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Integrated > Core Conditions > Flashcards

Core Conditions Flashcards

1
Q

Contents of spermatic cord in males?

A

Vas deferens, obliterated processus vaginalis and lymphatics Arteries to vas, cremaster and testis Pampiniform plexus and venous equivalent of above Genital branch of genitofemoral nerve and sympathetic nerve (in females, round ligament)

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1
Q

Treatment for hyperT?

A

Drugs - B-blockers for rapid symptom control. Anti-thyroid medication = carbimazole. Giving thyroxine and carbimazole together reduces risk of iatrogenic hypoT

Radioiodine - most become hypoT after treatment. Contraindicated in prego and breastfeeding.

Thyroidectomy - risk of damage to recurrent laryngeal nerve and hypoparathyroidism.

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1
Q

Common causative organisms of septic arthritis?

A

Staph Aureus, streptococci, Neisseria gonococcus and gram -ve bacilli

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1
Q

Where do pancreatic cancers arise?

A

60% pancreas head, 25% body, 15% tail

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1
Q

Risk factors for malnutrition in children?

A

Young age, co-existing chronic illness or developmental delay, neglect by care givers, poverty.

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1
Q
A
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2
Q

Mnemonic for worrying peptic ulcer symptoms?

A

ALARM Symptoms Anaemia (iron deficiency) Loss of weight Anorexia Recent onset/progressive symptoms Melena/haematemesis Swallowing difficulty

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2
Q

Causes of SAH?

A

Rupture of saccular aneurysm

Ateriovenous malformation

No cause (

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2
Q

Signs of motor neuropathy?

A

Often progressive (may be rapid); weak or clumsy hands; difficulty in walking (falls); difficulty in breathing.

Signs of LMN lesion: wasting and weakness most marked in distal muscles of hands and feet (foot/wrist drop). Reflexes reduced or absent.

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2
Q

Treatment of pulmonary fibrosis?

A

Immunosuppressive therapy, lung transplantation, oxygen therapy, smoking cessation, pulmonary rehabilitation

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3
Q

Enzymes for MI?

A

Troponins T and I, Creatine kinase

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3
Q

Biggest risk factor for lung cancer?

A

Cigarette smoking

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3
Q

Complications of gallstones in bile ducts?

A

Obstructive jaundice, cholangitis, pancreatitis

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3
Q

What is a direct inguinal hernia?

A

Push their way directly through the posterior wall of the inguinal canal, into a defect in the abdominal wall (meadial to inferior eigastric vessels and lateral to rectus abdominus)

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3
Q

What is a primay generalised seizure?

A

Simultaneous onset of electrical discharge throughout cortex, with no localising features referable to only one hemisphere.

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3
Q

Signs of varicose veins?

A

Oedema; eczema; ulcers; haemosiderin; haemorrhage; phelbitis; atrophie blanche (white scarring at site of previous healed ulcer); lipodermatosclerosis (skin hardness from subcutaneous fibrosis caused by chronic inflammation and fat necrosis)

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4
Q

Treatment of acute asthma?

A

Salbuatamol 5mg nebulised with O2 Hydrocortisone 100mg IV or prednisolone 40-50mg PO or both if very ill O2 if sats

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4
Q

Risk factors for depression?

A

Female sex - pregnancy and postnatal period
Significant physical illness
Other mental health problems - i.e. dementia
African-caribbean, aisan, refugee and asylum seeker communities
Family history of mental illness

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4
Q

Risk factors for dementia?

A

Age, FH, genetics

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5
Q

Specific causes of AAA?

A

Trauma, infection, inflammatory diseases, connective tissue disorders

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5
Q

Presentation of parathyroid adenoma?

A

First signs = bone fractures and urinary calculi.

Can experience common symptoms that can range from joint, muscle and abdominal pain to slight discomfort. Constipation and exhaustion can also be experienced as a result of irregularity in the bloodstream. Kidney damage could also occur.

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6
Q

What are blue bloaters?

A

Reduced alveolar ventilation, with low PaO2 and high PaCO2. Cyanosed but not breathless and may go on to develop cor pulmonale. Respiratory centres are relatively insensitive to CO2 and they rely on hypoxic drive to maintain respiratory effort. EMPHYSEMA

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6
Q

Causes of GORD?

A

Lower oesophageal sphincter hypotension Hiatus hernia Loss of oesophageal peristaltic function Abdominal obesity Gastric acid hypersecretion Slow gastric emptying Overeating Smoking Alcohol Pregnancy Drugs Systemic sclerosis H.pylori

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6
Q

Sinister complication of GORD?

A

Barrett’s oesophagus - distal oesophafeal epithelium metaplasia (sqaumous to columnar) - 0.6-1.6% will progress to cancer

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6
Q

Cardinal signs of dementia?

Behaviour, speech, thinking, perception, mood

A

Global intellectual deterioration without impairment of consciousness - plus memory loss.

Behaviour - restless, no initiative, repetitive, purposeless activity, sexual disinhibition, social gaffes, shoplifting, rigid routines.
Speech - syntax errors, dysphasia, mutism
Thinking - slow, muddled, delusions. Poor memory. No insight.
Perception - illusions, hallucinations (often visual).
Mood - irritable, depressed, affect blunt, emotional incontinence

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6
Q

Risk factors for gastric cancer?

A

Age, male gender, strong association with poor socio-economic status, H.pylori, diet, smoking, familial risk, atrophic gastritis, pernicious anaemia, post-gastrectomy

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6
Q

Valves most commonly affected by infective endocarditis?

A

In descending order: mitral, aortic, combined, tricuspid, pulmonary.

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6
Q

Common features of MS?

A

Visual
Eye movements - symmetrical horizontal jerking nystagmus, lateral rectus weakness
Facial weakness
Hearing and balance deficiencies
Unpleasant sensations
Loss of sensation in legs ascending to trunk
Transverse myelitis - acute episode of weakness or paralysis in both legs, with sensory loss and control of bowels and bladder
Autonomic - faecal incontinence, loss of inhibition of reflex bladder emptying, sexual problems, loss of thermoregulation.

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7
Q

Definition of AKI? (numbers)

A

Rise in creatinine >2umol/L in 48 hrs Rise in creatinine 1.5x baseline Urine output 6 consecutive hours

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7
Q

Risk factors for acute pyelonephritis?

A

Structural renal abnormalitieis, calculi, urinary tract catheterisation, stents, drainage procedures, pregnancy, diabetes, primary biliary cirrhosis, immunocompromised patients

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7
Q

Causes of somatisation?

A
  • Patient seems to seek sick role, which affords relief from stressful or impossible interpersonal expectations (primary gain)
  • Association between somatisation and history of sexual or physical abuse
  • Often associated with the interpersonal representation of the unmet need for closeness with others.
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7
Q

Causes of mitral stenosis?

A

Rheumatic, congenital, mucopolysaccharides, enocardial fibroelastosis, malignany carcinoid, prosthetic valve.

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8
Q

Symptoms and signs of macrocytic anaemia?

A

General symptoms of anaemia

Lemon tinge to skin due to combination of pallor (anaemia) and jaundice (haemolysis), glossitis, angular stomatitis.

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8
Q

Causes of femoral embolism?

A

Left atrial thrombus in AF, mural thrombus after MI, prosthetic and normal heart valves, aneurysm, proximal atheromatous stenosis, malignant tumour, or foreign body

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9
Q

Typical age of SAH?

A

35-65

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10
Q

Prostate cancer metastasis

A

liver, bone, lung

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10
Q

Risk factors for oesophageal cancer?

A

Smoking, alcohol, Barret’s oesophagus, chronic inflammation, obesity, family history of hiatus hernia

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10
Q

Classical triad of aortic stenosis?

A

Angina, syncope and heart failure (usually after 60)

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10
Q

Two types of Addison’s disease?

A

Primary insufficiency (Addison’s) - inability of adrenal glands to produce enough steroid hormones. Most common cause is autoimmune.

Secondary insufficiency - inadequate pituitary or hypothalamic stimulation of adrenal glands.

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10
Q

B symptoms in Hodgkin’s lymphoma?

A

Drenching night sweats, unexplained fever >38, weight loss >10% over 6 months.

Alcohol induced pain at sites of nodal disease.

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11
Q

Seizure history?

A

Is it actually a seizure? (witness history) What type is it? Any triggers?

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11
Q

What is coeliac disease?

A

An immune mediated inflammatory systemic disorder provoked by gluten and related prolamines in genetically susceptible individuals.

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11
Q

Curative treatment for bladder cancer?

A

Radical cystectomy

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12
Q

Treatment for cholecystitis?

A

Laproscopic cholecystectomy is treatment of choice

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12
Q

Investigations in chronic liver failure?

A

Thrombocytopenia.
INR raised.
Trasaminases through the rooooooofffff, alkaline phosphatase may be slightly raised. Bilirubin raised, ammonia high.

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12
Q

What is the prevalence of coeliac and when can it present?

A

1 in 100. Can present at any age.

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13
Q

Causes of large bowel obstruction?

A

Colon cancer, constipation, diverticular stricture, volvulus (sigmoid/caecal)

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13
Q

Symptoms of prostatitis?

A

Flu-like symptoms, low backache, few urinary symptoms, swollen or tender prostate on PR.

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13
Q

Management of self harm?

A

Referral to secondary mental health services
Activated charcoal should be given as early as possible in overdose to prevent or reduce absorption of the drug
Psychological intervention and stuff, care plans

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14
Q

How does COPD differ from asthma?

A

Age of onset >35 years Smoking involved Chronic dyspnoea Sputum production Minimal diurnal variation in FEV1

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15
Q

AXR in Small bowel obstruction?

A

AXR shows central gas shadows with valvulae coniventes that completely cross the lumen and no gas in the large bowel

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15
Q

Most common type of renal carcinoma in adults and children?

A

RCC in adults.

Wilms’ tumour in children.

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16
Q

Presentation of an AUGIB?

A

Haematemasis or malena, dizziness, fainting, abdo pain, ?dysphagia Hypotension, tachycardia, decreased JVP, decreased urine output, cool and clammy

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16
Q

Main causative organism of UTI?

A

E.coli

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16
Q

Causes of B12 deficiency?

A

Dietary

Malabsorption - stomach (lack of intrinsic factor - pernicious anaemia), terminal ileum (ileal resection, crohn’s)

Congenital metabolic errors

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16
Q

Cardinal features of critical ischaemia?

