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Yr 3 Med > All encompassing > Flashcards

All encompassing Flashcards

1
Q

List 4 presenting psychological symptoms of excessive alcohol consumption?

A
  • Depression - Anxiety - Insomnia - Memory problems - Dementia
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1
Q

Why do you get a short PR interval in wolf parkinson white syndrome?

A

Presence of an accessory pathway known as the bundle of kent which can help with the conduction down to the ventricles

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1
Q

How does carbamazepine work?

A

It increases the GABA mediated inhibitory transmission in the CNS thus dec electrical excitibality

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2
Q

How to distinguish between episcleritis and scleritis - what test can you do?

A

Instillation of phenylephrine will not blanch the scleral vessels = scleritis. Episcleritis = mild pain, photophobia, red eye.

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2
Q

Pt presents with unilateral, localised, circumscribed bleeding in one eye. No inflammation, pain or discharge. Vision unchanged. Differential?

A

Subconjunctival haemorrhage (assoc with minor injuries, anticoags and anti platelets)

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2
Q

What are sulphonylureas contraindicated in?

A
  • ketoacidosis
  • acute porphyrias
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2
Q

What investigations are you going to do to a pt presenting with a goitre?

A
  • TFTs
  • USS for nodules
  • CXR/thoracic inlet (tracheal compressions, retrosternal involvement)
  • fine needle aspiration
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2
Q

Most common cause of Addison’s disease?

A

80% is due to AI. TB is most common worldwide.

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3
Q

what is the most common source of ectopic ACTH production in ectopic cushing’s syndrome?

A

small cell lung cancer

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3
Q

When a pt brings in a newspaper article into the OSCE what method are you going to use to help analyse the paper?

A

PECOS

  • patient/participant/people
  • Exposure/event/experimental interventin
  • Comparison
  • Outcome
  • Study design
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4
Q

A 65-year-old man presents with chest pain radiating to the jaw. The ECG shows ST segment elevation in II, III and aVF, with T-wave inversion in V5 and V6.

A

Inferior MI

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5
Q

Causes of a headache worse in the morning?

A
  • Cluster - raised ICP
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5
Q

What is this? term and assoc condition?

A

Excoriations - loss of epidermis following trauma. Eczema

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5
Q

List 4 SE of ipratropium bromide?

A
  • Dry mouth
  • headache
  • tachycardia
  • urinary retention
  • ocular effects
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5
Q

Causes of large bowel obstruction?

A
  • colon cancer
  • sigmoid volvulus
  • diverticular disease
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6
Q

How does insulin lower plasma glucose?

A
  • stimulate glucose transport into fat and muscle cells
  • inhibit gluconeogensis & lipolysis
  • stimulate glycogen synth
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7
Q

Pt presents, lean, tanned, tired and tearful with some diarrhoea. Differential?

A

Addison’s disease. +/- weakness, GI disturbances, mood changes, postural hypotension.

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7
Q

What type of angina is provoked by vivid dreams and can wake a pt up at night?

A

Nocturnal angina. Critical Coronary artery disease

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8
Q

Pt presents complaining of visual floaters?

A

retinal detachment - painless loss of vision. Grey area of retina where retina is detached seen on fundoscopy.

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8
Q

What is Murphy’s sign used to test for?

A

Cholecystitis

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8
Q

What type of prevention is it when the prevention of clinical diseases is due to early detectiong and screening?

A
  • secondary
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8
Q

What are the four core features of depression?

  • other common features?
  • Somatic features?
  • What else should you ask about in a depression history?
A

Core features

  • low mood
  • loss of interest
  • tired all the time
  • Anhedonia

Other common features (3 P’s)

  • Poor concentration
  • Poor self esteem and self confidence
  • guilt & pessimism

Somatic

  • sleep disturbances (early morning waking)
  • morning depression
  • loss libido
  • loss of apetite/wt loss
  • social withdrawal
  • Anxiety, hallucinations, delusions, mania
  • Suicidal risk (and risk to others)
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9
Q

Pt presents with pain around the sub mandibular gland esp when eating. Also swelling, palpable hard lump. Diagnosis?

A

Sialolithiasis

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9
Q

Would the urine sodium levels be elevated in pre renal or intrinsic causes of acute renal failure?

A

Intrinsic causes = the tubules are damaged so cannot reabsorb the sodium therefore you piss more of it out.

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9
Q

Name a bigaunide? What is it used to treat?

A

Metformin. Type II DM.

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9
Q

What are the side effects of aspirin?

A
  • Bronchospasm (in aspirin sensitve pts)
  • Salicylate poisoning
  • Reye’s syndrome ( v.rare but potentially fatal condition - liver and brain damage)
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10
Q

What are the stages of Sepsis after SIRS?

A
  • SIRS (4 defining features)
  • Sepsis (SIRS as a result of infection)
  • Severe Sepsis (sepsis plus organ disorder)
  • Septic shock (sepsis plus hypotension despite adequate fluid resuscitation)
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11
Q

What is the positive predictive value?

A

The probability that the person has the condition.

= a / (a+b)

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12
Q

What symptom do all these conditions have in common? - Pneumothorax - Mitral stenosis - Pulmonary effusion - Anaemia - Cardiomyopathy - Acute epiglotitis

A
  • Dyspnoea (asthma, COPD, PE, foreign body etc.)
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12
Q

Formatting data prior to analysis:

  • Rows represent what?
  • columns represent what?
  • how many times should you input the data?
A
  • Rows = case/participants
  • Columns = variables
  • input data 2 (repitition is a way to remove human error)
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13
Q

Effect of thiazide and lithium?

A

Increased toxicity

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13
Q

Clinical audit or service evaluation?

“what standard does this service achieve?”

A

Service evaluation

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14
Q

Treatment of B12 deficiency?

A

Replenish stores with hydroxycobalamin (B12), 1mg IM every other day for 2wks. Maintenance = 1mg IM every 3 months for life.

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14
Q

Contraindications to Latanoprost?

A
  • Hypersensitivity
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14
Q

what is the equation for RR? (in word terms)

A

RR = the risk in the exposed group / the risk in the unexposed group

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14
Q

How would you take an anxiety history? What mneumonic will help you.

A

ICE them first

SEDATE

  • Symptoms (physical = hyperventilation, palpitations, chest pain, sweating, diarrhoea, loss of sleep, poor conc. Psychological = agitation, irritable, sense of impending doom)
  • Episodic or continuous (if episodic then it’s not GAD = persisent >6 months)
  • Depression, drinking or drugs (caffeine & smoking)
  • Avoidance or escape (groups of people, certain activities, phobias)
  • Triggers and timing
  • Effect on life
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15
Q

Drugs which cause renal failure:

  • interstitial nephritis?
  • acute tubular necrosis?
  • precipitate renal artery stenosis?
  • glomerular damage?
A
  • IN = NSAIDS & Abx
  • ATN = Lithium, contrast, gentamicin
  • Renal A stenosis = ACE-i
  • Glomerular damage = GOLD & NSAIDS
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16
Q

In which type of ARMD do you find DRUSEN?

A

Dry - drusen = accumulation of pigment epithelial waste products

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16
Q

Bifid P waves on an ECG indicate what?

A

Atrial delay due to mitral stenosis or mitral regurg

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16
Q

What are the contra-indications in metoclopramide?

A
  • GI obstruction, perforation, haemorrhage
  • 3-4 days post GI surgery
  • phaeochromocytoma
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17
Q

What is a mediator?

A

A covariate which is affected by the exposure and affects the outcome. It is along the causal pathway and so must NOT be adjusted for.

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18
Q

What is myopia?

A

Short-sightedness. They can’t see distant objects. Most common refractive error of the lens.

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19
Q

What drug is used to treat opioid overdose?

A

Naloxone (100-400 micrograms) IV

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19
Q

What’s the cause of cholesterol gallstones?

A
  • Males, obese, high chol, age, dec bile salts
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20
Q

What nail changes do you see in psoriasis?

A
  • Oncholysis
  • Pitting
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20
Q

Causes of erythema nodosum?

A
  • group A beta haemolytic strep
  • TB
  • preggo
  • malignancy
  • IBD
  • chlamydia
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21
Q

What is right axis deviation usually caused by?

A

Right ventricular hypertrophy. Extra heart muscles causes stronger positive signal picked up by the leads looking at the right side of the heart

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21
Q

Treatment of hypertension in pts

A

ACEi or ARB (if the ACEi intolerance)

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21
Q

Why do urinalysis as an investigation for suspected infective endocarditis?

A
  • microscopic haematuria is common
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22
Q

What are delusions?

A

a false unshakeable belief despite evidence to contrary not held by others in same culture and held with intense personal conviction and certainty.

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23
Q

Anterior epistaxis usually occurs in what area? Two names?

A

Anterior septal area = Little area

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23
Q

A pansystolic murmur is most likely due to what?

A

Mitral regurgitation

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23
Q

What is cardiac syndrome X?

A
  • Microvascular angina. There is a good hisotry of angina, but on angiography everything is normal.
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23
Q

Indications for beta blockers?

A
  • Angina, HT, HF, arrythmias
  • thyrotoxicosis
  • anxiety
  • prophylaxis of migraine
  • treatment of glaucoma (timolol)
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23
Q

What drug interactions does carbamazepine have>?

A
  • cimetidine, erythromycin, isoniazid, diltiazem inhibit metabolism of carb
  • OCP & warfarin = dec effect of these.
  • corticosteroids, phenytoin, ciclosporin = dec effect of carb
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23
Q
  • What is R^2?
  • Range of values R^2 can take?
  • What value of R^2 indicates a perfect fit?
  • Will adding variables to your model increase or decress the value of R^2?
A
  • Proportion of variation explained by the linear model
  • R^2 values range between 0 and 1
  • value of one = perfect fit
  • Adding variables will always improve the fit thereby increase R^2
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24
Q

What is Beck’s triad and what is it assoc with?

A
  • falling bp
  • rising JVP on inspiration
  • muffled heart sounds

Inidicator of cardiac tamponade/constrictive pericarditis

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25
Q

Gamma glutamyltransferase mirrors which other LFT?

A

ALP

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26
Q

At difference prevalences what is the relationship between RR and OR?

Low prevalence?

Increasing prevalence?

Decreasing prevalence?

A

Low: RR=OR

Increasing: RR

Decreasing: RR changes whilst OR stays the same

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27
Q

Give an example of a dermatophyte infection?

A

Tinea/ringworm

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27
Q

What type of error is it when you fail to find an effect when there is a genuine effect?

A

Type 2 - boo hoo

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28
Q

What is a nodule? (think derm)

A

Solid raised lesion >5cm in diameter. (bigger version of a papule)

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29
Q

Mechanism of action of metformin?

A

increase insulin sensitivity

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30
Q

Mark buys 30 candy sweets. Mark eats 16 of them. What has Mark got now?

A

DIABETES. Mark has diabetes.

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30
Q

What correlation coefficient should be used for not normally distributed variables? Give other times when this coeff could also be used?

A

Spearmans rank correlation coeff rho

  • one or both of the variables are ordinal
  • when the sample size is small
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31
Q

What commonly used respiratory drug causes a fine tremor in the hands?

A

Salbutamol (beta 2 agonist)

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31
Q

Beriberi is a result of what?

A

Lack of Thiamine (B1) = can cause delirium

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31
Q

What are the clinical features of MS?

A
  • usually monosymptomatic
  • unilateral optic neuritis
  • numbness and tingling in the legs
  • leg weakness
  • cerebellar dysfunction
  • GI disturbances
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32
Q

Reed sternberg cells are characteristic in what type of cancer?

A

Hodgkins lymphoma

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32
Q

What is sialolithiasis?

A

Salivary calculi

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32
Q

Drugs which cause interstitial nephritis?

A

NSAIDS & Abx

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32
Q

What is the most common malignant skin tumour?

A

BCC

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34
Q

Most common sites of aneurysms?

A

Aorta (infrarenal) Iliac Femoral Popliteal

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34
Q

Mesalazine is what class of drug? Used in?

A

Aminosalicylate. Used in UC maintenance of remission.

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34
Q

Common SE of sulphonylureas?

A
  • Hypoglycaemia
  • Wt gain
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34
Q

In what age group is alcohol dependence higher in?

  • in women
  • in men
A

Women 16-24 yo

Men 25-34 yo

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35
Q

What is Latanoprost and what is used to treat?

A

Protstaglandin analogue and used to treat raised intraocular pressure seen in open angle glaucoma and ocular hypertension.

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35
Q

What drugs cause hypercalcaemia?

A

thiazide diuretics

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35
Q

What immunosuppressants are used in eczema?

What immunomodulators?

A
  • oral prednisolone, azathioprine and ciclosporin
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35
Q

What drugs should be avoided when taking ipratropium bromide?

A
  • Erythromycin/Clarithromycin
  • inc risk of SE with antidepressants
  • dec effect of sublingual nitrates
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35
Q

If no effect what would be the OR?

A

1

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35
Q

Who are your potential stakeholders when conducting your own research?

A
  • Other researchers/evaluators
  • Research funders
  • Clinical practitioners
  • Service users
  • Society
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36
Q

What are the extra nodal presentations of non-hodgkins lymphoma?

A

- lymphadenopathy

- night sweats

- wt loss

  • indigestion

- skin discolouration

- papular rash

- raised ICP

- CN palsies

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37
Q

Pt presents with an itchy red eye?

A

Allergic eye disease

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37
Q

At a RRAPID station what are you going to assess in the Breathing section? What would you want to do, and how would you manage?

A
  • RR, oxygen sats, chest expansion, tracheal deviation, percussion, air entry (auscultation)
  • consider ABG if indicated
  • Manage using oxygen 15L non rebreathe mask, ?thoracocentesis, resusitative thoracotomy, intubation.
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38
Q

Alpha 1 antitrypsin deficiency is a cause of what respiratory disease?

A

COPD. Also a cause of asthma, lung cancer, pneumothorax.

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38
Q

What is phenytoin and how does it work?

A

Anti-convulsant.

  • Blocks voltage gated sodium channels so stops transmembrane movement of sodium and potassium
  • prevents spread of epileptic discharge
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39
Q

What are you going to look for on inspection of the legs in a peripheral vascular exam?

A
  • pallor - Scars - Muscle wasting - Discolouration (haemosiderin) - ulcers - Hair loss (PVD) - Missing limbs/toes
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39
Q

What is the epidemiological triad?

A

Person, time and place

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39
Q

When you have small sample sizes, is the chi squared test more likely to accept or reject the null hypothesis? How can you overcome this?

A

More likely to reject the null hypothesis. The use of Yates’s continuity correction.

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40
Q

O/E

Chest expansion: reduced on affected side

Trachea: deviated away from affected side

Percussion: hyperresonant on affected side

Breath sounds: reduced breath sounds on affected side

Vocal resonance: reduced on affected side

Differential?

A

Pneumothorax. trachea may be deviated towards the affected side in a simple, spontaneous pneumothorax.

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41
Q

Pt presents with transient vision loss with a headache, fever and night sweats and a temporal headache. Pt has reduced VA, and has a swollen pale optic disc. Differential and treatment?

A
  • GCA (jaw claudication, scalp tenderness, tender non pulsatile temporal artery) - Immediate referral to opthal and start steroids !
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43
Q

Is psoriatic arthritis symmetrical or asymetrical?

A

Asymmetrical

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43
Q

What does sodium valproate treat and how does it work?

A
  • Anticonvulsants for all types of epilepsy.
  • Inc GABA content in the brain by inhibiting GABA transaminase enzyme thereby stopping the re-uptake of GABA
  • also dec +ve aspartate
  • blocks voltage gated sodium channels
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44
Q

What four pieces of equipment/items do you need for a thyroid examination?

A
  • Glass of water - Stethoscope - Piece of paper - Tendon hammer
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45
Q

Complications of infectious mononucleosis?

A
  • splenic rupture - meningitis - encephalitis - haemolytic anaemia - Myocarditis
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46
Q

What are the contraindications to Levodopa?

A
  • Caution in severe pulmonary or CV disease, psych, endocrine.
  • caution to susceptible angle closure glaucoma pts
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47
Q

What 3 factors make up asthma? (reversible airway obstruction) Pathogenesis

A
  • Bronchial muscle contraction - Mucosal swelling and inflammation - increase mucus production
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47
Q

The symptoms of anxiety are due to the release of what chemical transmitter?

A

Adrenaline

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48
Q

What is madarosis?

A

Loss of outer third of eyebrow hair

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48
Q

How would you explore a patient’s suicidal thoughts in a mental health examination?

A
  • Have you felt that life is not worth living? - Have you ever wished you could die? - Have you ever considered ways in which you could end your life? - Are you planning to end it all?
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49
Q

What are you going to look for in the face of a pt during a thyroid examination?

A
  • Dryness, sweating
  • Exopthalmos (front, side, above)
  • Eye movements (H-test)
  • Lid lag
  • Mouth (undescended thyroid)
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50
Q

Most common type of colorectal cancer?

A

adenocarcinoma

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51
Q

Sudden painless loss of vision with preceding flashes of light (photopia) and floaters is likely to be what?

A

Retinal detachment. The flashes of light are due to the retina being pulled off and stimulating neurons.

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52
Q

Pt presents with vertigo. It lasts only for a few seconds at a time. No assoc auditory symptoms. What is the most likely diagnosis?

A

Benign paroxysmal positional vertigo

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52
Q

What are the different types of goitre?

A
  • Diffuse
  • Simple (physiological in puberty and preggo)
  • AI (firm diffuse - seen in graves and hashimoto’s)
  • Thyroiditis (acute tenderness, swelling and severe pain)
  • Nodular
  • Multinodular
  • Single nodular
  • Fibrotic
  • Tumours
  • Adenomas
  • Lymphomas
  • Carcinomas
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53
Q

How do you manage an MI?

A

ROMANCE

  • reassure
  • oxygen
  • morphone
  • aspirin
  • nitrites
  • clopidogrel
  • enoxaprin
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54
Q

What is the most common neck lump?

A

thyroglossal cyst. on swallowing it will not move. On protrusion of the tongue however, it will.

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54
Q

Stata command for:

  • expsoure = age
  • outcome = live or die

covariates age & sex

A

xi: logistic livedie age i.sex

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55
Q

An early diastolic murmur is most likely to be what?

A

aortic regurgitation

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56
Q

Is iron def anaemia, macro or microcytic? Hyper or hypo chromic?

A

Microcytic, hypochromic

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56
Q

What duct connect the sub mandibular gland to the mouth?

A

Whartnon’s duct = exits under tongue

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56
Q

What is the most common type of thyroid cancer?

A

Papillary carcinoma

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58
Q

A low pitched rumbling mid diastolic murmur is most likely to be what?

A

Mitral stenosis

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58
Q

During a RRAPID assessment of a pt what could potentially compromise a pt’s airway?

A
  • Facial burns
  • Neck wounds
  • Vomit
  • Epistaxis
  • head injury
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58
Q

Types of samples? + pros & cons

A
  • complete samples (+ no bias introduced by design. - potentially expensive)
  • unstratified random sampling (+ easy to design and conduct. - some groups may be underrepresented)
  • stratified random sampling (+ representative of population, unequal sampling of strata imrpoves power for rare strata. - pop may not easily be divisible into strata, partitions may not be known until after sampling)
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59
Q

What are the 3 types of causes of acute renal failure? Include examples.

A
  • pre renal (majority of cases) = renal hypoerfusion so hypovolaemia, sepsis, heart failure renal artery stenosis, NSAIDS, ACEi. - Intrinsic = Acute tubular necrosis most common intrinsic cause. Due to ischaemia (hypo perfusion) or due to drugs. - Post renal = urinary tract obstruction
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60
Q

Whenever the direction of electrical activity is towards a lead you get a POSITIVE or NEGATIVE deflection in that lead?

A

TOWARDS = POSITIVE

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60
Q

What covariate affects both the exposure and outcome?

A

CONFOUNDERS

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62
Q

Age of onset of Hodgkins?

