kidney, gonads

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2
Q

How long do you treat for after PE?

A

Unprovoked - 6/12
Provoked - 3/12

Heparin (till INR > 2) and Warfarin (long term)

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3
Q

Diagnostic tests for Addison’s?

A
  1. Short synacthen - measure cortisol 30 mins after
  2. 21 hydroxylase antibodies
  3. 9am ACTH - inappropriately high (>500)
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4
Q

What is deontology?

A

Ethics based upon whether actions themselves are right or wrong as opposed to the consequences of those actions

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5
Q

Causes of primary hypothyroidism?

A 
Iodine deficiency
Hashimoto's thyroiditis
Postpartum thyroiditis
Radioiodine therapy
Previous thyroidectomy
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6
Q

Exudative pleural effusion causes, definition and pathophys?

A

> 30 protein:

Px - increased permeability of pleura

Ax - infection, malignancy, SLE, RA, Dressler’s syndrome

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7
Q

Trasudate pleural effusion - causes, px, definition?

A

<30g protein

Px - disruption of hydrostatic forces

Ax - hypoalbuminaemia, cirrhosis, heart failure, hypothyroid, nephrotic syndrome

DONT TAP TRANSUDATES

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8
Q

CFx of pleural effusion?

A

Decreased chest expansion and breath sounds

STONY DULL

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9
Q

Light’s criteria for exudate

A

Pleural:serum protein >0.5
Pleural:serum LDH >0.6

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10
Q

Primary hyperparathyroidism? Ax and Dx and Rx

A

80% adenoma, 20% hyperplasia
High PTH, High Ca, Low PO4, High ALP
Parathyroidectomy, cinacalcet, bisphosphonates, IV fluid

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11
Q

Secondary hyperparathyroidism? Ax and Dx and Rx

A

Physiological compensatory hypertrophy - compensating for low Ca2+
Ax - CKD and Vit D def
High PTH, Low Ca, High PO4, Low VitD
Rx - vit d and cinacalcet, phosphate binders

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12
Q

Tertiary hyperparathyroidism? Ax Dx Rx

A

Hyperplasia after long standing 2ndary
Ca high, PTH vv high
Rx - cinacalcet, surgery

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13
Q

Causes of bacterial conjunctivitis

A 
H. influenzae
Staphs
Streps
Chlamidya trachomatis
N. gonnorhoeae
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14
Q

what are the different discharges of conjunctivitis?

How do you treat them?

A

Bacterial - sticky - Rx - chloramphenicol
Viral - serous (adenovirus) - Rx - supportive
Allergic - itchy - Rx- antihistamines

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15
Q

Most common cause of third degree heart block?

A

MI —> Sinoatrial disease

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16
Q

Treatment third degree heart block?

A

Pacemaker

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17
Q

What is fludrocortisone?

A

Synthetic aldosterone

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18
Q

How to treat SIADH?

A

Fluid restrict

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19
Q

CN3 palsy ax?

A

POSTERIOR COMMUNICATING ARTERY ANEURYSM

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20
Q

Lymphadenopathy DDx?

A

Leukaemia, Lymphoma, EBV, HIV, SLE, TB, Sarcoid

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21
Q

HIV test?

A

p24 antigen

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22
Q

HIV Hx

A

Sex, IVDU, tattoos, partners

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23
Q

AIDS defining diseases?

A 
Candidiasis of oesophagus, bronchi, trachea
Kaposi's sarcoma
Invasive cervical cancer
Cryptococcal meningitis
CMV retinitis
Burkitt's lymphoma
TB
PCPneumonia
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24
Q

Normal IOP?

A

<21

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25
Q

Example of Grp A beta haemolytic strep?

A

PYOGENES

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26
Q

How to investigate renal vein thrombosis?
What might have caused it?
Rx?

A

Doppler USS

Nephrotic syndrome

heparin and warfarin

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27
Q

Sign for DVT o/e

A

Homan’s sign = pain in calf on dorsiflexion of foot

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28
Q

Why do you give heparin AND warfarin

A

Warfarin is prothrombotic in first 5/7

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29
Q

Ix pre LMWH?

