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Case Questions Flashcards

1
Q

What is guanfacine indicated for?

A

ADHD (when stimulants are not suitable) and high BP

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2
Q

What is the most common presentation for vitamin B12 deficiency?

A

Peripheral neuropathy -> numbness, tingling, pain, decreased sensation -> increase B12 diet -> fish, meat, dairy / IM B12

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3
Q

Why are citalopram and escitalopram less commonly used?

A

Can have additive effects to other medicines causing a QT prolongation

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4
Q

What is the most common cause of glandular fever?

A

EBV (lifelong carrier state) -> sore throat, fever, lymphadenopathy

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5
Q

What is the management for glandular fever?

A

Self-limiting 2-4 weeks

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6
Q

Give triple therapy for H. pylori

A

Amoxicillin, clarithromycin/metronidazole, omeprazole

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7
Q

Differentiate OE and OM

A

OM involves ear drum
OE commonly associated with eczema and psoriasis

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8
Q

What two drugs does remidine consist of?

A

Paracetamol and Dihydrocodeine

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9
Q

Give the effects of PCOS (thinning hair, weight gain, irregular periods, hair growth, difficulty becoming pregnant) on hormones (androgens, LH, prolactin)

A

Ovaries produce an increase in all of the above hormones.

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10
Q

What are 2 long term conditions associated with PCOS?

A

Diabetes and CVD -> OGTT, BP check, diet advice, stroke risk

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11
Q

Give the symptoms of the menopause

A

Mood changes, irregular/absent periods, chills, night sweats, sleep changes

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12
Q

What is usually the first line for varicose veins?

A

Compression stockings

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13
Q

Which 2 hormones decrease in menopause?

A

Oestrogen and progesterone

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14
Q

Which HRT is given to females without a uterus?

A

Oestrogen only

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15
Q

What is first line AB for skin and soft tissue?

A

Flucloxacillin

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16
Q

What do ibuprofen and diclenofac increase the risk of?

A

Thrombotic events

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17
Q

What is a common side effect of ramipril?

A

Dry cough, light headedness

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18
Q

Give some common side effects of HRT

A

Weight gain, irregular bleeding, feeling sick, skin irritation
(increases risk of stroke - esp with oestrogen)

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19
Q

What is elecon prescribed for?

A

Potent topical steroid for managing severe dermatitis

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20
Q

What type of laxative is lactulose?

A

Osmotic lactulose -> hydration required

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21
Q

What is the follow-up for starting ramipril?

A

Bloods for kidney function and review in 3-4 weeks

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22
Q

Give some complications of influenza

A

Acute bronchitis, otitis media, exacerbations of asthma, pneumonia (secondary bacterial infection, esp with staphylococcus aureus), sinusitis

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23
Q

For complicated influenza (immunosuppressed) which antiviral is used?

A

Oral oseltamivir

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24
Q

If patient experiences migraines and would like a contraception option -> which 99% effective option could be used?

A

IUS

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25
Q

What does IUS release into the womb?

A

Progesterone (thickens cervical mucus and thins womb lining)

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26
Q

How often does the progesterone only pill taken?

A

Every day

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27
Q

Give the 2 types of progesterone only pills

A

3 hour / 12 hour within the same time every day

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28
Q

Which chart is used for for sleep apnoea?

A

Epworth sleep chart

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29
Q

Which hormone in CCP causes an increase in BP?

A

Oestrogen

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30
Q

Which contraception should be used if >35 or smoker?

A

Progestogen-only pills (due to oestregnic effects on blood clots and bp)

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31
Q

Which anitbody + factor are very common in patietns with Sjogren’s?

A

Anti-ANA + rheumatoid factor

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32
Q

Which test is used to diagnose Sjogren’s (dry mouth, lips, eyes?

A

Schirmer’s (paper strip under eyelid)

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33
Q

How often are eye exams for diabetes?

A

Annually

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34
Q

What is a common side effect of beta-blockers (e.g. bisoprolol)?

A

Cold hands and feet

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35
Q

What is the BRAT diet for GI distress?

A

Banana, Rice, Apple sauce, Toast

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36
Q

What mechanism is citirizine? What is a common side effect?