What virus is assoc with HL?

A

Two peaks of incidence = 15-30 and over 55

EBV

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63
Q

Koilonychia, atrophic glossitis, Angular cheilosis, conjunctival pallor are all signs of what?

A

Iron def anaemia.

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63
Q

Differentials for wt loss?

A
  • Malignancy (breast lump, lungs, prostate, bowels, jaundice,)
  • GI (colon cancer, IBD, coeliac)
  • Endo (thyrotoxicosis)
  • Psychological (anorexia, depression, stress)
  • DM TI
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64
Q

List 4 risk factors for lobar pneumonia?

A
  • Smoking - ETOH - Bronchial obstruction - Bronchiectasis - Immunosuppression
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64
Q

Infection of the liver would do what to the albumin and protein levels?

A
  • Decrease albumin - Normal protein
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64
Q

Contraindications to ABG?

A
  • inadequate collateral circulation - evidence of peripheral vascular disease - coagulopathy or high dose anticoag therapy
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64
Q

What drugs are contraindicated in renal failure?

A

Many People Like To Nap Naked

M = metformin

P = potassium sparing diuretics

L = lithium

T = tetracyclines

N = Nitrofurantoin

N = NSAIDS

+ all the drugs that can cause Renal failure (NSAIDS, ACE-i, Abx, gentamicin, Gold, contrast, lithium)

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65
Q

Consequence of folate def in preggo women?

A

Neural tube defects in the newborn

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66
Q

What are the most common bacteria to cause skin infection?

most common viruses to cause?

Fungi to cause?

A
  • Staph and strep
  • HPV, HSV, Herpes zoster
  • Tinea, candida and yeasts
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67
Q

What is the most common type of salivary gland tumour?

A

Adenoma

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67
Q

HLA DR3 is assoc with which type of Diabetes?

A

Type I DM. There is no HLA assoc with type III

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68
Q

Thyroid lumps are more common in which gender?

A

Females

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68
Q

On fundoscopy what does a dot and blot haemorrhage mean?

A

Seen in DM retinopathy. Dot = microaneurysm. Blot = haemorrhage

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69
Q

Where are the majority of salivary tumours located?

A

Parotid gland

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69
Q

What do you include in a mental state examination?

A

All Sane Men Think That Pizza Is Italian

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69
Q

Common causes of metabolic alkalosis?

A
  • Vomiting - Potassium depletion (diuretics) - Cushing’s syndrome - Conn’s syndrome (primary hyperaldosteronism)
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69
Q

How are you going to assess a patient’s breathing?

A
  • Give oxygen 15L/min via reservoir bag mask
  • sit pt up and attach monitorin
  • Use Look, Listen, Feel

Look (RR, cyanosis, effort, chest injury, coughing)

Listen (ability to complete full sentences, noisy breathing, coughing, percussion note, bilateral air entry, vescicular/bronchial breath sounds, creps, vocal resonance)

Feel (pulse, trach deviation, chest expansion, surgical emphysema)

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70
Q

What type of fungal infection is aspergillus?

A

Mould

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71
Q

What are the 2 most common causative organisms of meningitis?

A
  • Neisseria meningitidis
  • Streptococcal pneumoniae
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71
Q

True or false: it is easier to visually spot correlation close to zero

A

FALSE

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71
Q

Sinus bifid p waves?

A

Mitral stenosis

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72
Q

At a RRAPID station what are you going to assess in the Disability section? What would you want to do, and how would you manage?

A
  • review ABC
  • check pupils
  • AVPU/GCS - E4, V5, M6
  • Glucose
  • Temp
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72
Q

What are presenting symptoms of acute pancreatitis?

A
  • Gradual or sudden severe epigrastric or central abdo pain which radiates to the back, relieved on sitting on forward. Along with prominent vomiting.
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73
Q

What cardiorespiratory questions will you ask if someone presents with syncope, fits or LOC?

A
  • palpitations - chest pain - Breathlessness - cough - sputum - leg swelling
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74
Q

Knee examination: what are you going to feel for?

A

Pt lying on bed

  • tempt
  • joint lines (knee flexed, feeling for tenderness)
  • palpate collateral ligs and patello fem joint
  • measure quadriceps circum and compare
  • patella tap for large effusions and sweep test for small effusions
  • popliteal swellings
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75
Q

What 5 signs could a cerebellar problem present with?

A

DANISH - D = dysdiadokinesis - A = apraxia - N = nystagmus - I = intention tremor - S = speech disturbances - H = Hypotonia

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75
Q

What is a clinical audit?

A

It measures existing practice against evidence based clinical standards

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75
Q

What type of data can IQR be used as a measure of spread?

A
  • cont or discrete
  • ordered variables
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76
Q

What are the risk factors for age related macular degeneration?

A
  • Age - smoking - sun - diet - alcohol
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76
Q

Where is aldosterone made? what type of steroid is it? What is its function?

A

Made in adrenal cortex. Mineralocorticoids. Electrolyte balance

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77
Q

Causes of vitreous haemorrhage?

A
  • DM - Retinal detachment - ARMD - Trauma
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78
Q

Facial pain that is worse on bending forward is indicative of what condition?

A

Rhino-sinusitis

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78
Q

features that make up nephrotic syndrome?

A
  • Proteinuria
  • Oedema
  • Hypoalbuminaemia
  • hyperlipidaemia
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80
Q

Causes of hyperventilation?

A

Primary - anxiety - hypoxaemia - Pain/distress - salicylate toxicity - fever Secondary (metabolic acidosis)

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81
Q

How do you manage a cardiac arrest?

A
  • BLS
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82
Q

List 4 common causes of acute otitis media?

A
  • Common cold - influenza - Acute tonsillitis - Coryza less common = barotrauma, sinusitis, trauma of tymp membrane
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82
Q

Pt presents with blood in the anterior chamber of the eye. Severe vision loss. Name?

A

Hyphaema (trauma, intraocular surgery)

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82
Q

A pancreatic tumour in the head of the pancreas would typically present how?

A

Painless obstructive jaundice

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82
Q

How do you assess a CXR?

A
  • confirm identity of patient, date and time
  • PA or AP film
  • RIPE (rotation - check clavicles and spinous processes, inspiration - >7 ribs, penetration, exposure)
  • A (airway - trachea central or deviated)
  • B (breathing - assess lung markings throughout lung fields
  • C (cardiac - evdince of cardiomegaly)
  • D (diaphragm - any signs of gas underneath)
  • E (Everything else - bones, soft tissue, lines, pacemakers)
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82
Q

Will incidence be higher/lower/same as the prevalence in the following examples?

  • Chronic long term condition?
  • Incurable disease?
  • Short infectious disease?
A
  • chronic = prevalence will be higher than incidence
  • incurable = prevalence inc at same rate as incidence
  • acute = incidence will be higher than prevalence
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82
Q

What is meant by person time?

A

The size of a population at risk can vary over time:

  • individuals who are born or die
  • individuals who get and keep the disease
  • individuals who join or leave the study
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82
Q

Is the correlation coefficient affected by units of measurement?

A

No

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84
Q

Is there a cure for glaucoma?

A

No cure but slow progression

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84
Q

Anti-HBsAg +ve and IgG anti-HbcAg indicates what stage of hepatitis?

A

Chronic Hepatitis B infection

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85
Q

Causes of small bowel obstruction?

A
  • adhesions
  • hernias
  • crohns
  • intersusception
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86
Q

O/E

Chest expansion: Reduced on affected side

Trachea: central or shifted away from affected side if large

Percussion: stony dull

Breath sounds: reduced or absent

Vocal resonance: reduced over affected zone

Differential?

A

Pleural effusion

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87
Q

What are the signs of liver failure?

A
  • jaundice - hepatic encepahlopathy - fetor hepaticus (pear drops) - Asterixis - constructional apraxia
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89
Q

Give two differentials for a nocturnal cough?

A
  • Asthma - LVF (pink frothy sputum)
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89
Q

What leads represent the inferior view of the heart on an ECG?

A

II, III, aVF

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90
Q

If an elderly pt presents with symptoms of iron def anaemia, has a microcytic blood film but doesn’t respond to ferrous sulphate, what could be the diagnosis instead? (another anaemia)

A

Sideroblastic anaemia (rare but in 20% of the elderly with a low MCV, without iron def, think of sideroblastic anaemia)

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90
Q

What are you going to palpate for during a thyroid examination?

A
  • Thyroid gland (each lobe)
  • Palpate whilst swallowing and then protruding their tongue
  • Lymphadenopathy
  • Tracheal deviation
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91
Q

Pleuritic chest pain means..pain is worse on inspiration or on expiration?

A

Inspiration

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93
Q

Where do 2 classes of diuretics act? What are they? What do they both treat? What disease are they both contra-indicated in?

A
  • Distal tubule
  • Thiazide diuretics (bendroflumethazide)
  • Potassium sparing diuretics (spironalactone)
  • HTN, oedema, HF, ascites in liver cirrhosis
  • Addison’s disease
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94
Q

Clinical features of glandular fever?

A
  • fever - sore throat - lymphadenopathy - splenomegaly - petechial haemorrhage
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95
Q

O/E

Chest expansion: equal

Trachea: central

Percussion: normal

Breath sounds/added sounds: normal or localised creps/pleural rub

Vocal resonance: Normal

Differential?

A

PE

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96
Q

Overdiagnose or underdiagnose: high specificity?

A

Underdiagnose

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97
Q

What do you include in your secdonary survey once you’ve stabilised your patient?

A

AMPLE

  • ALLERGIES
  • medication
  • PMHx
  • last meal
  • events
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99
Q

How to investigate Varicose veins?

A

Doppler US probe (listen for flow in incompetent valves

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100
Q

What are going to assess in the exposure section of the RRAPID station?

A
  • Detailed examination of whole body
  • Reassess
  • Prevent heat loss and maintain dignity
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100
Q

Effect of ACE-i and potassium sparing diuretics?

A

Risk of severe hyperkalaemia

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101
Q

Otitis externa that has spread to the skull base to cause osteomyelitis is called what?

A

Malignant otitis externa. (likely pseudomonas aeruginosa or anaerobes). 50% facial palsy.

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102
Q

List 4 presenting physical symptoms of a pt with anxiety?

A
  • sweating - indigestion - diarrhoea - Nausea - trembling - dry mouth - palpitations
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103
Q

Which of the three hepatitis viruses is due to a DNA virus?

A

Hepatitis B

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104
Q

What other symptoms can pts with Parkinson’s present with?

A
  • anosmia
  • depression
  • dementia
  • mild urinary freq and urgency
  • visual hallucinations
  • sleep disturbances
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104
Q

Causes of resistant hypertension?

A
  • conn’s syndrome
  • chronic kidney disease
  • cushing’s syndrome
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104
Q

When are odds ratios used?

When are risk ratios/relative risk used?

Which of the two is used when the proportion of the population with the outcome or exposure is low?

A

OR = case-control/trial studies looking at prevalence

RR = cohort studies looking at incidence

OR is used when outcome or exposure is low BUT OR is stable as outcome prev changes

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105
Q

Malignant proliferations of lymphocytes is what?

A

Lymphoma

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106
Q

What is the effect of increased conc of: Methotrexate?

A

Myelosuppression

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107
Q

Indications for warfarin?

A
  • prophylaxis of embolism in AF, prosthetic heart valves, rheumatic heart disease
  • proph of DVT/PE
  • TIAs
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108
Q

What disease is caused by a T cell mediated autoimmune reaction in the small bowel?

A

Coeliac disease. Prolamin intolerance leading to villous atrophy and malabsorption.

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109
Q

What further assessments and examinations would you want to do following a Peripheral vascular exam?

A
  • Cardiovascular exam - ABPI if indicated - lower limb neuro exam
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110
Q

What are the different types of anxiety?

A
  • Generalised anxiety disorder (high level of background anxiety)
  • Panic attacks
  • Phobias
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111
Q

What are the 7 features of alcohol dependence?

A
  • Obsessive alcohol consumption - Increased tolerance - Narrowing of drinking repertoire - Withdrawal symptoms - Having to reinstate to alleviate withdrawal symptoms - Saliency (alcohol taking over form competing needs and responsibilities) - Continued drinking despite negative effects of alcohol on health
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111
Q

What would prescribe to a pt with bacterial tonsillitis?

A

500mg of phenoxymethylpenicillin tds for 10 days

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112
Q

How is Standard error of the mean calculated?

A

SE = Sd/route(n)

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113
Q

What is SIRS and how is it defined?

A

Systemic inflammatory repsonse syndrome.

Temp 38

HR >90bpm

RR >20breaths/min

WCC 12

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114
Q

Lower eye lid lag is named what? Also get diffuse redness, dry eyes and irritation.

A

Ectropion

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115
Q

Features that make up nephritic syndrome?

A
  • Haematuria
  • Proteinuria
  • Hypertension
  • Low urine volume
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116
Q

O/E

Chest expansion: equal

Trachea: central

Percussion: resonant

Breath sounds: vesicular

Vocal resonance: normal

Differential?

A

normal findings

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116
Q

What should be the width of the QRS complex?

A

0.12 seconds. (3 small sqaures)

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116
Q

What criteria do you use to diagnose infective endocarditis?

A

Duke criteria

  • postive blood cultures
  • endocardium involved

+

  • predisposing factors
  • fever
  • vascular signs
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117
Q

Pt presents with sino-nasal symptoms, what 5 symptoms are you going to specifically ask about?

A
  • Pain - Discharge - Obstruction/congestion - Nose bleeds - Loss of smell
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117
Q

What percentage of salivary gland tumours are benign?

A

80%

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118
Q

what classification of staging is used for colorectal cancer?

A

Dukes’

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119
Q

What 10 questions are asked in the AMTS?

A
  • How old are you? - What’s your date of birth? - What’s the year? - What is the time of day? Give address (42 west street) - Where are we? - Who is the current monarch? - What are the dates of the first world war? - Count backwards from 20 to 1 - Recognise two people - Can you remember the address?
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119
Q

What are the microvascular complications of DM?

A
  • Stroke - Renovascular disease - limb ischaemia - HEART disease
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119
Q

Contra-indications of sodium valproate?

A
  • hepatic dysfunction
  • acute porhyria
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120
Q

What is the negative predictive value?

A

The probability that the person does not have the condition.

= d / (c+d)

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120
Q

How do we engage with stakeholders?

A
  • study planning
  • implementation
  • dissemination
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121
Q

malar flush is due to what?

A

mitral stenosis.

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121
Q

What are the classic symptoms of Parkinson’s disease?

A
  • BRADYKINESIA + (1 other)
  • Tremor (worse at rest)
  • Rigidity (inc tone)
  • Postural instability
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121
Q

What can cause T wave inversion?

A
  • smoking
  • anxiety
  • tachycardia, haemorrhage, shock
  • hypokalaemia, pericarditis, MI
  • Bundle branch block
  • WPW
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121
Q

What is the most common type of BCC? What surface changes does it have?

A

Nodular.

  • telangectasia
  • pearly rolled edge
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122
Q

Normal ranges of plasma ionised calcium?

A

1 - 1.25 mmol/L

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122
Q

What would your response be to a severe asthma attack?

A
  • ABCDE approach
  • sit pt up
  • Oxygen 15L/min via reservoir mask
  • obtain IV access and take bloods
  • ABG
  • Salbutamol 5mg nebulised with oxygen (15-20min intervals)
  • Ipratropium bromide 500mcg nebulised with oxygen (4-6 hourly)
  • IV 200mg hydrocortisone
  • IV 2g magnesium sulphate over 20 mins
  • CXR to exclude infection and pneumothorax
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123
Q

Pharyngitis is most commonly a viral or bacterial infection?

A

Viral (rhinovirus, adenovirus, parainfluenzae)

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123
Q

What is this?

A

Tinea capitis

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125
Q

What are the 4 paranasal sinuses?

A
  • Sphenoid - Ethmoid - frontal - Maxillary
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126
Q

What anti-muscarinic drug is used to treat bradycardia?

A

Atropine

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127
Q

What do you include in a mental state examination?

A

All (appearance & behaviour) Sane (speech) Men (mood) Think (thought process) That (thought content) Pizza (Perceptions) Is (insight) Italian (IQ)

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128
Q

Pt has been taking prednisolone for a long time, what disease are they likely to get?

A

Addison’s disease (adrenal insufficiency)

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130
Q

What staging is used in lymphomas?

A

Ann-Arbor

stage 1 = localised single area of lymph nodes

stage 2 = two adjacent areas of involvement - either above or below diaphragm

stage 3 = areas in nodal areas both above and below diaphragm

stage 4 = multiple nodal areas plus involvement of one or more extra nodal areas (liver lung)

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131
Q

Non tender lymphadenopathy is a sign of what infection?

A

Chlamydial

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132
Q

What is trossier’s sign?

A

Enlarged virchows node.

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132
Q

What conditions is phenytoin contra-indicated in?

A
  • Sinus brady, AV block, SA block.
  • Caution with hypersensitivity, hepatic impairment, preggo
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132
Q

What sort of self reported bias are these?

  • If a subject gives an answer which they think will impress you
  • Subject gives an answer based on an event 6 months ago
  • subject gives an answer they think you want?
A
  • prestige bias
  • recall bias
  • response bias
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133
Q

How does Timolol work?

A

Blocks the beta receptors on the ciliary epithelium and therefore reduces aqueous humour production.

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135
Q

How is the accuracy of a test calculated?

A

(true pos + true neg a+d)/(total)

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136
Q

What HLA is assoc with RA?

A

HLA DR4/DR1 (assoc with inc severity)

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137
Q

What 2 tests are you going to do with the eyes in a thyroid exam?

A
  • Observe for lid lag (follow movement of finger = hyper) - H-test testing for ocular palsy seen in Graves
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137
Q

Overdiagnose or underdiagnose: sensitivity?

A

Over diagnose

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138
Q

What are the two most common parotid tumours?

A
  • Pleomorphic adenoma (benign, female) - Warthins tumour (adenolymphoma, benign, male)
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139
Q

When is the pain and stiffness from RA worse?

A

In the morning

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139
Q

Which research design are helpful when causes/exposures are rare?

A

Cohort

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140
Q

In what group of people is iron def anaemia fairly common? (prevalence 14%)

A

Menstruating women

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140
Q

Where in the world is MS more prevalent?

A

Temperate climates. if adults migrate they take their risk with them. Children acquire the risk of where they settle.

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141
Q

What is Auspitz sign?

A

Assoc with psoriasis. Scratch and gentle removal of scales cause capillary bleeding.

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142
Q

Pistol shots heard over the femoral arteries, Duroziez’s sign, de musset’s sign and quincke’s sign are all signs of which murmur?

A

Aortic regurg. Duroziez’s sign = to and fro murmur heard when the fem artery is auscultated and pressure applied distall. Quincke’s sign = capillary pulsation in nail beds. De Musset’s sign = head nod with each heartbeat.

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143
Q

Toxic thyroid adenoma is what type of tumours and what does it give rise to?

A

Benign tumours of thyroid gland which produces excessive amounts of thyroid hormones. Always arise follicular cells of the thyroid.

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145
Q

If the S-wave is greater than the R-waves it suggests depolarisation is moving towards or away from that lead?

A

AWAY from that lead

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146
Q

Which of the hepatitis viruses has the longest incubation period? Which has the shortest?

A

Longest = Hepatitis B avg 100 days

Shortest = avg 28 days Hep A

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147
Q

What are the most common causes of AF?

A
  • HTN
  • Rheumatic heart disease
  • MI/IHD
  • Thyrotoxicosis
  • Alcohol
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149
Q

Dizziness is a non-specific term. It can be categorised into 4 different subtypes according to the pts symptoms. What are they?

A
  • vertigo - Presyncope - Disequilibirum - Light headedness
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151
Q

Pt presents with general malaise, sore throat, dysphagia, pyrexia and cervical lymphadenopathy. Differential?

A
  • Tonsillitis
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152
Q

List 4 things that you can do to a pt on recognition of an airway compromise?