A

Weight, U+E (CrCl), Platelets, K+

Can cause thrombocytopenia and hyperkalaemia

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30
Q

6 Fx of T21

A

UPSLANTED palpebral fissure, epicanthic folds, brushfield spots @iris, single palmar crease, large sandal gap, small mouth, small ears, protruding tongue, AVSD, TofF, Hirschprungs, DD atresia, otitis media, early onset AD

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31
Q

RF for melanoma?

A

T1 skin, sun exposure, FHx, melanocytic naevi, prev melanoma

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32
Q

PVD Rx

A

Supervised exercise programme
Clopidogrel
Naftridifuryl Oxalate
Surgery - graft, bypass, stent, amputate

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33
Q

Gout 4 RF

A 
CKD
obesity
DM
Diuretics
Alcohol
CHD
High purine diet
FHx
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34
Q

Gout 4 triggers

A 
Surgery
Trauma
Cell lysis
Infection
Starvation
Dehydration
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35
Q

Rx for gout - prevention and acute

A

ACUTE - NAPROXEN // COLCHICINE

CHRONIC - Allopurinol, feboxustat (XO inhibitors)

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36
Q

Difference between gout and pseudogout

A

GOUT - Weakly NEGATIVE birefringent urate crystals

PSEUDOGOUT - +ve calcium pyrophosphate crystals

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37
Q

Why gout affect small joints?

A

Colder so makes urate solubility lower

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38
Q

Sx and Sx SLE

A 
Serositis
Oral ulcers
Arthralgia
Photosensitivity
Blood - cytopenias
Renal - nephrits, raynauds
ANA.
Immunology DSDNA
Nephritis, neurological - seizures. psychosis.
Malar rash
Discoid rash

+wt loss, fatigue, malaise etc. etc.

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39
Q

Hyperthyroidism Sx

A 
Tremor
HR up
Yawning
Restless
Oligomenorrhoea
Intolerance to heat
Diarrhoea
Irritable
Sweating
Muscle wasting - wt loss
Exopthalmos

++AF, anxiety

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40
Q

Hypothyroidism Sx

A 
Menorrhagia
Obesity
Memory loss
Slowness
Skin and hair dry
Onset gradual
Tired
Intolerance to cold
Reflexes slow
Energy levels down
Depression
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41
Q

superficial dermal burn?

A

Red and painful

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42
Q

Partial thickness burn?

A

Sup dermal - Pale, pink, painful, blistered

Deep dermal - Decreased sensation, white w patches of erythema

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43
Q

Full thickness burn

A

White/brown/black. No blisters. No pain.

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44
Q

AXR - small bowel obstruction

A 
Dilated loops - seen CENTRALLY
No gas in the large bowel
Valvulae conniventes seen whole way across bowel
Air fluid levels
Laddering
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45
Q

AXR - large bowel obstruction

A 
Dilated loops - peripheral
Air fluid levels
Collapsed distal colon
Intramural gas
Portal venous gas
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46
Q

AXR - perforation

A

Rigler’s sign (gas is seen on both sides of bowel wall)
Coffee bean sign = volvulus
Pneumoperitoneum

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47
Q

Rx bowel obstruction

A

IV fluids
ABx
NG tube w/ suction

DRIP AND SUCK

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48
Q

Which testicular tumour has 3 embryological layers?

A

Teratoma - get raised AFP too from yolk sac layers

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49
Q

What happens if you give pregnant woman lithium?

A

bad idea

Ebstein’s anomaly (congenital heart defect)

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50
Q

6 Fx of acromegaly?

A 
Large hands and feet
CTS --> acroparaesthesia
HTN
DM
Frontal bossing
Large Jaw
Sweating
Oily thick skin
headaches and VF defects
OSA and snoring
Arthralgia
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51
Q

2 Ix for acromeg

A

OGTT + measure GH - should be depressed but isnt in AMegaly

IGF-1 (makes stuff grow) increased

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52
Q

Rx Acromegaly

A

Transsphenoidal surgery
Ocreotide/Lanreotide (SST analogues)
Pegvisomant

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53
Q

Signs of Chronic liver disease

there are alot

A 
Palmar erythema
Terry's nails
Jaundice
Ascites
Caput medusae
Dupuytren's contracture
Hepatomegaly
Easy bruising and bleeding
Malabsorption
Leuconychia
Spider naevi
Fatigue/wt loss/ malaise
Pruritis
Loss of body hair
Portal htn --> hyperdynamic circulation (bounding pulse + low BP)
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54
Q