A

H1 histamine receptor blocker -> major metabolite of hydroxyzine -> dry mouth

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37
Q

Which quick test can be used for cataract?

A

Red reflex

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38
Q

Give the range for kidney disease stage 3a + 3b

A

3a = 45-59
3b = 30-44

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39
Q

What is a common condition (CMO) that can occur after cataract surgery?

A

Cystoid macular oedema

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40
Q

Define ESSENTIAL hypertension

A

BP 140/90 with no secondary cause identified

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41
Q

Give an unlicensed use for colchizine (heart)

A

Pericarditis

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42
Q

Give the indication for celecoxib + which events does it increase the risk of?

A

NSAID -> relieve pain and inflammation in osteoarthritis, RA and ankylosing spondylitis -> caution - risk of thrombotic event increase

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43
Q

Give the management for lichen sclerosus

A

Dermovate topical steroid

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44
Q

How does aspirin interact with diclofenac?

A

Both NSAIDs together -> Increase risk of bleeding, bruising and potassium levels

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45
Q

Give the mechanism of glimeperide

A

Sulfonylurea -> insulin secretatogue -> lowers blood sugar by stimulating the release of insulin by pancreatic beta cells and induce increased activity of intracellular insulin receptors

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46
Q

How does iron and B12 deficiency anaemia affect HbA1c?

A

Increases

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47
Q

How does metformin affect PCOS?

A

Improved irregular periods, normalised cholesterol, ovulation (90% when combined with clomiphene)

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48
Q

What is the only licensed medication for Raynauds?

A

Nefidipine

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49
Q

Very active, young, tibial tuberosity tenderness, thickening over tibial insertion of patellar tendon -> diagnosis?

A

Osgood-Sclatter -> rest and ice pack, avoidance of causative activity, paracetamol/NSAIDs, usually all resolve after puberty

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50
Q

What is first line for pregnant and non-pregnant adults pyelonephritis?

A

Oral cefalexin

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51
Q

What is first line for catheter associated UTI in pregnancy?

A

Cefalexin

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52
Q

Which hypersensitivity reaction is scabies?

A

Type IV

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53
Q

What is the interim first line treatment for DVT?

A

Apixaban/Rivaroxaban

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54
Q

Which score is used for DVT?

A

Well’s Score

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55
Q

Give the mechanism for metoclopramide?

A

Inhibits dopamine D2 and serotonin 5HT3 receptors in the chemoreceptor trigger zone

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56
Q

What type of diabetic drug is empagliflozin?

A

SGLT2 inhibitor -> stops kidneys reabsorbing glucose

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57
Q

Which urological condition does empagliflozin commonly cause?

A

Thrush -> candida balanitis on foreskin

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58
Q

Vestibular neuritis + unilateral hearing loss - constant vertigo, viral URI

A

Labyrynthitis

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59
Q

What is aldara cream used for?

A

Actinic keratoses

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60
Q

Give the effects of GTN on BP + HR + headaches

A

Hypotension, tachycardia, headaches

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61
Q

AF -> Amiodarone -> how can this affect thyroid function?

A

Amiodarone-induced hypothyroidism -> levothryoxine

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62
Q

HPV Positive, cytology normal -> repeated 12 months smear -> negative -> what next?

A

Normal routine call

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63
Q

Anticoagulant + Head injury, everything else unremarkable -> what scan is required and what is the time period?

A

CT scan within 8 hours

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64
Q

Define somatisation disorder?

A

Patient persistenly presents with symptoms despite negative tests and results

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65
Q

What is the investigation for acoustic neuromas?

A

MRI cerebellopontine angle

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66
Q

How does kyphoscoliosis (ankylosing spondylitis) affect spirometry?

A

Restrictive -> both FEV1 and FVC are reduced, ratio normal

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67
Q

After unprotected sexual intercourse -> how long can emergency levonorgestrel be taken up to?

A

72 hours

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68
Q

How do antipsychotics affect breasts?

A

Tenderness and enlargement due to increased serum prolactin

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69
Q

Which mid diastolic heart murmur can cause haemoptysis?

