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Beynon Flashcards

1
Q

Which type lung cancer is NOT related to smoking

A

Adeoma

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2
Q

Two places ulnar nerve can be damaged?

A

Elbow and the wrist (N.B. the more distal the lesion, the more severe the damage i.e. wrist lesion is more severe)

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3
Q

What does the hand look like when there is an ulnar nerve lesion?

A

‘Claw hand’ (flexion of ring finger and little finger)

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4
Q

What muscles are supplied by the median nerve

A 
Lateral two lumbricals
Obductor pollicis
Abductor pollicisF
lexor pollicis
N.B. LOAF
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5
Q

Give the four main causes of Horner’s syndrome

A
  1. Pancoast tumour
  2. Lateral medullary syndrome
  3. Syringomyelia
  4. Carotid artery dissection
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6
Q

What causes lateral medullary syndrome

A
  1. Occlusion of the PICA

2. Occlusion of the vertebral artery (in 25%)

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7
Q

What are the symptoms of lateral medullary syndrome

A 
Dysarthria
Dysphonia
Dysphagia
Ipsilateral Horner's
Unilateral loss of pain and temperature sensation on one side of the face
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8
Q

Which cranial nerves exit from the pons

A

5, 6, 7, 8

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9
Q

Name the 7 bacteriostatic antibiotics

A 
Trimethoprim
Tetrocycline
Ethambutol
Erythromycin
Clarythromycin
Chloramphenicol
Sufonamides
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10
Q

What T score indicates osteopenia? What about osteoporosis?

A

Osteopenia: -1–2.5
Osteoporosis: <-2.5

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11
Q

What change in which two electrolytes causes prolongation of the QT interval?

A

Hypokalaemia

Hypocalcaemia

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12
Q

What is the normal range for ESR

A

Men: age/2
Women: age+10/2

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13
Q

In what condition is ESR raised while CRP is normal?

A

SLE

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14
Q

What is the normal range for CRP?

A

<10

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15
Q

Where is CRP produced?

A

Liver

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16
Q

What is it’s time to rise? What is it’s half life?

A

4 hours

18 hours

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17
Q

What are the four causes of shock

A

Cardiogenic- failure of the heart to act as an effective pump e.g. ischaemic heart disease
Obstructive: mechanical impediments to forward flow. Obstruction to outflow e.g. PE OR restricted cardiac filling e.g. cardiac tamponade, tension pneumothorax
Hypovolemic/haemorragic
Distributive- abnormalities of peripheral circulation e.g. sepsis, anaphylaxis

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18
Q

Drugs which cause gout

A 
Cyclosporine
Aspirin
Nicotinic acids
Thiazides and theophylline
Loop diuretics and L-DOPA
Ethambutol
Alcohol
Pyrazinamide
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19
Q

Causes of high lactic acid?

A

Type A: tissue hypoxia
Hypoperfusion: LV failure, impaired cardiac output
Hypoxaemia: asphyxiation, respiratory failure, acute anaemia, haemorrhage

Type B: Tissue hypoxia absent
B1: underlying disease e.g. sepsis, chronic kidney disease, liver failure
B2: Drug/toxin mediated: metformin, HIV drugs
B3: errors in metabolism causing acidosis e.g. pyruvate dehydrogenase deficiency

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20
Q

Describe the pharmacokinetics of phenytoin

A

Zero order

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21
Q

What is the major interaction to consider when prescribing phenytoin?

A

It should not be prescribed in conjunction with the OCP (as it is a P450 inducer)

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22
Q

Which antibiotic should not be prescribed with statins?

A

Macrolides- prescription of macrolides and statins increases risk of myopathy

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23
Q

What is the major risk carried by quinolones

A

tendon damage

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24
Q

What is the major complication of use of augmentin?

A

Obstructive jaundice

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25
Q

What is augmentin made up of? Why is it useful against some resistant bacteria?

A

Amoxicillin+ clavulanic acid

CA prevents beta-lactam resistance

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26
Q

What are the most common causative agents of cellulitis?

A

Streptococcus

Staphylococcus

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27
Q

What antibiotic is commonly used to treat cellulitis?