WHO surgical safety - before anaesthetic

A 
Pt site, name, procedure, consent
Is the site marked?
Anaesthetic machine checked?
SPO2 monitor on patient?
Allergies?
Airway risk?
Risk of >500ml blood loss?
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55
Q

WHO surgical safety - before incision

A 
Everyone introduce themselves by name and role
Pt name, procedure, incision site
ABx prophylaxis?
Anaesthetic concerns?
Surgical concerns?
Equipment concerns?
Essential imaging displayed?
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56
Q

WHO surgical safety - post op

A 
Name of procedure
Instrument counts
Specimen labelling
Equipment concerns?
Recovery concerns?
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57
Q

What’s in the bone marrow in AML?

A

Auer rods, monoblasts, myeloblasts

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58
Q

Definition of osteoporosis?

A

Low bone mass and micro architectural deterioration of bone

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59
Q

What vitamin deficient in eczema?

A

DDDDDDD

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60
Q

ASA grades?

A
  1. Normal human being
  2. Mild systemic disease
  3. Severe systemic disease
  4. Severe systemic disease which is a constant threat to life
  5. Moribound pt
  6. Braindead
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61
Q

Whats the risk of an LMA?

A

Laryngospasm –> pt occludes airway but the diaphragm continues to contract which draws fluid into alveoli

= Negative pressure pulmonary oedema

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62
Q

How do loop diuretics work?

A

Blockage of NaK2Cl channel @ thick ascending limb of LofH

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63
Q

How do thiazide diuretics work?

A

Block NaCL@ DCT

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64
Q

How does spiro work?

A

Competes with aldosterone @ collecting ducts

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65
Q

What causes rheumatic fever?

A

strep A infn

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66
Q

RF for Mitral prolapse

A 
young women
marfans
hyperthyroidism
rheumatic fever
IHD
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67
Q

Septal leads?

A

V1 and V2

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68
Q

Anterior leads?

A

V3 and V4

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69
Q

What do you give NAC in?

A

5% dex

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70
Q

Alternative to NAC?

A

Methanione

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71
Q

What’s the metabolic syndrome?

A

Obesity, T2DM, HTN, Hyperlipidaemia +/- NAFLD

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72
Q

How to treat AI hepatitis>

A

Pred then azathioprine

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73
Q

Rx for hepatic encephalopathy?

A

LACTULOSE - stops faecal build up which decreases ammonia

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74
Q

What tests might you do on ascitic aspirate?

A 
Albumin
Neutrophils
MC+S
Gram stain
Cytology
Amylase
75
Q

Rx for ascites?

A

Na restriction, Spironolactone, +/- furosemide

Paracentesis

76
Q

What do you see on Multiple Sclerosis histology?

A

Demyelination
Plaques
Oligodendrocyte loss

77
Q

What dx might you give with morphine

A

Lactulose

Cyclizine

78
Q

Parkland formula?

A

4xkgx%BSA

79
Q

DDx facial droop?

A

Ramsay hunt
CVA
Bell’s
Parotid tumour

80
Q

Why don’t you see kids with alpha thallasaemia?

A

Barts fetal hydrops

Hb barts - v high O2 affinity - accumulation of fluid and IUD

81
Q

Example of iron chelator?

A

Desferrioxamine

82
Q

Bowel tumour marker?

A

CEA

83
Q

Ix for oropharyngeal cancer

A

Swab, biopsy, PET

84
Q

Multiple myeloma - full skeletal survey or technetium scan?

A

Full skeletal survery

Technetium relies on osteoblasts which aren’t great in MM

85
Q

HypoK+ ECG

A

ST depression
U wave
Long PR
Flat T

86
Q

What channels do mineralocorticoids work @?

A

ENAC

87
Q

What does ST elevation actually mean?

A

1mm or more in 2 contiguous limb leads
2mm or more in 2 contiguous chest leads
+/- LBBB

Transmural infarction

88
Q

What do NICE reccomend for DTs

A

Loraz (not chlordiazepoxide)

89
Q

Hypothyroid and Iron def anaemia

A

iron inhibits levothyroxine so won’t work

90
Q

Rx erythema nodosum?