A

Mitral stenosis (can be caused by rheumatic fever) - thickened valve causes increased pressure in pulmonary circulation causing rupture of pulmonary vessels

70
Q

How does osteoporosis affect ALP + calcium + phosphate + PTH?

A

Normal

71
Q

What is the first line imaging for peripheral artery disease?

A

Duplex ultrasound?

72
Q

What is the first line investigation for intussusception?

A

Ultrasound

73
Q

What can idiopathic thrombocytopenic purpura (daily epistaxis, petechiae and bruising on legs, low platelets) be preceded by?

A

Self-limiting viral infection (e.g. glandular fever)

74
Q

What is first line for chronic pelvic pain?

A

Progestogen

75
Q

6 weeks of persistent tiredness + post-exertional malaise/unrefreshing sleep/cognitive disability -> which syndrome?

A

Chronic Fatigue Syndrome

76
Q

In children with DKA -> what is there a significant risk of?

A

Cerebral oedema

77
Q

During DKA -> once BG falls below 14mmol/L -> what should be added and how is insulin rate changed?

A

Reduce saline to 150mL/h + Add 10% dextrose 100mL/h + Reduce insulin infusion to 3 units per hour + 10% glucose with potassium chloride 100mL/h

78
Q

Mrs Black recovers well from this episode and continues on her usual insulin - Glargine 24 units before bed and Novorapid (dose adjusted for BG level and carbohydrate eaten) with meals.

The next morning you are called urgently to the ward as she is unrousable and her BG reading is ‘lo’.

BM ‘lo’.

What should be given to mobilise glycogen stores?

A

IM Glucagon 1mg (then try IV 20% dextrose)

79
Q

Why is IV 50% dextrose not used in severe hypoglycaemia?

A

Risk of extravasation

80
Q

In children -> can some proteinaceous material in their eyes around the optic nerve head -> can lead to elevated head -> what is the material + diagnosis?

A

Drusen -> pseudopapilloedema

81
Q

Which inhibitors can be used for Lewy body and Alzheimer dementias?

A

Acetylcholinesterase Inhibitors

82
Q

How does glaucoma cause halos?

A

Increased IOP -> misshapen cornea -> diffracted light rays -> halos

83
Q

Pain, peritonitis, pyrexia -> air under left diaphragm, PMH sigmoid cancer -> diagnosis + procedure?

A

Bowel perforation (air, viscous) + Hartman’s

84
Q

What does a high prothrombin time (e.g. paracetamol OD) signify?

A

Liver failure

85
Q

For pigment dispersion syndrome -> what is the main symptom?

A

Blurring of vision when exercising

86
Q

Unilateral tinnitus, vertigo, hearing loss, absent corneal reflex -> diagnosis?

A

Acoustic neuroma

87
Q

Genital ulcers, sexually active, bilateral tender inguinal lymphadenopathy -> Diagnosis + Investigation?

A

Genital herpes -> Nucleic Acid Amplification Test

88
Q

Which vitamin is given with isoniazid (TB)?

A

Pyridoxine to prevent peripheral neuropathy

89
Q

210 pefr exacerbation - 620 best -> what is the level of severity?

A

33-50% severe

90
Q

Which syndrome can follow gastroenteritis -> what is first line?

A

GBS -> IV Ig

91
Q

Metallic taste, dream-like state, loses time/memory for 3 minutes, difficulty talking for 5 minutes -> which type of seizure?

A

ANS Focal

92
Q

Rapid and progressive muscle weakness and changes in sensation peripherally + isolated high protein in CSF -> diagnosis?

A

GBS

93
Q

AST:ALT + vague liver symptoms

A

Alcoholic hepatitis

94
Q

Why is smoking important to consider in radio iodine therapy?

A

Smoking can worsen thyroid eye disease

95
Q

What is the first line for testicular torsion?

A

Surgical Exploration + Orchidopexy

96
Q

Which sign is negative and which reflex is absent in testicular torsion?

A

Phren’s and cremasteric (both positive in acute epididymitis)

97
Q

Pansystolic left lower sternal border murmur?

A

VSD

98
Q

Machinery murmur

A

PDA

99
Q

What is first line to treat spasticity in cerebral palsy?

