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Phase 3B > 3B past papers > Flashcards

3B past papers Flashcards

1
Q

What is the first investigation for PE?

A

Chest X-Ray, then Wells’ score

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2
Q

If PE is unlikely, what is the next investigation?

A

D-Dimer

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3
Q

If PE is likely, what is the next investigation?

A

CTPA (or V/Q scan)

USS Doppler lower leg within 4 hours if clinically indicated

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4
Q

Which investigation measures intra-ocular pressure?

A

Tonometry

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5
Q

What is the pathophysiology of pleural effusions?

A

Increased capillary permeability due to exudate

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6
Q

What is a differential of PCOS and what is the appropriate investigation?

A

Androgen secreting tumour

CT adrenals

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7
Q

What are the components of the sepsis 6 (BUFALO)?

A 
Blood cultures
Urine output
Fluids IV
Antibiotics IV
Lactate
Oxygen
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8
Q

What are some risks for non-accidental injury in children?

A

Domestic abuse
Parent with mental health problems
Delayed emotional attachment e.g. premature baby
Alcohol/drug use

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9
Q

If non accidental injury is suspected what is the investigation of choice?

A

Skeletal survey (X-Ray whole body)

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10
Q

What is seen on slit lamp examination in anterior uveitis?

A

Keratic precipitates on cornea
Ciliary flush/cell and flare
Hypopyon

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11
Q

What is an infective cause of anterior uveitis?

A

VZV

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12
Q

In secondary eczema infection with staph and/or herpes, what must be stopped?

A

Topical steroid creams

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13
Q

Which immunosuppressants are not used in SLE?

A

Anti-TNFs

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14
Q

Which drugs can cause low mood as a side effect?

A 
Isoretinoin
COCP
Lithium
Anti-epileptics
Doxycycline
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15
Q

What is seen on examination in a patient ascites?

A

Shifting dullness

Fluid thrill

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16
Q

What investigations are needed in a patient with ascites?

A

Diagnostic ascitic tap/paracetesis
Abdominal ultrasound
CT abdomen

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17
Q

What investigations are required in suspected Lymphoma patient?

A

FBC
BM biopsy
PET/CT

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18
Q

What is the treatment of primary generalised seizures?

A

Sodium valproate

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19
Q

What are the components of a health economic evaluation?

A

Cost-effectiveness of a treatment in terms of costs and benefits, and in terms of increments - can be measured in natural units, monetary, or QALY

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20
Q

Define QALY.

A

Quality of life (Y) x Quantity of life (X)

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21
Q

Define DALY.

A

Years lost to premature mortality x years lost due to disability

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22
Q

What does a QALY take into account?

A

Age, causality, rareity, severity, and end of life

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23
Q

What is a subarachnoid haemorrhage?

A

Bleeding between the arachnoid and pia mater

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24
Q

What is the cause of a fixed dilated pupil?

A

3rd (oculomotor) nerve palsy

Increased ICP from posterior communicating artery aneurysm/SAH

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25
Q

What is the management of SAH?

A 
ABCDE
Phone neurosurgery
IV fluids, analgesia, pre-op bloods
CT and CT angiogram for aneurysm
Nimodipine to reduce vasospasm
LP after 12h if CT -ve
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26
Q

What is seen on CT in SAH?

A

Pooling of blood in cisterns, ventricles, and sulci

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27
Q

Name three complications of SAH.

A

Rebleeding
Hydrocephalus
Cerebral ischaemia

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28
Q

Name four features of brainstem death.

A 
Absent pupillary response
Absent corneal reflex
Absent gag reflex
Absent cough reflex
No motor response
No respiratory movement when patient is disconnected from a ventilator
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29
Q

What is done in GP as part of screening for microvascular complications of diabetes?

A

Fundoscopy
eGFR/urine A:C ratio
Neurological and diabetic foot examination

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30
Q

What class of drug is an atypical antipsychotic?

A

Dopamine antagonist

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31
Q

What talking therapies are available for psychotic patients?

A

CBT
Family therapy
Interpersonal therapy

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32
Q

What is important to check on breast examination?

A

Axillary and cervical nodes

Check other breast

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33
Q

What three investigations are required in suspected retinal detachment?

A

Visual field testing (peripheral loss)
Fundoscopy - detached retinal fold
Slit lamp microscopy - detached retinal fold

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34
Q

Give three causes of retinal detachment.

