2020+1 Paper Flashcards
What is required for a diagnosis of Ulcerative Colitis?
A negative stool culture
Why is flexible sigmoidoscopy preferred to colonoscopy in ulcerative colitis?
It is less expensive, less invasive, doesn’t require sedation and can be performed in practise
What is hyperventilation syndrome?
Recurrent palpitations and dysponea commonly due to anxiety
What is the fastest diagnostic test for TB?
Zheil-Neelson staining or Auramine test
What is the Auramine stain?
An alternative to the Zhiel-Neelson stain for TB, both of which yield results within 24 hours
What is the Mantoux test?
A test for latent TB (aka Tuberculin test)
Which organisms cause aspiration pneumonias?
- Klebsiella
- Staph aureus
- Haemophilus influenzae
- Strep pneumoniae
- Anaerobes
What is the first line pain medication for sickle cell crisis?
Paracetamol and then NSAIDs
What is the most common cause of basal actelectasis?
Surgery, particularly abdominal surgery
Why is surgery a risk factor for actelectasis?
- Patients are under anaesthetic and therefore are unable to breathe deeply/ cough increasing risk of basal collapse
- Patients are often in pain after surgery which may be exacerbated by breathing deeply therefore breaths may be more shallow
What are the most effective treatments of atelectasis?
- Physiotherapy
- Breathing exercises
What haematological abnormality can iron deficiency anaemia cause?
Thrombocytosis as erythropoieten is increased due to the anaemia which in turn increases WBCs
How can meningitis and encephalitis be differentiated?
Meningitis will rarely cause neurological symptoms such as a seizure, whereas encephalitis commonly presents with seizure
How long should PPIs be stopped before endoscopy?
3-4 weeks
What is the cut off for referring patients for endoscopy with suspected GORD without alarm symptoms?
>55 without any red flags
What type of haemorrhoids would be painful?
External thrombosed haemorrhoids (grade 3/4)
What is the most common causative organism of infective endocarditis?
Staph aureus
- Strep viridans is associated with dental proceedures
- Staph epidermidis is associated with IVDU and medical proceedures
What is the mechanism of palmar erythema in alcoholic cirrhosis?
There’s increased circulating oestrogen which would have been metabolised in the liver
What are the life threatening O2 stats?
- <92 % non-COPD
- <88% COPD
When would rate control over rhythm control be given in AF?
If the patient has been in AF >48hrs or the time-course is unknown
What is a fragility fracture?
A fracture due to a fall from standing height or less
What is deficient in Gilbert’s syndrome?
UDP glucuronosyltransferase
What is the inheritance pattern of Guilbert’s syndrome?
Autosomal recessive
What is the management of PBC?
Ursodeoxycholic acid
What is the diagnostic test for carpal tunnel syndrome?
Nerve conduction studies or EMG
What is an important side effect of carbimazole?
Agranulocytosis, therefore patients with new onset illnesses after commencing treatment should have a FBC taken
What are the common causative organisms of acute epididymitis?
- <35 Neisseria gonorrhoea, Chlamydia trachomatis
- >35 E.coli
Which electrolytes should be checked before starting theophylline?
- Us and Es, especially K+
- LFTs
What type of haematuria do kidney stones commonly cause?
- 80ish% microscopic
- 20ish% macroscopic
What are the two most common causes of DKA?
- Pneumonia
- UTI
How long should patients with medication overuse headache stop taking medications for?
At least one month
What is the INR target for first episode VTE?
2-3
What is a normal INR?
1-1.5
What is the difference in presentation between large and small bowel obstruction?
Large bowel
- Distention common
- With or without pain
- Faceulent vomiting
- May not be present
- More gradual onset
Small bowel
- Distention less common
- Painful
- Vomiting an early sign
- Bilious
Sigmoid volvulus
- Acute onset
- Colicky pain
What is the main cause of large bowel obstruction?
Colorectal cancer
What is the presentation of sigmoid volvulus?
Acute colicky pain
What is the management of anal fissures?
- Conservative (constipation reducing)
- Topical GTN (Diltiazem if GTN causes headaches)
- Botox injection (recurrent)
- Surgical sphincterectomy (recurrent)
What is the Waterlow score?
A score used to estimate the risk of development of pressure ulcers
What is the Ranson criteria?
A score used to assess the severity of acute pancreatitis
What are the scores for acute pancreatitis?
- Glasgow score
- Ranson criteria
- APACHE II
What is the HAS-BLED score?
The one year risk of bleeding for patients who have AF
What is polymorphic ventricular tachycardia?
Torsades de Pointes
Managed with IV MgSO4
When should adults with a bowel habit change be urgently referred?
>60
What are labyriniths?
