Case Questions Flashcards
What is guanfacine indicated for?
ADHD (when stimulants are not suitable) and high BP
What is the most common presentation for vitamin B12 deficiency?
Peripheral neuropathy -> numbness, tingling, pain, decreased sensation -> increase B12 diet -> fish, meat, dairy / IM B12
Why are citalopram and escitalopram less commonly used?
Can have additive effects to other medicines causing a QT prolongation
What is the most common cause of glandular fever?
EBV (lifelong carrier state) -> sore throat, fever, lymphadenopathy
What is the management for glandular fever?
Self-limiting 2-4 weeks
Give triple therapy for H. pylori
Amoxicillin, clarithromycin/metronidazole, omeprazole
Differentiate OE and OM
OM involves ear drum
OE commonly associated with eczema and psoriasis
What two drugs does remidine consist of?
Paracetamol and Dihydrocodeine
Give the effects of PCOS (thinning hair, weight gain, irregular periods, hair growth, difficulty becoming pregnant) on hormones (androgens, LH, prolactin)
Ovaries produce an increase in all of the above hormones.
What are 2 long term conditions associated with PCOS?
Diabetes and CVD -> OGTT, BP check, diet advice, stroke risk
Give the symptoms of the menopause
Mood changes, irregular/absent periods, chills, night sweats, sleep changes
What is usually the first line for varicose veins?
Compression stockings
Which 2 hormones decrease in menopause?
Oestrogen and progesterone
Which HRT is given to females without a uterus?
Oestrogen only
What is first line AB for skin and soft tissue?
Flucloxacillin
What do ibuprofen and diclenofac increase the risk of?
Thrombotic events
What is a common side effect of ramipril?
Dry cough, light headedness
Give some common side effects of HRT
Weight gain, irregular bleeding, feeling sick, skin irritation
(increases risk of stroke - esp with oestrogen)
What is elecon prescribed for?
Potent topical steroid for managing severe dermatitis
What type of laxative is lactulose?
Osmotic lactulose -> hydration required
What is the follow-up for starting ramipril?
Bloods for kidney function and review in 3-4 weeks
Give some complications of influenza
Acute bronchitis, otitis media, exacerbations of asthma, pneumonia (secondary bacterial infection, esp with staphylococcus aureus), sinusitis
For complicated influenza (immunosuppressed) which antiviral is used?
Oral oseltamivir
If patient experiences migraines and would like a contraception option -> which 99% effective option could be used?
IUS
What does IUS release into the womb?
Progesterone (thickens cervical mucus and thins womb lining)
How often does the progesterone only pill taken?
Every day
Give the 2 types of progesterone only pills
3 hour / 12 hour within the same time every day
Which chart is used for for sleep apnoea?
Epworth sleep chart
Which hormone in CCP causes an increase in BP?
Oestrogen
Which contraception should be used if >35 or smoker?
Progestogen-only pills (due to oestregnic effects on blood clots and bp)
Which anitbody + factor are very common in patietns with Sjogren’s?
Anti-ANA + rheumatoid factor
Which test is used to diagnose Sjogren’s (dry mouth, lips, eyes?
Schirmer’s (paper strip under eyelid)
How often are eye exams for diabetes?
Annually
What is a common side effect of beta-blockers (e.g. bisoprolol)?
Cold hands and feet
What is the BRAT diet for GI distress?
Banana, Rice, Apple sauce, Toast
What mechanism is citirizine? What is a common side effect?
H1 histamine receptor blocker -> major metabolite of hydroxyzine -> dry mouth
Which quick test can be used for cataract?
Red reflex
Give the range for kidney disease stage 3a + 3b
3a = 45-59
3b = 30-44
What is a common condition (CMO) that can occur after cataract surgery?
Cystoid macular oedema
Define ESSENTIAL hypertension
BP 140/90 with no secondary cause identified
Give an unlicensed use for colchizine (heart)
Pericarditis
Give the indication for celecoxib + which events does it increase the risk of?
NSAID -> relieve pain and inflammation in osteoarthritis, RA and ankylosing spondylitis -> caution - risk of thrombotic event increase
Give the management for lichen sclerosus
Dermovate topical steroid
How does aspirin interact with diclofenac?