A
  • CALL FOR HELP
  • oxygen via 15L reservoir mask
  • Basic airway manoeuvres (head tilt/chin lift, jaw thrust)
  • airway adjuncts (oropharyngeal airway or Guedel airway)
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153
Q

Elevation of the ST segment indicates what?

Depression of the ST segment indicates what?

A

Elevation >1mm = MI

Depression = ischaemic myocardial tissue in the ventricles

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153
Q
A
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154
Q

How do you define unstable angina?

A

Angina of recent onset (

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156
Q

What are the three types of causal relationships?

A
  • functional
  • theoretical (acceptable culture)
  • speculative
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157
Q
A
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158
Q

What is the normal range for a P-R interval?

A

0.12 to 2 secs

3-4 small squares

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159
Q

If ALT > AST = ?

A

Chronic liver disease

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160
Q

Who does somatisation most commonly affect?

A

Women > Men.

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161
Q

Why do you give thiamine replacement in those who are chronic alcoholics?

A

Lack of thiamine can lead to Wernicke’s encephalopathy (opthalomoplegia, ataxia, confusion)

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163
Q

What is the commonest cause of Varicose Veins?

A

Unknown cause. Secondary causes include obstruction (DVT, fetus), valve destruction, constipation, arteriovenous malformation

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164
Q

What are the contraindications for Timolol drops?

A
  • COPD/Asthma - Cardiogenic shock - Bradycardia - Hypersensitivity - Hyperthyroidism - Diabetes
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165
Q

Aetiology of septic arthritis?

A
  • Suppurative infection caused from a haematogenous spread - or from direct spread from a penetrating trauma
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166
Q

What electrolyte imbalance does loop diuretics, bisphosphonates and phenytoin cause?

A

Hypocalcaemia

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168
Q

Aetiology of chronic liver failure?

A
  • Infections (hepatitis) - Drugs (para overdose) - Vascular (Budd Chiari synd) - Others (alcohol, primary biliary cirrhosis, alpha 1 antitryp def)
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169
Q

What waveform should there be if the pt is in sinus rhythm on an ECG?

A
  • P wave preceding each QRS complex
  • look at whether they occur regularly
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170
Q

Name given to a solid raised skin lesion

A

Papule

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171
Q

Differentials for Tiredness?

A
  • Haematological (anaemia - SOBE, weakness, palpitations, angina, claud)
  • Endo (hypothyroid, DM)
  • Pscyh (depression)
  • malignancy
  • Chronic infection (TB) & addisons
  • Drugs
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171
Q

Assign these statements to the following; ethics, governance and consent

  • ensuring that projects have appropriate permissions
  • ensuring participation is voluntary and without cost
  • ensuring that projects minimise risks and maximise benefits
A
  • permissions = governance
  • voluntary participation = consent
  • minimise risks and max benefits = ethics
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172
Q

What is the effect of increased conc of: Phenytoin?

A
  • Arrhythmia
  • cerebellar syndrome
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173
Q

How many cases of tonsillitis does a pt need to have had in the last year in order to be considered for a tonsillectomy?

A

>7

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175
Q

What are most common presenting complaints in someone with somatisation?

A
  • chronic pain
  • GI problems
  • Nervous system problems
  • reproductive problems
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176
Q

Pts ABG results: PaO2 low, PaCO2 normal, bicarb normal. What could be going on?

A

Type I respiratory failure. PaCO2 could be normal or low.

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177
Q

Bacterial & chlamydial eye infections cause what sort of discharge?

A

Yellow and sticky

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179
Q

During a mental health evaluation what do you want to ask after having asked about suicidal thoughts?

A

Assessment of risks to others? - have you ever thought about harming somebody else? - Are there people you know who would be better off dead?

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180
Q

List some causes of increased urea levels?

A
  • Kidney injury - Dehydration - GI bleed - increased protein breakdown (infection, trauma, malignancy)
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181
Q

What four things are you going to look for in an ECG?

A

RRAW

  • Rate
  • Rhythm
  • Axis
  • Waveform (various parts of the ECG)
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182
Q

What are the 6 red flags symptoms that you need to ask if someone presents with back pain?

A
  • urinary incontinence or retention
  • faecal incontinence
  • saddle anaesthesia
  • unilateral or bilateral weakness in legs
  • hyperreflexia
  • wt loss
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182
Q

What model would you use to identify an association between two variables?

A

Linear model

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183
Q

List 4 social problems that patients with alcohol misuse commonly have?

A
  • Financial problems - Divorce - Traffic violations & criminal offences - Job loss - Social isolation
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185
Q

What is the most common cause of cataracts? List 2 other causes

A
  • Age related = most common - Traumatic - Post inflam (recurrent uveitis) - Metabolic (DM)
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185
Q

What are you going to palpate in both the arms and legs in a peripheral vascular exam?

A
  • Temperature - Cap refill Pulses Arm = radial, radial radial delay, brachial, bp, carotid Legs = femoral, popliteal, post tib, dorsalis pedis Sensation - start distally
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186
Q

Which lead would you expect to see the most negative deflection in?

A

You would expect to see the most negative deflection in aVR. This is due to aVR looking at the heart in the opposite direction to the overall electrical activity.

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186
Q

What is a serious SE of DMARDS?

A

Myelosuppression - inc infection risk, overwhelming neutropenic sepsis

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187
Q

Name a corticosteroid and its function?

A

Cortisol. Glycogen and lipid metabolism. Made in adrenal cortex

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187
Q

What are the presenting symptoms of macrocytic anaemia?

A
  • symptoms of anaemia
  • Lemon tinge to skin (pallor + jaundice (haemolysis))
  • Neuropsych (irritable, depression, psychosis)
  • Neuro (Parasthesiae, peripheral neuropathy, SCDSC)
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188
Q

Left axis deviation is usually caused by what?

A
  • conduction defects and not by increased mass of the left ventricle
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190
Q

Causes of Delirium?

A

HIDEMAP-H H - hypoxia I - Infection D - drugs E - endocrine M - metabolic A - alcohol withdrawal P - psychosis H - head injury

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191
Q

What is the effect of increased conc of: Insulin?

A
  • Hypoglycaemia
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192
Q

Examples of sources of missingness?

A
  • clinically unimportant/irrelevant variables
  • variables that are too difficult/costly to collect
  • variables that require invasice or potentially sensitive measurement
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193
Q

What is the normal PaO2 on an ABG?

A

11-13kPa

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195
Q

How could a pt with AF present?

A
  • Asymptomatically
  • Palpitations
  • dyspnoea
  • chest pain
  • faintness
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196
Q

What is the product of the break down of haem?

A

Bilirubin

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197
Q

Difference between the survival and hazard function?

A

Survival function = as the chance of survival until a certain time

Hazard function = as the chance of instantaneous failure at any one time

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199
Q

Local factors that predispose to rhino sinusitis?

A
  • nasal obstruction (nasal tumour, nasal polyps, foreign body) - infection in neighbouring tissue (tonsils, adenoids) - URTI - pre-existing rhinitis
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200
Q

What drugs can interact with phenytoin?

A
  • amiodarone, cimetidine, OCP, warfarin, rifampicin, nifedipine.

THERE ARE FRICKING LOADS! Just think P450.

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201
Q

Name a drug that prolongs the refractory period in all parts of the conduction system? Used to treat what? SE x 5? Interactions?

A
  • Amiodarone (anti-dysrhythmic)
  • supraventricular/ventricular arrhythmias & tachyarrythmias assoc with Wolf-Parkinson White syn.
  • Nausea & vomiting, bradycardia, thyroiditis, photosensitivity, pulmonary fibrosis, sleep disturbances
  • Beta blockers, phenytoin, warfarin, digoxin, diltiazem
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202
Q

Pros & cons:

  • prospective data collection ?
  • retrospective data collection?
A

Prospective: pros = record ALL variables, using BEST techniques and applied consitently. ALL participants provide data on ALL variables.

Cons = time and resource intensive. collect more variables than you need.

Retrospective: pros = data already there. quick and not resource intensive

Cons = can not chose which variables are measured or number of participants. no role in level of missingness

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203
Q

What drug does metoclopramide inc the plasma conc of?

A
  • ciclosporin
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204
Q

What is the most common type of gastric carcinoma? what are the different types of this type of carcinoma?

A

Adenocarcinoma.

  • fungating
  • malignant ulcers
  • infiltrating carcinoma
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205
Q

What would you see on fundoscopy in a pt with ARMD?

A
  • Drusen - atrophy - scarring and pigmentation - haemmorhages
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207
Q

What drugs are you concerned about when taking a epistaxis history?

A
  • Warfarin - Aspirin - all other anticoagulants
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207
Q

SE of metformin?

A

Nausea, abdo pain, diarrhoea. NOT hypoglycaemia

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208
Q

Pt is in shock, has a rigid abdo and cullen’s sign. Differential?

A

Acute pancreatitis. In assoc with fever, grey-turner’s sign

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208
Q
A
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209
Q

Bifid P waves on an ECG indicate what?

A

Atrial delay due to mitral stenosis or mitral regurg

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210
Q

5 presenting symptoms of lobar pneumonia?

A
  • Fever - Dyspnoea - Cough - Purulent sputum - Haemoptysis - malaise - Rigors
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211
Q

What symptoms are you going to explore in a depression history? what other conditions are you going to screen for?

A

DEPRESSION

  • D = depressed mood

E = energy loss

P = pleasure lost

R = retardation

E = eating habits changed/wt loss

S = sleep disturbances (early morning waking)

S = suicidal thoughts

I = I’m a failure (low self esteem)

O = Only me to blame (pessimism)

N = no concentration

Screen for:

  • Mania
  • Anxiety
  • Delusions
  • hallucinations
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213
Q

Which two hormones are stored in the posterior pituitary gland?

A

Oxytocin and Vasopressin (ADH)

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215
Q

What is anti-VEGF used to treat?

A

Wet macular degeneration. Aim to minimise angiogenesis to stabilise vision.

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216
Q

What are the risk factors for an AKI?

A
  • Age > 75
  • CKD
  • cardiac failure
  • liver disease
  • PVD
  • DM
  • Nephrotoxins (iodinated contrasts, gentamicin, NSAIDs, ACE-i)
  • Hypovolaemia & sepsis
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217
Q

What does B12 bind to in order to be absorbed?

A

Intrinsic factor in the stomach

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217
Q

What are the symptoms of ARMD?

A
  • Disturbed central vision (scooter, blurring, distortion) - Difficulty appreciating detail (reading fine print, recognising faces)
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219
Q

What AI disease causes the destruction of acinar and ductal cells especially in the salivary and lacrimal glands?

A

Sjogren syndrome

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220
Q

What does Hodgkins lymphoma commonly present with?

List the other symptoms

A
  • Painless enlargement of a group of lymph nodes
  • night sweats
  • unexplaine dwt loss
  • splenomegaly
  • hepatomegaly
  • non specific pain
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222
Q

Ankylosing spondylitis is assoc with what condition in the eyes? Assoc with what HLA?

A

Uveitis. HLA-B27

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223
Q

Symptoms to ask in a pt with DM?

A
  • Polyuria
  • Polydipsia
  • Prone to infection
  • blurry vision
  • No loss of feeling or pins and needles in your legs
  • mood
  • Lethargy
  • exlcusion of UTI
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224
Q

Low pitched, rumbling mid diastolic murmur?

A

Mitral stenosis

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226
Q

SE of metoclopramide?

A

Extra-pyramidal SE: acute dystonic reactions

  • rarely galactorrhoea, cardiac conductive abnormalities, drowsiness
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227
Q

What signs would you expect to see in a pt with glaucoma?

A
  • Optic disc (cupping, pallor, splinter haemorrhages) - Raised intraocular pressure - RAPD if asymp adv glaucoma
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228
Q

Name 3 ototoxic drugs?

A
  • Aminoglycosides (gentamicin) - Salicylates (aspirin) - Loop diuretics (furosemide)
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230
Q

Boutonniere and swan neck deformity are seen in what disease?

A

Rheumatoid arthritis

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231
Q

Most common type of eczema?

A

Atopic

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232
Q

What is the most common measure of linear correlation?

A

Pearson correlation coefficient R.

Value r lies between -1 & 1. R =1 = perfect positive correlation. R = -1 = perfect neg correlation. R = 0 = no correlation. R

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233
Q

A 5yo boy presents with conductive deafness. He’s rubbing his R ear, complaining of ear ache. He looks flushed, T >39.5. Blood stained discharge with some mucus. Diagnosis?

A

Acute otitis media

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234
Q

Goodpasture’s disease:

  • what is it?
  • Serology?
  • presenting symptoms?
A

Pulmonary renal syndrome. Anti-GBM Abs bind to kidney glomerular membrane and lung alveolar membrane and cuase a type II hypersensitivity reaction. HLA DR2 assoc

Serology = anti glomerular basement membrane Abs of IgG can be found in good pastures. definitive diagnosis is made on renal biopsy as it shows a classic linear staining on direct immunofluorescence.

Presenting symptoms: cough, intermittent haemoptysis, haematuria.

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235
Q

Chronic hypercapnia is followed by what as seen on an ABG?

A

rise in bicarb

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235
Q

When doing linear regression on cont variables everything is easy when telling stata what to do. When you have a categorical variable for example sex, how would you tell stata what to do now? exposure = height. outcome = weight. Covariates are age and sex.

A

xi: regress weight height age i.sex (just need to tell stata which variables are categorical)

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237
Q

What two questions are you going to ask to a pt presenting with haemoptysis? (in terms of finding out the common/more serious causes)

A
  • Recent wt loss (malignancy) - Recent foreign travel (TB)
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239
Q

How would you perform a volume assessment?

A
  • Skin turgor
  • HR, CRT, BP, JVP
  • sunken eyes
  • mucosal membranes
  • auscultate chest, abdo distension, urine output
  • haemorrhage, burns
  • confusion
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240
Q

What drugs cause hyperkalaemia?

A
  • K+ sparing diuretics
  • NSAIDS
  • ACE-i
  • Trimethoprim
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241
Q

Name an anti-diarrhoeal?

Mechanism of action?

A

Loperamide. Acts on opioid receptors in myenteric plexus. Inhibits peristalsis by inhibiting Ach release.

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242
Q

List 3 conditions/disease that excessive alcohol consumption can cause?

A
  • Liver cirrhosis - Pancreatitis - Liver cancer - Peptic ulcer disease - Hypertension etc.
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244
Q

What are the risk factors for colorectal cancer?

A
  • Neoplastic polyps
  • IBD
  • FAP
  • HNPCC
  • smoking
  • previous cancers
  • low fibre diet
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244
Q

What does the ST segment represent on an ECG?

A

Ventricular repolarisation

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245
Q

Golds & NSAIDS can cause what type of damage to cause renal failure?

A

Glomerular damage

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246
Q

In terms of respiratory conditions…malignancy, surgery and the OCP are risk factors for which condition?

A

PE. Along with immobility, leg fractures, preggo, thrombophilia.

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247
Q

Name 4 questions that you’re going to asia apt who presents with ‘vertigo’?

A
  • Constant or episodic? - Duration? - Triggers? - Assoc symptoms (pain, hearing loss, tinnitus, n&v)
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248
Q

Pt presents with vertigo. Rapid onset. Duration of days. Occurs on awakening. No assoc auditory symptoms. N&V. Previously had an URTI (viral). On examination there is horizontal nystagmus. What is your diagnosis?

A

Vestibular neuronitis

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248
Q

Does grave’s disease present with a nodular or diffuse goitre?

A

Firm diffuse goitre

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248
Q

What are the macrovascular complications of DM?

A
  • Stroke - Renovascular disease - limb ischaemia - HEART disease
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248
Q

4 major aetiologies of stroke?

A
  • thrombosis in situ
  • cardiac emboli
  • atherothromboembolism
  • CNS bleeds
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249
Q

What autoantibodies would be present in autoimmune addison’s disease?

If these are not present, what should you do to investigate further”?

A

21-hydroxylase adrenal autoantibodies.

  • Get a CXR/AXR for signs of TB
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250
Q

What drug is used to treat beta blocker overdose and hypoglycaemia?

A

Glucagon

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250
Q

Difference between fatality and ‘cause specific mortality’?

A

Fatality = number of cases who die / number of cases with disease

Cause specific mortality = number of cases with disease who die / total number of any cause deaths

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251
Q

The number of squares between the RR interval can tell you what on an ECG?

A
  • Rate
  • Rhythm (regular or irregular)
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252
Q

What is a latent variable? How to overcome this problem

A

A missing variable. Use a proxy variable.

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253
Q

Clinical features of an AKI?

A
  • hypovolaemia (CRT, pulse, bp, JVP, skin turgor, pulm oedema, periph oedema, urine output, wt)
  • palpable bladder?
  • signs of vasculitis (wt loss, fever, rash, uveitis, haemoptysis, joint swelling)
  • bruits
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255
Q

name given to a primary skin lesion which is a flat, non palpable area of skin which is less than 0.5cm?

A

papule

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257
Q

What is the Wells score used to determine the probability of?

A

PE. Looks at the risk factors and a score >3 = probable chance of getting a PE

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258
Q

What immunosuppressants are used to treat psoriasis?

A
  • methotrexate, ciclosporin, mycophenolate, retinoids (acetretin)
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259
Q

What are classes of calcium channel blockers?

A
  • Dihydropyridines (amlodipine - vascular resistance and arterial pressure lowering)
  • Non-dihydropyridines (verapamil - mycordial selective)
  • Benzothiapine (diltiazem - somewhere between amlodipine and verapamil = vasodilatory and cardiac depression)
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261
Q

What features in a history would make you think about postural hypotension?

A
  • whether they get dizzy/LOC on standing from a lying position - recently started on or change their anti-hypertensive medication
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261
Q

Aetiology of chronic liver failure?

A
  • Infections (hepatitis) - Drugs (para overdose) - Vascular (Budd Chiari synd) - Others (alcohol, primary biliary cirrhosis, alpha 1 antitryp def)
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263
Q

ECG: - a prolonged P-R interval may suggest what?

  • a shortened may suggest what?
A
  • Present of heart block
  • wolf parkinson white syndrome
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264
Q

SE of ferrous sulphate?

A
  • Nausea - Abdo discomfort - Dark stools - Constipation
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265
Q

What are the commonest causes of chronic kidney injury?

A
  • Diabete Mellitus - Hypertension - chronic glomerulonephritis disease
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265
Q

SE of lamotrigine?

A
  • N&V + the usual
  • Stevens-Johnson syn. & toxic epidermal necrolysis
  • hypersensitivity reactions
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265
Q

Differentials for headache?

A
  • Infection (meningitis - fever, rash, photophobia, neck stiffness. abscess)
  • Inflammatory (Tension headache - late in day, assoc with stress. Cluster headache - painful attacks around one eye, lacrimation, occurs 2xday for 1-3mnths. GCA - throbbing scalp pain, jaw claudication)
  • Vascular (stroke, TIA, SAH - think about assoc motor/sensory weakness)
  • Trauma (head injury)
  • Raised ICP (worse in morning, leaning forward, coughing)
  • Extracranial (Glaucoma - pain around eye, swollen red eye. Sinusitis - congestion, facial pain leaning forward. Scleritis - burning pain to temple)
  • Drugs (nitrates, analgesia overuse, caffeine)
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267
Q

What test can be used to examine survival data?

A

Log rank test or Cox proportional hazards modelling

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268
Q

Mild increase in ALT & AST indicates what? (list 3 things)

A
  • Liver cirrhosis - Non-alcohol fatty liver disease - hepatocellular carcinoma - Wilsons disease
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270
Q

Working with hard wood increases the risk to what cancer?

A

Sinonasal cancer

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271
Q

Anti-cyclic citrullinated peptide antibodies (anti-CCP) are highly specific for what disease?

A

Rheumatoid arthritis

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271
Q

Most common type of psoriasis? List the others

A
  • chronic plaque psoriasis
  • guttate, seborrhoeic, flexural, pustular, erythrodermic
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272
Q

What sign would you observe in the hands/wrists of a pt with COPD?

