2020 Paper Flashcards
What is contact dermatitis?
Red, itchy, irritating skin after coming into contact with an allergen
What is Erythrasma?
Redness or brownness under the armpits, groin and in between the toes that is well demarcated and occasionally scaly with some superficial fissures
What are some key triggers of psoriasis?
Stress and smoking
What is flexural psoriasis?
Psoriasis located in the skin folds and genitals, the scaly overlayer is commonly lost leaving red and shiny skin below
- Breast folds
- Axilla
- Groin
- Natal cleft
What is the most common solid, benign renal mass?
Angiomyolipoma, it can present with retroperitoneal bleeding due to the vascularisation of the mass
What are the first and second line medical treatments for BPH?
- Tamsulosin (alpha blocker)
- Finasteride (5 alpha reductase inhibitor)
Tamsulosin tends to work more quickly and is more effective at reducing the discomfort LUTS
What is the presentation of mastitis?
- Systemic symptoms
- Generalised swelling and tenderness of the breast
- Erythema and inflammation
- Breastfeeding
What is the difference in presentation between mastitis and a breast abscess?
Mastitis will be generalised inflammation, whereas abscess will be a local area of inflammation walled off by an area of pus and will be a fluctuant (lump)
What is the classic presentation of haemorrhoids?
Painless PR bleeding, frank blood on the toilet paper and in the stool
What is the investigation of choice for haemorrhoids?
Proctoscopy
Which investigation is used to distinguish between IBD and IBS?
Faecal calprotectin (IBS also tends to improve post-defecation)
How does diverticulitis present?
Painful mass (usually in the left iliac fossa) with spiking temperatures
What is the histology of Barrett’s oesophagus?
- Columnar epithelial cells
- Goblet cells
What is the presentation of haemochromatosis?
Skin
- Bronzing of the skin
Liver
- Cirrhosis
- Hepatocellular carcinoma
Pancreas
- Diabetes mellitus
Heart
- Arrhythmias
Pituitary
- Hypopituitarism
Joints
- Arthralgia
What are the features of peritonitis?
- Rigitdity
- Rebound tenderness
- Guarding
- Diffuse abdominal pain
What is the first line investigation for suspected perforation of peptic ulcer?
Erect chest x-ray to screen for subphrenic gas
What is the Parkinsonian triad?
- Rigidity
- Bradykinesia
- Tremor
Which drugs improve morbidity and mortality of heart failure?
ACE inhibitors
What is the function of digoxin?
It’s a glycoside that is cardioprotective and is especially useful in atrial fibrillation and reduced left ventricular output
What is the gram stain of haemophilus influenzae?
Gram negative cocculobacillus
What is the gram stain of Klebsiella pneumoniae?
Gram negative bacillus
What is the gram stain of staphylococcus aureus?
Gram positive cocci in clusters
(strep pneumoniae gram positive diplococci)
What is a dermoid cyst?
A benign congenital cyst formed when the layers of skin don’t grow together properly
What are the eye symptoms of a cluser headache?
- Conjunctival injection
- Lacrimation
- Eyelid swelling
There is NO loss of vision, however there can be visual disturbance in migraine
What would fundoscopy show in benign intracranial hypertension?
Papilloedema
Are tension headaches pulsatile?
NO
Why is temporal arteritis an emergency?
Because it can lead to ischaemia of the retinal arteries leading to irreversible blindness
What is the inheritance pattern of neurofibromatosis?
Autosomal dominant
What is the difference in presentation between neurofibromatosis type 1 and 2?
Neurofibromatosis type 1:
- Axillary freckling
- Cafe au lait spots on the chest and back (>=6)
- Renal artery stenosis
- Lisch nodules
- Phaeochromocytoma
Neurofibromatosis type 2:
- Bilateral vestibular schwannomas
- Meningiomas
- Glioblastomas
What is the only condition that will lead to a painful thyroid goitre?
De Quervain’s thyroiditis (sub-acute thyroidits)
What is MR angiography used for?
MR angiography is used for imaging the carotid arteries and intracranial vessels
Which drug causes cholestatic hepatitis?
Co-amoxiclav
What are the most common areas for a fragility fracture?
The neck of femur, spine and wrists
What is a skeletal survey?
A series of x-ray scans of all the bones in the body, commonly used for mutliple myeloma where the bones demonstrate punched out lesions
What’s seen in the urine of multiple myeloma patients?
Bence Jones proteins
What DEXA scan score would indicate osteoporosis?
t= -2.5
What is the diagnostic test for AAA?
Abdominal ultrasound
Which AAA patients should CT angiography be offered to?
>5.5cm or query rupture
Where are inguinal hernias usually located?
Superior and medial to the pubic tubercle
Where are femoral hernias usually located?
Inferior and lateral to the pubic tubercle
How long after surgery do incisional hernias occur?
3-6 months
What is sephena varix?
Dilation of the saphenous vein due to an incompetent valve proximal to the saphenofemoral junction
Why is there tachypnoea in DKA?
Attempt of correcting the metabolic acidosis
What is one of the side effects of Carbamazepine?
Hyponatraemia
Presentation:
- Coma
- Somnolence
- Cerebellar symptoms
What is the presentation of ecstasy overdose?
Hyperactivation of the sympathetic nervous system
What is the most common presentation of alcoholic liver disease on FBC?
Thrombocytopaenia
What is the most important investigation for suspected thyroid malignancy?
Fine needle aspiration and cytology
When are Calcitonin levels ascertained in the thyroid context?
If there is query medullary thyroid cancer
What is physiologic jaundice?
Jaundice that occurs days after birth due to increased rate of haemolysis and reduced hepatic clearance in new-borns 2-3 days after birth
How are Warfarin’s effects monitored?