Both NSAIDs together -> Increase risk of bleeding, bruising and potassium levels
Give the mechanism of glimeperide
Sulfonylurea -> insulin secretatogue -> lowers blood sugar by stimulating the release of insulin by pancreatic beta cells and induce increased activity of intracellular insulin receptors
How does iron and B12 deficiency anaemia affect HbA1c?
Increases
How does metformin affect PCOS?
Improved irregular periods, normalised cholesterol, ovulation (90% when combined with clomiphene)
What is the only licensed medication for Raynauds?
Nefidipine
Very active, young, tibial tuberosity tenderness, thickening over tibial insertion of patellar tendon -> diagnosis?
Osgood-Sclatter -> rest and ice pack, avoidance of causative activity, paracetamol/NSAIDs, usually all resolve after puberty
What is first line for pregnant and non-pregnant adults pyelonephritis?
Oral cefalexin
What is first line for catheter associated UTI in pregnancy?
Cefalexin
Which hypersensitivity reaction is scabies?
Type IV
What is the interim first line treatment for DVT?
Apixaban/Rivaroxaban
Which score is used for DVT?
Well’s Score
Give the mechanism for metoclopramide?
Inhibits dopamine D2 and serotonin 5HT3 receptors in the chemoreceptor trigger zone
What type of diabetic drug is empagliflozin?
SGLT2 inhibitor -> stops kidneys reabsorbing glucose
Which urological condition does empagliflozin commonly cause?
Thrush -> candida balanitis on foreskin
Vestibular neuritis + unilateral hearing loss - constant vertigo, viral URI
Labyrynthitis
What is aldara cream used for?
Actinic keratoses
Give the effects of GTN on BP + HR + headaches
Hypotension, tachycardia, headaches
AF -> Amiodarone -> how can this affect thyroid function?
Amiodarone-induced hypothyroidism -> levothryoxine
HPV Positive, cytology normal -> repeated 12 months smear -> negative -> what next?
Normal routine call
Anticoagulant + Head injury, everything else unremarkable -> what scan is required and what is the time period?
CT scan within 8 hours
Define somatisation disorder?
Patient persistenly presents with symptoms despite negative tests and results
What is the investigation for acoustic neuromas?
MRI cerebellopontine angle
How does kyphoscoliosis (ankylosing spondylitis) affect spirometry?
Restrictive -> both FEV1 and FVC are reduced, ratio normal
After unprotected sexual intercourse -> how long can emergency levonorgestrel be taken up to?
72 hours
How do antipsychotics affect breasts?
Tenderness and enlargement due to increased serum prolactin
Which mid diastolic heart murmur can cause haemoptysis?
Mitral stenosis (can be caused by rheumatic fever) - thickened valve causes increased pressure in pulmonary circulation causing rupture of pulmonary vessels
How does osteoporosis affect ALP + calcium + phosphate + PTH?
Normal
What is the first line imaging for peripheral artery disease?
Duplex ultrasound?
What is the first line investigation for intussusception?
Ultrasound
What can idiopathic thrombocytopenic purpura (daily epistaxis, petechiae and bruising on legs, low platelets) be preceded by?
Self-limiting viral infection (e.g. glandular fever)
What is first line for chronic pelvic pain?
Progestogen
6 weeks of persistent tiredness + post-exertional malaise/unrefreshing sleep/cognitive disability -> which syndrome?
Chronic Fatigue Syndrome
In children with DKA -> what is there a significant risk of?
Cerebral oedema
During DKA -> once BG falls below 14mmol/L -> what should be added and how is insulin rate changed?
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
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?
IM Glucagon 1mg (then try IV 20% dextrose)
Why is IV 50% dextrose not used in severe hypoglycaemia?
Risk of extravasation
In children -> can some proteinaceous material in their eyes around the optic nerve head -> can lead to elevated head -> what is the material + diagnosis?
Drusen -> pseudopapilloedema
Which inhibitors can be used for Lewy body and Alzheimer dementias?
Acetylcholinesterase Inhibitors
How does glaucoma cause halos?
Increased IOP -> misshapen cornea -> diffracted light rays -> halos
Pain, peritonitis, pyrexia -> air under left diaphragm, PMH sigmoid cancer -> diagnosis + procedure?