A

Asterixis (CO2 retention flap)

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273
Q

Does the nose receive internal or external carotid artery supply or both?

A

Both. Ethmoidal arteries = internal carotid. Maxillary and facial arteries = external carotid

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274
Q

Name a MAO-B inhibitor? List 2 SE

A

Rasagiline. (alternative to dopamine agonists in the treatment of PD).

SE = postural hypotension and AF

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275
Q

Normal PaCO2 on ABG?

A

4.7-6 kPa

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277
Q

Pt presents with a boring/throbbing eye pain. It radiates to the forehead. Wakes pt at night. No precipitants. Differential?

A

Scleritis

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279
Q

Mneumonic for aetiology of acute pancreatitis?

A

GET SMASHED

G = gall stones

E = ethanol

T = trauma

S =steroids

M = mumps

A = autoimmune

S = scorpion venom

H = hyperlipidaemia, hypothermia, hypercalcaemia

E = ERCP

D = drugs

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280
Q

How do beta 2 receptors work? (salbutamol)

A

Stimulates receptors to produce intracellular cAMP. Dec in intracellular cAMP leads to bronchodilatation.

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280
Q

How do corticosteroids work?

A
  • inhibits phospholipase A2 activity which dec arachidonic acid production
  • arachidonic acid is a precursor for prostaglandins and leuktorien synth (inflam). so by dec arach acid = anti inflamm effect.
  • dec B and T lymphocyte response to antigens = immunosuppressive effect
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282
Q

How does gliclazide work?

A

Increases insulin secretion

283
Q

Which statement represents a ‘sample’, a ‘population’?

  • every member of a defined group of interest
  • subset of group of interest, intended to be representative of that group of interest
A

Pupulation = every member of a defined group of interest

Sample = subset of a population, intended to be representative of that population, from which we can explore the population by inference

284
Q

Pt presents with sudden and painless loss vision. Fundoscopy revels cotton wool spots, optic disc swelling, retinal haemorrhage visible in all four quadrants. Pt has DM & HT. Differential?

A

Retinal vein occlusion

285
Q

How do you assess a neck lump? 6 things

A
  • Location (midline, ant triangle, post triangle) - Size (width, depth, height) - Shape (well defined) - Consistency (Smooth, rubbery, hard, nodular, irregular) - Temperature - Overlying skin changes (erythema, ulceration etc.) - Fluctuance - Transillumination
286
Q

List 4 neurological causes for a fit, faint, LOC or syncope?

A
  • TIA/stroke - Parkinsons - Seizure - Vasovagal
287
Q

HLA B27 is associated with what condition?

A

Uveitis

288
Q

causes of megaloblastic anaemia? And causes of non megaloblastic anaemia?

A
  • megaloblastic = B12 def (dietary, malabsorption, congenital), folate def, cytotoxic drugs
  • non megaloblastic = alcohol, preggo, hypothyroidism, reticulocytosis
289
Q

Where are malignant melanoms more common on women, and where more common on men?

A
  • women = legs
  • men = trunk
290
Q

List 3 risk factors for a ruptured AAA?

A
  • Hypertension - Smoker - female - Family history
291
Q

What drugs can cause acute tubular necrosis?

A
  • Lithium
  • Contrast
  • gentamicin
293
Q

What drugs are cytochrome P450 inhibitors?

A

Some Certain Silly Compounds Annoyingly Inhibit Enzymes, Grrrr.

295
Q

List some causes of decreased urea levels?

A
  • Malnutrition - liver disease - Preggo
296
Q

List 3 cardiovascular causes for a fit, faint or syncope?

A
  • Aortic stenosis - Postural hypotension - Arrhythmia
297
Q

Stata comman for the linear regression of two variables (weight, height) with a covariate of age. (exposure = height, outcome = wt)

A

regress weight height age

298
Q

Inflammatory disease of the pilosebacaeous follicles?

A

Acne vulgaris

299
Q

What condition can cause these EMERGENCY symptoms? (respiratory) - Silent chest - Cyanosis - bradycardia

A

Asthma

300
Q

Long sightedness is known as ?

A

Hyperopia.

302
Q

Why do pts with addison’s disease get pigmented palmar creases and buccal mucosa?

A

Increase in ACTH which cross reacts with melanin receptors

303
Q

What is GTN spray metabolised to in smooth muscle cells? Mechanism of action?

A

Metabolised to NO which causes coronary artery/systemic vein vasodilatation

304
Q

Which of the two aminotransferases is specific to the liver only? And what is the other one assoc with?

A

ALT sources = LIVER.

AST sources = liver, skeletal muscle, heart, pancreas, kidneys

306
Q

What is Felty’s syndrome?

A

RA + splenomegaly + neutropenia

307
Q

What does a competing exposure affect?

A

Only influences the outcome

307
Q

List 5 examples of when Pearson correlation should not be used?

A
  • a non linear relationship between 2 variables
  • outliers present
  • there are distinct sub groups
  • onr or both of the variables is not normally distributed
  • one or both variables is non-numeric
308
Q

How would you treat skin cancers?

A
  • excision
  • mohs micrographic surgery
  • radiotherapy
309
Q

How do you diagnose MS?

A

Based on clinical presentation and the attacks must last >1 hr and there must be >30days between attacks.

  • MRI abnormality
310
Q

Non tender lymphadenopathy is a sign of what infection?

A

Chlamydial

311
Q

The width of the CI depends on?

A
  • size of sample
  • level of confidence requried
  • variability of characteristics being studied (he greater the variability of the characteristic, the greater the standard deviation which increases the standard error and so increases the width of the confidence interval.)
312
Q

Why would a patient with both hypo and hyper thyroidism present with dyspnoea?

A

Hyper = more prone to AF which can cause dyspnoea Hypo = pleural effusions

314
Q

List the 3 common organisms to cause otitis externa?

A
  • S.aureus - Pseudomonas - Proteus
315
Q

What the cause of pigmented gall stones?

A

Haemolysis

316
Q

How do you calculate degrees of freedom using a student’s t distribution?

A

n-1. (n = sample size)

317
Q

ST depression can be caused by many different things….?

A
  • ischaemia
  • anxiety
  • tachycardia
  • digoxin toxicity
  • Haemorrhage, hypokalaemia, myocarditis
  • Coronary artery insuff
  • MI
318
Q

Which type of diuretic acts on the ascending loop of Henle? How does it act?

A

Furosemide. Inhibits sodium and potassium reabsorption.

320
Q

Where is B12 absorbed?

A

Terminal ileum

322
Q

List 4 presenting symptoms of iron def anaemia?

A
  • Dyspnoea (SOB) - Fatigue (if pt presents saying “i’m tired all the time”, have anaemia as a differential - Palpitations - Faintness - Headache
324
Q

List 6 presenting symptoms in an otological history?

A
  • Otalgia - Discharge - Hearing loss - Tinnitus - Vertigo - Dizziness
324
Q

Along with assessing the neck lump what questions in the history are you going to ask?

A
  • Duration - how many lumps? - Size change - skin changes - Painful - Assoc symptoms
325
Q

SE of beta blockers?

A
  • bronchoconstriction
  • fatigue
  • Bradycardia
  • cold extremities
325
Q

What conditions is salbutamol contra-indicated in?

A
  • CV disease
  • hyperthyroidism
  • DM
  • hypokalaemia
326
Q

SE of a sulphonylurea?

A

HYPOGLYCAEMIA. Wt gain

327
Q

Term used to describe how good a test is at correctly excluding those without the condition?

A

Specificity - true negatives.

= d / b + d

= true negatives / false positives + true negatives

328
Q

Normal ranges of plasma potassium?

A

3.5-5 mmol/L

330
Q

Pt presents with sudden and painless loss vision. Fundoscopy revels cotton wool spots, optic disc swelling, retinal haemorrhage visible in all four quadrants. Pt has DM & HT. Differential?

A

Retinal vein occlusion

332
Q

Indications for Prednisolone?

A
  • Suppression of allergic/inflamm disorders
  • IBD
  • asthma
  • rheumatoid disease
  • Immunosuppression
334
Q

Pts ABG results: PaO2 normal, PaCO2 low, Bicarb normal. What could be going on?

A

Hyperventilation

336
Q

which type of research design is helpful when conditions/outcomes are rare?

A

Case-control

337
Q

Name a sulphonylurea? What is it used to treat?

A

Gliclazide. Type II DM.

338
Q

What is the CAGE questionnaire used for? What does it stand for?

A

Alcohol dependence screening. - Cut down - Angry/annoyed - Guilty - Eye opener

340
Q

What are the four most common presenting problems seen in somatisation?

A
  • Chronic pain - Problems with GIT - Problems with nervous system - Problems with reproductive system
341
Q

What would you see in proliferative diabetic retinopathy?

A
  • macula oedema - retinal haemorrhages - vitreous haemorrhages - neovascularisation
343
Q

What sign do you see on an X-ray in a pt with supraglottitis?

A

Thumb sign

344
Q

Most common bacterial organism to cause bacterial Tonsillitis?

A

Group A Beta Haemolytic strep

346
Q

Pt presents with mild conductive deafness, irritation around the ear, oedematous meatus. Little discharge. Diagnosis?

A

Otitis externa.

346
Q

What part of the mnemonic for the mental state exam does asking the patient whether they think anything is wrong with the way their thinking? (is the pt aware of the nature of their disorder)

A
  • Insight
348
Q

How would you explain an endoscopy or gastroscopy to a pt?

A
  • Intro (WIPE)
  • Check understanding
  • Explain what it is
  • Invasive procedure which allows doctor to view the lining of your oesophagus, stomach and the first part of your small intestine.
  • Involves passing a flexible tube through the mouth, down the oesophagus and into the stomach. The tube is about the width of the index finger.
  • reason for it
  • accurate way to diagnose and sometimes treat conditions that have been causing you problems
  • visualisation of any abnormalities
  • Painless biopsies which help in the diagnosis
  • Procedure details
  • Prep (clear fluids 8hr before, NBM 4
  • During (either sedated (GA not recommended - (midazolam IV)) or unsedated with a throat spray of local anaesthetic (lidocaine)
  • After (if under GA then accompanied for 24 hrs. Go home within 2-4 hrs. DO NOT drive, operate machinery, drink alcohol, sign legal docs for 24 hours)
  • Risks and benefits
  • Sore throat (very common but short lived)
  • Perforation and haemorrhage (rare but serious, need to stay in hospital)
  • Reaction to sedative drugs
  • Risk of damage to teeth and dental bridge work
  • Alternate = barium meal but does not allow for tissue diagnosis
349
Q

What are nuisance variables?

A

The likes of confounders and competing exposures which undermine the associations between the two main variables. (we can eliminated these though aslong as we identify- DAG, and measure them)

351
Q

Investigations for complicated/recurrent rhino-sinusitis?

A
  • Nasal endoscopy - CT paranasal sinuses - Microbiology
352
Q

How would yo manage sepsis?

A

BUFALO

  • Blood cultures prior to Abx administration
  • U = urine output (catheter)
  • F = fluids to treat hypotension/clinical shock
  • A = broad spectrum Abx
  • L = Serum lactate and Hb
  • O = 15L/min oxygen via reservoir bag
354
Q

What is a complication of acute otitis media? What are the presenting symptoms and signs?

A

Acute mastoiditis. - Earache, - Profuse creamy discharge - conductive deafness - Pinna is looking like elephant ears - Pt looks v unwell. Pyrexial.

354
Q

What Abx is given to pts with meningitis under the age of 55yo?

A

IV cefotaxime

355
Q

It is easier to detect an effect (greater power) if …list 3 things?

A
  • the mean effect is greater
  • variation in the effect is smaller
  • your sample is bigger (you can calculate your sample size and adjust in order to make sure your CI are stat significant. e.g if n = 49 CI (-0.1 to 2) and n = 50 (CI 0.1 to 2) then you could say that >50 = sufficent power to produce a significant result. If CI does not include zero then it is significant at p
357
Q

What cancer can sjogren syndrome progress to?

A

Non-hodgkins lymphoma

358
Q

What 5 things are you going to comment on whilst doing fundoscopy? (start with the red reflex)

A
  • red reflex = comment on opacification like cataracts
  • Optic disc (colour, contour, cupping, size, shape)
  • Vessels (A-V nipping (HTN), copper wiring, narrowing of A., neovascularisation)
  • Retinal background (dot and blot haemorrhages, flame and spinter haemorrhages, hard and soft exudates, microaneurysms, cotton wool spots)
  • Macula (drusen, haemorrhages, hard exudates) & then foveal reflex
360
Q

Is insulin given to those with Type II DM?

A

yes if needed.

361
Q

What happens in left axis deviation in terms of the leads?

A
  • deflection in lead one to become more positive
  • deflection in lead three to more negative

LEFT axis deviation = leaving each other

363
Q

What would you see on a CXR in a pt with COPD?

A

Hyperinflation

365
Q

What 3 things are you going to look for in the eye region in a thyroid exam?

A
  • Exopthalmos (look from front, side and above) = graves - Lid retraction (more sclera visible than normal) - Periorbital swelling (hypo) - Madarosis (hypo) - Conjunctival chelosis (hyper)
366
Q

Which of the two types of lymphoma most often causes systemic upset?

A

Hodgkins lymphoma

366
Q

HbsAg: +ve

anti-HbsAg: -ve

anti-HbcAg IgM: -ve

anti-HbC: +ve

?

A

Chronic Hepatitis B infection

367
Q

What causes white, stringy mucoid discharge from the eye?

A

Allergic

369
Q

Pt presents with photophobia, red eye with some visual disturbances. Red eye with ciliary injection around iris. Urgent referral to ophthalmologist is needed. Diagnosis?

A

Acute anterior uveitis

371
Q

A headache which gets worse throughout the day? Dull, tight, pressure like.

A

Tension headache

372
Q

What does carbamazepine treat?

A
  • Tonic clonic seizures
  • partial seizures
  • Trigeminal neuralgia (second line treatment is phenytoin)
  • proph of bipolar disorder unresponsive to lithium
373
Q

What drugs are contraindicated in gout?

A
  • Diuretics
375
Q

Alpha-fetoprotein is a tumour marker for what type of carcinoma?

A

Hepatocellular carcinoma

377
Q

What is Wegener’s granulomatosis? Presenting symptoms?

A

Small artery vasculitis (ANCA positive).

  • lesion in URT, lungs and kidneys.
  • symptoms = nasal obstruction, cough, haemoptysis, pleuritic chest pain. possible eye signs like scleritis, uveitis, retinitis.
  • CXR showing multiple nodular masses
379
Q

What 9 questions are you going to ask a patient suspected of having a DVT?

A
  • Is it both legs? - Any pain? - Any skin changes? - Is there oedema elsewhere? - trauma (surgery..) - Preggo? - Mobile? - Medication (HRT/OCP)? - Any skin pitting?
380
Q

What is hypopyon?

A

Pus in the eye

382
Q

What is Timolol and what is used to treat?

A

non selective beta blocker used to treat open angle glaucoma.

383
Q

Herbedens nodes are present in what condition? And affect what?

A

Osteoarthritis. DIP.

384
Q

What is friedereichs ataxia?

A
  • inherited disroder affecting young men.
  • dorsal columns affected so loss of vibration and proprioception
  • deep tendon reflexes absent
385
Q

What are the potential sources of bias and what solutions are there: sampling/selection bias

A
  • external validity (stratified and random sampling)
  • confounding (adjustment or random sampling)
386
Q

Young patients are likely to have anterior or posterior epistaxis compared with elderly patients?

A

Young = ant Elderly = starts to move more posteriorly

387
Q

What is sjogren’s syndrome?

A

Autoimmune disease. Usually occurs secondary to RA.

  • xerostomia
  • keratoconjunctivitis sicca
388
Q

Name given to a larger flat area of altered colour or texture of skin > 0.5cm?

A

Patch

389
Q

Which hepatitis is there no treatment for?

Which hepatitis is there no vaccine for?

Which hepatitis can most pts make a recovery from without any chronic damage?

Which hepatitis is acute infection uncommon?

Which hepatitis is most likely to develop chronci liver disease?

A
  • Hepatitis A
  • Hepatitis C
  • Hepatitis A
  • Hepatitis C
  • Hepatitis C
390
Q

How do you check a urine sample?

A
  • Note clarity, particles and colour before removing the lid of container - remove the lid of container and check odour - check multistix container is intact and in date. DO NOT use if stored in humid environment or if out of date - Remove a strip from container and replace lid - dip test strip into urine and wet all test zones - do not leave in urine for more than one second - remove strip from urine and drag edge on container to remove excess urine - replace lid - take note of time and compare test zones against those on multisite container at appropriate time - Note any abnormalities - dispose of waste appropriately (urine down sluice, container into clinical waste bin, fold test strip inside gloves as you remove them) - wash hands - record results
392
Q

Where in the tympanic membrane does chronic suppurative otitis media cause perforation?

A

Pars tensa

393
Q

What associated symptoms are you going to ask about if a patient presents with a headache?

A
  • Aura (migraine) - Nausea - Vomiting - Photophobia (migraine) - Neck stiffness (meningitis, SAH) - LOC (SAH) - Fever (meningitis) - Rhinorrhoea (cluster)
394
Q

What is beclometasone?

A

Inhaled steroid

395
Q

What is the effect of increased conc of: ciclosporin?

A
  • renal failure
395
Q

SE of retinoids?

A
  • Dry skin and lips
  • hepatotoxic?
  • teratogenic
397
Q

What type of regression must you do when the outcome is continuous?

What type of regression must you do when the outcome is categorical?

A

Linear regression

Logistic regression (most likely a binary outcome)

398
Q

Pts ABG results: PaO2 low, PaCO2 high, bicarb raised. What could be going on?

A

Type 2 resp failure with metabolic compensation from raised bicarb. PaO2 could be normal or low

400
Q

Which of the three skin cancers is least likely to metastasise?

A

BCC

401
Q

If only 2 out of 4 of the cells in a chi squared test have an expected value of 5 then what other test could you do?

A

Fisher’s exact test. If the contingency table fails to meet the conditions required for chi squared.

403
Q

What is the chief cause of goitre worldwide? Also the same as the most common cause of hypothyroidism?

A

Iodine def

405
Q

What are the presenting symptoms of a gastric carcinoma?

A
  • dyspepsia
  • wt loss
  • vomiting
  • dysphagia
  • anaemia
406
Q

Effect of statin and amiodarone?

A

Inc statin conc and therefore inc risk of rhabdomyolysis

407
Q

What are the different symptoms a pt can present with depending on the location of the colorectal cancer?

A

Left side = bleeding/mucus/mass on PR, tenesmus, altered bowel habit/obstrcution.

RIght side = wt loss, anaemia, abdopain.

Either side = abdo mass, haemorrhage, perforation

409
Q

What is the most common cause of facial n. palsy?

A

Bell’s palsy

410
Q

What drug is used to treat benzodiazepine overdose?

A

Flumazenil

411
Q

What other conditions could present similary to meningitis?

A
  • Encephalitis
  • Septicaemia
  • Malaria
  • Dengue & tetanus
413
Q

What are the side effects of Latanoprost?

A
  • Blurred vision - Increased pigmentation of iris - darkening of eyelid skin colour - darker, thicken eyelashes
414
Q

Where does stensens duct enter the mouth?

A

Opposite the 2nd upper molar. (parotid duct)

415
Q

Infection of lung parenchyma leading to fluid accumulating in alveoli?

A

Lobar pneumonia

417
Q

If the QRS complex is longer than 0.12 seconds what does this suggest?

If QRS complex is shorter than 0.12 seconds what does this suggest?

A
  • Longer = complex originated in ventricles
  • Shorter = complex is supraventricular in origin
419
Q

What drug interferes with formation of vit K dependant clotting factors?

A

Warfarin

421
Q

What is this? Assoc condition?