A

NSAIDs
Pred
Cold compresses
Bed rest + elevation

91
Q

Where’s the acoustic neuroma if you got hearing loss and facial weakness?

A

cerebellopontine angle

92
Q

DM nephropathy hallmark?

A

Kimmelstein-Wilson nodules

93
Q

Neutrophils high or low CML?

A

HIGH

94
Q

Signs of smoke inhalation?

A 
Singed nasal hairs
Stridor
Hoarse voice
Facial burns
Polycythaemia
Cough w/ black sputum
95
Q

Mouth signs of EBV?

A

Palatal petichiae
Uvula oedema
Tonsillar exudate
Tonsillar enlargement?

96
Q

How do statins work?

A

HMG CoA reductase inhibitors

97
Q

Non medical Rx postural hypotension

A

Pump arms x5
Get up slowly
Compression stockings

98
Q

Rx of isoniazid neuropathy?

A

PYRIDOXINE (b6)

99
Q

Where do SSRIs work

A

Prefrontal cortex

100
Q

OD of TCA’s

A

Wide pupils, HR up, Retention

101
Q

Contraindications to thrombolysis?

A 
BP >180
Hemorrhagic stroke
Recent head trauma
Recent surgery (2/52)
High INR
Brain tumour
Low platelets (<100 x10^9)
Over 4.5 hours since stroke
102
Q

What’s a subcapital fracture?

A

Type of NOF

103
Q

Alternatives to warfarin in AF?

A

Dabigatran
LMWH
Aspirin

104
Q

How do you treat contacts of TB patient?

A

Rifampicin and Isoniazid - 3/12

Isoniazid alone - 6/12

105
Q

Microbiological investigations for TB?

A

AFB on ZN
PCR - good for identifying rifampicin resistance
Lowenstein Jensen medium

106
Q

CXR of TB?

A

Consolidation
Cavitation
Fibrosis
Calcification

107
Q

Ax of Bulbar palsy?

A 
MND
MG
GBS
Polio
Tumour
108
Q

Ax of Pseudobulbar palsy?

A

MS
MND
Stroke
Cerebral pontine myelinosis

109
Q

Why has woman with PBC got splenomegaly and ascites?

A

CIRRHOSIS

110
Q

Complications of PBC?

A

HCC
Osteoporosis
Vitamin KADE deficiency
Coagulopathy

111
Q

HTN o/e?

A

LVH - displaced apex
Tachy
Enlarged apical impulse
S4 sound

112
Q

Complications of ramsay hunt?

A

Post herpetic neuralgia
Hearing loss
Loss of vision
Facial palsy

113
Q

Tests in ramsay hunt?

A

ESR
PCR
VZV antigen
WBC

114
Q

Complications of pancreatitis?

A 
Shock
Psuedocyst
Renal failure
Hypocalcaemia
Hyperglycaemia
Abscess
Necrosis
renal failure
115
Q

Why do you get thrombosis in nephrotic syndrome?

A

High clotting factors
Platelet abnormalities
LOSS OF ANTITHROMBIN III

116
Q

Causes of night sweats?

A 
menopause
lymphoma
leukaemia
TB
myeloma
phaeo
carcinoid
hyperthyroid
117
Q

What do you see on blood film in myeloma?

A

Rouleaux formation

118
Q

Diagnosing gonorrhoea?

A

G-ve diplococci

Vulvovaginal // endocervical swab and NAAT

119
Q

Non malignant causes of cauda equina?

A

Haematoma
Epidural abscess
Disc prolapse

120
Q

Malaria Rx

A

Artesunate and amodiaquine

artesunate and mefloquine

121
Q

Complications of malaria?

A 
Seizures
DIC
Anaemia
ARDS
AKI
Hypoglycaemia
122
Q

Ectopic pregnancy - what do you see o/e?

A 
Abdo pain w/ peritonism
Normal sized uterus
Adnexal tenderness
Cervical excitation
PV bleeding
123
Q

Blood tests in ectopic pregnancy?

A

BHCG
FBC
G+S
Progesterone

124
Q

Other tests in ectopic?