A

Ulceration, gangrene a foot pain at rest (e.g. burning pain at night relieved by hanging legs over side of bed)

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16
Q

Risk factors for OA?

A

Genetic factors

Constitutional factors - ageing, female sex, obesity, high bone density (risk for development of OA), low bone density (RF for progression of knee and hip OA)

Biomechanical factors - joint injury, occupational and recreational stresses on joints, reduced muscle strength, joint laxity, joint malalignment

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16
Q

Risk factors for anxiety?

A

Being aged between 35 and 54
Being divorced or separated
Living alone or as a lone parent

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16
Q

Types of benign salivary gland neoplasms?

A

Pleomorphic adenoma (benign mixed tumour) is most common tumour of parotid gland - slow growing and asymptomatic.

Warthin’s tumour - second most common benign salivary gland neoplasm. 6th decade in women, 7th in men.

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18
Q

Most common sites of metastasis for lung cancer?

A

brain, bone, liver, adrenals

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19
Q

Risk factors for Parkinsons?

A

Men, age

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19
Q

Presentation of mitral stenosis?

Symptoms, signs, ECG, CXR

A

Symptoms - dyspnoea, fatigue, palpitations, chest pain, systemic emboli, haemoptysis, chronic bronchitis like picture.

Signs - malar flush (low cardiac output), low volume pulse, AF common, tapping non-displaced apex beat.
On auscultation - loud S1, opening snap, rumbling mid-diastolic murmur (expiration with patient on left side).

ECG - AF; P mitrale if in sinus rhythm (bifid P waves); RVH; progressive RAD.

CXR - left atrial enlargement, pulmonary oedema, mitral valve calcification

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19
Q

Symptoms of right heart failure?

A

Peripheral oedema, ascites, nausea, anorexia, facial engorgement, pulsation in face and neck, epistaxis.

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21
Q

CXR features of LVF?

A

Alveolar oedema (bats wings) Kerley B lines (interstitial oedema) Cardiomegaly Dilated prominent upper lobe vessels Pleural effusion

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21
Q

Management of acute pancreatitis?

A

NBM Analgesia Continuous observations ERCP + gallstone removal may be needed Repeat imaging (CT) to monitor progress

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22
Q

Ulnar nerve palsy signs?

A

weakness/wasting of ulnar side wrist flexors, interossei (can’t cross fingers), medial 2 lumbricals (claw hand), hypothenar eminence wasting, sensory loss over medial 1 1/2 fingers

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22
Q

M:F ratio and peak onset of RA?

A

F:M 2:1 - 5th-6th decade

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23
Q

Symptoms of appendicits?

A

Classically umbilical pain that moves to RIF (McBurney’s point) Anorexia and important feature Vomiting rarely prominent - pain normally precedes pain in surgical abdomen Constipation normal, diarrhoea may occur

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24
Q

Oesophageal symptoms of GORD?

A

Heartburn (retrosternal burning discomfort after meals, stooping or straining, relieved by antacids) Belching Acid brash (acid/bile regurgitation) Waterbrash (mouth filling with saliva) Odynophagia (painful swallowing)

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24
Q

Management of aortic regurgitation?

A

Aim to reduce systolic hypertension - ACE-i helpful. Aim to replace valve before significant LV dysfunction occurs.

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25
Q

Treatment of tension pneumothorax?

A

Large bore cannula in 2nd intercostal space mid clavicular line on side of suspected PT, then a chest drain

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25
Q

Risk factors for RA?

A

Smoking, HLA DR4/DR1 linked

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26
Q

M:F ratio of OA and typical age of onset?

A

M:F 1:3 - >50 yrs

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27
Q

Secondary prevention of MI?

A

aspirin, clopidogrel, beta blockers, statins, ACE-i, ARBs

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27
Q

What are pink puffers?

A

Have increased alveolar ventilation, a near normal PaO2 and a normal or low PaCO2. Breathless but not cyanosed, may progress to type 1 resp failure (V/Q mismatch) CHRONIC BRONCHITIS

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27
Q

Most common causative organisms of bacterial gastroenteritis?

A

Salmonella, campylobacter, shigella

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28
Q

When should someone be admitted for AUGIB?

A

Aged >60 yeas Witness haematemesis Haemodynamic disturbance (BP 100) Liver disease or known varices Other significant comorbiditiy

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28
Q

Management of somatisation?

A

General advice/explanation, psychotherapy, pharmacological (for underlying mood disorders)

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29
Q

Extra-oesophageal symptoms of GORD?

A

Nocturnal asthma Chronic cough Laryngitis (hoarseness, throat clearing) Sinusitis

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30
Q

Commonest cause of CAP?

A

Streptococcus pneumoniae

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30
Q

Surgery for GORD?

A

Aims to increase resting lower oesophageal sphincter pressure Nissen fundoplication; HALO or Stretta radiofrequency ablation of GOJ if high grade dysplasia

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32
Q

How to distinguish between indirect and direct hernias clinically?

A

Occlude deep inguinal ring and ask patient to cough - if hernia restrained it is direct, if not, it is indirect.

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32
Q

Classifications of anxiety?

A

GAD - anxiety and 3 somatic symptoms for >6 months
Panic disorder
Phobia
PTSD
Social anxiety disorder
Obsessive-compulsive disorder

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34
Q

What is the treatment of choice for non-small cell tumours?

A

Excision, then chemo/radiotherapy

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35
Q
A
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36
Q

Ohter causes of primary hypoT?

A

Iodine deficiency

Post thyroidectomy or radioiodine treatment

Drug induced

Subacute thyroiditis

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36
Q

What antigens are associated with coeliac disease?

A

HLA-DQ2 or HLA-DQ8

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38
Q

Signs of stroke?

A

Sudden onset, maybe with further progression over hours.

Pointers to bleed = meningism, severe headache and coma.

Pointers to ischaemia = carotid bruit, AF, past TIA, IHD

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39
Q

Risk factors for UTI?

A

Female Sex Pregnancy or menopause Urinary tract: obstruction, stones, catheter, malformation decreased host defence (DM)

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40
Q

Treatment of RA?

A

Early use of DMARDs and biological agents.

Steroids rapidly reduce symptoms, useful for treating acute exacerbations.

NSAIDs good for symptom relief but no effect on disease progression.

Surgery may relieve pain, improve function and prevent deformity.

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40
Q

Who is anxiety more common in?

A

Women

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40
Q

Left colon cancers presentation?

A

Often colicky pain, rectal bleeding, bowel obstruction, tenesmus, mass in LIF, early change in bowel habit, less advanced at presentation

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42
Q

Types of partial seizure?

A

Simple - awareness unimpared, focal motor, sensory, autonomic or psychic symptoms. No post-ictal symptoms.

Complex - awareness impaired. May have aura or impaired awareness at onset. Most commonly arise from temporal lobe. Post-ictal confusion common with seizures from temporal lobe, recovery rapid in seizures from frontal lobe.

with secondary generalisation - typically convulsive

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43
Q

When does pancreatic ca usually present?

A

>60yrs

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45
Q

Treatment for AAA rupture?

A

IT’S A FUCKING SURGICAL EMERGENCY AGHHHHHHHHHHHHH

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47
Q

Risk factors for T2DM?

A

Obesity, lack of exercise, calorie and alcohol excess.

High prevalence in asian men and the elderly.

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48
Q

Signs of hypoT?

A

BRADYCARDIC

Bradycardia, reflexes relax slowly, ataxia (cerebellar), dry thin hair/skin, yawning/drowsy, cold hands, ascites, round puffy face/double chin, defeated demeanour, immobile + ileus, CCF

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49
Q

Causes of iron deficiency anaemia?

A

Blood loss (menorrhagia, GI bleeding)

Poor diet (in children)

Hookworm (GI bleeding, commonest cause in tropics)

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49
Q

Risk factors for varicose veins?

A

Prolonged standing, obesity, pregnancy, family history, OCP

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49
Q

Plain radiographs show what in OA?

A

LOSS

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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50
Q

Symptoms of a polyneuropathy?

A

Numbness, pins and needles, ‘feels funny’ or ‘burning’. Affects extremities first (glove and stocking). May be difficulty holding small objects. Signs of trauma or deformation may indicate sensory loss.

Diabetic and alcoholic neuropathies particularly painful.

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51
Q

Duration and exacerbating factors of IBS?

A

Symptoms are chronic (>6 months) and exacerbated by stress, menstruation or gastroenteritis

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52
Q

Cases in which ruputre of AAA is more likely?

A

Hypertensive, smoker, female, strong FH

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52
Q

Presentation of right colon cancers?

A

Weight loss, anaemia, occult bleeding, mass in RIF, disease more likely to be advanced at presentation

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53
Q

When is pneumonia classed as hospital acquired?

A

>48h after hospital admission

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54
Q

How common is AKI?

A

15% of adults admitted to hospital

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54
Q

When should you consider septic arthritis?

A

in any acutely inflamed joint, as it can destroy a joint in under 24h

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55
Q

What is Cushing’s syndrome?

A

Clinical state produced by chronic glucocorticoid excess and loss of normal feedback mechanisms of hypothalamo-pituitary adrenal axis and loss of circadianrhythm of cortisol secretion

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56
Q

What is most common surgical emergency?

A

Acute appendicits

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56
Q

ABPI - normal, PVD, critical ischaemia?

A

Normal = 1-1.2

PAD = 0.5-0.9

Critical ischaemia =

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57
Q

Investigation and treatment of gastric cancer?

A

Rapid access flexible endoscopy is investigation of choice.

Distal tumours treated by subtotal gastrectomy and proximal tumours by total gastrectomy.

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58
Q

Risk factors for DVT?

A

Biggest = prior history of DVT age over 60 yrs, surgery, obesity, prolonged travel, acute medical illness, cancer, immobility, thrombophilia, pregnancy, COP, HRT therapy

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58
Q

Where do majority of salivary gland neoplasms arise?

A

Parotid glands (80%)

10-15% submandibular, remainder in sublingual and minor salivary glands.

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59
Q

Signs of cerebral infarct?

A

Contralateral sensory loss or hemiplegia - initially flaccid (floppy limb), spasticity (UMN), dysphasia, homonomous hemianopia, visuo-spatial deficit.

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59
Q

Presentation of delerium?

A

Patient disorientated in time and with greater impairment, in place.

Sometimes quiet or drowsy, sometimes adgitated.