A

Recent eye surgery
Eye trauma and vitreous haemorrhage
Diabetic retinopathy

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35
Q

What are the guidelines with eye conditions and driving?

A

One eye affected - ask if treatment affects driving.

Treatment in both eyes - inform DVLA

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36
Q

Where is transitional cell carcinoma found?

A

Bladder, renal pelvis, ureter

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37
Q

What are four risk factors for bladder cancer?

A 
Smoking
Aromatic amines
Aniline dye/rubber
Schistosomiasis
Cyclophosphamide
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38
Q

Where does cauda equina start?

A

L1

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39
Q

What are the bowel/urinary symptoms of cauda equina?

A

Retention first, incontinence later

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40
Q

What are the investigations for lung cancer?

A

Bronchoscopy and biopsy
CT whole body
PET scan +/- bone scan

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41
Q

What features suggest small cell cancer

A

Paraneoplastic features

Central tumour

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42
Q

What is the surgical treatment of lung cancer?

A

Lobectomy
Pneumonectomy
Wedge resection

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43
Q

Give four causes of constipation in an elderly patient.

A

Dehydration
Malignancy
Immobility
Lack of fibre

44
Q

What are the components of the health transaction?

A

Persons health needs and demands
Providers services that are supplied
How is it paid for

45
Q

What is the main difference between different healthcare systems?

A

How it is paid for

46
Q

Name 5 barriers to accessing healthcare.

A 
Costs
Geography
Awareness/education
Risk perception
Physical barriers
47
Q

What are the components of health economics?

A

Opportunity cost
Economic efficiency
Equity
Economic evaluation

48
Q

What is opportunity cost?

A

Sacrifice e.g. benefits lost from not allocating resources to the next best activity

49
Q

What is economic efficiency?

A

Resources allocated to maximise benefit

50
Q

What is an economic evaluation?

A

Comparative study of costs and benefits of healthcare interventiosn

51
Q

What does a QALY measure?

A

Disease burden

52
Q

What is the incremental cost analysis ratio?

A

Cost intervention A - cost intervention B
/
Benefit intervention A-benefit intervention B

53
Q

What type of antibiotic is tazocin?

A 
Tazobactam = b-lactamase inhibitor
Piperacillin = penicillin
54
Q

What is the most common type of renal cancer?

A

Renal (clear) cell carcinoma

55
Q

What is the treatment of stable angina?

A

Aspirin and statin if not CI
GTN for symptoms
BB or CCB (non-dihydropyridine)

56
Q

What is seen on spirometry in asthma?

A

FEV1 <70% predicted

FEV1/FVC ratio <0.7

57
Q

What is the ABPI value that indicates ischaemia?

A

0.9-0.6 = intermittent claudication
0.3-0.6 = rest pain
0-0.3 = impending gangrene

58
Q

When is a stem cell transplant given?

A

When patient is in remission

59
Q

What is the treatment of acute heart failure?

A 
LOON
IV furosemide
Morphine
Oxygen
Vasodilators/inotropes
Discontinue beta blockers
60
Q

Define incidence.

A

Number of new cases per 100,000 per year

61
Q

Give an example of confounding?

A

Grey hair gives you AMD

62
Q

What are three talking therapies for psychosis?

A

CBT
Interpersonal therapy
Family therapy

63
Q

What test shows chronic hepatitis B?

A

HbsAg - surface antigen

HbcAb - core antibody

64
Q

What is the mechanism of aspirin?

A

Thromboxane A2 inhibitor

65
Q

When should IV amiodarone and IV adrenaline be given in cardiac arrest?

A

If pulseless electrical activity

in VT, if three shocks have been given with no response

66
Q

Give two medications used to maintain sobriety.

A

Antabuse (disulfiram) - makes you feel sick when you drink

Acamprosate - stops cravings

67
Q

How is Conn’s syndrome diagnosed, apart from renin:aldosterone ratio and hypokalaemia?

A

Selective adrenal venous sampling

68
Q

Which medications interact with lithium?

A

Amiodarone
Amitriptyline
St Johns Wort

69
Q

What are the symptoms of serotonin syndrome?

A

Altered mental state
Autonomic excitation eg hyperthermia
Neuromuscular excitation

70
Q

What is the treatment of serotonin syndrome?

A

Cyproheptadine

71
Q

Why is lorazepam preferred to diazepam?

A

Decreased risk of respiratory depression

72
Q

What are the components of the paediatric sepsis 6?