A

TVUSS

Laparoscopy

125
Q

HIV treatment?

A

HAART
2NRTI (tenofovir, abacavir, zidovudine)+ NNRTI (Efavirenz)
2NRTI + PI (atanavir)/FI (efurvitidie)

126
Q

MofA quinolone?

A

DNA Gyrase inhibitor

E.g. Ciprofloxacin

127
Q

Post strep glomerulonephritis

A

S. Pyogenes - Grp A Beta haemolytic strep

128
Q

MS histology?

A

Demyleniation
Oligodendrocyte loss
Plaques

129
Q

What’s the 2nd line treatment for Status Eplipeticus when you don’t have IV access?

A

Rectal Paraldehyde

130
Q

Complications of burns?

A

HyperK+
Septic shock
Disfigurement

131
Q

5 initial managements for fracture?

A 
A-->E
X-Ray
NV status
Analgesia
Reduce
132
Q

Hypercalcaemia Rx?

A

Furosemide, Fluids,

Bisphosphonates (2nd line)

133
Q

Calculate relative risk reduction?

A

1-RR

134
Q

S/E Methotrexate

A

Pneumonitis
Hepatotoxicity
Marrow Suppression
N+V

135
Q

Rx Erythema Nodosum?

A

Oral prednisolone
NSAIDS
Cold compress
Bed rest + elevation

136
Q

ECG for HYPERKALAEMIA

A

Tall tented T
Wide QRS
Sine wave –> VF
LOSS OF P WAVES

137
Q

ECG for hypokalaemia

A 
ST depression
Flat T
U Wave
Long QT
Long PR
138
Q

What cells does EBV like?

A

Skin and B lymphocytes

139
Q

Why do you get cannon waves in the JVP?

A

If there is AV dissociation:

RA is contracting against closed tricuspid valve so a column of blood shoots up the jugular vein

140
Q

Complications of MI

A 
DEPARTS + FAILS
Death, Dresslers
Electrical - arrhythmia
Pericarditis, Papillary muscle rupture
Aneurysm
Re MI
Tamponade, Thrombus
Shock
Failure
141
Q

What is bifasciucular block?

A

RBB and LAD

142
Q

Trifascicular block

A

RBB + LAD + LONG PR

143
Q

What counts as prediabetes?

A

Fasting BM - 5.5 - 7
HbA1C - 42-47
OGTT - 7.8-11.1

144
Q

Causes of pneumoperitoneum?

A

Post laparotomy
Perfration
Abscess

145
Q

Sensitivity =

A

TP / TP + FN

146
Q

Specificity =

A

TN / TN + FP

147
Q

PPV =

A

TP / TP + FP

148
Q

NPV =

A

TN / TN + FN

149
Q

Define acute exacerbation of COPD

A

Sustained worsening of the patients condition from the stable state and beyond normal day to day variations

150
Q

Rx Acute exacerbation of COPD

A 
SABA
O2
Steroids
ABx (if infective)
Physio
IV aminophylline
NIV
ET tube
151
Q

TIA Rx

A 
Lifestyle
Statin
Clopidogrel
Antihypertensive
Carotid endarterectomy
152
Q

Why deliver baby post maturity?

A

Intrapartum and postpartum death more common
Higher incidence of operative deliveries
Placental insufficiency
Macrosomia + shoulder dystocia

153
Q

Causes of erectile dysfunction?

A 
Smoking, Alcohol, DM
Hypogonadism, Hyperthyroid, Hyperprolactin
Cord lesions, MS, Autonomic neuropathy
Pelvic surgery / radiation
SSRI, Antipsychotics, Beta blockers
154
Q

Scan for primary hyperparathyroidism?

A

techenetium mibi subtraction scan

155
Q

Complications of pancreatitis?

A 
Early:                                                
Shock
ARDS
Renal Failure
DIC
Sepsis
HypoCa
HyperBM
Late:
Pancreatic necrosis
Pseudocyst
Haemorrhage
Thrombosis
Fistulae
Chronic
156
Q

Dx of Varicose veins?

A

Long, tortuous and dilated veins of the superficial venous system

157
Q

Why get varicose veins?