A

Koebner phenomenon. Linear eruption arising at the side of trauma. See in psoriasis

422
Q

What defect on examining the eyes is a sensitive marker for unilateral or asymmetric optic nerve disease?

A

Relative afferent pupillary defect

423
Q

SE of methotrexate?

A

Pneumonitis, oral ulcers & hepatotoxicity

423
Q

What conditions is prednisiolone contra-indicated in?

A
  • systemic infection
  • hypersensitivity
  • osteoporosis
  • glaucoma
  • recent MI
  • preggo
  • vaccines
425
Q

What are the three types of anxiety?

A

Generalised anxiety disorder Panic attacks Phobias

427
Q

What is lamotrigine and what is used to treat?

A
  • Anti-convulsant
  • Partial seizures, primary/secondary generalised tonic-clonic seizures
  • lennox gestaut syndrome seizures
  • trigeminal neuralgia
429
Q

What is a risk factor in adenocarcinoma of the oesophagus? Premalignant lesion?

A
  • Barret’s oesophagus - Smoking - GORD - Obesity
430
Q

What would you see in non-proliferative diabetic retinopathy?

A
  • Cotton wool spots - Dot and blot haemorrhages - hard exudates - microaneurysms
431
Q

Statistical name for the commonest value?

A

Mode

432
Q

Why do we use adjustment when comparing populations and samples?

A

Correcting sample statistics to make them:

  • better estimates of the true population
  • comparable to other samples/populations with different baseline characteristics
433
Q

Mechanism of action of a cardiac glycoside? Name the drug. Indicated in?

A

Digoxin. Inhibits sodium/potassium pump to inc intracellular sodium conc which inhibits sodium/calcium pump. Dec calcium pumped out of cell = inc force of contraction. Also inc vagal activity and reduced HR/AV node conduction.

  • HF, and supraventricular arrhythmias (AF)
434
Q

What condition causes “Autoimmune atrophic gastritis leading to achlorhydria”?

A

Pernicious anaemia

435
Q

What is prevalence?

A

It measures the number of cases that exist at a specified time point in a population at risk

436
Q

Is the pulse weaker on inhalation or exhalation in a pt with a paradoxical pulse? What resp conditions is this assoc with?

A

Weaker on inspiration. Asthma, PE, Tension pneumothorax, COPD. Abnormally large dec in systolic blood pressure and pulse wave amplitude during inspiration.

437
Q

Most common causative organism?

A

S.aureus

438
Q

List 3 complications of a pneumonia?

A
  • Type 1 resp failure - Hypotension - Pleural effusion - Empyema - Lung abscess - AF
440
Q

What are the microvascular features of DM?

A
  • retinopathy - neuropathy - nephropathy
441
Q

Increased levels of growth hormone stimulate the overproduction of what? where?

A

overproduction of IGF1 from the liver. Stimulates overgrowth of tissues and alters blood glucose and lipid metabolism. Symptoms of acromegaly

443
Q

Is Stridor an inspiratory or expiratory sound?

A

Inspiratory sound due to partial obstruction of upper airways

444
Q

What organ is responsible for excreting metabolic acids?

A

KIDNEYS - secrete hydrogen ions into urine and reabsorb bicarb from urine.

445
Q

ECG:

Small sqaures represent?

Large square represents?

5 large squares represent?

300 large sqaures represent?

A

Small squares = 0.04 seconds

Large square = 0.2 seconds

5 large squares = 1 second

300 large squares = 1 minute

446
Q

List 5 presenting physical symptoms of excessive alcohol consumption?

A
  • Sleep disturbances - Diarrhoea - Inability to concentrate - Headache - Sexual dysfunction - Loss of appetite
447
Q

O/E

Chest expansion: can be reduced on affected side

Trachea: central

Percussion: dull over affected zone

Breath sounds: reduced breath sounds, coarse creps, bronchial breathing over affected zone

Vocal resonance: increased over affected zone

Differential?

A

Pneumonia

449
Q

What is Uhthoff’s phenomenon?

A

Seen in MS in Optic neuritis

  • vision worsens on exercise, eating a hot meal or in hot baths
451
Q

If the R & S-waves are of equal size it means depolarisation is travelling at what?

A

Exactly 90 degrees to that lead

453
Q

What is seen in herpes simplex keratitis?

A
  • Sore non sticky red eye - Abnormal corneal epithelium in dendrite pattern which stains with fluorescein.
455
Q

What is relative freq?

A

Freq = number of cases/events expressed as if they were counts

Rel freq = these counts expressed as percentage of total number of counts

456
Q

What are you going to ask the pt to do with their hands during a thyroid exam?

A

“can you place your hands out in front of you” Place paper on back of hands and observe for fine tremor

458
Q

What investigation do you not do if a pt has suspected raised ICP?

A

Lumbar puncture

459
Q

What drugs are cytochrome P450 inhibitors?

A

Some (sodium valproate) Certain (ciprofloxacin) Silly (sulphonamide) Compounds (cimetidine) Annoyingly (antifungals, amiodarone) Inhibit (isoniazid) Enzymes (erythromycin), Grrrr (grapefruit juice).

461
Q

List 4 topical steroids in order of potency?

A

Hydrocortisone 1% Eumovate Betnovate C Dermovate

462
Q

What score is used to predict the risk of a DVT?

A

Well’s score. >3 = treat as DVT

464
Q

If iron def is detected on blood tests, but there is no obvious source of bleeding what is the diagnosis until proven otherwise?

A

GI carcinoma. RED FLAG

466
Q

For normally distributed variables:

  • populations >200 we can use what to calculate conficence intervals?
  • populations
A
  • Normal (Gaussian) distibution and its Z statistic of 1.96
  • Student’s t distribution
467
Q

What is the most common cause of macrocytosis? (without accompanying anaemia)

A

Alcohol excess

469
Q

What is the equation for OR? (in terms of words)

A

OR = the odds that an event will occur/the odds of an event not occuring

470
Q

In essence what is the core difference between nephrotic and nephritic syndrome?

A

Nephrotic = loss of a lot of protein

Nephritic = loss of a lot of blood

471
Q

What conditions are contraindicated in pts taking atrovent?

A

Atrovent = ipratropium bromide.

  • BPH, bladder outflow obstruction (precipitates urinary retention)
  • Angle-closure glaucoma
473
Q

What are the SE of statins?

A
  • Muscle pains
  • Hair loss
  • Itching

Also nausea, vomiting, diarrhoea, abdo pain

474
Q

What is the pattern of presentation for: septic arthritis?

A

Monoarthritis

475
Q

What must we do in order to find the CI for Odds ratios?

A

Apply the log of the OR and then find the exponential of it

476
Q

List 3 causes of an aneurysm?

A
  • Atheroma - trauma - Infection (infective endocarditis, tertiary syphillis) - Connective tissue disorders (marfans = josh, ehlers danlos) - Inflammatory disorders (takayasu’s aortitis)
476
Q

What is the effect of increased conc of: Digoxin?

A
  • GI disturbances
  • Xanthospia (colour vision def - yellow in vision)
  • Arrhythmias
476
Q

Difference between vesicle and bulla?

A

Vesicle = raised clear fluid filled lesion

Bulla > 0,5cm

477
Q

What 3 things are you going to look for in the hands on a thyroid examination?

A
  • Moisture (sweaty = hyper, dry = hypo) - Thyroid acropachy (phalangeal bone overgrowth) - Palmar erythema (hypo) - Oncholysis (hyper)
477
Q

What murmur is characterised by early diastolic?

A

Aortic regurg

478
Q

What type of unilateral vision loss is described during a TIA?

A

Amaurosis fugax

479
Q

What is the most common cause of blindness in industrialised countries?

A

Age related macular degeneration

479
Q

Cotton wool spots on retinopathy indicate what?

A

DM retinopathy. Ischaemic changes.

480
Q

Side effects of Timolol drops?

A
  • Blurred vision - Burning or stinging in the eye less common include those of cardiovascular and respiratory SE similar to those of other beta blockers
481
Q

What medical conditions predispose to epistaxis?

A
  • Kidney failure - Thrombocytopenia - Haemophilia - Hypertension
483
Q

What are the complications of diabetes in pregnancy?

A
  • poor birth outcomes
  • Macrosomia (birth wt above 90th percentile)
484
Q

What is this?

A

Tinea capitis

486
Q

What are mucolytics used for?

A

Make the sputum less thick

487
Q

Post bilateral thyroidectomy, what 3 drugs could the pt be put on? One for definite, one is a possibility depending on what?, the third is dependant on the second.

A
  • Thyroxine for life - Calcium (due to the potential of resection of the parathyroid glands as well) - Vit D
489
Q

What class of drug is sitagliptin? What is it used to treat?

A

Glucagon like peptide analogue - DPP4 inhibitor. Type II DM.

490
Q

What type of error is it when you find an efect when actually there is no genuine effect?

A

Type 1 - oh what fun

492
Q

What name is given to this condition “the generation of physical symptoms of a psychiatric condition”?

A

Somatisation

493
Q

What are risk factors for infective endocarditis on a normal valve?

A
  • dermatitis
  • IV injections
  • open wounds
  • renal failure
  • DM
494
Q

what will you be able to tell from the pulse in a thyroid exam?

A
  • rate (fast = hyper, slow = hypo) - Rhythm (irregular AF = hyper)
495
Q

What type of prevention is it when you remove a cause from unaffected individuals?

A

Primary prevention

496
Q

What drugs affect all antiepileptics and lower the convulsive threshold?

A
  • Antidepressants (SSRI, tricyclic)
  • antipsychotics
  • MAOIs
497
Q

Pt presents with lethargy, blurry vision and genital thrush? Differential?

A

Diabetes

499
Q

What type of glaucoma is a medical emergency?

A

Acute angle closure glaucoma

500
Q

What are the potential sources of bias and what solutions are there: analytical bias?

A
  • loss to follow up = intention to treat
  • omitted variable bias = prori hypothesis and primary data collection
  • attributional bias = priori design
502
Q

HbsAg: -ve. Anti-HbC -ve. Anti-HbS +ve?

A

Immunity due to hep B vaccination

503
Q

What tests are you going to do in a pt with acute pancreatitis?

A
  • serum amylase and lipas
  • AXR
  • LFTS (looking at ALT and ALP) before doing a USS for gallstones
  • ABG to monitor oxygenation and acid-base
504
Q

What are the three biologics commonly used in RA?

A
  • Infliximab
  • etanercept
  • adalimunab
505
Q

What causes gestational diabetes insipidus?

A

During preggo the placenta produces vasopressinase which breaks down vasopressin. GDI is caused by overproduction of vasopressinase by the placenta causing a lack of functional vasopressin.

506
Q

Causative organisms for epiglottitis?>

A
  • H.influenzae - Strep pneumoniae, - Group A strep
508
Q

What is the classic presentaiton of Lyme disease?

A

Erythema migrans rash. Lyme disease is a tick borne infection caused by Borrelia burgdorferi.

510
Q

Causative organism of croup?

A

parainfluenza virus

511
Q

True or false: the 95% confidence interval is a plausible range of values for the population mean

A

true

512
Q

Differentials for chest pain?

A
  • Cardiovascular (MI, angina, pericarditis, arrhythmias, aortic dissection)
  • Respiratory (pneumonia, pneumothorax, PE)
  • Other (Reflux, Anxiety, rib fracture, costocondritis)
514
Q

Explain the three different types of inhalers their purpose and when to use them plus their SEs?

A
  • Salbutamol is the blue reliever inhaler so you take this during an attack to relieve your symptoms. You may get a tremor or a fast heart rate by using this.
  • Steroid inhaler (beclomethasone) is the brown preventer inhaler and you use it every morning and night to prevent an attack. Make sure to rinse your mouth after use. You may experience a dry mouth, hoarse voice or thrush from using this but that’s why it’s important to wash your mouth out.
  • Dry powder or breath activate inhalers can be used as a reliever or preventer depending on the drug inside.
515
Q

Are case study and cross sectional studies a descriptive/inductive or analytical/deductive sampling research design?

A

Descriptive/inductive (producing evidence)

516
Q

Indications for phenytoin?

A
  • SEIZURES (tonic clonic, focal, status epilepticus)
  • Secondary treatment for trigeminal neuralgia (after carbamazepine)
518
Q

O/E

Chest expansion: equal

Trachea: central

Percussion: resonant

Breath sounds/added sounds: bilateral expiraotry wheeze and creps

Vocal resonance: normal

Differential?

A

COPD exacerbation

519
Q

What two Autoimmune disease present with firm diffuse goitres?

A

Graves’ disease & Hashimoto’s disease

520
Q

What is the effect of increased conc of: Gentamicin?

A
  • Renal Failure
  • Ototoxicity
521
Q

Pt presents with sudden and painless loss of vision. Fundoscopy reveals retinal oedema, pale, no haemorrhages. Differential?

A

Occlusion of retinal artery

522
Q

What is first line treatment in the black and elderly patient population for hypertension?

A
  • thiazide diuretics
  • calcium channel blockers (verapamil)
524
Q

Ropinirole is what type of drug use to treat what?

A

dopamine agonist used in the treatment of Parkinson’s disease

526
Q

What is used to cauterise bleeding vessels?

A

Silver nitrate

527
Q

Most common cause/risk factor for Hep A?

Moss common cause/risk factor for Hep B?

Most common cause/risk factor for Hep C?

A

Hep A = Foecal oral route (contaminated food or drinking water, person to person contact)

Hep B = Vertical transmission (from mother to infant) or horizontal (unprotected sex, sharing of needles, bodily fluid transmission)

Hep C = IVDU or sharing needles

528
Q

Systemic factors that predispose to rhino sinusitis?

A
  • Mucociliary disorder (Kartagener’s, CF) - Immunosuppressed.
529
Q

What is a unilateral periorbital headache indicative of?

A

Cluster headache

530
Q

What is this?

A

Tinea corporis

531
Q

O/E

Chest expansion: Equal

Trachea: central

Percussion: normal

Breath sounds: High pitched expiratory wheeze

Vocal resonance: normal

Differential?

A

Asthma exacerbation

532
Q

3 most common causes of vision loss?

A
  • Cataracts - Glaucoma - Macular degeneration
534
Q

Two most common ways of blood loss in a pt with iron def anaemia?

A
  • Mennorrhagia - GI bleed
535
Q

What should you think of in all patients with unexplained abdo pain and vomiting?

A

Addison’s disease

536
Q

Indications for salbutamol?

A
  • asthma, COPD
  • premature labour
  • used in treatment of hyperkalaemia
537
Q

What is a sialogram?

A

X-ray using contrast to look at salivary glands

538
Q

Complications of rhino sinusitis?

A

Can be very serious - Periorbital cellulitis - orbital cellulitis - Periorbital abscess - epidural abscess (most common) - meningitis - encephalitis - subdural empyema

539
Q

5 signs elicited from lobar pneumonia?

A
  • Tachypnoea - Confusion - Fever >39.5 - Increased vocal resonance - Dec chest expansion - Dull percussion note - Rusty coloured sputum
539
Q

What are the complications of chronic kidney injury?

A
  • hypertension - oedema - anaemia - renal bone disease - hyperkalaemia - hyperlipidaemia
540
Q

What are you going to look for on inspection of the arms in a peripheral vascular exam?

A
  • Colour (pallor) - tar staining - tendon xanthoma - gangrene
542
Q

What percentage of pts who have gallstones are symptomatic?

A

10%

543
Q

Heberden’s nodes are seen in what condition? What are they?

A

Osteoarthritis. Small bony nodules affecting the distal interphalangeal joints

544
Q

What are the two types of ARMD?

A
  • Dry - Wet
546
Q

Odds of 1 mean that the event will occur half the time. True or false?

A

True

548
Q

Most common cause of extrinsic compression of the trachea or oesophagus?

A

Multinodular goitre = can also cause laryngeal n. palsy.

549
Q

List 4 things you are going to do prior to checking a urine sample?

A
  • Introduction to pt - Check pt ID - Explain you need a mid stream sample of urine - wash hands and put on gloves and apron
551
Q

What are the 3 options that you have if your key variables are missing?

A
  • compre participants with complete and and missing data
  • create a missing category for missing measurements (reduce cont to categorical variables = losing info)
  • interpolate what the missing variable are likely to have been
552
Q

What does FSH stimulate? and to produce what?

A

Sertoli cells to produce androgen binding globulin which binds to testosterone to keep it at high concs in the seminiferous tubules.

553
Q

What is the normal range for the anion gap and if >? what does it indicate?

A

10-18 mmol/L. If over 18 then indicates presences of an increase in unmeasured anions (e.g lactate, salicylate)

555
Q

What is desmopressin?

A

ADH (synthetic vasopressin)

556
Q

What are the early features of meningitis?

A
  • Headache
  • cold hands and feet
  • abnormal skin colour
  • leg pains
558
Q

O/E

Chest expansion: equal

Trachea: central

Percussion: Dull at the bases

Breath sounds: fine inspiratory creps

Vocal resonance: reduced over affected zone

Differential?

A

Pulmonary oedema

558
Q

Knee examination: What are you looking for?

A
  • Inspect around bed side for walking sticks, wheelchair, knee brace
  • Gait (normal heel strike-toe off, inc step, smooth, symmetrical, antalgia, festinance, waddling)
  • Inspect
  • Front (scars, swellings, asymmetry, valgus or varus deformities, quad wasting)
  • Side (hyperextension or flexion)
  • Back (popliteal swellings, like bakers cysts or pop aneursym)
559
Q

What test would you use when examining the association between two categorical variables? What are the conditions?

A

Chi squared test.

The number of expected values in each of the fours cells in the contingency table need to be greater than one. And in 3 of the 4 the expected value should be greater than 5.

561
Q

Pt presents with acute tenderness in a diffuse swelling in the midline of his neck. Sometimes has severe pain.He’s currently got a systemic viral illness. Differential lump diagnosis? (think thyroid)

A

De quervain’s thyroiditis.

563
Q

What test would you use to diagnose addison’s disease?

A

ACTH stimulation test. Synacthen test. Give ACTH and this should cause an increase in cortisol but in addison’s due to the adrenal insuff, it doesn’t.

564
Q

List the 3 most common causative organisms for acute otitis media?

A
  • s. pneumoniae - H.influenzae - moraxella
565
Q

Painless, frank haematuria is what until proven otherwise?

A

Bladder cancer

567
Q

Name a thyrotoxic drug that is used in cardiac conditions?

A

Amiodarone (interferes with iodine absorption). Treatment for AF, atrial flutter, complex tachys.

568
Q

ECG - what’s the rate?

  • RR interval of 3 squares
  • RR interval of 4 squares
  • RR interval of 5 squares
A

bpm = 300/number of squares

3 squares = 100 bpm

4 squares = 75 bpm

5 squares = 60 bpm

568
Q

Which type of arthritis is symmetrical in nature?

A

RA

570
Q

What drug is used to treat ketoacidosis but what drugs are contraindicated in ketoacidosis?

A
  • treat = insulin
  • contra-indicated = gliclazide, metformin.
571
Q

What drugs can cause renal artery stenosis?

A

ACE-i

572
Q

What are the primary causes of nephrotic syndrome?

A
  • minimal change glomerulonephritis
  • focal segmental glomerulosclerosis
  • membranous glomerulonephritis

secondary causes include DM, SLE, Heb B and C, malig

573
Q

How does a pt with eczema present?

A
  • itchy, erythematous, dry sclay patches
  • more common on flexor acpest of children and adults
  • acute lesion erythematous, vesicular and weepy
  • nail pitting, excoriations and lichenification follows.
574
Q

What is the pattern of presentation for: crystal arthritis?

A

mono or oligoarthritis

575
Q

What is incidence?

A

Measures the number of new cases that occur over a specified time period in a population at risk

576
Q

Which of the following types of projects do requires formal ethical approval and which do not?