A

High flow oxygen
IV/IO access and take blood cultures and bloods
IV/IO antibiotics
IV fluids
Involve specialist help early
Consider inotropes early: dopamine or adrenaline given via peripheral line

73
Q

What are the risk factors of oesophageal cancer?

A

Barrett’s oesophagus
Obesity
Smoking
Alcohol

74
Q

What score indicates prognosis of PE within 30 days?

A

Pesi score

75
Q

What are the doses of adrenaline in anaphylaxis and cardiac arrest?

A

Anaphylaxis: 0.5mls of 1 in 1000 IM
Arrest: 10mls of 1 in 10000 IV

76
Q

What is the pathophysiology of Graves’ eye disease?

A

TSH receptors on extra ocular muscles

TSH receptor stimulating antibodies

77
Q

What is a side effect of levothyroxine?

A

Can worsen angina

78
Q

What is the score that predicts a difficult intubation?

A

Mallon-Pati

79
Q

Morphine –> diamorphine

A

divide by 2

80
Q

How is compartment syndrome prevented against?

A

Ice and elevation to decrease pressure in the compartment

81
Q

What is the mode of action of rivaroxaban?

A

Factor Xa inhibitor

82
Q

What are the transmission rates following a needle stick injury in HBV, HCV, and HIV?

A

HBV - 30%
HCV - 3%
HIV - 0.3%

83
Q

What is the mode of action of hydroxyurea in sickle cell anaemia and polycythaemia?

A

SC: increases foetal haemoglobin
PV: decreases platelets

84
Q

When is BiPAP and CPAP given?

A

CPAP - type 1 resp failure

BiPAP/NIV - Type 2 resp failure

85
Q

Name four thromboprophylaxis measures for PE.

A

Compression stockings
Encourage mobilization
Leg elevation
Intermittent compression device - flowtron

86
Q

What are the two causes of Down’s syndrome?

A

Trisomy 21

Non-disjunction

87
Q

What drug class is colchicine?

A

Plant alkaloid

88
Q

Which antibodies are present in coeliac disease?

A

Anti-gliaden
Anti-endomysial
Anti-tissue transglutaminase

89
Q

What are the deficiency states of vitamins D, E, A, and K?

A

D - osteomalacia
E - peripheral neuropathy
K - bleeding disorder
A - night blindness

90
Q

Why might malaria prophylaxis not work?

A

Poor compliance
Resistance in that area
Incorrect prophylaxis e.g. for plasmodium falciparum

91
Q

What is the diagnostic test for malaria?

A

Thick and thin blood films, 3 taken on 3 subsequent occasions

92
Q

What are the signs of cerebral malaria?

A

Confusion, seizures, coma

93
Q

What are the signs of lithium toxicity?

A

Tremor
Confusion
Ataxia
Irritability

94
Q

What must you check before starting lithium?

A

TFTs
eGFR
FBC

95
Q

What nerve root corresponds to the median nerve?

A

C8-T1

96
Q

What are the signs of bulbar palsy?

A

Dysarthria and dysphagia
Drooling
Absent gag reflex
Tongue fasciculations

97
Q

What is amiodarone and its mechanism?

A

Class III anti-arrhythmic agent - K+ channel blocker

98
Q

What is flecainide and its mechanism?

A

Class Ic anti-arrhythmic agent - Na+ channel blocker

99
Q

In Ramsey Hunt syndrome, where does the HSV virus reside?

A

Geniculate ganglion of facial nerve

100
Q

What enzyme do NSAIDs inhibit and what substances do they inhibit the production of?

A

Cyclo-oxygenase

Prostaglandin and thromboxane

101
Q

What is the cause of confusion in myeloma?

A

Hypercalcaemia

Uraemia

102
Q

Which bone scan Is used in myeloma and why?

A

Skeletal survey - technetium scan looks at osteoblastic activity and plasma cells secrete IL-6 which inhibits osteoblasts and increases osteoclasts

103
Q

How can a person apply for non-NICE funded treatment?

A

Private funding
Charity drug fund
Individual funding - consultant can apply

104
Q

Where does spironolactone act?

A

Collecting ducts

105
Q

What are the components of the mental state examination

A

Appearance, behaviour, mood/affect, speech, thoughts, insight, cognition

106
Q

What is the treatment of erythema nodosum?

A

Analgesia, compression, elevation

Phase 3B (20 decks)

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