A

Valves that usually prevent blood going from deep to superficial system are incompetent therefore you get dilation and hypertension of superficial system

158
Q

RF Varicose veins?

A 
OCP
FHx
Prolonged standing
Pregnancy
Obese
159
Q

Rx plan for varicose veins?

A 
Rx cause
Avoid standing
Stockings and weight loss
Endovascular: radiofrequency ablation / injection sclerotherapy
Surgical: Saphenofemoral ligation
160
Q

Ax of hypoCa

A 
CKD
Vitamin D deficiency
Hypoparathyroidism
Acute pancreatitis
Tumour lysis syndrome
Malabsorption
Phenytoin
161
Q

MRI in ?Epilepsy?

A

SOL?
Cortical dysplasia
Migrational defects

162
Q

Amoebiasis - prevention

A

boil water and infected food

163
Q

Amoebiasis - Sx

A

High swinging fever
RUQ pain
Sweats

164
Q

Amoebiasis - Ix

A

Stool - pus cells, blood, trophozoites

165
Q

Rx AMOEBIASIS

A

Metronidazole
Diloxanide fuovate
Tinidazole

166
Q

What’s Leriche syndrome?

A

Aortoiliac occlusive disease

presents with:
Erectile dysfunction
Absent femoral pulses
Claudication of buttocks and thighs

167
Q

Causes of a raised BNP?

A 
Obesity
RVH
MI
Cirrhosis
LVH
Tachycardia
PE
DM
Sepsis
COPD
168
Q

Causes of a low BNP?

A

Aldosterone antagonists
Beta blockers
ACE-Inh + ARB

169
Q

Causes of transudative peritoneal fluid

A

CIRRHOSIS
Heart failure
Hypoalbuminaemia
Nephrotic

170
Q

Exudative peritoneal fluid

A

Infection
Pancreatitis
Hypothyroid
Chylous ascites

171
Q

Risk factors for diabetes

A 
FHx
Cushings
Acromegaly
South Asian
HTN
Gestational
PCOS
Antipsychotics
Smoking
Central obesity
Age over 40
Alcohol
172
Q

Diet for DM

A

High starchy carb
Moderate protein
Low sugar
Low fat

173
Q

Acromegaly signs

A 
Widely spaced teeth
Oily skin
Acanthosis nigricans
OSA
Goitre
CTS
Macroglossia
Arthropathy
Big supraorbital ridges
Coarse face
Growth of hands jaw and feet
174
Q

Acromegaly symptoms

A 
Acroparaesthesia
Amenorrhoea
Sweating
Arthralgia
Backache
Snoring
Shoes/clothes don't fit
Weight gain
Low libido
Headache
175
Q

Causes of sensorineural hearing loss

A 
Post infective e.g. meningitis
Ototoxic drugs
Menieres
Vascular
Acoustic neuroma
Presbyacusis
176
Q

Calculate alcohol units

A

ml x ABV / 1000

177
Q

Complications of meningitis

A 
Hearing loss
Vision loss
Learning difficulties
Amputation
Recurrent seizure
178
Q

Menopause sx

A 
Genitalia and breast atrophy
Menstrual irregularity
Sweats
Palpitations
Flushes
Osteoporosis
UTI 
Dyspareunia
Proplapse
179
Q

Sx and Sx Anorexia

A 
Constipation
Fatigue
Dizziness
Sensitivity to cold
Altered sleep
Hypotension
Dental caries
Dry skin
Brittle hair
Lanugo hair
Amenorrhoea
180
Q

Sx and Sx Bulimia

A 
Tetany
irregular menses
Russel sign
Englarged parotids
Erosion of enamel
Fatigue
lethargy
bloating
181
Q

Some stuff that increases INR on warfarin

A 
Ciprofloxacin, Erythromycin
Isoniazid
Amiodarone
SSRI's
NSAID's
Liver disease
182
Q

What decreases INR on warfarin?

A

Antiepileptics
Rifampicin
St John’s wort
Smoking

183
Q

Rx of varices - prophylaxis

A

propanolol
Endoscopic variceal band ligation
Transjugular intrahepatic porto-systemic shunt

184
Q

Acute bleed varices Rx

A 
A---E
NaCL
FFP and Vit K
IVI terlipressin
Endoscopic variceal band ligation

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