§*Non-human subjects/material covered by the Animals (Scientific Procedures) Act 1986

§Projects collecting new information only on service delivery – Service Evaluation*
§*Service Evaluations involving vulnerable participants or ethically sensitive topics

§Projects on non-human subjects/materials – Non-Human Research*
§Projects involving a new intervention – Experimental Research

§Projects using only existing service management data – Audit
§Projects collecting new information on more than only service delivery – Non-Experimental Research

§Data/material already published/publicly available – Secondary Research

A

Do =
§*Non-human subjects/material covered by the Animals (Scientific Procedures) Act 1986
§*Service Evaluations involving vulnerable participants or ethically sensitive topics
§Projects involving a new intervention – Experimental Research
§Projects collecting new information on more than only service delivery – Non-Experimental Research

Do Not =
§Data/material already published/publicly available – Secondary Research
§Projects on non-human subjects/materials – Non-Human Research*
§Projects using only existing service management data – Audit
§Projects collecting new information only on service delivery – Service Evaluation*

578
Q

HbsAg: +ve

anti-HbsAg:

anti-HbcAg IgM: +ve

anti-HbC: +ve

?

A

Acute hepatitis B infection

579
Q

What drug is given to those with paracetemol overdose?

A

N-acetylcysteine

580
Q

What is the dominant symptom in metabolic acidosis?

A

Hyperventilation (Kussmaul’s respiration)

581
Q

Differentials for cough?

A
  • Cardiac (LVF = frothy pink)
  • Respiratory (LRTI (yellow/green), URTI, asthma (nocturnal), COPD (clear/gray), pulmonary oedema (foamy pink), pleural effusion, PE (haemoptysis), allergy, malignancy, TB, CF)
  • Other (PND, GORD, Drugs (ACE-i))
582
Q

List 4 triggers for otitis externa?

A
  • moisture (Swimming) - foreign objects (ear buds, finger nails) - Trauma - Skin conditions (eczema, psoriasis)
583
Q

List 5 causes of cerebellar dysfunction?

A
  • MS
  • Tumour
  • Stroke
  • Chronic alcoholism
  • Iatrogenic (phenytoin, carbamazepine)
  • Friedereichs ataxia
584
Q

Effect of gentamicin and loop diuretics interaction?

A

renal failure risk

585
Q

from the tympanic membrane to the oval window, name the ossicles?

A
  • Malleus - Incus - Stapes
586
Q

Cholestasis would cause which LFT to rise?

A

ALP

587
Q

Differentials for change in bowel habit?

A
  • Gastro (colon cancer, IBD, IBS, gastroenteritis, coeliac disease, bowel obstruction, diverticulitis)
  • Thyroid (Thyrotoxicosis, hypothyroidism)
  • Drugs (opiates, iron, Abx)
588
Q

From a stata output:

  • what part will tell you the m and b aprts of y = mx +b?
  • what part will tell you the proportion of variation explained by the linear model?
A
  • coefs of the exposure = m
  • the coefs of _cons = b
  • R^2
589
Q

What is metoclopramide, what does it treat, how does it work?

A
  • Antiemetic (dopamin antagonisT0
  • Vomiting/Nausea & GOR
  • blocks dopamine receptors in chemoreceptor trigger zone of brain stem
  • dec pyloric sphincter tone = inc gastric emptying
  • Inc lower oesoph sphincter tone
590
Q

Difference between vesicle and pustule?

A

Vesicle = clear fluid filled lesion

Pustule = pus filled lesion

591
Q

True or false: the 95% confidence interval is wider than the 90% confidence interval

A

True - If we want to be more confident (95% confident rather than 90% confident) that our range of plausible values includes the true population value then it makes sense that the confidence interval has to be wider

592
Q

What is the effect of increased conc of: Warfarin?

A

Bleeding. monitor with INR.

593
Q

Pt presents with otorrhoea > 3 wks. No pain. Apyrexial. Previous history of glue ear. Otoscopy reveals perforated ear drum. Diagnosis?

A

Chronic suppurative otitis media.

595
Q

Alcohol induced lymph node pain is indicative of what?

A

Hodgkins lymphoma

596
Q

Which organism is more likely to give lobar pneumonia in a pt with a preexisting lung disease?

A

Haemophilus influenzae

597
Q

Lymphomas are histologically divided into 2 types?

A

Hodgkins & non-Hodgkins

598
Q

What is palmar hyperkeratosis called?

A

Tylosis (seen in oesophageal cancer)

599
Q

Which carcinoma of the skin is most likely to metastasise?

A

SCC

600
Q

Effect of ACE-i & metformin?

A

Enhances hypoglycaemic effect

602
Q

What is levodopa and what is it used to treat?

A

Dopamine precursor. Used to treat PD and parkinsonism

603
Q

What is the average age of onset of MS?

A

30 yo

604
Q

What do you observe for during the buerger’s test as the pt swings their legs over the side of the bed?

A

reactive hyperaemia - legs first returns to pink then become red. due to arteriolar dilatation in order to remove build up of metabolic waste.

605
Q

Common causes of mechanical bowel obstruction?

A
  • constipation
  • hernia
  • adhesions
  • tumour
606
Q

Which chest leads give the anterior view of the heart?

A

V3 & V4

607
Q

What two clinical entities make up COPD?

A

Emphysema & Bronchitis

608
Q

Differentials for breathlessness?

A
  • Cardiac (MI, angina, aortic stenosis, CCF, VSD)
  • Respiratory (asthma, COPD, pneumonia, PE, pneumothorax, pulmonary fibrosis, pulmonary oedema, pleural effusion, TB)
  • Other (anaemia, overdose of opioids, thyroid, DKA)
609
Q

How would you treat anxiety?

A
  • CBT
  • self help (lifestyle, education)
  • medication (benzodiazapines, SSRIs, antihistamines)
611
Q

What are the different types of gallstones? Which type is most common?

A
  • Cholesterol stones (large and often solitary)
  • Pigment stones (small and irregular)
  • Mixed stones (faceted made up of all constituents) Most common
612
Q

What is the effect of increased conc of: Lithium?

A

Tremor & coma

613
Q

What are the potential sources of bias and what solutions are there: dissemination bias?

A

Publication bias = prior registration and meta analysis

615
Q

What tests/investigations would you like to do after assessing a patient’s breathing during the ABCDE assessment?

A
  • Pulse oximetry
  • ABG (pH, PaO2, PaCO2, bicarb & base excess)
  • Portable CXR
617
Q

Extra nodal disease is more common in which of the two types of lymphomas?

A

Non-hodgkins lymphoma

618
Q

Term used to describe how well the tests detect a condition?

A

Sensitivity = picks up the true positives.

= a / a + c

= true positives / true positives + false negatives (total number who have tested postive according to gold standard)

619
Q

What is Decubitus angina?

A

Angina that occurs on lying down. Impaired LV function due to severe CAD.

620
Q

What are the 3 key types of study that support the development and assessment of healthcare?

A
  • Audit
  • Service evaluation
  • Research
622
Q

How do you identify confounders?

A
  • DAG (able to summarise all causal relationships between your known/available variables)
623
Q

Differentials for vertigo?

A
  • Peripheral (BPPV, viral labyrinthitis, vestibular neuritis, menieres disease, acoustic neuroma)
  • Central (vertobasilar insufficiency, head injury, MS, epilepsy, tumour, migraine, stroke)
  • Infection (COM, Ramsay Hunt syn.)
  • Drugs (gentamicin, alcohol, salicylates)
624
Q

What is another cause of microcytic hypo chromic anaemia?

A
  • Thalassaemia (inherited disorder - alpha and beta types) - Sideroblastic anaemia
626
Q

Where in the colon does colorectal cancer usually affect?

A

45% rectum. 25% sigmoid. 15% caecum.

627
Q

How are CI calculated with normal SD and distribution?

A

mean - 1.96 * SE to mean + 1.96 * SE

  • remember SE = sd/root of n
628
Q

What skin barrier function underlies atopic eczema?

A

loss of function in the protein fillaggrin

629
Q

Clinical features of cataracts?

A
  • gradual vision loss (can be rapid in DM) - Glare (esp at night) - Blurred, lazy vision - Halos - Monocular diplopia signs - reduced VA - reduced red reflex - poor view of fundus due to cloudy lens
630
Q

How does simvastatin work?

A
  • reversibly inhibits HMG CoA reductase which is the rate limiting eznyme in chol synth.
  • liver responds by inc LDL receptor expression to inc LDL uptake
631
Q

Normal ranges of plasma sodium?

A

125-145 mmol/L

632
Q

A red eye caused by coughing, sneezing, hypertension is likely to be what?

A

Subconjunctival haemorrhage (asymptomatic)

633
Q

pH ? leads to death?

A

pH 7.8 = death!

634
Q

What is the prevalence of clinical depression?

Risk factors for depression?

Is there a genetic element to depression?

A
  • 20% prevalence

Risk factors:

  • birth, loss, divorce, illness, jobs
  • endo problems (dexa suppression test abnor in 1/3)
  • lack of intimate relationships

Yes there is a genetic element (higher concordance in identical twins)

636
Q

Two types of hearing loss?

A
  • Sensorineural - Conductive
637
Q

Risk factors for an SCC?

A
  • UV exposure, pre-malignant skin condition (actinic keratoses), chronic inflammation, immunosuppression, genetics.
638
Q

Mechanism of action of clopidogrel? SE?

A
  • Inhibits platelet aggregation by preventing activation of gp11b/IIIa.
  • SE = dyspepsia, abdo pain, diarhhoea, bleeding
639
Q

What are the two most common causes of acute pancreatitis?

A
  • Gallstones
  • Alcohol
640
Q

How would diagnose depression?

How would manage depression?

A
  • Based on history

Treat using:

  • psychological treatment (behavioural therapy)
  • manage co-morbib condiitons (alcohol, anxiety, psychotic symps, eating disorders, dementia)
  • antidepressants (tricylic = amitriptyline. SSRIs = sertraline, citalopram, fluoxetine. MAOIs = Phenelzine)
  • ECT
  • Admission
642
Q

Another name for iritis?

A

Anterior Uveitis

643
Q

What are the symptoms of ARMD?

A
  • Disturbed central vision (scooter, blurring, distortion) - Difficulty appreciating detail (reading fine print, recognising faces)
644
Q

Differentials for fits/faints/syncope?

A
  • Vascular (postural hypotension, aortic stenosis, arrhythmia, ruptured AAA
  • Neurological (stroke, epilepsy, PD, head injury, vasovagal - emotional, fear, pain, nausea, pallor, sweat LOC 2 mins. intracranial haemorrhage, MS)
  • Drugs (alcohol, polypharmacy)
  • Others (hypoglycaemia, anaemia)
  • Postural instability
645
Q

Name a direct renin inhibitor?

A

Aliskerin

646
Q

Bounding pulse in a pt with SOB, what would you be thinking?

A

Acute Carbon dioxide retention

647
Q

what is injection sclerotherapy used to treat?

A

Varicose veins

648
Q

If AST > ALT = ?

A
  • established cirrhosis - ++ alcoholic liver disease
649
Q

What are you going to look for during examination of the hands during a thyroid exam?

A
  • temperature
  • thyroid acropachy
  • moisture of skin
  • palmar erythema
  • tremor
  • pulse (rate and rhythm)
650
Q

What are the signs of infective endocarditis?

A
  • Septic signs (fever, wt loss, rigors, night sweats, anaemia, splenomegaly, clubbing, malaise)
  • New or changing murmur
  • Oslers nodes, janeway lesions, roth spots
651
Q

How are you going to assess someone’s airway?

A

LOOK - for chest movements

  • paradoxical ‘see-saw’ pattern indiactes obstruction.
  • use of accessory muscles
  • misting of oxygen mask

LISTEN - abnormal sounds

  • snoring, choking, gurgling, stridor
  • silence

FEEL - airflow on inspiration and expiration

653
Q

What are the clinical features of delirium?

A

DELIRIUM

  • Disordered thinking (slow and irrational)
  • Euphoric (angry, depressed)
  • Language impaired
  • Illusions
  • Reversal of sleep cycle
  • Inattention
  • Unaware
  • Memory deficits
654
Q

Post strep glomerulonephritis and IgA nephropathy both cause what syndrome?

A

Nephritic syndrome.

655
Q

What can be given to a pt with acute tubular necrosis to protect the kidneys?

A

Sodium bicarbonate

657
Q

Amoxicillin + EBV = ?

A

Rash

658
Q

What are the differentials for rectal bleeding?

A
  • Gastro (Oesophageal varicies, Haemorrhagic peptic ulcer, Proximal polyp/cancer, Haemorrhagic infective gastroenteritis, IBD, IBS, distal colon cancer, Diverticular haemorrhage, haemorrhoids, anal fissures)
659
Q

B12 def can lead to what neurological problem?

A

Subacute combined degeneration of the spinal cord

660
Q

Pt presents with short history of painful swelling, purulent exudate from duct, cheek oedema, mild fever. Diagnosis?

A

Sialadenitis

661
Q

What drugs are cytochrome P450 inducers?

A

CRAPS out drugs - C = carbamazepine - R = rifampicin - A = bArbituates - P = phenytoiin - S = st johns wort

662
Q

Pt presents with a fever and a new murmur - what is the diagnosis until proven otherwise?

A

Infective endocarditis

663
Q

What drugs cause hyponatraemia?

A
  • Anti-depressants
  • Diuretics
  • Lithium
664
Q

What is the underlying mechanism of type I respiratory failure?

A

V/Q mismatch

665
Q

What is Buerger’s angle?

A

the angle at which a limb develops pallor during the buerger’s test indicating limb ischaemia.

666
Q

List 6 signs of respiratory failure?

A
  • Dyspnoea
  • redcued conciousness
  • tachycardia
  • tachypnoea
  • cyanosis
  • accessorry muscles for ventialtion
  • confusion
667
Q

List some causes of iron def anaemia?

A
  • BLOOD LOSS (menorrhagia or GI bleed)
  • Poor diet in babies and children
  • Malabsorption = coeliac disease is a cause of refractory IDA
  • Tropical (hookworm)
669
Q

Differentials for haemoptysis?

A
  • Respiratory (Pneumonia, PE, Lung tumour)
  • Others (Prolonged coughing, Mitral stenosis, TB, laryngeal carcinoma, Aspergillosis)
670
Q

How would you managed a DKA?

A
  • Fluid management
  • Blood glucose
  • check potassium
  • Give insulin and dextrose together
671
Q

In a mental health evaluation, what 4 or 5 questions are you going to ask before asking about suicidal thoughts?

A

During the last month, have you been bother by… - ..feeling down, depressed or hopeless? - having a persistent sadness of low mood? - have little interest in doing things of pleasure? - having fatigue? Have you felt like this for more than 2 weeks?

672
Q

What name is given to this?

A

Tinea manuum

673
Q

Name given to the folding over of the eyelid and going into the eye?

A

Entropion

674
Q

What is the most common cause of acute vertigo? Assoc symptoms include n&v, sweating, diarrhoea, profound sensorineural hearing loss, nystagmus towards the side opposite lesion.

A

Labyrinthitis

674
Q

What do you want to know about the presenting symptoms of a rheumatological history?

A
  • pattern of joint involvement
  • symmetry
  • morning stiffness >30mins
  • pain, swelling, warmth, erythema, loss of function
675
Q

Commonest cause of a bilateral pleural effusion?

A
  • Heart failure
676
Q

What drugs is prescribed as an opioid antagonist to prevent opiate overdose?

A

Naloxone

677
Q

What are the sources of ALP?

A
  • Biliary tract - Bone - Less so in placenta, SI & kidneys
678
Q

Pt presents with dysphagia. Initially was just dysphagia with food but has now progressed to dysphagia on liquids as well. There is odynophagia. No neck bulge. No difficulty in starting the swallowing movement. Diagnosis?

A

Oesophageal cancer

680
Q

What drugs do statins interact with? Include effect?

A
  • Ciclosporin = inc risk of myositis
  • Fibrates = inc risk of myopathy
  • Warfarin = inc effects of warfarin
  • Clarithromycin = inc risk of myopathy and rhabdomyolysis
681
Q

What interactions occur with Levodopa?

A
  • Anaesthetics (inc risk of dysrhthmias)
  • MAOIs (risk of HTN crisis)
682
Q

Most common cause of mitral stenosis?

A

Rheumatic heart disease

684
Q

Explain y = mx + b + E

A

y = y axis

m = gradient

x = x axis

b = y-intercept

E = residual part N(0, variance). Where N(0, variance) is the normal distribution of the residual with mean zero and a variance of whatever). As variance increases, the amount of noise increasse so less of the variation in the data is explained by the model. Variance = standard dec squared

685
Q

What type of chart or gram easily summarises freq/relative freq of cases which can also in confidence intervals?

What types of variables can a histogram only be drawn for?

A
  • Bar chart
  • continuous variables or for ordinal categorical variables
686
Q

List 3 causes of clubbing for each system? - Cardiac - Respiratory - GI - Endo (1)

A

Cardiac - Cyanotic congenital heart disease - Infective endocarditis - Atrial myxoma Resp - Lung cancer - Pulmonary fibrosis - Chronic pulmonary suppuration (bronchiectasis, empyema) - CF GI - IBD - Liver cirrhosis - Coeliac disease Endo - Thyrotoxicosis

687
Q

The overall direction of electrical activity are towards which leads?

A

Leads I, II, III.

688
Q

List 6 causes of red eye?

A
  • Conjunctivitis - Corneal abrasions - Acute iritis - Scleritis - Acute glaucoma - sub conjunctival haemorrhage
689
Q

What are the four key types of variable?

A

Categorical (nominal - male/female and ordinal - score)

Numerical (discrete and continuous)

690
Q

Name three salivary glands?

A
  • Parotid - Submandibular - Sub lingual
692
Q

What is made in the adrenal medulla? Give an example

A

Catecheloamines. Adrenaline.

693
Q

Commonest cause of Addison’s disease in the world?

A

TB

694
Q

ECG: Which chest leads give the septal view of the heart?

A

V1 & V2

695
Q

What would you see on examination of quinsy? How would the patient be speaking?

A
  • Deviated uvula (away from abscess) - Hot potato voice
696
Q

What drugs can mask warning signs of hypoglycaemia if a diabetic is taking insulin?

A

Beta-blockers

697
Q

How would you manage anaphylaxis?

A
  • call for helo
  • removal of trigger
  • IM or IV adrenaline
  • maintain airway patency
  • management of bronchospasm and CV collapse
698
Q

Which type of diabetes is there more of a genetic link with?

A

Type II DM. >80% concordance with identical twins

699
Q

In what leads would you see right axis deviation?

A

Lead 1 would become more negative and the deflection in lead III would be more positive. Right axis deviation = reaching towards

700
Q

What drugs cause hypokalaemia?

A
  • Salbutamol
  • Insulin
  • Diuretics
701
Q

What special tests are you going to perform to conclude your thyroid examination?

A
  • Pretibial myxoedema
  • Proximal myopathy
  • Ankle reflexes bilaterally (when they stand up out of chair, get them to rest a knee on the chair to elicit ankle reflex)
703
Q

Malar flush is due to what?

A

mitral stenosis.

704
Q

What is left censored data?

A

When we are not certain what happened to people before the time at which they entered the study. Common example is when people already have the disease of interest when the study starts

705
Q

List 6 presenting complaints for the respiratory system?

A
  • Cough +/- sputum production - Dyspnoea - Haemoptysis - Fever - Chest pain - Fever/night sweats
706
Q

Pt presents with unilateral stabbing pain in the head which last for about 2 seconds. Pt screws up face in pain. Pt gets pain in certain regions of the face. Differential?

A

Trigeminal neuralgia

707
Q

What the presenting symptoms of iron def anaemia?

A
  • Dyspnoea
  • Fatigue
  • palpitations
  • faintness
  • headache
709
Q

ECG: what would you see in a pt with a PE?

A
  • Tachycardia - S1 Q3 T3 (rare but indicative of PE)
710
Q

Mechanism of action of aspirin? Contra-indicated in what?

A

Inactivates COX. and dec thromboxane synthesis.