A

Baclofen (GABA agonist)

100
Q

How is croup (Parainfluenza I) and epiglottitis (HiB) differentiated?

A

Croup -> coughing and no drooling

101
Q

Which sign is associated with DMD when standing up from floor?

A

Gower’s

102
Q

What is the feed volume for a child up to 6 months?

A

130-160mL/kg/day

103
Q

How is the risk of ALL (t12:22) affected in Trisomy 21?

A

Significantly increases

104
Q

What is the name of the characteristic rash in SJS?

A

Erythema multiforme

105
Q

What percentage of the body is covered in SJS + toxic epidermal necrosis?

A

10%, >30%

106
Q

What is the mainstay of ALL treatment?

A

Chemotherapy (Induction, Consolidation, Interim Maintenance, Delayed Intensification, Maintenance)

107
Q

What is given in ITP with mucosal bleeding?

A

IVIg

108
Q

Which type of anaemia is folate deficiency?

A

Macrocytic -> megaloblastic anaemia

109
Q

Which LFT increases during pregnancy?

A

ALP (produced by placenta)

110
Q

Which LFT increases in rhabdomyolysis?

A

ALT

111
Q

Which blood Bourne virus is HIV associated with?

A

HIV

112
Q

What is the first line screen for acute pancreatitis?

A

Lipase

113
Q

Which biochemical screen is used for coeliac?

A

TTG

114
Q

What does a coffee bean sign indicate on x-ray?

A

Sigmoid volvulus

115
Q

If there is ?hyponatraemia + low serum osmolality (salt loss or water overload) -> which volume is assessed?

A

ECF volume

116
Q

What is the most common radio isotope used?

A

Technecium-99m

117
Q

State Courvoisier’s Law

A

In painless, obstructive jaundice, palpable gallbladder is unlikely to be due to gallstones

118
Q

Leakage of contrast from aorta -> what does this suggest?

A

AAA rupture -> intra-abdominal haemorrhage

119
Q

Extreme abdominal pain out of keeping with examination -> main differential?

A

Mesenteric ischaemia

120
Q

Until proven otherwise, what is a CN III palsy with absent pupillary reflex due to?

A

Posterior communicating artery aneurysm

121
Q

Give Cushing’s triad

A

Increasing systolic ( +decreasing diastolic), bradycardia, irregular/low resp

122
Q

How many mmol/h for K+ replacement?

A

10mmol/h

123
Q

After 3 doses of IV lorazepam and IV phenytoin following a seizure with no improvement -> what is the next step?

A

ICU for intubation due to dysregulation of breathing

124
Q

Give the neutropenic sepsis effect on WCC + platelets + CRP?

A

Increase WCC, CRP and decrease platelets

125
Q

How is chest infection and pneumonitis (chemo) differentiated on auscultation?

A

Pneumonitis -> bilateral crepitations

126
Q

Define Gilbert’s Syndrome

A

Isolated elevation of bilirubin

127
Q

Give the antibodies for autoimmune hepatitis

A

Budd-Chiari

128
Q

How does magnesium affect calcium?

A

Magnesium controls the release and production of PTH -> low PTH = low calcium

129
Q

Baby is at term, mother presenting with UTI symptoms -> which antibiotic?

A

Amoxicillin (nitrofurantoin can cause neonatal haemolysis)

130
Q

Veil-like opacity on CXR

A

LUL collapse

131
Q

Sail-sign

A

LLL collapse

132
Q

Loss of right diaphragm

A

RLL collapse

133
Q

Nasogastric Tube

A

Follows oesophagus, bisects carina, diaphragm cross centrally, tip below diaphragm

134
Q

What is the management for Budd-Chiari?

A

TIPS

135
Q

SBP >250 polymorphonuclear leukocytes -> first line?

A

Co-trimoxazole

136
Q

ABC for liver

A

Albumin, Bilirubin, Clotting

137
Q

AAC for TIA

A

Aspirin, atorvastatin, clopidogrel

138
Q

What stroke mimic can occur after an epileptic seizure?

A

Tod’s paresis

139
Q

When to carotid doppler after potential stroke/TIA?

