2014

Question 1

why does obesity increase risk of clots

Answer 1

promotes a state of chronic inflammation that activates prothrombotic signaling pathways in platelets and other vascular cells

Question 2

what is virchow’s triad

Answer 2

Virchow's triad = factors that contribute to thrombosiss.
hypercoaguability
haemodynamic changes (stasis, turbulence)
endothelial damage
injury/dysfunction

Question 3

why is pregnancy a risk of VTE

Answer 3

Pregnancy is a state hypercoagulability - alterations of coagulation proteins + increased resistance to the antithrombotic factors (protein C and S)
also venous stasis

Question 4

4 methods of thromboprophylaxis

Answer 4

mechanical - anti-embolism stockings or intermittent pneumatic compression

pharmacological - LMWH, NOAC

early mobilisation if possible?

Question 5

what is included in the TWO LEVEL wells score

two level is the one talked about on NICE

Answer 5

active Ca
paralsysis, paresis or recent immooboilsitaion
recently bed ridde
majory surgery within 12 weeks
localised tenderness along deep veous system
entire leg swollen
calf sweeling >3cm than other side
pitting oedema only in symptomatic leg
collateral superficial veins (non-varicose)
previous DVT

Question 6

what to do with Wells score

Answer 6

> =2 -> proximal leg USS within 4 h. if -ve -> d dimer

OR

d dimer and intermim 24 hr dose of parenteral anticoag if proximal USS not carried out within 4 hr. then do USS within 24 h

if <2 -> d dimer. if positive go to above

Question 7

when to follow up the proximal leg vein USS if positive D dimer but -ve proximal elg vein USS

Answer 7

6-8 days

Question 8

score for PE vs DVT

Answer 8

PE 2 level PE wells score

DVT 2 level Wells score

Question 9

what is in the 2 levfel PE Welss score

Answer 9

clinical features of DVT
alternative diagnosis less likely than PE
hr >100
immobilisation for >3 days
surgery in previous 4 wk
hx VTE
haemoptysis
malignancy

Question 10

what to do with PE score

Answer 10

> 4 = immediate CTPA or immediate interim parenteral anticoag followed by CTPA if it cannot be carried out immediately

if =<4 -> d dimer. if positive go to above

Question 11

4 things to measure before prescribing LMWH

Answer 11

U+E + eGFR
weight
fbc - for platelets??
idk what last thing? clotting?

Question 12

MOA of DOACs

Answer 12

reversible direct inhibitor of factor Xa

Question 13

2 genetic mutations in Down’s

Answer 13

Robertsonian translocation (2-4%) - long arm of chromosome 21 is attached to another chromosome, often chromosome 14.

trisomy 21

Question 14

GI malformations in Down’s

Answer 14

• duodenal atresia
• imperforate anus
• tracheoesophageal fistula (think if bubbling up milk feeds, frequent choking)

Question 15

what does ABCDE stand for

Answer 15

asymmetry
border irregularity
colour
diameter >6
evolving shape, colour, size

Question 16

risk factors malignant melanoma

Answer 16

sun/UV exposure
dysplastic naevi (atypical moles)
lentigo maligna
fhx
hx
immunosuppressed
skin type 1

Question 17

what skin cancer does phototherpay for psoriasis put you at risk of

Answer 17

BCC

Question 18

risk factors for vid d deficiency

Answer 18

insufficient sunlight
malabsorption e.g. coeliac, IBD
CKD

Question 19

describe vitamin d metabolism

Answer 19

light  skin  vitamin d3  liver  25 hydroxyvitamin d  kidneys  1, 25 DIhydroxyvitamin D  kidneys

 = –>
obviously 1,25 DI - remember chemistry. if there are to OH attached it becomes di

Question 20

effect of vitamin D on bone

Answer 20

INDIRECT
-increase Ca intestinal absorption, slight increase in kidney resorption –> more Ca deposited in bone because increase Ca in blood

also moves Ca out of bone by increasing number of osteoclasts (but this is less obvious)

Question 21

why does vit d deficiency cause undermineralisation

Answer 21

normal mineralisation depends on availability of ca an phos
vitamin d is essential for normal absorption of ca from the gut

insufficiency of either ca or vit D can lead to prolonged secondary hyperparathyroidism

Question 22

risk factors for gout

Answer 22

male
thiazides
CKD
obesity
psoriasis
diabetes
HF
high alcohol consumption
chemo
CHD
HTN

Question 23

gout triggers

Answer 23

stress

illness

Question 24

why does gout affecft distal joints

Answer 24

lower temperature
lower pH
subject to more trauma

uric acid crystalises more easily due to the above

Question 25

MOA allopurinol

Answer 25

xanthine oxidase inhibitor

Question 26

how does allopurinol reduce number of gout attacks

Answer 26

inhibits oxidase of xanthine to uric acid in purine metabolism

Question 27

colchicine mode of action

Answer 27

anit-mitotic drugs that modules pro and anti inflammatory pathways

Question 28

bladder Ca risk factors

Answer 28

AGE IS THE MAIN ONE
male
smoking
azo dyes
pelvic radiation

Question 29

vitamin a deficiency

Answer 29

night blindness

increase susceptibility to infection

Question 30

increase risk of what malignancy in coeliac disease?

Answer 30

hodgkin’s and non hodgkin’s

small bowel

Question 31

diagnostic test of malaria

Answer 31

gold standard: thick and thin blood smears stained with Giemsa stain

Rapid diagnostic tests (RDTs) detect parasite antigens. dipstick. cheaper, less training needed

Question 32

drug to treat malaria

Answer 32

depends not only on the severity of the disease but also the strain of Plasmodium involved and the degree of resistance that it exhibits

Question 33

3 things to test before lithium

Answer 33

TFT
U+E
parathyroid
pregnancy

Question 34

lithium neuro

Answer 34

coarse tremor
confusion
fasciculations
chorea
hypotonia
ataxia

FAHCCC!!!

Question 35

what type of tumour is pancoast tumour

Answer 35

apical non-small cell lung Ca

Question 36

3 things in horner’s

Answer 36

• meiosis - pupil constriction
• anhidrosis
• ptosis

ptosis is milder compared to oculomotor (CN III) palsy which supplies a different muscle

Question 37

symptoms of bulbar palsy

Answer 37

dysphagia 
dysarthria
dysphonia
difficulty chewing
nasal regurgitation.
difficulty in handling secretions.
aspiration of liquids.