CI = peptic ulcer, haemophilia, active bleeding

711
Q

Pt presents with melaena, haematemesis, haemoptysis, anaemia, nausea but is otherwise well. Thinking ENT, what could be a differential?

A

Posterior Epistaxis. (less common than anterior epistaxis). Bleeding from the sphenopalatine arteries.

712
Q

Drug interactions with prednisolone?

A
  • ciprofloxacin (and other quinolones)
  • phenytoin (dec effect of pred)
  • rifampicin (dec effect of pred)
  • coumarins (enhance or reduce anticoag effect)
  • amphotericin ( inc risk of hypokal)
713
Q

What is the definition of an AKI?

A
  • Rise in serum creatinine > 26 micromol/L within 48 hours

OR

  • Rise in serum creatinine >1.5 baseline within 1 week

OR

  • urine output
714
Q

What is the effect of increased conc of: Theophylline?

A
  • Arrhythmias
  • Seizures
715
Q

What are the two types of authorised research ethics committees?

A
  • Institutional
  • Government
716
Q

Knee examination: what are you going to move?

A
  • Perform flexion and extension both actively and passively (can you move your heel towards your bottom please?)
  • lift both legs by feet and note any hyperextension
  • Special tests
  • Ant/post drawer tests (flex pts knee at 90degrees, rest forearem on shin and elbow on foot, pull and push tibia)
  • Collateral ligs (extend knee fully, hold pts knee in one hand and lower portion of leg in other hand. attempt to bend lower leg medially = lat collateral lig and then laterally = med collateral lig)
717
Q

name given to a palpable raised lesion which is like a plateau >0.5cm?

A

Plaque

718
Q

Infectious mononucleosis is what? caused by what?

A

Glandular fever. EBV.

719
Q

What is the range for relative risk?

A

0 to infinity

721
Q

Most common nodular goitre?

A

Multinodular goitre

722
Q

Clinical audit or service evaluation?

“does this service reach a certain standard?”

A

Clinical audit

723
Q

Causes of a simple diffuse goitre?

A

Physiological changes (puberty or preggo)

724
Q

What is this an example of? term and assoc condition?

A

Lichenification. Eczema

725
Q

Can research include elements of both audit and service evaluation?

A

Yes it can. Research is designed to generate new, generalisable knowledge.

727
Q

5 features of Heart failure on CXR?

A

A - Alveolar oedema (Bat wings) B - Kerley B lines (interstitial oedema - outer margins) C - Cardiomegaly D - Dilated upper lobe vessels E - Pleural Effusions

729
Q

Pt with a PE presents to A&E. Is their haemoptysis going to be blood mixed into sputum or not mixed into sputum?

A

Blood is not mixed with sputum in a PE. Along with Trauma and bleeding into lung cavity.

730
Q

What is right censored data?

A
  • occurs when people in the study to do not reach a failure before the end of the study
731
Q

Name a pansystolic murmur?

A

Mitral regurg

732
Q

What final test would you do to demonstrate poor lower limb perfusion? Describe it

A

Buerger’s test - pt supine - stand at bottom of bed and raise both legs to 45 degrees for 2-3 mins. - observe for pallor (emptying of superficial veins) - healthy leg should remain pink even at 90 - after 3 mins ask pt to swing legs over side of bed - observe for reactive hyperaemia (goes pink then red)

733
Q

What further investigations would you like to do following a thyroid examination?

A
  • Full neck examination
  • TFTs
  • USS
734
Q

What are the late features of meningitis?

A
  • Meningism (photophobia, neck stiffness, Kernig’s sign)
  • seizures
  • petechial rash (non blanching)
  • Dec in conscious level
735
Q

Give an example of a yeast infection?

A

Candidiasis

736
Q

What is a perceptual experience without an object or stimulus, that appears subjectively real known as?

A

Hallucination

737
Q

What antibodies do you look for to help diagnose coeliac disease?

A

Alpha gliadin

738
Q

What causes dementia?

A
  • Alzheimers (60%)
  • Vascular (more sudden onset than AD)
  • Lew body (shares many features wioth AD & PD)
  • Others (huntingtons, metabolic disorders (alcohol. vitb12), hypothyroidism, psych)
739
Q

What conditions is carbamazepine contra-indicated in?

A
  • Bone marrow depression
  • AV conduction abnormalities
  • Porhpyrias
740
Q

Commonest cause of a unilateral pleural effusion?

A
  • Pneumonia - Malignancy
741
Q

List 5 presenting symptoms of coeliac disease?

A
  • Diarrhoea - Steatorrhoea - Wt loss - Abdo pain - Nausea & vomiting - Bloating
742
Q

Respiratory failure is defined as a Pa02 less than what?

A

Pa02

743
Q

What is sialadenitis?

A

inflammation of salivary gland

744
Q

What effect does alcohol have on a blood film?

A

macrocytosis

745
Q

Who does acute otitis media most commonly affect?

A

3-7 yo

747
Q

What is Dressler syndrome?

A

Secondary form of pericarditis that occurs as a complication of MI. Consists of fever, pleuritic pain, pericarditis and/or pericardial effusion.

748
Q

Tall T waves caused by?

A
  • hyperkalaemia (tall tented T waves)
  • Myocardial ischaemia (hyper acute MI)
749
Q

What is variant (prinzmetal’s) angina?

A

Angina without provocation. Usually at rest due to coronary artery spasm

750
Q

Name a H2 antagonist?

A

Ranitidine

751
Q

Commonest cause of Addison’s disease in UK?

A

Autoimmunity

752
Q

Slow rising and small volume carotid pulse - what murmur?

A

Aortic stenosis

753
Q

List 4 presenting psychological symptoms of a pt with anxiety?

A
  • Inability to concentrate - Poor sleep - constant worry - irritable - feeling depressed - tired
754
Q

HbsAg and IgM anti-HbcAg indicates what stage of hepatitis?

A

Acute hepatitis B infection

755
Q

What is Lhermitte’s sign?

A

Neck flexion that causes electric shocks in trunk and limbs. +ve in MS and cevrical spondylosis, cord tumours and Subacute combined degeneration of spinal cord

756
Q

What are the clinical features of dementia?

A
  • Memory loss (short term memory loss)
  • Decline in cognitive function (language impairment, planning, difficulty performing complex tasks)
  • Challenging behaviours (depression, anxiety, incontinence, aggression, wandering, psychosis, dis-inhibition)
757
Q

Common causes of metabolic acidosis?

A
  • Lactic acidosis
  • Ketoacidosis
  • Poisoning
  • Acute or chronic kidney disease
758
Q

How do you managed hyperkalaemia?

A
  • 10% 10ml Calcium gluconate (cardio protective)
  • Insulin and dextrose
  • Salbutamol nebs (pushes K+ back into cells)
759
Q

What is koilonychia? Indicative of?

A

Spoon shaped nails. iron def anaemia

760
Q

What is the most common cause of macrocytic anaemia in the Western World?

A

B12 def, pernicious anaemia

761
Q

HBsAg -ve, anti-HBc +ve, anti-Hbs +ve?

A

Immunity via natural infection

762
Q

What is the most common salivary gland to suffer from sialadenitis?

A

Parotid

763
Q

What are the signs of liver failure?

A
  • jaundice - hepatic encepahlopathy - fetor hepaticus (pear drops) - Asterixis - constructional apraxia
765
Q

What is Trismus?

A

Spasm of jaw muscles keeping it closed aka lockjaw

766
Q

What signs would you elicit in a pt with subacute combined degeneration of the spinal cord?

A
  • symmetrical posterior column loss so sensory and LMN signs - symmetrical corticospinal trat loss so motor and UMN signs - Classic triad of extensor plantars, absent knee jerks, absent ankle jerks.
767
Q

How would you perform a cognitive assessment?

A

Old (orientation) Tired (time) Psychiatrists (Place) Persevere (person) At (attention - observe for distractions) Creating (concentration - test using sequencing exercises) Mnemonic (memory - working, short and long term) Learning (language) - Codswallop (construction - apraxia)!

768
Q

Two most common types of oesophageal cancers?

A
  • Squamous cell carcinoma (middle third of oesoph) - Adenocarcinomas (lower third)
769
Q

What word is given to describe an auditory hallucination?

A

Tinnitus

770
Q

Clinical signs of hypercapnia?

A
  • confusion - flapping tremor - drowsiness - bounding pulse - headache - warm extremities
771
Q

Marked raise in ALT & AST indicates what? (list 3 things)

A
  • drug/toxin induced hepatitis - viral hepatitis - liver ischaemia
772
Q

Common causes of type 1 respiratory failure?

A
  • Pneumonia - PE - Pneumothorax - Pulmonary oedema - Acute asthma - COPD
773
Q

In a thyroid examination, what would be testing if you asked the patient to stand up from a low chair without using their arms?>

A

Peripheral myopathy

774
Q

What is this?

A

tinea pedis with tinea unguium

776
Q

Which lymph nodes are most likely to be affected in hodgkins lymphoma>?

A

Cervical lymph nodes. Enlarged, painless, non tender, rubbery superficial lymph nodes.

777
Q

Which lead will show the most positive deflection?

A

Lead 2

778
Q

Effect of thiazide and PPI?

A

Hyponatraemia

779
Q

Pt presents with breathless worse on exertion and also collapses. Differentials?

A
  • Aortic stenosis! - LRTI - Exacerbation of asthma - PE
780
Q

What are the ALARM symptoms in peptic ulcer disease?

A

Anaemia, Loss of wt, Anorexia, Recent onset of progressive symptoms, Maleana, swallowing difficulty

781
Q

Side effects of amlodipine?

A
  • abdo pain
  • nausea
  • ankle oedema
  • dizziness
  • constipation
782
Q

Causes of delirium (confusion)?

A

HIDEMAP-H

  • Hypoxia (pneumonia, anaemia, MI)
  • Infection (URTI/LRTI, UTI, malaria, wounds)
  • Drugs (opiates, sedatives, anticonvulsants)
  • Endocrine (hyper/hypothyroid, addison’s and cushing’s, DKA)
  • Metabolic (uraemia, liver failure, hyper/hypo natraemic/glycaemic, malnutrition)
  • Alcohol withdrawal
  • Pyschosis
  • head injury
783
Q

Carcino-embryonic antigen (CEA) is a tumour marker for what type of cancer?

A

GI neoplasms, esp colorectal Ca.

784
Q

Normal bicarb range on an ABG? Normal base excess range?

A

21-28mmol/L.

BE +/- 2

785
Q

Is vomited or coughed up blood acidic and dark?

A

Vomited. (bright red, alkaline and frothy = coughed up)

786
Q

What are the two main symptoms of Sjogren syndrome?

A
  • Xerostomia (dry mouth) - karatoconjunctivitis sicca (dry eyes)
787
Q

Entacapone is a type of what drug? Use in the treatment of what disease?

A

COMT inhibitor. Parkinson’s disease

788
Q

What is the Kiesselbach’s plexus?

A

Area in the anterior inferior part of the nasal septum where four arteries anastomose - 90% of epistaxis

789
Q

Which is the most common salivary gland to get sialolithiasis?

A

Sub mandibular

790
Q

What class of drug is sitagliptin? What is it used to treat?

A

Glucagon like peptide analogue - DPP4 inhibitor. Type II DM.

791
Q

How long is termed chronic in the case of rhino sinusitis?

A

>12 wks. Acute

792
Q

3 most common causes of GI malabsorption in the UK?

A
  • Coeliac disease - Chronic pancreatitis - Crohn’s disease
793
Q

Young child presents with stridor, odynophagia, dyspnoea, hoarse voice. Diagnosis?

A

Epiglottitis

794
Q

What score is used to predict the risk of a DVT?

A

Well’s score. >3 = treat as DVT

795
Q

In which type of lymphoma is extra nodal disease more common?

  • which type of lymphoma has alcohol induced lymph node pain?
A
  • Non hodgkins lymphoma
  • Hodgkins lymphoma
796
Q

What investigations would you do to someone with potential hearing loss?

A
  • Audiogram - MRI if tumour suspected
797
Q

Reference range for anaemia in men? Hb

A

Hb

798
Q

Clubbing, soft tissue swelling and new sub periosteal bone formation is a sign of what condition and what is it called as a collective group of signs?

A

Thyroid acropachy

799
Q

Differentials for abdo pain?

A
  • Infection (cholecystitis, cholangititis, hepatitis, pancreatitis, gastroenteritis, appendicitis, peritonitis, diverticulitis, pyelonephritis, pneumonia)
  • Inflammatory (PUD, GORD, IBD, IBS, coeliac, renal colic, endometriosis)
  • Vascular (ruptured AAA, MI, mesenteric ischaemia)
  • Malignancy (gastric Ca. colorectal Ca)
  • Mechanical (bowel obstruction, hernia, ectopic preggo)
800
Q

What names is given to the condition which is due to the inflammation of the mucosal membranes of the paranasal sinuses?

A

Rhinosinusitis

801
Q

Which leads represent the lateral view of the heart on an ECG?

A

V5, V6, Leads I, aVL & aVR

802
Q

Where is folate absorbed?

A

duodenum/ prox jejunum

803
Q

Name two types of analytical (deductive) research designs and list some examples of each?

A
  • Observational (selective sampling) = cross sectional analytical, case-control, cohort
  • Experimental (selective exposure) = trials
804
Q

Where does the aqueous humour drain?

A

Via the trabecular meshwork in the angle formed by the iris and cornea.

805
Q

What are the clinical features diabetic ketoacidosis?

A
  • coma
  • severe hyperglycaemia
  • Kussmaul respiration (deep gasping breaths)
  • breath smells of pear drops
  • cerebral oedema
  • severe abdo pain
806
Q

What sign is caused by skin hardening from subcutaneous fibrosis due to chronic inflammation and fat necrosis in varicose veins?

A

Lipodermatosclerosis

807
Q

How do you explain to a pt about using their inhalers?

A
  • Introduction (WIPE)
  • Check for current understanding of condition and inhaler treatments
  • Initial explanation (type of inhaler, purpose and when to use + inhaler contains set dose of medication and the aim is to get it into the lungs + you release the drug by twisting/clicking the device)
  • Steps of use
  • Check expiration
  • Shake vigorously
  • remove cap and check inside is clean
  • Stand it up right
  • Place index finger on top and thumb underneath
  • Breath out completely
  • Seal mouth well around mouthpiece
  • Simultaneously press down and breath in deeply and slowly
  • Hold breath for 10 seconds
  • Breathe out slowly
  • Replace cap
  • Repaet after 1 min if required
  • Demonstration and observation
  • Other advice (seek emergency help if symptoms are sevre or not being relieved by inhaler, see GP if suffering SE or using reliever > 3 x /wk, any questions?
808
Q

How do you manage anaphylaxis?

A
  • IM adrenaline injection
  • Give anti-histamines later
809
Q

Diabetes insipidus is characterised by what?

A

The passage of large volumes of dilute urine

810
Q

List 5 causes of sialadenitis?

A
  • Sialolithiasis (obstruction) - Dehydration - Mumps - surgery - trauma - AI disease
811
Q

What should you think of in all patients with unexplained abdo pain and vomiting?

A

Addison’s disease

812
Q

What is Reiter’s syndrome?

A

Reactive arthritis - AI condition which develops due to an infection in another part of the body.

  • inflammatory arthritis
  • urethritis
  • conjunctivitis
813
Q

Pt presents with severe vertigo and hearing disturbances, and has had a cough for the past week. Differential?

A

Viral labyrinthitis

814
Q

What are the potential sources of bias and what solutions are there: measurement bias?

A
  • information bias = priori hypotheiss and prospective data collection
  • observer bias = blinded, indepedant and objective
  • recall/response/prestige bias = blinded
815
Q

Complications of acne vulgaris?

A
  • post inflam hyperpigmentation, scarring, deformity, socail effects
816
Q

What would you look for on general inspection of a pt during a thyroid examination?

A
  • comment on behaviour (appear irritable or apathetic)
  • comment on body habitus
  • comment on clothes for current time of year
817
Q

Name a cardioselective and a nonselective beta blocker?

A

Cardioselective = Atenolol & bisoprolol

Nonselective = Propanolol, carvedilol

818
Q

What are the three factors in diagnosing acute otitis media?

A
  • recent, sudden onset of middle ear inflammation and effusion - Signs of middle ear effusion (bulging of tympanic membrane, otorrhoea, fluid air level behind membrane) - Signs and symptoms of middle ear inflammation (red tympanic membrane, otalgia)
819
Q

Which type of respiratory failure is due to inadequate alveolar ventilation?

A

Type II respiratory failure

820
Q

At a RRAPID station what are you going to assess in the circulation section? What would you want to do, and how would you manage?

A
  • looking for signs of shock
  • HR, BP, CRT, JVP, ausculation of heart sounds, volume status, urine output, ECG external haemorrhage
  • Manage using IV access (warm fluid replacement or blood replacements)
  • catheter
821
Q

What drugs interactioins does gliclazide have?

A
  • Fluconazole/miconazole = inc hypoglycaemic effect
  • chloramphenicol, coumarins, NSAIDs
822
Q

What are the SE of levodopa?

A
  • N & V
  • Abdo pain
  • insomnia
  • agitation
  • postural hypotension
  • palpitations

Rarely reddish discolouration of bodily fluids, psych symptoms

823
Q

ECG: if the R wave is greater than the S wave, does it suggest that depolarisation is moving towards or away from that lead?

A

Towards that lead

824
Q

Risk factors for a BCC?

A
  • UV, male, immunosuppression, age, skin type I, previous history of skin cancer, sun burn.
825
Q

What would a AXR show in a pt with acute pancreatitis?

A
  • no psoas show due to inc in retroperitoneal fluid
826
Q

Common causes of type 2 respiratory failure?

A
  • COPD - Exhaustion - Flail chest injury - Opiate toxicity - Obstructive sleep apnoea
827
Q

True or false: if we repeatedly sampled a population and constructed a 99% confidence interval for the mean of each sample then, in the long run, 99%?of the confidence intervals would include the true value of the mean

A

True

828
Q

What would you see on CXR in aortic regurg?

A

LV enlargement

829
Q

Pt presents with vertigo following a herpes zoster infection. O/E of external ear there are vesicular lesions. Pt complains of otalgia, sensorineural deafness, ipsilateral facial paralysis. Diagnosis?

A

Ramsay Hunt syndrome

830
Q
A
831
Q

What type of aneurysm can you get in infective endocarditis?

A

Mycotic aneurysm

832
Q

How do you manage a tension pneumothorax?

A
  • Thoracocentesis (cannula)
  • Later on put in chest drain
833
Q

What drugs have a narrow therapeutic index and have lots of interactions?

A

Guys (Gentamicin) With (warfarin) Large (Lithium) Dongles (digoxin) Totally (theophylline) Make (methotrexate) Perfect (phenytoin) Internet (insulin) Connections (ciclosporin)

834
Q

List 4 ENT (inner ear) differentials for vertigo and say how you would distinguish between them in a history?

A
  • benign paroxysmal positional vertigo (episodes lasting around 30 seconds, evoked by head turning. Rotational vertigo) - Viral labyrinthitis (severe vertigo and hearing disturbances, preceded by URTI, may have tinnitus, otalgia, N&V, fever) - Vestibular neuritis (lasts several days, preceded by URTI, rotational vertigo and vomiting, several episodes a year) - Meiniere’s disease (classic triad of vertigo, hearing loss and tinnitus)
835
Q

Are ACE-i or calcium channel blockers safe in preggo?

A
  • calcium channel blockers
836
Q

Complication of bacterial tonsillitis?

A

Quinsy = peritonsilar abscess

837
Q

Gustatory sweating is a complication of what surgery? What syndrome does it give rise to?

A

Surgery around the parotid gland. frey syndrome.

838
Q

What are the red flags for urgent referral to a colorectal cancer clinic?