A

Suspected anterior circulation

140
Q

Define Hoover’s

A

Test for true LL weakness -> not feeling downward pressure in opposite leg

141
Q

What type of MCV does PCV show?

A

Microcytic and iron deficient with increase RBC and platelet

142
Q

What type of MCV is seen in liver impairment?

A

Macrocytic

143
Q

Which test for autoimmune haemolysis?

A

Coombs

144
Q

What could hypersegmented neutrophils show?

A

B12/folate deficiency

145
Q

How is PD-L1 used in lung cancer?

A

If lung cancer expresses high levels of PD-L1, immune checkpoint inhibitors can be used to prevent T-cells from putting brakes on their immune response

146
Q

What is the normal PR interval?

A

120-200

147
Q

Define GMAWS + give first line for score 1-3 + 4-10

A

Glasgow Modified Alcohol Withdrawal Scale -> 10-20mg diazepam

148
Q

What does a positive Rovsing sign suggest?

A

Appendicitis -> RLQ tenderness upon LLQ palpation

149
Q

How does uvula deviate in CN IX/X palsy?

A

Deviates to contralateral side

150
Q

Give 2 contraindications to GTN in STEMI

A

Hypotension, inferior lead ischaemia

151
Q

Define PAILS in ECG and STEMI

A

ST elevation in one area will cause ST depression in adjacent leads

152
Q

What is a serious side effect of statins?

A

Rhabdomyolysis

153
Q

Which nerve innervates the scapula?

A

Long thoracic nerve

154
Q

Which type of mechanism is briminodine?

A

Alpha-2 adrenergic agonist (raised ocular pressure, glaucoma, facial erythema)

155
Q

What is phenylephrine used for?

A

Alpha 1 agonist - Hypotension in surgical setting

156
Q

Give the class of guanfacine + indications

A

Alpha-2 agonist -> ADHD

157
Q

What is the suffix for alpha 1 antagonists?

A

-sin (tamsulosin, doxazosin)

158
Q

If oligohydramnios is present -> which syndrome can occur?

A

Potters (renal agenesis, pulmonary hypoplasia, low set ears, flattened nose, prominent epicanthic folds)

159
Q

Give the 4 dopamine pathways

A

Mesolimbic (psychosis), Mesocortical, Nigrostriatal (Parkinsons), Tuberoinfundibular (hyperprolactinaemia)

160
Q

Which syndrome can occur after long term antipsychotic usage?

A

Metabolic Syndrome (reduces insulin sensitivity leading to diabetes, increases cholesterol, and increased appetite)

161
Q

Which antipsychotic can be used to prevent osteoporosis in females?

A

Quetiapine -> least prolactinaemia (tuberoinfundibular tract)

162
Q

Which antipsychotic is ideal for substance misuse patients? (sleep)

A

Substance misuse patients generally have a low BMI and difficulties sleeping at night, olanzapine causes the most weight gain and sedation)

163
Q

Which 2 side effects are important to consider with clozapine (consultant psych after baseline FBC, BP, ECG, fasting glucose + trials of 2 antipsychotics)

A

Agranulocytosis + eosinophilia

164
Q

What is the clinical relevance of the coeliac plexus (solar plexus)? (Pain)

A

Pain relief in palliative care for patients with abdominal metastasis

165
Q

Give the 3 main contraindications for ECT

A

Unfit for general anaesthesia
Unstable fractures
Raised intracranial pressure

166
Q

Developmental History -> take each problem -> type, duration, current status, pattern, symmetry + REGRESSION

A

Ask about social services, play at school and home

167
Q

Red flags with development -> trauma, limp, weakness, audiovisual concerns, systemic symptoms

A

A

168
Q

Give 3 secondary causes of developmental delay

A

Hypoxia during premature birth, social deprivation, congenital causes

169
Q

Which mutation causes PCV?

A

JAK2 -> low dose aspirin, venesection, hydroxycarbamide

169
Q

What can be seen on FBC in PCV?

A

Thrombocytosis, leucocytosis, increased RBC, low ERO

170
Q

Where is the lesion in right internuclear ophthalmoplegia?

A

Right medial longitudinal fasciculus -> right sided impaired adduction + contralateral nystagmus

171
Q
A

GP Conditions (5 decks)

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