May be deluded or hallucinating.

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60
Q

Definition of macrocytosis?

A

MCV > 96fL

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61
Q

RVF + LVF = ?

A

CCF

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62
Q

Signs of acute cholecystitis?

A

Local peritonism, possible GB mass - main difference from biliary colic is inflammatory component (local peritonism, increased WCC) If stone moves to common bile duct obstructive jaundice and cholangitis may occur. Murphy’s sign

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62
Q

Causes of prerenal AKI?

A

Renal hypoperfusion. Hypotension (any cause, hypovolaemia, sepsis) Renal artery stenosis, ACEi

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62
Q

Causes of a diffuse smooth goitre?

A

Grave’s disease

Thyroiditis

Iodine deficiency

Drugs

Hereditary factors

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62
Q

What causes peripheral vascular disease?

A

Atherosclerosis causing stenosis of arteries via a multifactorial process involving modifiable and non-modifiable risk factors

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63
Q

Differences in presentation between small and large bowel obstruction?

A

SBO - vomiting occurs earlier, distension is less, pain higher in abdomen. LBO - pain more constant

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63
Q

Causes of anxiety?

A

Genetic predisposition
Stress
Events
Faulty learning or secondary gain

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65
Q

What is chronic bronchitis?

A

Cough, sputum production on most days for 3 months of 2 successive years

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65
Q

When would you do a LP in meningitis?

A

When meningitic signs predominate and so signs of shock or raised ICP

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66
Q

What are worse; non-small cell or small cell carcinomas?

A

Small cell - almost always disseminated at presentation

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66
Q

Risk factors for cholecystitis?

A

Gallstones Hospitalisation for trauma or acute billiary illness Female gender Increasing age Obesity Rapid weight loss Pregnancy Crohns disease Hyperlipidaemia

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66
Q

Two groups of Non-Hodgkin’s?

A

Low grade - relatively good prognosis, but usually not curable in advanced clinical stages.

High grade - shorter natural history but significant number can be cured with intensive chemo

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67
Q

Who does epilepsy affect?

A

Can develop in anyone at any age. Seizures more common in young children and old people

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68
Q

Treatment for CAP?

A

Oral amoxicillin or clarithromycin or doxycycline Severe - co-amoxiclav or cephalosporin in IV and clarithromycin

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69
Q

Types of duct papilloma?

A

Central type - near nipple, solitary, nearing menopause Peripheral type - multiple, peripheries, younger women (higher risk of malignancy)

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69
Q

What does a parathyroid adenoma generally casuse?

A

more PTH to be secreted, causing hypercalcaemia

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69
Q

Presentation of low-grade non-Hodgkins lymphoma?

A

Painless, slowly progressive peripheral lymphadenopathy. Systemic symptoms not common at presentation but common in advanced disease. Bone marrow frequently involved, cytopenia. Splenomegaly, hepatomegaly.

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70
Q

Management of mitral stenosis?

A

Control rate if fast AF. Anticoagulate. Diuretics improve symptoms - aim to replace valve before LV irreversibly impaired.

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71
Q

Complications of GORD?

A

Oesophagitis Ulcers Benign stricture Iron-deficiency

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71
Q

Treatment of PAD?

A

Risk factor modification - smoking, treat HT and cholesterol, antiplatelet agent

Management of claudication - supervised exercise programmes, encourage them to exercise to point of maximal pain, vasoactive drugs (noftidrofuryl oxalate)

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72
Q

Age of onset of IBS

A
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74
Q

Test for ACTH dependent cushing’s?

A

Dexamethasone suppression test

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74
Q

Risk factors for septic arthritis?

A

Pre-existing joint disease (esp RA)
DM
Immunosuppression
CKD
Recent joint surgery
Prosthetic joints
IV drug abuse
Age >80 years

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75
Q

Signs of pneumothorax?

A

Reduced expansion, hyper-resonance to percussion and diminished breath sounds on affected side. Tension pneumothorax - trachea deviated away from affected side

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77
Q

Features of hyperparathyroidism?

A

Osteopenia (bone pain and pathological fractures), renal calculi (from excessive renal calcium absorption)

Muscle weakness, proximal myopathy, fatigue

Anorexia, nausea, vomiting, constipation, abdo pain, peptic ulcer disease, acute pancreatitis

Neruopsychiatric manifestations

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78
Q

MF ratio of IBS?

A

M:F 1:2

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79
Q

Where do most AAAs arise?

A

Infra-renally

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80
Q

What causes gout?

A

Deposition of monosodium urate crystals in and near joints, precipitated for example, by trauma, surgery, starvation, infection or diuretics.

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81
Q

Commonest sites of mets of renal cancer?

A

Lungs - classical picture of cannonball secondaries is almost diagnostic.

Adrenal glands, liver, spleen, colon, pancreas.

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83
Q

What are mononeuropathies?

A

Lesions of individual peripheral nerves or cranial nerves. Causes usually local, such as trauma or entrapment.

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85
Q

Management of AF?

A

Control of arrythmia and thromboprophylaxis, plus treatment of underlying cause and HF. Rhythm control - flecainide, beta blockers, amiodarone, dronedarone

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86
Q

Presentation of rheumatic heart disease?

Symptoms, signs, ECG, CXR

A

Symptoms - elderly person with chest pain, exertional dyspnoea, syncope. Dyspnoea, dizziness, faints, systemic emboli if infective endocarditis, sudden death.

Signs - slow rising pulse with narrow pulse pressure; heaving non displaced apex beat, LV heave, aortic thrill, ejection systolic murmur (left sternal edge, base, radiates to carotids)

ECG - P-mitrale, LVH with strain patter, LAD, poor R wave progression, LBBB or complete AV block (calcified ring)

CXR - LVH, calcified aortic valve, post-stenotic dilatation of ascending aorta.

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87
Q

AD more common in men or women?

A

Women

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87
Q

Patterns of MS?

A

Relapsing/remitting

Secondary progressive

Primary progressive

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88
Q

Investigations for gout?

A

Polarised light microscopy of synovial fluid shows negatively birefringent urate crystals.

Serum urate usually raised but may be normal.

Radiographs show only soft-tissue swelling in early stages. Later, well defined ‘punched out’ erosions seen in juxta-articular bone.

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89
Q

M:F ratio of UC?

A

1:1

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90
Q

Treatment of breast ca?

A

Wide local excision or mastectomy, axillary node clearance or sentinel node biopsy. Radiotherapy recommended for all breast ca. Chemo improves survivial in most groups. Endocine agents - Aim to reduce oestrogen activity (ER/PR blockers) ER blocker = tamoxifen (5 yrs after surgery) Aromatase inhibitors (anastrazole) - target peripheral oestrogen synthesis

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90
Q

Who does meningitis affect?

A

All groups, mainy infants, young children and the elderly

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91
Q

Presentation of Addison’s disease?

A

Persistent non-specific symptoms

Fatigue/weakness, nausea, vomiting, weight loss, abdo pain, diarrhoea, constipation, cravings for salt, muscle cramps/joint pains, syncope/dizziness, confusion, personality change, irritability, loss of pubic or axillary hair in women.

Signs - hyperpigmentation (buccal mucosa, lips, palmar creases, pressure areas), hypotension, postural hypotension.

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93
Q

Extra intestinal signs of UC?

A

May be none. In acute severe UC: clubbing, apthous oral ulcers, erythema nodosum, pyoderma gangrenosum, conjunctivitis, episcleritis, iritis… loads more

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94
Q

What causes depression?

A

Genetics
Biochemistry (excess 5HT2 receptors in frontal cortex of suicide victimes)
Endocrinology
Stressful events
Learned helplessness
Vulnerability factors - physical illness, pain, lack of intimate relationships

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95
Q

Investigations in hypoT?

A

High TSH, low T4

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95
Q

Signs of RA?

A

Early - swollen MCP, PIP, wrist or MTP joints (often symmetrical)

Late - ulnar deviation of fingers and dorsal wrist subluxation. Boutonniere and swan neck deformities of fingers or z-deformity of thumbs occur. Hand extensor tendons may rupture. Foot changes similar.

Extra-articular - nodules on elbows and lungs, lymphadenopathy, vasculitis, fibrosing alveolitis, eye shit, bone shit…

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97
Q

what are varicose veins?

A

Long tortuous and dilated veins of the superficial venous system

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99
Q

Treatment of migraine?

A

Analgesia (NSAIDs)

Anti-migraine drugs and anti-emetics

Identify possible trigger factors and remove

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100
Q

95% of pancreatic cas have mutations in what gene?

A

KRAS2 gene

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100
Q

Highest period of incidence of RCC?

A

Incidence rises after age 40 and is highest between 60 and 70.

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101
Q

Where does Crohn’s affect?

A

Anywhere from mouth to anus (especially terminal ileum and proximal colon) Characterised by skip lesions

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102
Q

When does MS usually start? Who gets it? Prevalence?

A

Early adult life

F:M 3:2, caucasians, strong familial inheritance

1:1000

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103
Q

Types of AKI?

A

Pre-renal, renal and post-renal

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104
Q

What is the most important risk factor for illness and dealth globally?

A

Manutrition

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106
Q

Risk factors for epilepsy?

A

Fucked up babies, bleeding in brain, abnormal cerebral vasculature, serious brain injury, brain tumours, infections in the brain, stroke, cerebral palsy, conditions with intellectual and developmental disabilities, family history, use of illegal drugs

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107
Q

UTI commoner in?

A

Women

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107
Q

What causes varicose veins?

A

Valves prevent blood from passing from deep to superifical veins - if they become incompetent there is venous hypertension and dilatation of the superficial veins occurs.

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108
Q

Risk factors for an acute upper GI bleed?

A

Alcohol abuse Chronic renal failure NSAID use Age Low socio-economic class

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109
Q

Result of high levels of PTH?

A

Serum calcium levels increase, serum phosphate levels decrease

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110
Q

Peak age and gender for urinary tract stones?

A

30-50, M:F 3:1

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112
Q

Causes of epilepsy/seizures?

A

2/3 idiopathic (often familial)

Cortical scarring, developmental, space occupying lesion, stroke…

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112
Q

Prevalence of parkinson’s?

A
  1. 6% at 60-64
  2. 5% at 85-89
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113
Q

What is Addison’s disease?