An inflammatory disorder affecting the vestibular and cochlear organs causing sensorineural hearing loss and balance impairment
- Attacks last hours to days
- Viral or bacterial
What is vestibular neuritis?
An inflammatory disorder affecting just the vestibular organs
- Attacks last hours to days
- No hearing impairment
When should mastitis be treated?
- Symptoms fail to improve 12-24 hrs
- Culture indicates an infection
- Nipple fissure is present
- Systemically unwell
What is the definitive imaging modality in ruptured AAA?
CT
Ultrasound if not ruptured
When is surgery indicated for AAA?
>5.5cm or 4cm and growing more than 1cm per year
Or ruptured
What is the strongest risk factor for diverticular disease?
Age >50
Why does tanning occur in haemochromatosis?
Due to the accumulation of iron in the sweat glands
What is the inheritance pattern of essential tremor?
Autosomal dominant
What are the risk factors for C.diff infection?
- Broad spectrum antibiotic use
- Hospitalisation
- Residency in a nursing home
- Use of acid suppressing drugs, eg. PPI
What is the most common cause of hypercalcaemia?
Primary hyperparathyroidism
How long is the latent period of asbestosis?
15-30 years
What are the CT changes in asbestosis?
- Pleural thickening
- Ground glass opacities
- Lower lobe fibrosis
What does sarcoidosis imaging show?
- Bilateral hilar lymphadenopathy
- Upper lobe scarring
What can skin tags reflect in patients with PCOS?
Hyperinsulinaemia
Usually found in the neck region
What is the presentation of chronic venous disease?
Oedema on standing and new varicose veins
Which types of inguinal hernias are more common?
Indirect
Where does the pain radiate in pneumothorax?
Shoulder tip
What are the causes of pleuritic chest pain?
- Pneumonia
- PE
- Pleural effusion
- Pneumothorax
- Pericarditis
What is the management of acute heart failure?
- A-E
- Treat the cause
- Furosemide
- Consider GTN or another vasodilator if there is a hypertensive crisis*
- Consider ionotopic drug if there is cardiogenic shock*
What is the management of trigeminal neuralgia?
Carbamazepine
When would carotid doppler be used?
To investigate cause of TIA or anterior circulation stroke
When should patients with temporal arteritis urgently be referred to an opthalmologist?
If there is any visual disturbance, but prednisolone is ALWAYS commenced first
Without visual disturbance, referral is made to rheumatology and patients are seen within 3 days
What’s the standard dose of prednisolone for GCA patients without visual loss?
40-60mg
What is the mechanism of statins?
They inhibit endogenous formation of cholesterol in the liver by inhibiting HMG-CoA reductase
Is colonoscopy or flexible sigmoidoscopy necessary for a diagnosis of IBS?
No
What is the main risk factor for hepatocellular carcinoma?
Cirrhosis
What is the usual presentation of amoebic liver abscess?
Usually asymptomatic, but can present with fever and RUQ pain
What is the cut off for upper GI symptoms and urgent 2ww referral?
>55
What are the possible surgical treatments for varicose veins?
- Endothermal ablation
- Foam sclerotherapy
- Ligation or stripping of the veins
- Surgical
What is the difference between hot and cold nodules on thyroid uptake scan?
Hot nodules will uptake lots of iodine as they’re hyperactive, cold nodules will not uptake iodine and are usually cancerous
What is the guidance on managing diabetes during surgery?
Patients on variable rate insulin infusion until they are able to eat and drink again post surgery without vomiting
What is the management of non-haemolytic febrile reaction?
- Stop the transfusion
- Give paracetamol
- Restart the transfusion
What is the managment of acute haemolytic transfusion reaction?
- Stop the transfusion
- Check patient details
- A-E
What are the features of acute haemolytic transfusion reaction?
- Fever
- Abdominal pain
- Hypotension
What is the management of transfusion associated circulatory overload?
IV furosemide
How does transfusion associated circulatory overload present?
- Hypertension
- Pulmonary oedema
Usually in patients with previously existing heart failure
Can fibroadenomas fluctuate during menses?
Yes
What is the most common cause of cauda equina syndrome?
Lumbar disc herniation
Which cortisol levels would prompt short synACTHen test to be performed?
100-500 nmol/L 9am cortisol
What is the gold standard diagnostic tool for bladder outlet obstruction?
Urianry outflow studies
When should patients be referred on suspected bowel cancer?
Any bowel habit change or anaemia in >60
How does hep C usually present?
With a flu prodrome, but it rarely causes symptoms
What are the warfarin INR guidelines?
Between 2-3
What is fibromyalgia?
Abnormal sensory processing in the CNS, making people more receptive to muscle pain