A

Flucloxacillin

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28
Q

Which nerve(s) and/or vessels pass through the wall of the cavernous sinus

A

3, 4, 5a, 5b

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29
Q

Which nerve(s) and/or vessel(s) pass through the cavernous sinus itself?

A

6 and the carotid artery

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30
Q

Causes of small, reactive pupils (unilateral and bilateral)

A

Unilateral: Horner’s
Bilateral: Old age, drugs (pilocarpine, opiates)

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31
Q

Causes of small, irregular pupils

A

Argyll Robertson pupil

Uveitis/iritis

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32
Q

What is Argyll-Robertson pupil?

A

Pupil is constricted and unreactive to light but reacts to accommodation. Occurs in neurosyphillis and may be seen in diabetic neuropathy

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33
Q

Causes of large pupil

A

Adie’s pupil: dilated pupil which reacts slowly to light and accommodation. Associated with diminished reflexes- often seen in women with impaired knee/ankle jerk and impaired sweating. Caused by damage to post-ganglionic fibres of the parasympathetic innervation of the eye, usually due to viral or bacterial infection

CN III lesion- unilateral, unreactive, dilated pupil

Mydriatic drugs e.g. anticholinergics- atropine. MDMA

34
Q

Causes of hypothyroidism

A 
Autoimmune: Hashimoto's thyroiditis
Iodine deficiency
Surgical removal of thyroid gland
Amioderone
Congenital iodine deficiency- cretinism
Post-viral thyroiditis
35
Q

What are neurological symptoms of hypothyroidism

A 
Cerebellar ataxia
Proximal myopathy--> Hoffman's syndrome
Mental slowing- reversible cause of dementia
Slow reactive reflexes
Hearing loss
Coma
36
Q

Which nerve is compressed in carpal tunnel syndrome

A

Median nerve

37
Q

What is the nerve root of the ulnar nerve?

38
Q

Is carpal tunnel syndrome more common in men or women? Why?

A

Women as risk is increased by OCP use and pregnancy

39
Q

What causes achondroplasia?

A

Defective receptors for fibroblast growth factor (FGF)

40
Q

Describe the bodily proportions of a patient with acondroplasia

A

Short long bones; normal torso

41
Q

List 7 common signs of an UPPER motor neurone lesion

A 
Signs on opposite side to the lesion
No fasciculation
No muscle wasting
Hypertonic- clasp knife/lead pipe (in Parkinson's)
Hyper-reflexive
Positive Babinski (foot goes upwards)
Weakness in arm extensors and leg flexors (i.e. anti-gravity muscles are stronger)
Pronator drift
42
Q

List 5 common signs of a LOWER motor neurone lesion

A 
Signs on same side as the lesion
Muscle wasting
Reduced tone
Fasciculation present
Hypo-reflexive
43
Q

List common symptoms of Marfan’s syndrome

A 
Lens dislocation
Aortic dissection or dilatation
Arachnodactyly (long, spidery fingers)
Arm span>height
Chest deformity (pectus carinatum/excavatum)
Scoliosis
Pes planus
Ligamentous laxity
Dural ectasia (widening or ballooning of the dural sac round the spinal cord)
44
Q

What might be indicated by bilateral hilar lymphadenopathy on a CXR?

A

TB
Sarcoids
Lymphomametastatic disease

45
Q

Causes of erythema nodosum

A

Streptococcal infection
Sarcoidosis
Drugs (OCP, sulfonamides, dapsone)

46
Q

What is indicated by the combination of erythema nodosum and hilar lymphadenopathy?

47
Q

Signs of a cerebellar lesion

A 
Dysdiadokinesia
Ataxia
Nystagmus
Intention tremour
Scanning speech- ask the patient to say hippopotamus)
Hypotonia
48
Q

Which four drugs are used to treat TB? How long is each drug used for?

A
  1. Rifampicin (24 weeks)
  2. Isoniazid (24 weeks)
  3. Pyrazinamide (8 weeks)
  4. Ethambutol (8 weeks)
49
Q

What is the route of excretion of pyrazinamide?

50
Q

What is the major side-effect of isoniazide?

A

Peripheral neuropathy

51
Q

What are the major side-effects of pyrazinamide?

A

hepatitis, arthralgia

52
Q

What is the major side-effect of Ethambutol?