A

Adrenal insufficiency - destruction of adrenal cortex and subsequent reduction in output of adrenal hormones (glucocorticoids and/or mineralocorticoids)

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115
Q

2 ACTH dependent causes of Cushing’s?

A

Cushing’s disease

Ectopic ACTH production (small cell lung cancer and carcinoid tumours)

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117
Q

Causes of Renal AKI?

A

Tubular (ATN) Glomerular (autoimmune, glomerulonephritis) Interstitial (drugs, etc) Vascular (vasculitis)

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118
Q

Investigation of DVT?

A

WELL’S SCORE Either: a proximal leg ultrasound scan and a D-dimer test OR a D-dimer test and an interim 24 hour dose of a parenteral anticoagulant Venography Standard CXR, bloods, urinalysis etc

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119
Q

Definition of AKI? (wordy)

A

rapid deterioration of renal function, resulting in an inability to maintain fluid, electrolyte and acid-base balance

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119
Q

Presentation of hereditary renal cancers?

A

Tend to be multiple, bilateral and occur at an earlier age

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120
Q

Investigations in Addison’s disease?

A

High sodium, low potassium, high calcium, cortisol usually reduced.

ACTH levels raised in primary insufficiency - Synacthen test required to confirm diagnosis

Renin high and aldosterone low in Addison’s

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121
Q

Most common causes of HF?

A

hypertension and CHD

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121
Q

Risk factors for Non-Hodgkin’s?

A

Chromosomal translocations, some viruses, environment factors (pesticides, solvents, chemicals, preservatives, chemo, radiation), congenital and acquired immunodeficiency states. Autoimmune disorders.

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122
Q

What is RA?

A

Chronic systemic inflammatory disease characterised by a symmetrical, deforming, peripheral polyarthritis.

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124
Q

Presentation of pleural effusion on CXR?

A

Small effusions blunt the costophrenic angles, larger ones seen as water dense shadows with concave upper borders. A completely flat horizontal upper border implies that there is also a pneumothorax

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124
Q

Symptoms/signs of ruptured AAA?

A

Intermittent or continuous abdo pain (radiating to back, iliac fossae or groins), collapse, an expansile abdominal mass and shock.

Should be considered in any patient with hypotension and atypical abdominal symptoms.

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125
Q

How long do you have to stop driving for after a seizure?

A

1 year, they have to contact DVLA

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125
Q

Risk factors for PVD?

A

Smoking, DM, hypertension, hyperlipidaemia, physical inactivity, obesity

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126
Q

Empirical treatment for acute pyelonephritis?

A

Ciprofloxacin - third gen cephalosporin is alternative

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127
Q

Chief cause of Cushing’s syndrome?

A

Oral steroids

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128
Q

Symptoms of acute pyelonephritis?

A

High frequency, rigors, vomiting, loin pain/tenderness, oliguria

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129
Q

Investigations in RA?

A

Rheumatoid factor positive in about 70%.

Inflammation causes increased platelets, increased ESR, increased CRP.

X-rays show soft tissues swelling, juxta-articular osteopenia and reduced joint space. Later there may be bony erosions, subluxation or complete carpal destruction.

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129
Q

Hallmarks of chronic liver failure?

A

Hepatic encephalopathy, abnormal bleeding, ascites, jaundice

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131
Q

Symptoms of acute cholecystitis?

A

Continuous epigastric or RUQ pain (referred to right shoulder), vomiting, fever

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132
Q

Other causes of peptic ulcer?

A

NSAID use, pepsin, smoking, alcohol, bile acids, steroids, stress

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133
Q

Causes of meningitis in neonates?

A

Group B streptococci, listeria monocytogenes, E.coli

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135
Q

Where in the bowel does UC affect?

A

Never spreads proximal to ileocaecal valve - may just affect rectum or extend to affect some or all of colon

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137
Q

Treatments for alcohol dependence?

A

Abstinence/controlled intake
Refer to specialists - self-help/group therapy
Disufiram - produces nasty reaction if taken with alcohol
Education and counselling
Homelessness common - sort this out

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138
Q

Risk factors for stroke?

A

Hypertension, smoking, DM, heart disease, peripheral vascular disease, past TIA, carotid bruit, OCP, hyperlipidaemia, alcohol excess, clotting disorders

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139
Q

Risk factors for prostate cancer?

A

+ve family history, increased testosterone

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140
Q

Symptoms/signs of T1DM?

A

Polydipsia, polyuria, lethargy, boils, pruritis vulvulae

Weight loss, dehydration, ketonuria, hyperventilation

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141
Q

Increased risk of what in RA?

A

Cardiovascular disease - atherosclerosis accelerated in RA

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143
Q

Management of pancreatic ca?

A

Pancreaticoduodenectomy (Whipple’s procedure) if fit and no mets. Post op mortality high.

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145
Q

Investigations in macrocytic anaemia?

A

Low Hb, high MCV, WCC and platelets

low serum b12

low reticulocytes

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146
Q

What is a Mallory-Weiss tear?

A

bleeding from a tear in the mucosa at the junction of the stomach and esophagus, usually caused by severe alcoholism, retching, coughing, or vomiting.

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146
Q

Risk factors for bladder carcinoma?

A

Main = increasing age.

Smoking (aromatic amines and polycyclic aromatic hydrocarbons)

Occupational exposure to AAs and PAHs (dyes, paints, metal, petrol)
Radiation to pelvis
Chronic inflammation from stones or catheters
Schistosomiasis - 80% bladder cancers in developing world

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147
Q

Causes of polyneuropathy?

A

Diabetic neuropathy
Nutritional - alcohol, B12 deficiency
Heavy metal poisoning
Infection
Metabolic
Chronic vascular disease
Chronic inflammtory demyelinative polyneuropathy
Postinfective polyeneuriti (Guillain-Barré)
Sarcoidosis
Drugs
Congenital

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149
Q

Signs of pleural effusion?

A

Decreased expansion, stony dull percussion note, diminished breath sounds occur on affected side, tactile vocal fremitus/vocal resonance decreased

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151
Q

Local complications of lung cancer?

A

Recurrent laryngeal nerve palsy, phrenic nerve palsy, SVC obstruction, Horner’s syndrome, rib erosion, pericarditis, AF

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152
Q

Commonest age of onset for appendicits?

A

10-20

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152
Q

Abx for meningitis?

A

Cefotaxime

Ampicillin too for Listeria, also if >55 yrs old

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154
Q
A
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154
Q

Causes of mononeuropathy?

A

Mechanical (trauma, compression)
Entrapment
DM
Hypothyroidism
Rheumatoid arthritis
Vitamin deficiencies
Vasculitis
Sarcoidosis
Amyloidosis
Pregnancy - carpal tunnel syndrome

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155
Q

Two things associated with prognosis in breast ca?

A

Oestrogen receptor +ve = better prognosis HER2 positivity = poorer prognosis

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156
Q

Severity scoring system for pneumonia?

A

CURB-65 Confuson - AMTS 7mmol/L RR >30 BP 65 0-1 = home 2 = hospital therapy >3 = severe pneumonia, mortality 15-40%

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157
Q

Presentation of bladder cancer?

A

Painless haematuria is bladder cancer until proven otherwise.
Advanced disease may cause voiding symptoms. Muscle invasive disease.

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159
Q

Symptoms of IBS?

A

Abdo pain (or discomfort) relieved by defecation or associated with altered stool form or bowel frequency (constipation and diarrhoea may alternate) >2 or: urgency, incomplete evacuation, abdominal bloating/distension, mucous PR, worsening of symptoms after food.

161
Q

Complications of hyperT?

A

Heart failure (thyrotoxic cardiomyopathy), angina, AF, osteoporosis, opthalmopathy, gynaecomastia.

162
Q

Symptoms of Crohn’s?

A

Diarrhoea/urgency, abdo pain, weight loss/failure to thrive Fever, malaise, anorexia

164
Q

Sign of common peroneal nerve damage and where is it vulnerable?

A

Foot drop

As it winds around the fibular head

166
Q

Presentation of gout?

A

Acute monoarthropathy with severe joint inflammation.

>50% occur at MTP joint of big toe. Other joints affected = ankle, foot, small joints of hand, wrist, elbow or knee.

167
Q

Management of UTI?

A

Drinking plenty and urinating often Empirical treatment - trimethoprim/nitrofurantoin Alternative - amoxicillin, cefalexin, co-amoxiclav In men, refer to urology

167
Q

Endogenous cause of Cushing’s?

A

80% due to increased ACTH - pituitary adenoma (cushing’s disease) is commonest cause

168
Q

Treatment of tension headache?

A

Attention to stress, anxiety, depression. Adviceon exercise, physiotherapy and posture, lifestyle changes.

Simple anlgesics. If not working, tricyclic antidepressants (amitryptiline)

169
Q

What is an indirect inguinal hernia?

A

Pass through internal inguinal ring, and, if large, out through the external ring.

170
Q

What drugs would you want to stop in AKI?

A

NSAIDs, ACE-i, gentamicin, amphotericin

171
Q

Features of bowel obstruction?

A

Fermentation of intestinal contents causes ‘faeculent’ vomiting. Constipation need not be absolute if obstruction is high, though in distal obstruction nothing will be passed. Abdominal distension is marked as obstruction progresses Active, tinkling bowel sounds

172
Q

Viruses causing gastroenteritis?

A

Rotavirus, norovirus, adenovirus, astrovirus

173
Q

Signs of PVD?

A

Absent femoral, popliteal or foot pulses

Cold white legs, atrophic skin, punched out ulcers, postural/dependent colour change, Buerger’s angle 15s

174
Q

How to distinguish between indirect and direct hernias in surgery?

A

Direct hernias arise lateral to inferior epigastric vessels, indirect hernias are medial

176
Q

WHO criteria for manutrition in children?

A

Bipedal oedema, visible severe wasting, weight for height more than 3 SDs below the median of international reference population.

177
Q

What is pulmonary fibrosis?

A

Group of diseases which produce interstitial lung damage and ultimately fibrosis and loss of elasticity of the lungs

178
Q

Functions of PTH? (4)

A

Increases release of calcium from bone matrix
Increases calcium reabsorption by kidney
Increases phosphate excretion
Increases renal production of calcitrol, which increases intestinal absorption of calcium

179
Q

Prevalence of breast ca?

A

1 in 9 women, rare in men

179
Q

Cardiac causes of stroke?

A

Non-valvular AF, external cardioversion, prosthetic valves, acute MI, paradoxical systemic emboli (via venous circulation), cardiac surgery, valve vegetations from SBE/IE

181
Q

Prevalence of depression?