Bowel perforation (air, viscous) + Hartman’s
What does a high prothrombin time (e.g. paracetamol OD) signify?
Liver failure
For pigment dispersion syndrome -> what is the main symptom?
Blurring of vision when exercising
Unilateral tinnitus, vertigo, hearing loss, absent corneal reflex -> diagnosis?
Acoustic neuroma
Genital ulcers, sexually active, bilateral tender inguinal lymphadenopathy -> Diagnosis + Investigation?
Genital herpes -> Nucleic Acid Amplification Test
Which vitamin is given with isoniazid (TB)?
Pyridoxine to prevent peripheral neuropathy
210 pefr exacerbation - 620 best -> what is the level of severity?
33-50% severe
Which syndrome can follow gastroenteritis -> what is first line?
GBS -> IV Ig
Metallic taste, dream-like state, loses time/memory for 3 minutes, difficulty talking for 5 minutes -> which type of seizure?
ANS Focal
Rapid and progressive muscle weakness and changes in sensation peripherally + isolated high protein in CSF -> diagnosis?
GBS
AST:ALT + vague liver symptoms
Alcoholic hepatitis
Why is smoking important to consider in radio iodine therapy?
Smoking can worsen thyroid eye disease
What is the first line for testicular torsion?
Surgical Exploration + Orchidopexy
Which sign is negative and which reflex is absent in testicular torsion?
Phren’s and cremasteric (both positive in acute epididymitis)
Pansystolic left lower sternal border murmur?
VSD
Machinery murmur
PDA
What is first line to treat spasticity in cerebral palsy?
Baclofen (GABA agonist)
How is croup (Parainfluenza I) and epiglottitis (HiB) differentiated?
Croup -> coughing and no drooling
Which sign is associated with DMD when standing up from floor?
Gower’s
What is the feed volume for a child up to 6 months?
130-160mL/kg/day
How is the risk of ALL (t12:22) affected in Trisomy 21?
Significantly increases
What is the name of the characteristic rash in SJS?
Erythema multiforme
What percentage of the body is covered in SJS + toxic epidermal necrosis?
10%, >30%
What is the mainstay of ALL treatment?
Chemotherapy (Induction, Consolidation, Interim Maintenance, Delayed Intensification, Maintenance)
What is given in ITP with mucosal bleeding?
IVIg
Which type of anaemia is folate deficiency?
Macrocytic -> megaloblastic anaemia
Which LFT increases during pregnancy?
ALP (produced by placenta)
Which LFT increases in rhabdomyolysis?
ALT
Which blood Bourne virus is HIV associated with?
HIV
What is the first line screen for acute pancreatitis?
Lipase
Which biochemical screen is used for coeliac?
TTG
What does a coffee bean sign indicate on x-ray?
Sigmoid volvulus
If there is ?hyponatraemia + low serum osmolality (salt loss or water overload) -> which volume is assessed?
ECF volume
What is the most common radio isotope used?
Technecium-99m
State Courvoisier’s Law
In painless, obstructive jaundice, palpable gallbladder is unlikely to be due to gallstones
Leakage of contrast from aorta -> what does this suggest?
AAA rupture -> intra-abdominal haemorrhage
Extreme abdominal pain out of keeping with examination -> main differential?
Mesenteric ischaemia
Until proven otherwise, what is a CN III palsy with absent pupillary reflex due to?
Posterior communicating artery aneurysm
Give Cushing’s triad
Increasing systolic ( +decreasing diastolic), bradycardia, irregular/low resp
How many mmol/h for K+ replacement?
10mmol/h
After 3 doses of IV lorazepam and IV phenytoin following a seizure with no improvement -> what is the next step?
ICU for intubation due to dysregulation of breathing
Give the neutropenic sepsis effect on WCC + platelets + CRP?
Increase WCC, CRP and decrease platelets
How is chest infection and pneumonitis (chemo) differentiated on auscultation?
Pneumonitis -> bilateral crepitations
Define Gilbert’s Syndrome
Isolated elevation of bilirubin
Give the antibodies for autoimmune hepatitis
Budd-Chiari
How does magnesium affect calcium?
Magnesium controls the release and production of PTH -> low PTH = low calcium
Baby is at term, mother presenting with UTI symptoms -> which antibiotic?