A

Optic neuritis- colour vision deteriorates first

53
Q

What are the major side-effects of rifampicin?

A

Increased bilirubin, reduced platelets, inactivation of OCP, orange discolouration of urine and tears

54
Q

What are the causes of apical lung shadowing

A 
N.B. Breast
B: Berylliosis
R: radiation
E: Extrinsic allergic alveolitis
A: Allergic bronchopulmonary aspergillosis
S: Sarcoid
T: TB
55
Q

What is caused by a lesion in Broca’s area?

A

Expressive dysphasia

Comprehension of spoken and written word is normal but expression is poor with impaired non-fluent speech

56
Q

What is caused by a lesion in Wernicke’s area?

A

Receptive dysphasia

Difficulty understanding spoken and written word but with fluent speech

57
Q

Which cranial nerves arise from the midbrain

58
Q

Which cranial nerves arise from the medulla

A

9, 10, 11, 12

59
Q

How much oxygen does 1g of fully saturated Hb carry?

60
Q

Malignancies which metastasise to bone

Which of these does not cause hypercalcaemia?

A 
Thyroid
Lung
Breast
Kidney
Prostate (does not cause hypercalcaemia)
Sarcoma
61
Q

Common causes of optic atrophy

A 
Optic neuritis
Ischaemia
Glaucoma
Multiple sclerosis
Trauma
Congenital causes
Toxic causes: methanol; ethambutol; B12
62
Q

Causes of swollen optic disc

A

Pappiledema
Accerated stage hypertension
Papillitis
Retinal vein thrombosis

63
Q

How do you deferentiate between pappiledema and papillitis

A

Papilledema- visual accuity is preserved

Papillitis= visual acuity drops

64
Q

Which CN do the parasympathetic nerves come from?

A

3, 7, 9 and 10

65
Q

3 commonest causes of vomitting

A

Pregnancy
Post- operative
Alcohol

66
Q

3 rarer causes

A

Endocrine
Uraemia
Psychiatic

67
Q

Endocrine causes of vomitting

A

Addisons’s
Diabetic ketoacidosis
hyper T4
hypo and hyper PTH

68
Q

Common causes of swollen salivary glands

A 
Sarcoids
Amyloidosis
Lymphoma
Chronic alcoholism
Mumps
Bulimia/anorexia
69
Q

Glycated HbA1c in diabetes?

A

> 6.5 in old units

>48 in new units

70
Q

Which is the only class of oral anti-glycaemic agent which causes hypoglycaemia?

A

Sulfonylureas e.g. gliclazide

71
Q

Lesion of which lower motor neurone causes foot drop? What are the nerve roots of this nerve?

A

Common peroneal nerve (round the head of femur). L4, L5 and S1

72
Q

What muscles are supplied by the L4 nerve root?

A

Hip abductors and ankle evertors

73
Q

What are the classical presenting symptoms of ankylosing spondylitis?

A

back pain and early morning stiffness with loss of lumbar lordosis

74
Q

When is chest expansion abnormal?

A

Thumbs move apart less than 2.5cm

75
Q

Causes of polydypsia and polyuria

A
  1. DM type 1 and 2
  2. Psychogenic
  3. Diabetes insipidus
  4. Hypercalcaemia
76
Q

Normal calcium?

77
Q

Causes of hypercalcaemia

A
  1. Cancer metastases
  2. Multiple myeloma
  3. Sarcoidosis
  4. Hyperparathyroidism
  5. Drugs: Thiazides
78
Q

How do you calculate the anion gap?

A

(Na+K) - (Cl+HCO3)

79
Q

Causes of metabolic acidosis with a normal anion gap

A

Renal tubule acidosis (distal and proximal)
Aceto
Severe cholera diarrhoea
Loss of bicarbonate from a pancreatic fistula
Acetazolamide

80
Q

What is the normal anion gap

A

12-16mmol/L

81
Q

Causes of low Hb with raised MCV

A 
B12 deficiency
Folic acid deficiency
Haemolytic anaemia
Aplastic anaemia
Sideroblastic anaemia
82
Q

Which part of the gut is affected in coeliac disease?

A

Duodenum

Jejunum

Acute (1 decks)

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