A

20% each year

181
Q

Presentation of somatisation?

A

Cardiac - sob, palpitations, chest pain
GI - vomiting, abdo pain, dysphagia, nausea, bloating, diarrhoea
MSK - pain in limbs, back pain, joint pain
Neuro - headahces, dizziness, amnesia, vision changes, paralysis, muscle weakness
Urogenital - dysuria, low libido, dyspareunia, impotence, dysmenorrhoea

182
Q

What is the commonest joint condition?

A

OA

183
Q

How does femoral hernia present?

A

Bowel enters femoral canal, presenting as mass in upper medial thigh or above the inguinal ligament where it points down the leg, unlike inguinal which points to the groin

184
Q

Presentation of infective endocarditis?

A

Majority = fever, associated with systemic symptoms of chills, poor appetite and weight loss.

Heart murmurs in up to 85%

Splinter haemorrhages, osler’s nodes, clubbing, Roth’s spots, Janeway’s lesions, arthritis, splenomegaly, meningism.

185
Q

Peak age of incidence of pulmonary fibrosis?

A

50-70

186
Q

Cause of parkinsons?

A

Mitochondrial DNA dysfunction causes degeneration of dopaminergic neurons in the substantia nigra pars compacta

188
Q

Treatment of acute stroke?

A

Thrombolysis - if onset

NBM - swallowing may lead to choking.

Antiplatelet agent - once haemorrhagic stroke exlcuded, give aspirin 300mg.

190
Q

Types of malignant salivary gland neoplasm?

A

Mucoepidermoid carcinoma - most common malignany of parotid gland (2nd of submandibular after adenoid cystic)

Adenocarcinoma - poorly differentiated and anaplastic

SCC, malignant mixed tumours, adenoid cystic carcinoma

191
Q

AXR in large bowel obstruction?

A

AXR shows peripheral gas shadows proximal to blockage but not in rectum, unless PR has been done. Large bowel haustra do not cross all the lumen’s width.

192
Q

Presentation of renal carcinoma?

A
  • Classic triad = haematuria, loin pain, loin mass (not often seen now)
  • Fatigue, weight loss, macroscopic haematuria, palpable mass, varicocele, bilateral ankle oedema, pyrexia of unknown origin and hypertension.
  • 25-30% present with symptoms of metastatic disease - haemoptysis, bone pain and pathological fracture.
193
Q

Treatment for prostate ca?

A

Radical prostatectomy Radical radiotherapy Hormone therapy Active surveillance

195
Q

Risk factors for alcohol dependence?

A

Steady drinking over time
Age
FH
Depression/other mental health problems
Social/cultural factors
Mixing medication and alcohol

196
Q

Symptoms of hypoT?

A

Tired, sleepy, lethargic, low mood, cold-disliking, weight gain, constipation, menorrhagia, hoarse voice, reduced memory/cognition, dementia, myalgia, cramps, weakness

198
Q

Other causes of CAP?

A

Haemophilus influenzae, mycoplasma pneumoniae, Staph aureus, legionella species, moraxella catarrhalis and chlamydia.

198
Q

Treatment for PE?

A

Anticoagulate with LMWH Start warfarin Stop heparin when INR >2 and continue warfarin for a minimum of 3 months Thrombolysis for massive PE Consider placement of veno caval filter in patients who develop emboli despite adequte coagulation

200
Q

Signs of Iron deficiency anaemia?

A

Pallor (e.g. conjunctival)

Signs of hyperdynamic circulation (tachycardia, flow murmurs, cardiac enlargement)

Chronic IDA signs - koilonychia, atrophic glossitis, angular stomatitis, post-cricoid webs

201
Q

Smoking and UC?

A

Protective - 3 times as common in non-smokers, symptoms may relapse on stopping smoking

202
Q

Symptoms of hyperT?

A

Diarrhoea, weight loss, increased appetite, overactive, sweats, heat intolerance, palpitations, tremor, irritability, liable emotions, oligomenorrhoea +/- infertility.

203
Q

Where might the radial nerve be damaged?

A

Compression against the humerus

204
Q

Secondary hypoT?

A

Very rare - hypopituitarism

205
Q

Other causes of LVF?

A

Valve disease, secondary to myocardial disease, high output failure (anaemia, pregnancy, hyperthyroid)

206
Q

Age relation to peripheral neuropathy?

A

More common as you get older

207
Q

Symptoms of prostate cancer?

A

Lower urinary tract symptoms - nocturia, hesitancy, poor stream, terminal dribbling, obstruction

209
Q

Symptoms of PVD?

A

Cramping pain felt in calf, thigh or buttock after walking a given distance and relieved by rest.

210
Q

Sign of brachial plexus injury?

A

Pain/paraesthesia and weakness in the affected arm in a variable distribution

211
Q

Symptoms of UC?

A

episodic or chronic diarrhoea (with or without blood/mucus); crampy abdominal discomfort; bowel frequency relates to severity Urgency/tenesmus indicates rectal UC. Systemic symptoms in acute attacks - fever, malaise, anorexia, weight loss

213
Q

Specific features of ectopic ACTH production?

A

pigmentation, hypokalaemic metabolic acidosis, weight loss, hyperglycaemia

214
Q

What would you see on colonoscopy in UC?

A

Inflammatory infiltrate, goblet cell depletion, glandular distortion, mucosal ulcers, crypt abscesses

215
Q

Complications of macrocytic anaemia?

A

Neuropsychiatric

Neurological - paraesthesiae, peripheral neuropathy

Subacute combined degeneration of spinal cord

216
Q

Median age at diagnosis of Non-Hodgkin’s lymphoma?

A

Older than 50

218
Q

Prostate cancer PR?

A

Hard, irregular prostate

219
Q

Causes of hyperT?

A

Grave’s disease

Toxic multinodular goitre - elderly and iodine deficient areas.

Toxic adenoma

Ectopic thyroid tissue

Exogeneous - iodine excess

220
Q

Causes of aortic stenosis?

A

Senile calcification is commonest. Others = congenital and rheumatic heart disease.

221
Q

How does alcohol dependence present?

A

Difficulty or failure of abstinence
Narrowing of drinking repertoire
Increased tolerance to alcohol
Often aware of compulsion to drink
Priority is to maintain alcohol intake
Sweats, nausea or tremor on withdrawal

social problems, mental health problems, law problems, physical problems spanning all systems

222
Q

Treatment for hypoT?

A

Levothyroxine (t4) - once normal check TSH yearly

223
Q

Management of delerium?

A

Find the cause. Optimise surroundings and nursing care. Monitor BP often. If adgitation distressing patient, consider haloperidol or risperidone.

224
Q

Treatment of acute gout?

A

Use high dose NSAID or coxib. Symptoms should subside in 3-5 days.

Steroids may also be used. Rest and elevate affected joint. Ice packs can be effective.

225
Q

Causes of RHF?

A

LVF, pulmonary stenosis, lung disease

226
Q

Definition of AAA?

A

Aortic diameter exceeding 3cm

227
Q

Who does bladder carcinoma occur in?

A

Mostly patients over 60 years. M:F 3:1 but women have poorer prognosis.

228
Q

Presentation of breast abscess?

A

>1 week postpartum Only one breast affected, only one quadrant or lobule painful to touch, inflamed, swollen, hot.

230
Q

What causes urinary tract stones?

A

Renal calculi formed when urine supersaturated with salt and minerals such as oxalate, struvite, uric acid and cytseine.

231
Q

Who is at risk of aspiration pneumonia?

A

Stroke patients, myasthenia, bulbar palsies, those with decreased consciousness

233
Q

Symptoms of fibrocystic change?

A

Pain or discomfort in both breasts Pain that commonly comes and goes with the period but may last the whole month Breasts that feel full, swollen and heavy Pain or discomfort under the arms Thick or lumpy breasts

234
Q

Causes of delerium?

A

Infection, drugs, deranged electrolytes, hypoglycaemia, weird blood gases, epilepsy, alcohol withdrawal, trauma, surgery

235
Q

Treatment for T1DM?

A

Insulin

236
Q

Risk factors for goitre?

A

Women, age, iodine deficiency, pregnancy/menopause, medication, exposure to radiation

238
Q

Risk factors for pulmonary fibrosis?

A

Occupational hazards
Smoking
GORD
Infectious agents
Genetic factors

240
Q

What proportion of parotid neoplasms are benign?

A

80%

242
Q

Investigation for fibrocystic disease?

A

Triple assessment if lump found Under 35 - USS, over 40 - mammogram

243
Q

Main aetiological factor in peptic ulcers?

A

H.pylori - 95% of duodenal ulcers, 80% of gastric ulcers

244
Q

Smoking and Crohn’s?

A

Increases risk by 3-4x

245
Q

Symptoms of lung cancer?

A

Cough (80%), haemoptysis (70%), dyspnoea (60%), chest pain (40%), recurrent or slowly resolving pneumonia, lethargy, anorexia, weight loss

246
Q

Most common sites of mets of colorectal cancer?

A

Liver, lung, peritoneum

248
Q

What is a parathyroid adenoma?

A

Benign tumour of parathyroid gland

250
Q

AF signs?

A

irregularly irregular ventricular pulse and loss of association between cardiac apex beat and radial pulsation

250
Q

Signs illicted in RIF in appendicitis?

A

Guarding Rebound and percussion tenderness PR painful on right (sign of low lying pelvic appendix)

250
Q

Types of generalised seizure?

A

Absence - brief, pauses, then carries on where left off. Presents in childhood.

Tonic-clonic - loss of consciousness, limbs stiffen then jerk. Post ictal confusion and drowsiness.

Myoclonic seizures - sudden jerk of a limb face or trunk. Patient may be thrown to the ground or have a very disobedient limb.

Atonic (akinetic) seizures - sudden loss of muscle tone causing a fall, no LOC

252
Q

Joints most commonly affected in septic arthritis?

A

Knee (50%)
Hip (20%)
Shoulder (8%)
Ankle (7%)
Wrists (7%)

253
Q

Causes of a single nodule in the thyroid?

A

Cyst, adenoma, carcinoma

254
Q

Investigation of choice in coeliac disease?

A

IgA anti-tissue transglutaminase antibodies (tTGAs)

255
Q

What do you want to do with a pleural effusion?