A
  • rectal bleeding or a persistent change in bowel habit >6 wks
  • iron def anaemia without an obvious cause
  • palpable abdo or rectal mass
  • recent onset of looser stools and or inc in freq of shitting >6 wks
839
Q

ECG: which leads do you apply to the four limbs?

A
  • Red = right wrist or shoulder
  • Yellow = left wrist or shoulder
  • Green = left ankle
  • Black = right ankle (earth electrode)
840
Q

Perform a shoulder examination

A

Look

  • front (scars, swellings, asymmetry, muscle wasting)
  • Side (scars, muscle wasting, alignment of shoudler girdle)
  • Back (scars, trapz bulk, scapula - elevated, depressed, winging)

Feel

  • Joints and bones
    • start at sterno-clavicular joint
    • clavicle
    • acromio-clavicular joint
    • coracoid
    • acromion
    • head of humerus
    • spine of scapula
  • Muscle bulk of deltoid

Move

  • Active (flexion, extension, abduction, adduction, internal and external rotation)
  • Passive movement (feeling for crepitus)

Function

  • Hands behind head (ext rot and abd)
  • Hands as far up your back as you can (int rot and add)

Special tests

  • Impingement (painful arc) - abduction of arm against light resistance = supraspin
  • Internal rotation against resistance (subscapularis muscle) - dorsum of hand on back, apply resistance and lift off
  • External rotation against resistance (infraspin and teres minor) - loss of power = tear. pain on forced ext rot = tendonitis.
841
Q

Perform an elbow exam

A
  • Look
  • Front (Scars, swelling, eyrthema, carrying angle)
  • Side (fixed flexion derformity, olecranon bursitis, scars, swelling, erythema)
  • Back (Rheumatoid nodules, psoriatic plaques)
  • Feel
  • Temperature
  • Palpate joint lines
  • Move (active and passive)
  • elbow flexion and extension
  • supination and pronation
  • Special tests
  • Medial epicondylitis (golfers) - flex elbow, supinate hand, ask pt to flex wrist against resistance
  • Lateral epicondylitis (tennis) - flex elbow, pronate hand, ask pt to extend wrist against resistance
842
Q

Observing the patient from the end of the bed, what features might make you suspect an airway obstruction?

A

Paradoxical breathing pattern, added noises such as snoring, gurgling

843
Q

What features, if present, would alert you that the patient was experiencing an anaphylactic reaction? 

A
  • Sudden deterioration, rash, urticaria
  • airway swelling, wheeze, CV collapse
844
Q

Anaphylaxis: Other than high flow O2, what drug would you immediately consider giving?

A

Adrenaline (0.5 mls of 1:1000 IM)

845
Q

Treatment for Pulmonary oedema?

A
  • high flow oxygen
  • diuretics
  • nitrates
  • possibly non invasive ventialation
846
Q

What are the 5 principle categories of shock? with some causes

A
  • hypovolaemic (dehydration, fluid loss and haemorrhage - reduced JVP)
  • Distributive shock (septic - bounding pulses, warm pt, anaphylactic)
  • Cardiogenic (MI, HF - increased JVP)
  • Obstructive (PE, tamponade, tension pneumothorax)
  • Neurogenic (spinal transection or brain stem injury)
847
Q

What are 4 causes of hypoglycaemia?

A
  • excess insulin
  • oral hypoglycaemics
  • alcohol
  • liver failure
848
Q

What Abx is used to treat chlamydia infection?

A

Tetracyclin

849
Q

What is contra-indicated for tetracycline?

A

-preggo & breat feeding. deposits in gorwing bone and lead to pemanent staining of teeth.

850
Q

What products should you avoid when taking tetracyclines?

A

Milk products as these dec absorption of the drug

851
Q

Name two glycopeptides?

A
  • Vancomycin & teicoplanin
852
Q

What abx to treat MRSA?

A

Vacomycin

853
Q

List 3 drugs which can cause pulmonary fibrosis?

A

Methotrexate, nitrofurantoin and amiodarone

854
Q

Common side effect of sulphasalazine?

A

Reversible oligospermia

855
Q

Gum hypertrophy can be due to what drugs?

A

ciclosporin, phenytoin and calcium channel blockers

856
Q

What is a stoke-adam attack?

A
  • Transient arrhythmias that decrease CO sufficient to cause syncope.
  • recovery is quick

= pt is usually pale with syncope and then becomes flushed on recovery

857
Q

List some drugs which could cause postural hypotension?

A
  • Antihypertensive medication. Beta blockers, L-dopa and tricyclic antidepressants affect autonomic nervouse system
858
Q

CXR: tramlining and ring shadows are characteristic of what lung pathology?

; miliary shadowing?

; wedge shaped infarct?

; ground glass appearance?

; honeycomb appearance?

; pleural mass with lobulated margin?

A
  • Bronchiectasis
  • miliary tb
  • PE
  • fibrosis early
  • fibrosis late
  • mesothelioma
859
Q

Causative organisms in pts with pneumonia:

  • cavitating lungs
  • contact with birds
  • HIV +ve with bilateral hilar shadowing
  • occupation involving water symptoms
A
  • staph/klebsiella
  • chlamydia psittaci infection
  • pneumocystis carinii pneumonoa
  • legionella infection
860
Q

Side effects of some drugs:

  • orange coloure tears/urine, deranged LFTs, hepatitis
  • peripheral neuropathy, hepatitis
A
  • Rifampicin
  • Isoniazid
861
Q

Normocytic anaemia is caused by?

A
  • anaemia of chronic disease (malignancy, RA)
862
Q

Pt is of mediterranean origin, rapid anaemia, jaundice, precipitated ny fava beans and sulphonamides;

  • what haematological disease are you suspecting?
A

Glcuose 6 phosphate dehydrogenase def

863
Q

Presentation of malignancy - what type of cancer is most likely?

  • change in bowel habit, per bleeding
  • painless total haematuria
  • painless obstructive jaundice
  • anaemia and dysphagia
  • haemoptysis with a smoking history
  • bladder outflow obstruction with bone pain
A
  • colorectal cancer
  • bladder cancer
  • head of pancreas cancer
  • Gastric cancer
  • bronchial cancer
  • prostate cancer
864
Q

Haematological malignancy:

  • reed sternberg cells?
  • auer rods?
  • Middle age with inc WCC, philadelphia chromosome?
A

= Hodgkin’s lymphoma

  • AML
  • CML
865
Q

Neuro disease:

  • lead pipe rigidity, cog wheel rigidity, pill rolling tremor, festinant gait with poor arm swing
  • optic neuritis, leg weakness, ataxia, heat worsens symptoms, IgG oligoclonal bands on electrophoresis, raised CSF protein
  • mixed UMN & LMN signs but no sensory loss
  • chorea onset middle age, with a positive family history
A
  • Parkinson’s disease
  • MS
  • Motor neuron disease
  • Huntington’s disease
866
Q

Name the syndrome;

  • triad of nystagmus, opthalmoplegia, ataxia (caused by thiamine def)
  • ipsilateral pyramidal signs plus contralateral loss of pain and temp
  • saddle anaesthesia with bowel/bladder disturbances, bilateral leg pains
  • signs of gross defect in memory of recent events, confabulation may be present, condition irreversible
  • ascending symmetrical flaccid muscle weakenss, preceding recent resp/GI infection
A
  • Wernicke’s encephalopathy
  • Brown-sequard syndrome
  • cauda equina syndrome
  • Korsakoff’s syndrome
  • Guillain Barre syndrome
867
Q

Describe the gait in the following conditions;

  • Cerebellar lesion
  • Cerebrovascular disease
  • Sensory ataxia
  • Parkinson’s disease
A
  • wide based gait
  • shuffling small steps
  • high stepping/stamping gait
  • shuffling/festinant gait
868
Q

What’s the problem?;

  • constricted, irregular pupils which react to accomodation but not to light?
  • dilated pupil with ptosis, eye is deviated laterally and downward?
  • bilateral pin point pupils with respiratory depression?
  • bilateral dilated pupils plus anticholinergic signs *tachycardia, hypotension, urianry retention?
  • unilateral constricted pupil, ptosis, anhidrosis?
A
  • Neurosyphilis (argyll robertson pupil)
  • CNIII palsy
  • opiate overdose
  • tricyclic antidepressant overdose
  • Horner’s syndrome
869
Q

Nerve injury;

  • Wasting thenar eminence, Loss of sensation on lateral palmar surface of three and a half digits, Test for weakness in abductor pollicis brevis?
  • weakness of wrist extension, anaesthesia over first dorsal interosseous muscle
  • weakness in dorsiflexion and eversion of foot
  • wasting of hypothenar eminence, sensory loss over medial one and a half fingers. cla hand deformity
  • inability to invert foot or stand on tip-toe?
  • waiter’s tip sign?
A
  • Median nerve
  • radial nerve
  • common peroneal
  • ulnar nerve
  • tibial nerve
  • Erb’s palsy
870
Q

What are the four A’s association with ankylosing spondylitis?

A
  • Arthritis
  • anterior uveitis
  • apical lung fibrosis
  • aortic regurg
871
Q

Pt presents with orogenital ulceration, uveitis, arthritis and is Turkish. What connect tissue disease does she have?

A

Behcet’s disease

872
Q

What would you use to treat trichomonas vaginalis? Foul, yellow smelly vaginal dishcarge. Flagellate.

A

Metronidazole

873
Q

Which of the bowel obstructions is more likely to present with early vomiting and colicky central abdo pain?

A

Small bowel obstruction. Large bowel, vomiting appears later and is faeculent.

874
Q

What type of drug is carbimazole? How does it work?

A

Anti-thyroid. Inhibits thyroid peroxidase which is needed for thyroid synth.

875
Q

SE of carbimazole. What should the doctor counsel the pt on about the SE of carbimazole?

A
  • Nausea & GI disturbances, taste disturbances, headache
  • rarely bone marrow suppression (agranulocytosis)
  • warn pts to tell doc immediately if sore thorat, mouth ulcers, bruising, fever, malaise, or non-specific illness develops.
876
Q

What would you prescribe for rapid relief of thyrotoxic symptoms?

A
  • Propanolol
  • carbimazole
  • during a thyrotoxic crisis you could als prescribe hydrocortisone.
877
Q

What advice must be given to pts taking alendronic acid?

A
  • Tablets should be swallowed whole with plenty of water while sitting or standing and taken on an empty stomach at least 30 mins before breakfast and should remain sitting or standing for 30 minutes after taking the tablet.
878
Q

What is alendronate? What is it used for? What are its contraindications & SE?

A

Bisphosphonate.

  • Used in post menopausal osteoporosis, osteoporosis and corticosteroid induced osteroporosis.
  • Abnormalities in oesophagus (strictures), hypocalacaemia, renal impairment and preggo
  • Oesophageal reactions, abdo discomfort, GI disturbances
879
Q

What drugs impair the absorption of bisphosphonates?

A
  • Antacids
  • calcium salts & iron salts
880
Q

Interaction of calcium salts?

A
  • ciprofloxacin, tetracyclin (dec absorption of Abx)
  • Diuretics (inc risk of hypercalcaemia)
881
Q

What are the contraindications for Vit D? What interactions?

A

Hypercalcaemia. Metastatic calcification.

  • Phenytoin/carbamazepin = inc Vit D requirements. Diuretics = inc risk of hypercalcaemia.
882
Q

Interactions of Diclofenac?

A
  • Anticoags (inc risk of haemorrhage)
  • Ciclosporin (plasma conc of diclo inc by ciclo)
  • Methotrexate (reduceds excretion of metho so inc risk of toxicity
883
Q

How does morphine work?

A
  • Mimics endogenous opioids and acts on the opioid receptors in the dorsal horn, the periaqueductal grey matter and the midline raphe nuclei.
884
Q

Contra-indications for morphine?

A
  • Severe respiratory depression (COPD, asthma attack(
  • Head injury or raised ICP
  • paralytic ileus or other undiagnosed acute abdo
885
Q

Indications for codeine?

A
  • mild-mod pain
  • diarrhoea
  • cough suppression
886
Q

Interactions for morphine?

A
  • Antihistamines = inc sedative effects
  • MAOIs = possible CNS excitation or depression
887
Q

Indications for paracetamol? Cautions? SE? Interactions for paracetamol?

A
  • mild to mod pain & pyrexia
  • alcohol dependence, hepatic or renal impairment
  • Rare skin reactions like SJS, TEN, blood disorders. LIVER damage.

Indications:

  • Phenytoin & carbamazepine = inc metabolism rate
  • Metoclopramide = inc rate of absorption
888
Q

A 25 year old is rushed to A&E presenting with vomiting, hyperventilation, tinnitus and sweating. Blood gases show a respiratory alkalosis. What drug has this pt overdosed on? How would you treat?

A
  • aspirin

Treat usiing multiple doses of oral activated charcoal. If moderate, give sodium bicarb. If severe haemodialysis.

889
Q

Which of these dilate the pupil and which constrict the pupil?

  • cocaine
  • heroin
  • amphetamine
  • tricyclics
A
  • cocaine, amhetamine and tricylics = dilate
  • heroin = constrict
890
Q

A 42-year-old man presents with cyanosis and confusion. On examination he is noted to have the smell of almonds on his breath. What drug has this pt been poisoned with?

A

Cyanide

891
Q

A 50-year-old woman on treatment for paroxysmal atrial fibrillation presents with a photosensitive rash. What drug could give this adverse reaction?

A

Amiodarone.

892
Q

Most common cause of hand, foot and mouth disease?

A
  • Coxsackie Virus
893
Q

Warfarin Counselling:

A
  • Intro
  • “I’ve been asked to come talk to you about a recent medication you’ve been started on - is this okay?”
  • “I understand you’ve just been diagnosed with AF/have got a DVT post op, is that right?”
  • Explain AF or DVT (inc risk of Stroke or PE)
  • Signpost (explain warfarin and why it’s needed. Treatment, SE, advice)
  • Warfarin is a drug which thins your blood and makes it less likely to clot. It’ll help dissolve your current clot and prevent it from going to your lungs. You’ll need to take it for 3-6 months (PE), lifelong (AF) every day. The aim of warfarin is to get the blood consistency just right just that it doesn’t clot too much or bleed too much. For that we’ll need to do regular blood tests called INR - every day for a week, then every week for 3 weeks, then once a month for 3 months. Yellow warfarin book for you to record your INR levels.
  • SE (notice any unusual bleeding, black stools, coughing or vomiting up blood you must let your doc know)
  • Do you take any current regular medication? (CYP450 crap). If on OCP STOP, as it inc risk of clotting but also interferes with warfarin. Need alt contraceptive though as warfarin and preggo are bad)
  • Food and alcohol. Do you drink alcohol? Do you drink cranberry juice, eat lots of spinach? Advise is to drink no more than a pint a day, no binge. Don’t eat lots of spinach, liver etc.

ADVICE: Contact sports STOP due to inc risk of bleeding. Any procedure you must let your doc or dentist know. Stay mobile though.

894
Q

Pt presents with eye pain. What are your red flags? What are you trying to exclude?

A
  • Acute angle closure glaucoma
  • Haloes, triggered by low illumination
895
Q

Differentials for inc urinary freq/dysuria?

A
  • Urological
  • cystitis
  • Urethritis
  • Pyelonephritis
  • BPH
  • Bladder calculus
  • Prostatitis

Other

  • Anxiety
  • Preggo
  • Drugs (diuretics)
896
Q

Differentials for haematuria?

A

Urological

  • Bladder cancer
  • Urethral trauma
  • UTI
  • Urethritis
  • Calculi
  • Glomerulonephritis
  • BPH/prostate cancer
  • Schistosomiasis

Other

  • IE
  • Drugs (sulphonamides, cyclophosphamide, NSAIDs)
  • Menstruation
  • Strenuous exercise
897
Q

Differentials for polyuria?

A

Endocrine

  • DM
  • Diabetes insipidus
  • Cushing’s syndrome

Urological

  • Chronic kidney disease

Drugs (diuretics, alcohol, tetracyclines, lithium)

898
Q

Differentials for urinary incontinence?

A
  • Stress incontinence (incompetent sphincter = small losses with effort like coughing or exersion)
  • Urge incontinence (Detrusor instability = idiopathic, cystitis. or hyperreflexia = MS, CVA, spinal cord injury. Urge to pass followed by uncontrollable bladder emptying)
  • Overflow (Prostatic hypertrophy, stricture or stone. Dribbling and poor stream)
  • True (fistula between bladder and vag or urethre = cont urine leak)
  • Mixed
899
Q

Differentials for urinary retention?

A

Urological

  • BPH
  • Urethral stricture
  • Bladder neck obstruction (calculus, tumour)
  • UTI
  • CONSTIPATION
  • Prostatitis
  • Genital herpes
  • Pelvic mass

Neuro (MS, spinal cord compression)

Drugs (anticholinergics)

900
Q

What type of arthritis can patients with IBD have?

A

Enteropathic arthritis (symmetrical arthritis of lower limb joints, early morning stiffness)

901
Q

What are the causes of hyponatraemia?

A

Hypovolaemic

  • Diuretics
  • Addison’s disease
  • Kidney failure
  • Diarrhoea and vomiting
  • Burns

Oedematous

  • CCF
  • Nephrotic syndrome

Euvolaemic

  • Hypothyroidism
  • SIADH
902
Q

What are the causes of hypernatraemia?

A

Normovolaemia

  • excess IV crystalloids

Hypovolaemia

  • Fluid loss (vomiting/diarrhoea, burns)
  • DIabetes insipidus
  • Osmototic diuresis (DKA) or hypoaldosteronism
903
Q

Causes of pre-hepatic jaundice?

A

Physiological neonatal jaundice.

  • Haemolytic anaemia
  • hereditary spherocytosis
  • ineffective erythropoiesis
904
Q

In which two types of jaundice is there dark urine colour?

A

Hepatic and post hepatic jaundice

905
Q

Comment on each of these for Pre-hepatic jaundice;

Colour of stool and urine.

ALP levels

AST/ALT level

Bilirubin levels

Conjugated bilirubin levels

A

Colour of urine and stool = Normal

ALP = normal

AST/ALT = normal

Bilirubin = normal or inc

Conjugated = normal

906
Q

Comment on each of these for hepatic jaundice;

Colour of stool and urine.

ALP levels

AST/ALT level

Bilirubin levels

Conjugated bilirubin levels

Unconjugated bilirubin levels

A

Colour = dark urine but normal stool colour

ALP = raised

AST/ALT = raised

Bilirubin = raised

Conjugated = raised

Unconjugated bili = raised

907
Q

Comment on each of these for Post-hepatic jaundice;

Colour of stool and urine.

ALP levels

AST/ALT level

Bilirubin levels

Conjugated bilirubin levels

Unconjugated bilirubin levels

A

Colour = dark urine and pale stools

ALP: raised

ALT/AST: raised

Bilirubin: raised

Conjugated: raised

Unconjugated: normal

908
Q

Causes of hepatic jaundice?

A
  • acute or chronic hepatitis
  • cirrhosis
  • primary biliary cirrhosis
  • alcoholic liver disease
909
Q

Causes of extra hepatic jaundice?

A
  • GALLSTONES in the bile duct
  • Carcinoma of the head of the pancreas
  • pancreatitis
  • parasites

Shit ton of others

910
Q

Triple therapy for H.pylori eradication?

A

2 abx + 1 PPI

(amoxicillin and clarithromycin)

+ omeprazole

911
Q

Iron def anaemia is more common in which of the IBD?

A

UC.

Crohns disease = normocytic/normochromic anaemia of chronic disease

912
Q

pANCA is positive in which of the IBD?

A

UC

913
Q

Which IBD?

Strictures?

Superficial inflam?

Crypt abscesses?

Goblet cells?

Cobblestone appearance?

All GIT involved?

Non caseating epithelioid cell aggregated with Langhan’s giants cells?

Granulomas?

Tenesmus and urgency?

Fistulas?

A
  • CD
  • UC
  • UC
  • CD
  • CD
  • CD
  • CD
  • CD
  • UC
  • CD

Yr 3 Med (1 decks)

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