Amoxicillin (nitrofurantoin can cause neonatal haemolysis)
Veil-like opacity on CXR
LUL collapse
Sail-sign
LLL collapse
Loss of right diaphragm
RLL collapse
Nasogastric Tube
Follows oesophagus, bisects carina, diaphragm cross centrally, tip below diaphragm
What is the management for Budd-Chiari?
TIPS
SBP >250 polymorphonuclear leukocytes -> first line?
Co-trimoxazole
ABC for liver
Albumin, Bilirubin, Clotting
AAC for TIA
Aspirin, atorvastatin, clopidogrel
What stroke mimic can occur after an epileptic seizure?
Tod’s paresis
When to carotid doppler after potential stroke/TIA?
Suspected anterior circulation
Define Hoover’s
Test for true LL weakness -> not feeling downward pressure in opposite leg
What type of MCV does PCV show?
Microcytic and iron deficient with increase RBC and platelet
What type of MCV is seen in liver impairment?
Macrocytic
Which test for autoimmune haemolysis?
Coombs
What could hypersegmented neutrophils show?
B12/folate deficiency
How is PD-L1 used in lung cancer?
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
What is the normal PR interval?
120-200
Define GMAWS + give first line for score 1-3 + 4-10
Glasgow Modified Alcohol Withdrawal Scale -> 10-20mg diazepam
What does a positive Rovsing sign suggest?
Appendicitis -> RLQ tenderness upon LLQ palpation
How does uvula deviate in CN IX/X palsy?
Deviates to contralateral side
Give 2 contraindications to GTN in STEMI
Hypotension, inferior lead ischaemia
Define PAILS in ECG and STEMI
ST elevation in one area will cause ST depression in adjacent leads
What is a serious side effect of statins?
Rhabdomyolysis
Which nerve innervates the scapula?
Long thoracic nerve
Which type of mechanism is briminodine?
Alpha-2 adrenergic agonist (raised ocular pressure, glaucoma, facial erythema)
What is phenylephrine used for?
Alpha 1 agonist - Hypotension in surgical setting
Give the class of guanfacine + indications
Alpha-2 agonist -> ADHD
What is the suffix for alpha 1 antagonists?
-sin (tamsulosin, doxazosin)
If oligohydramnios is present -> which syndrome can occur?
Potters (renal agenesis, pulmonary hypoplasia, low set ears, flattened nose, prominent epicanthic folds)
Give the 4 dopamine pathways
Mesolimbic (psychosis), Mesocortical, Nigrostriatal (Parkinsons), Tuberoinfundibular (hyperprolactinaemia)
Which syndrome can occur after long term antipsychotic usage?
Metabolic Syndrome (reduces insulin sensitivity leading to diabetes, increases cholesterol, and increased appetite)
Which antipsychotic can be used to prevent osteoporosis in females?
Quetiapine -> least prolactinaemia (tuberoinfundibular tract)
Which antipsychotic is ideal for substance misuse patients? (sleep)
Substance misuse patients generally have a low BMI and difficulties sleeping at night, olanzapine causes the most weight gain and sedation)
Which 2 side effects are important to consider with clozapine (consultant psych after baseline FBC, BP, ECG, fasting glucose + trials of 2 antipsychotics)
Agranulocytosis + eosinophilia
What is the clinical relevance of the coeliac plexus (solar plexus)? (Pain)
Pain relief in palliative care for patients with abdominal metastasis
Give the 3 main contraindications for ECT
Unfit for general anaesthesia
Unstable fractures
Raised intracranial pressure
Developmental History -> take each problem -> type, duration, current status, pattern, symmetry + REGRESSION
Ask about social services, play at school and home
Red flags with development -> trauma, limp, weakness, audiovisual concerns, systemic symptoms
A
Give 3 secondary causes of developmental delay
Hypoxia during premature birth, social deprivation, congenital causes
Which mutation causes PCV?
JAK2 -> low dose aspirin, venesection, hydroxycarbamide
What can be seen on FBC in PCV?
Thrombocytosis, leucocytosis, increased RBC, low ERO
Where is the lesion in right internuclear ophthalmoplegia?
Right medial longitudinal fasciculus -> right sided impaired adduction + contralateral nystagmus