A

Diagnostic aspiration - clinical chemistry, bacteriology, cytology, immunology. Drainage Pleurodesis - with tetracycline, bleomycin or talc - may be useful in recurrent effusions Surgery required if persistent collections and increasing pleural thickness

257
Q

Drugs for epilepsy?

A

Sodium valproate or lamotrigine are 1st line, then carbameazepine or topiramate (for tonic clonic)

259
Q

Investigations in hyperparathyroidism?

A

Hypercalcaemia, raised PTH, hypophosphataemia, increase in 24 hour urinary calcium excretion

260
Q

Causes/risk factors for pleural effusion?

A

CCF, kidney failure, malignancy, infection, PE, hypoalbuminaemia, cirrhosis, trauma

261
Q

Who does somatisation affect?

A

Higher percentages in people with IBS and chronic pain patients, patients with PTSD.

Antiosocial personality disorder is associated with risk.

Usually begins before age 30 and occurs more commonly in women than men.

262
Q

Investigations in somatisation?

A

Diagnostic tests used to rule out physical causes

Psychological evaluation

263
Q

Presentation of oesophageal carcinoma?

A

Dysphagia, vomiting, anorexia/weight loss, symptoms of GI bleeding

264
Q

Prevalence of alcohol dependence?

A

9% men, 4% women

265
Q

Risk factors for meningitis?

A

CSF shunts or dural defects

Spinal procedures

Bacterial endocarditis, DM, alcoholism and cirrhosis, IV drug abuse, renal/adrenal insufficiency, malignancy, hypoparathyroidism, thalassaemia major, CF

Splenectomy, sickle cell disease

Crowding

267
Q

What does CSF look like after SAH?

A

Typically bloody early on and becomes xanthanchromic after several hours due to bilirubin

268
Q

Presentation of breast ca?

A

Painless increasing mass, may be associated with nipple discharge, skin tethering, ulceration. In inflammatory cancers oedema and erythema may also be present (peau d’orange) Nipple inversion, blood-stained nipple discharge Disseminated disease - bone pain, pathological fracture, dyspnoea, pleural effusion, hepatomegaly, jaundice

269
Q

Conditions associated with hypothyroidism?

A

Other AI disorder (T1 DM, addison’s, PA), Turner’s, down’s, CF, primary biliary cirrhosis, POEMS syndrome

270
Q

Differential diagnosis of claudication pain?

A

Sciatica, spinal stenosis, entrapment syndromes, muscle/tendon injury

271
Q

Most sublingual and minor salivary gland neoplasms are …?

A

Malignant

272
Q

Signs of unruptured AAA on examination?

A

Pulsatile and expansile abdominal swelling

274
Q

Presentation of coeliac disease?

A

Anaemia, non-specific symptoms of abdo discomfort, arthralgia, anaemia, fatigue and malaise.
Diarrhoea, steatorrhoea and malabsorption.
Mouth ulcers and angular stomatitis are common. Deficiencies of vit E and B12 can occur.

275
Q

Signs suggesting incurable gastric cancer?

A

Epigastric mass, hepatomegaly, jaundice, ascites, Troiseir’s sign (virchows), acanthosis nigricans

276
Q

Types of breast cancer?

A

Invasive ductal carcinoma (70%) Invasive lobular carcinoma (10-15%) Medullary (5%)

277
Q

What is COPD?

A

Chronic bronchitis and emphysema

278
Q

Most common cause of ruputre in the abdomen?

A

Perforated duodenal ulcer

279
Q

When does UC usually present?

A

15-30 years

279
Q

Symptoms of cystitis?

A

Frequency, dysuria, urgency, haematuria, suprapubic pain

280
Q

Definition of neurosis?

A

Maladaptive psychological symptoms not due to organic causes or psychosis and usually precipitated by stress

281
Q

Empirical abx therapy for IE?

Native valve, prosthetic valve, staph native valve, staph prosthetic valve

A

native valve = amoxicillin and (optional) gentamicin
Prosthetic valve = vancomycin AND gentamicin AND rifampicin
Staph, native valve = flucloxacillin IV, 6 weeks
Staph, prosthetic valve = flucloxacillin and rifampicin and gentamicin

282
Q

Later signs of meningitis?

A

Meningism - neck stiffness, photophobia, kernig’s sign (pain/resistance on passive knee flexion with hip fully flexed)

Conscious level decreased, coma

Seizures

Petechial rash (non blanching)

Signs of galloping sepsis - slow cap refill, DIC, low BP, high temp and pulse

284
Q

Presentation of mitral regurgitation?

Symptoms, signs, ECG, CXR

A

Symptoms - dyspnoea, fatigue, palpitations, infective endocarditis.

Signs - AF; displaced hyperdynamic apex; RV heave; pansystolic murmur at apex radiating to axilla.

ECG - AF; P mitrale if in sinus rhythm; LVH

CXR - big LA and LV, mitral valve calcification, pulmonary oedema.

286
Q

Signs of Crohn’s?

A

Apthous ulcerations, abdo tenderness/mass, perianal abscess/fistulae/skin tags, anal strictures. Clubbing, skin joint and eye problems

287
Q

Causes of mitral regurgitation?

A

Functional (LV dilatation), annular calcification, rheumatic fever, infective endocarditis, mitral valve prolapse, ruptured chordae tendinae, papillary muscle dysfunction/rupture, connective tissue disorders, cardiomyopathy, congenital.

288
Q

Parkinson’s gait?

A

Gait - reduced arm swing, festinance, freezing at obstacles, expressionless face.

290
Q

what is a pneumothorax?

A

Collection of air in pleural space surrounding lung

291
Q

Presenting features of localised disease in OA?

A

Pain on movement and crepitus, worse at the end of the day

Background pain at rest

Joint gelling - stiffness at rest up to ~30 mins

Joint instability

292
Q

Risk factors for SAH?

A

Smoking, alcohol misuse, high BP, bleeding disorders, mycotic aneurysm, post-menopausal decrease in oestrogen. Close relatives have 3-5 fold increase in risk

293
Q

Diagnostic criteria for T1DM?

A

Symptoms of hyperglycaemia AND raised venous glucose once - fasting >7mmol/L or random >11.1 mmol/L

Or asymptomatic with rasied readings on two separate occasions.

294
Q

Pharmacological management of T2DM?

A

Metformin (biguanide) - increased insulin sensitivity and helps weight

Sulfonylurea - increased insulin secretion (e.g. gliclazide)

Insulin may be needed

Glitazone - increased insulin sensitivity

Sulfonylurea receptor binders - increased beta-cell insulin resistance

Glucagon like peptide (GLP) analogues - augment insulin release

Alpha-glucosidase inhibitors (acarbose) - reduced breakdown of starch to sugar

295
Q

Breast ca risk factors?

A

Family history, age, uninterrupted oestrogen exposure (early menarche, late menopause, 1st prego >30 yrs old, HRT, obesity), BRCA genes, not breastfeeding, past breast ca

296
Q

Risk factors for delerium?

A

Age >65 years, male sex, pre-existing cognitive deficit, severity of dementia, severe comorbidity, previous episode of delerium, operative factors (frature repairs), certain conditions, current hip fracture or severe illness, drug use, substance misuse, extremities of sensory experience, visual or hearing problems, poor mobility, social isolation, stress, terminally ill, movement to new environment, ICU admission

297
Q

Who does tension headache affect?

A

More common in women than men and most common in young adults.

298
Q

Presentation of high-grade non-Hodgkin’s lymphoma?

A

Rapidly growing and bulky lymphadenopathy. Systemic symptoms and extranodal involvement more common. Hepatomegaly, splenomegaly. Obstructive hydronephrosis due to bulky retroperitoneal lymphadenopathy obstructing ureters. Testicular mass, skin lesions.

300
Q

ECG signs in AF?

A

absence of P waves, irregular R-R intervals, QRS complexes narrow

301
Q

Most common causes of hospital acquired pneumonia?

A

Gram negative enterobacteria or Staph Aureus

302
Q

Symptoms of iron deficiency anaemia?

A

Fatigue, dyspnoea, faintness, palpitations, tinnitus, anorexia

304
Q
A
305
Q

Treatment of DVT?

A

LMWH or fondaparinux Compression stockings Temporary IVC filters for patients with proximal DVT or PE who can’t have anticoagulation treatment

306
Q

Cardinal triad or parkinsonism?

A

Tremor - worse at rest, ‘pill rolling’

Rigidity/hypertonia - rigidity and tremor gives ‘cogwheel rigidity’

Bradykinesia/hypokinesia - slow to initiate movement and slow low amplitude excursions in repetitive action.

Reduced blink rate, monotonous monophonic speech, micrographia.

307
Q

Signs of LVF?

A

tachypnoea, cool peripheries, central/peripheral cyanosis, tachycardia at rest, low systolic BP, displaced apex (LV dilatation), crackles in lung bases

308
Q

Complications of acute pancreatitis?

A

Shock, ARDS, renal failure, DIC, hypocalcaemia, hyperglycaemia,. Pancreatic necrosis, psuedocyst, asbcesses, bleeding, thrombosis, fistulae, recurrent odematous pancreatitis.

310
Q

Main type of bladder cancer?

A

90% = transitional cell carcinoma, rest = SCC

311
Q

Risk factors for AF?

A

Hypertension, primary heart diseases (CHD, valvular), lung pathologies, excess alcohol consumption, hyperthyroidism, HF

312
Q

Imaging modality of choice for urinary tract stones?

A

Non-enhanced CT scanning, USS

314
Q

Typical symptoms of RA?

A

Symmetrically swollen, painful and stiff small joints of hands and feet, worse in the morning. Can fluctuate and larger joints may be involved.

315
Q

Core treatments for OA?

A

Exercise to improve local muscle strength and general aerobic fitness. Weight loss if overweight.

Analgesia - regular paracetamol and topical NSAIDs. If ineffective use codeine or short term oral NSAID. Topical capsaicin. Infra-articular steroid injections temporarily improve symptoms, intra-articular hyaluronic acid injections. Glucosamine not recommended

Non-pharmacological - MDT approach. Heat or cold packs, walking

Surgery - joint replacement best way to deal with it

317
Q

Difference between ileus and obstruction?

A

Ileus is functional obstruction from reduced peristalsis - no pain and bowel sounds absent.

318
Q

Presentation of Hodgkin’s lymphoma?