Via INR
How many days prior to surgery should Warfarin be stopped?
3-5 days prior to surgery, unless there are contra-indications such as life threatening emboli
If warfarin cannot be stopped 3 days prior to surgery, what actions should be taken?
An INR of less than 2.5 should be achieved and heparin therapy should be given
How can lymphoma present on chest x-ray?
Bilateral hilar lymphadenopathy
How does mesothelioma tend to present on x-ray?
- Pleural thickening
- Plerual effusion
- Tumour tends to be peripheral
What is retrograde ejaculation?
Ejaculation from the penis into the bladder, commonly as a consequence of TURP`
What is the most common malignancy in men 20-40?
Testicular
What is the first line investigation for intestinal obstruction?
Supine abdominal x-ray
What is IV crystalloid?
IV crystalloid is fluid containing electrolytes eg. NaCl saline
What is a Sengstaken-Blakemore tube?
A tube inserted into the oesophagus with a balloon inflated in order to reduce variceal bleeding (commonly in oesophageal varices)
What is orthostatic proteinurea?
Abnormal amount of protein passed in the urine when the patient is upright and a normal amount of protein passed when the patient is supine
Which organs are most commonly affected by primary amyloidosis?
Kidenys
Does amyloidosis cause nephrotic or nephritic syndrome?
Amyloidosis causes nephrotic syndrome
What is the most common symptom of interstitial nephritis?
Fever
What is the first line managment of perianal abscess?
Incision and drainage
Which patients with peri-anal abscesses should be given broad spectrum antibiotics?
- Immunocompromised
- Elderly
- Patients showing signs of related cellulitis
- Cardiac valvular disease
- Diabetes
What is the post-surgical care of peri-anal abscesses?
Salt baths and analgesia
What is the difference between peri-anal and peri-rectal abscess management?
Peri-anal abscesses can be drained in office (surgery, clinic etc) whereas peri-rectal abscesses need to be drained in an opperating theatre where there is adequate access to anaesthetics
What is the most common cause of osteomalacia?
Vitamin D deficiency
What does anticonvulsant therapy increase the risk of?
(particularly carbamazepine and phenytoin)
Catabolism of vitamin D and decreased Ca2+ absorption
Carbamazepine can also induce hyponatraemia
What does a diagnosis of Sjorgen’s syndrome require?
3/4 of:
- Positive anti-Ro and anti-La antibodies
- Objective ocular involvement eg positive Schirmer’s test
- Objective salivary gland involvement eg. salivary gland scintigraphy
- Salivary gland histopathology
What is Schirmer’s test?
A strip of paper is placed inside the lower eyelid and the moisture length measured
<5mm within 5 minutes is a postive test
Normal is 15mm within 5 minutes
What is the ideal INR for patients with AF taking Warfarin?
Between 2-3
What is the WHO pain ladder?
Measurement of which parameter is the most effective in measuring iron levels?
Ferritin
How long do cluster headaches typically last for?
15 mins- 3 hrs
What is the definition of significant hyperkalaemia?
K+ >6mmol/L
What tends to exacerbate essential tremors?
Movement
What is the most common location for obstruction in acute cholecystitis?
Cystic duct
What is the most common cause of acute pancreatitis?
Gallstones, followed by alcohol
What is the traid for Budd Chiari syndrome?
- Hepatomegaly
- Abdominal pain
- Ascites
Blood clots blocking drainage from the liver
What is a cherry red fovea a sign of?
Central retinal artery occlusion
What is typical for a history of allergic bronchopulmonary aspergillosis?
- Bronchiectasis
- Eosinophilia
How is eosinophilic granulomatosis with polyangiitis distinguished from allergic bronchopulmonary aspergillosus?
Eosinophilic granulomatosis with polyangiitis often includes sinusitis, whereas sinusitis is not present in ABPA
Which dermatological sign can present with pneumocystis jerovecii?
Kaposi’s sarcomas
Which antibodies are positive in PBC?
Anti-mitochondrial
What is the difference on neurological examination between myaesthenia gravis and lambert eaton myaesthenic syndrome?
Reflexes will be preserved in myaesthenia gravis, however they will be diminished/ absent in LEMS
Which leukocytes are markedly raised in a bacterial infection compared to viral?
Neutrophils
Where is acanthosis nigricans commonly found?
- Vulva
- Groin
- Umbilicus
- Axillae
- Mammary folds
- Nape of the neck
- Elbows
- Knuckles
What are the symptoms of anastamotic leak?
- Abdominal pain
- Prolonges ileus
- Delayed bowel movements
- Delayed passage of flatus
- Faeculent drainage
- Prurulent drainage
Usually 5-7 days post operatively
What is the presentation of atelectasis?
- Dysponea
- Tachycardia
- Febrile
One of the most common complications following surgery:
- Basal actelectasis following abdo surgery
What should be suspected in a patient with a catheter, fever but no urinary signs?
UTI
What is the first line investigation in suspected hepatobiliary disease?
Abdominal ultrasound
What should be done if an ultrasound scan is normal, but there is clinical suspicion of pancreatic cancer?
Pancreas-specific CT
What are plasma tumour markers generally used for?
Guidance in treatment rather than diagnosis
What is acute rheumatic fever?
An autoimmune disease following a group A strep infection, typically 2-3 weeks after an URTI has been cleared
What are the 5 manifestations of rheumatic fever?
- Carditis (most common)
- Arthritis (most common)
- Chorea
- Subcutaneous nodules
- Erythema marginatum
Why is raised urea a risk in pneumonia?
Water deprevation developes rapidly in patients with pneumonia therefore urea is an indicator of dehydration