A

Enlarged but otherwise asymptomatic lymph node, typically in lower neck or supraclavicular region.
Mediastinal masses frequent - may complain of chest discomfort with cough or dyspnoea.
B symptoms.

OE - lymphadenopathy, hepatomegaly, splenomegaly, SVC syndrome.

319
Q

Risk factors for self-harm?

A

Psychiatric problems - borderline personality disorder, bipolar disorder, schizophrenia, drug/alcohol abuse

Domestic violence, socio-economic disadvantage, eating disorders, South Asian women

320
Q

Signs of MI?

A

BP low, HR fast, pulmonary oedema

321
Q

Complications of gastric ulcer?

A

Bleeding, perforation, malignancy, decreased gastric outflow

323
Q

Cardinal features of bowel obstruction?

A

Vomiting, colicky pain, constipation, distension

324
Q

Surgical treatment of breast abscess?

A

Incision and drainage

326
Q

Premalignant breast conditions?

A

Non-invasvie ductal carcinoma in situ (DCIS) - premalignant and seen on mammography Non-invasive lobular CIS - rarer

327
Q

Where is ulnar nerve vulnerable to damage?

A

At elbow

328
Q

Joints most commonly affected by OA?

A

Knee and hip

330
Q

Three things that make up asthma?

A
  1. Bronchial muscle contraction 2. Mucosal swelling/inflammation 3. Increased mucus production
331
Q

Who does stroke affect?

A

People over 65, men more than women, black people at increased risk

332
Q

Signs of sciatic nerve damage?

A

Damaged by pelvic tumours of fractures to pelvis or femur

Affects hamstrings and all muscles below the knees (foot drop) with loss of sensation below the knee laterally

334
Q

Common cause of pneumothorax?

A

Spontaneous rupture of sub-pleural bulla

335
Q

Definition of an aneurysm?

A

A permanent and irreversible dilatation of a blood vessel by at least 50% of the normal expected diameter.

336
Q

Lifestyle changes to treat GORD?

A

Raising the bed head Weight loss Smoking cessation Small regular meals Avoid: hot drinks, alcohol, citrus, tomatoes, onions, fizzy drinks, spicy foods, chocolate and eating

339
Q

Abx treatment for mastitis?

A

Flucloxacillin or erythromycin

340
Q

TTH compared to migraine?

A

More gradual in onset
More variable in duration (usually shorter)
More constant in quality
Less severe
Usually responsive to over the counter medication

Pain is bilateral and occipitio-nuchal or bifrontal. Well between attacks.

341
Q

MI treatment?

A

morphine, oxygen, aspirin, PCI

342
Q

Causative organisms of UTI?

A

E.coli, proteus mirabilis, klebsiella pneumonia, staphylococcus saprophyticus

343
Q

Classical pattern of PE in ECG?

A

sinus tachycardia, SI QIII TIII, RBBB, right ventricular strain (inverted T in V1 to V4)

344
Q

Risk factors and associations for gout?

A

Hereditary, excess dietary purines, alcohol excess, diuretics, lukaemia, cytotoxics

Associations = CVD, hypertension, diabetes, CKD

345
Q

Presentation of malnutrition in adults?

A

Lose weight often insidiously. Listlessness, increasing fatigue, cold sensitivity, non-healing wounds and severe decubitus ulcers.

347
Q

Where does bladder cancer metastasise to?

A

LNs, lung, liver, bone, CNS

348
Q

Treatment for hyperparathyroidism?

A

Parathyroidectomy

350
Q

AF symptoms?

A

palpitations, tired and/or breathless on exertion, sometimes angina and ankle oedema

352
Q

Symptoms of T2DM?

A

Polydipsia, polyuria, lethargy, boils, pruritis vulvulae, increased hunger/thirst

353
Q

Causes of aortic regurgitation?

A

Acute - infective endocarditis, ascending aortic dissection, chest trauma.

Chronic - congenital, connective tissue disorders, rheumatic fever, RA, SLE, seronegative arthritides, hypertension, osteogenesis imperfecta, syphilitic aortitis.

354
Q

Risk factors for Crohn’s?

A

Smoking NSAID use FH Age

355
Q

Most common pancreatic ca?

A

Ductal adenocarcinoma - metastasise early, present late

356
Q

Symptoms of Cushing’s syndrome?

A

Weight gain, mood change, proximal weakness, gonadal dysfunction, acne, recurrent achilles tendon rupture,

358
Q

Claudication sites an where they suggest disease is?

A

Calf claudication = femoral disease

Buttock claudication = iliac disease

359
Q

What is triple assessment?

A
  1. Clinical examination/history 2. Radiology - US for 35 3. Histology/cytology
360
Q

Presentation of pancreatuc cancer?

A

Tumours in head of pancreas present with painless obstructive jaundice.
75% in body and tail present with epigastric pain (radiates to back and relieved by sitting forward)

May cause anorexia, weight loss, diabetes or acute pancreatitis

362
Q

Presentation of depression?

A
  1. Anhedonia
  2. Poor appetite with weight loss
  3. Early waking (mood worse in mornings)
  4. Psychomotor retardation (sluggish)
  5. Decrease in sexual drive or other appetites
  6. Reduced ability to concentrate
  7. Ideas of worthlessness, inappropriate guilt or self-reproach
  8. Recurrent thoughts of death and suicide, or suicide attempts
363
Q

Management of parathyroid adenoma?

A

Surgery is only cure

365
Q

Signs of Grave’s disease?

A

Eye disease - exopthalmos, opthalmoplegia

Pretibial myxoedema - odematous swellings above lateral malleoli

Thyroid acropachy - extreme manifestation, with clubbing, painful finger and toe swelling and periosteal reaction in limb bones.

366
Q

Most common cause of bloody nipple discharge in women 20-40?

A

Duct papilloma - biopsy needed to rule out malignany

367
Q

Signs of pancreatic cancer?

A

Jaundice and palpable gallbladder, epigastric mass, hepatomegaly, splenomegaly, lymphadenopathy, ascites

368
Q

Symptoms of SAH?

A

Sudden devastating typically occipital headache

Vomiting, collapse, seizures and coma often follow

369
Q

M:F ratio for inguinal and femoral hernia?

A

Inguinal - M:F 8:1 Femoral - women

370
Q

Rarer causes of bowel obstruction?

A

Crohn’s stricture, gallstone ileus, intussusception, TB, foreign body

371
Q

Causes of chronic pancreatitis?

A

Alcohol (by far biggest cause) Familial CF Haemochromatosis Pancreatic duct obstruction High PTH levels Congenital

372
Q

Age of onset, TIDM?

A

Adolescent usually

373
Q

Treatment for varicose veins?

A

Treat any underlying cause, education (avoid prolonged standing, elevation, support stockings, lose weight, regular walks), endovascular treatment, surgery (stripping etc.)

375
Q

Side effects of oral iron?

A

Nausea, abdo pain, diarrhoea/constipation, black stools

376
Q

Signs of brainstem and lacunar infarcts?

A

Brainstem - quadriplegia, disturbances of gaze and vision, locked-in syndrome.

Lacunar - in basal ganglia, internal capsule, thalamus and pons. 5 syndromes -ataxic hemiparesis, pure motor, pure sensory, sensorimotor and dysarthria/clumsy hand.

377
Q

Symptoms of LVF?

A

cough (frothy/blood tinged mucus), decreased urine production, orthopnoea, fatigue, weakness, faintness, irregular or rapid pulse, palpitations, SoB, PND, weight gain from fluid retention, wheeze, nocturia, cold peripheries

378
Q

Endocrine complications of lung cancer?

A

Ectopic hormone secretion (SIADH and ACTH) by small cell tumours; PTH by squamous cell tumours

379
Q

Types of hyperparathyroidism?

A

Primary - single PT adenoma producing excess PTH
Seconary - PT glands become hyperplastic in response to long term hypocalcaemia because of kidney, liver or bowel disease.
Tertiary - after prolonged secondary hyperparathyroidism, glands become autonomous, producing excess PTH even after cause of hypocalcaemia has been corrected. Renal disease = main cause

381
Q

Age of fibrocystic disease?

A

Between 20 and 45 (rare in women after menopause unless on oestrogen)

382
Q

Signs of pneumonia?

A

Pyrexia, cyanosis, confusion, tachypnoea, tachycardia, hypotension, signs of consolidation (diminished expansion, dull percussion note, increased TVF/VR, bronchial breathing and a pleural rub

383
Q

Presentation of gastric cancer?

A

Nonspecific with dyspepsia, weight loss, vomiting, dysphagia and anaemia.

384
Q

Early presentation of meningitis?

A

Headache, leg pains, cold hands and feet, abnormal skin colour

385
Q

Treatment for depression?

A

Psychological treatment - in all depression

Antidepressants

Delusions or hallucinations require physical treatment

Lithium or valproate prophylaxis may be needed

Reasons to admit: social circumstances, high suicide drive, isolation

386
Q

Signs of median nerve palsy?

A

No precision grip. Weakness of abductor policis brevis and sensory loss over radial 3 1/2 fingers and palm.

387
Q

Who does gout affect?

A

M:F 4:1

388
Q

Signs of mets from lung cancer?

A

Bone tenderness, hepatomegaly, confusion, fits, focal CNS signs, cerebellar syndrome, proximal myopathy, peripheral neuropathy

390
Q

Presentation of BPH?

A

nocturia, frequency, urgency, post-micturation dribbling,, poor stream/flow, hesitancy, overflow incontinence, haematuria, bladder stones, UTI

391
Q

When do MI enzymes appear?

A

Troponins - 3-12 hours, peak 24-48, baseline 5-14 days CK - 3-12 hours, peak 24, baseline 48-72

392
Q

Signs of UTI?

A

Fever, adbo tenderness, foul-smelling urine,

394
Q

Treatment of pneumothorax?

A

Always give oxygen Pneumothroax due to trauma or mechanical ventilation requires a chest drain Surgical treatment if bilateral pneumothoraces, lung fails to expand after intercostal drain insertion, 2 or more previous on the same side, or history of pneumothorax on opposite side

395
Q

What is a partial seziure?

A

Focal onset, with features referable to part of one hemisphere, often seen with underlying structural disease.

396
Q

How long does a urinary tract stone take to pass?

A

1-3 weeks

398
Q

Organisms that cause acute pyelonephritis?

A

Same as UTI

399
Q

Symptoms of migraine?

A

classically visual or other aura lasting 15-30 minutes followed by unilateral throbbing headache. Prodrome often precedes headache by hours/days.

400
Q

When would you do an endoscopy for GORD?

A

Symptoms for >4 weeks Persistent vomiting GI bleeding/iron deficiency Palpable mass Age >55 Dysphagia Symptoms despite treatment Relapsing symptoms Weight loss

401
Q

Signs of SAH?

A

Neck stiffness, retinal, subhyaloid and vitreous bleeds (=Terson’s syndrome, mortality 5x more likely)

Focal neuropathy at presentation may suggest site of aneurysm (e.g. pupil changes suggesting a IIIrd nerve palsy with a posterior communicating artery aneurysm.

402
Q

Symptoms of pneumonia?

A

Fever, rigors, malaise, anorexia, dyspnoea, cough, purulent sputum, haemoptysis, pleuritic pain

403
Q

Drugs for GORD?

A

Antacids or alginates PPI for oesophagitis (better than H2 antaganists)

405
Q

Typical age of onset of Parkinson’s?

A

65

407
Q

Signs of hyperT?

A

Pulse fast/irregular, warm moist skin, fine tremor, palmar erythema, thin hair, lid lag, lid retraction (exposure of sclera above iris).

Goitre, nodules or bruit.

408
Q

Symptoms of chronic pancreatitis?

A

Epigastric pain ‘bores’ through to back, relieved by sitting forward or hot water bottle on epigastrium/back. Bloating, steatorrhoea, weight loss, brittle diabetes. Symptoms relapse and worsen.

410
Q

ACTH independent causes of Cushing’s?

A

Adrenal adeonoma - dexamthasone does nothing because it is autonomous

Adrenal nodular hyperplasia - no dexamethasone suppression

Iatrogenic - drugs (steroids)

411
Q

What valve disease can cause LVF?

A

aortic stenosis can cause LVH due to chronic excessive afterload. Aortic/mitral regurgitation, ASD/VSD and tricuspid incompetence can cause excessive preload

412
Q

Definition of iron deficiency anaemia?

A

Men

Women

413
Q

Causes of meningitis in adults and older children?

A

S pneumoniae, H influenzae B, N meningitidis, gram -ve bacilli, staph, strep, l.monocytogenes

414
Q

Causes of chronic liver failure?

A

Toxins - chronic alcohol abuse, paracetamol poisoning, illicit drugs
Infections - viral hepatitis, adenovirus, EBV, cytomegalovirus, viral haemorrhagic fevers
Neoplastic - hepatocellular carcinoma or metastatic carcinoma
Metabolic - Wilson’s disease, alpha-1-antitrypsin deficiency, fructose intolerance, galactoseamia, tyrosinaemia
Vascular
Autoimmune liver disease

415
Q

Management of coeliac disease?

A

Gluten free diet nigga

416
Q

Signs suggest of salivary gland malignancy?

A

Hardness, fixation, tenderness, infiltration of surrounding structures, overlying skin ulceration.

Facial palsy + salivary gland mass = malignancy

418
Q

Management of urinary tract stones?

A

NSAIDs to relieve colic, antiemetics and rehydration.
Conservative management up to 3 weeks, unless patient unable to manage pain, or if they develop signs of infection or obstruction.

Medical expulsive therapy - calcium channel blockers, alpha blockers, corticosteroids.

1 in 5 stones need surgery

419
Q

Risk factors for renal cell carcinoma?

A

Smoking, obesity, hypertension, long term dialysis, von-Hippel-Lindau disease, renal transplant recipients, tuberous sclerosis, acquired renal cystic disease

420
Q

Drugs used to treat LVF?

A

Loop diuretics ACE-i Beta blockers Spironolactone Digoxin Vasodilators (hydralazine and isosorbide dinitrate)

421
Q

What do you have to be careful to avoid in management of malnutrition?

A

Refeeding syndrome

422
Q

Risk factors for PE?

A

Recent surgery Thrombophilia Leg fracture Prolonged bed rest/reduced mobility Malignancy Pregnany; OCP; HRT Previous PE

423
Q

Risk factors for Hodgkin’s lymphoma?

A

EBV, previous mononucleosis, HIV, immunosuppresion, tobacco smoking

424
Q

Organisms responsible for infective endocarditis?

A

Staph aureus = most common overal, most common with prosthetic valves (coagulase negative)

Streptococci

Strep viridans = most common
Group D strep
Strep intermedius
Group A, C and G strep
Group B strep

425
Q

M:F ratio and age of presentation of Crohn’s?

A

1:1, 20-40 years

427
Q

What are polyneuropathies?

A

Disorders of peripheral or cranial nerves whose distribution is usually symmetrical and widespread, often with distal weakness and sensory loss (‘glove and stocking’)

428
Q

Complications of gallstones in gut?

A

Gallstone ileus

429
Q

Signs of tibial nerve damage?

A

Inability to tiptoe, invert the foot, flex the toes, sensory loss over sole

430
Q

Causes of pneumothorax?

A

Asthma, COPD, TB, pneumonia, lung abscess, carcinoma, CF, lung fibrosis, sarcoidosis, CT disorders, trauma, iatrogenic, CPAP

431
Q

Main causes of acute GI bleed?

A

Peptic ulcer disease (35-50%) Gastroduodenal erosions (8-15%) Oesophagitis (5-15%) Mallory-Weiss tear (15%) Varcies (5-10%) Upper GI malignancy

433
Q

Treatment for SAH?

A

Refer to neurosurgery immediately

Maintain cerebral perfusion by keeping well hydrated

Nimodipine - Ca2+ antagonist reduces vasospasm and consequent mortality from cerebral ischaemia

Endovascular coiling preferable to surgical clipping

434
Q

Causes of pneumonia in the immunocompromised patient?

A

Strep pneumoniae, H.influenzae, Staph Aureus, M.catarrhalis, M.pneumoniae, gram -ve bacilli, pneumocystis jiroveci Other fungi, viruses (CMV, HSV) and mycobacteria

435
Q

Causes of meningitis in infants and younger children?

A

H influenzae B, Neisseria meningitidis, strep pneumoniae

436
Q

Which is commoner Hodgkins or Non-Hodgkins?

A

Non-Hodgkins 5x more

437
Q

Investigations in IDA?

A

Microcytic hypochromic anaemia with anisocytosis and poikilocytosis

Low MCV, low MCH, low MCHC, low ferritin, low serum iron with high TIBC (total iron binding capacity)

438
Q

Less common symptoms of RA?

A

Sudden onset, widespread arthritis; recurring mono/polyarthritis of various joints (palindromic RA)

Persistent monoarthritis (often knee, shoulder or hip); systemic illness with extra-articular symptoms (eg. fever, fatigue, weight loss, pericarditis and pleurisy, but initially few joint problems)

Polymyalgic onset - vague limb girdle aches. Recurrent soft tissue problems - frozen shoulder, carpal tunnel.

440
Q

Risk factors for breast abscess?

A

Nipple fissures, cracks and sores breast engorgement and poor milk drainage Maternal age over 30 years Women with history of mastitis Gestational age over 41 weeks Improper nursing technique

441
Q

Who does malnutrition affect disproportionately?

A

Children and pregnant women

442
Q

What is emphysema?

A

Defined histologically as enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

444
Q

How are polyneuropathies classified?

A

Course - acute or chronic

Function - sensory, motor, autonomic, mixed

Pathology - demyelination, axonal degeneration or both

445
Q

Presentation of aortic regurgitation?

Symptoms, signs, ECG, CXR

A

Symptoms - exertional dyspnoea, orthopnoea, PND. Palpitations, angina, syncope, CCF.

Signs - collapsing pulse, wide pulse pressure, displaced, hyperdynamic apex beat, high pitched early entry diastolic murmur (expiration, sitting forward)

ECG - LVH

CXR - cardiomegaly, dilated ascending aorta, pulmonary oedema

446
Q

Treatment for iron deficiency anaemia?

A

Ferrous sulphate 200mg/8h PO

448
Q

Causes of CKD?

A

Diabetes Hypertension Glomerulonephritis Unknown Pyelonephritis and reflux nephropathy

449
Q

Treatment of UC?

A

Aminosalicylate (treatment of choice in induction and maintenance of remission) Corticosteroids Infliximab (moderate to severe) Surgery in 20% of cases

450
Q

Risk factors for inguinal hernia?

A

Male gender Constipation Urinary obstruction Heavy lifting Ascites Past abdominal surgery

452
Q

Most common types of lung carcinoma?

A
  1. Squamous cell (35%) 2. Adenocarcinoma (27%) 3. Small Cell (10%) 4. Large cell (10%) 5. Alveolar cell (rare)
453
Q

Risk factors for colorectal ca?

A

Age, FH, past history, IBD

Polyposis syndromes

Hormonal factors - nullparity, late age at first prego, early menopause

Diet - rich in meat and fat, poor in fibre, folate and calcium

Sedentary lifestyle, obesity, smoking, alcohol, DM

Previous irradiation, occupational hazards

History of small bowel ca, endometrial ca, breast ca, ovarian ca

454
Q

Risk factors for urinary tract stones?

A

Anatomical abnormalities in the kidney/urinary tract
Family history of renal stones
Hypertension
Gout
Hyperparathyroidism
Immobilisation
Metabolic disorders which increase excretion of solutes
Drugs - diuretics, calcium/vit D supplements
More common in hot climates and increased risk in higher socio-economic groups

455
Q

Treatment of MS?

A

Disease modifying treatment - interferon beta, glatiramer, dimethyl fumarate

Acute attacks - IV infusion of methylprednisolone

Treat all other complications

456
Q

Definition of self harm?

A

A behaviour which resulted in a nonfatal act which included one or more of the following:

  • A behaviour intended to cause self-harm
  • Ingesting a substance in excess of the prescribed or generally recognised therapeutic dose
  • Ingesting a recreational or illicit drug that was an act the person regarded as self harm
  • Ingesting a non-ingestible substance or object
457
Q

Aortic aneurysms can be classified as what?

A

Abdominal (majority) or thoracic

458
Q

Hodgkin’s lymphoma - peaks in incidence?

A

20-34 years, then over 70 years

459
Q

What is raised in acute pancreatitis?

A

Serum amylase, serum lipase

460
Q

Risk factors for pancreatic ca?

A

Smoking, alcohol, carcinogens, DM, chronic pancreatitis, high waist circumfrence

462
Q

Management of AKI?

A

Aim for euvolaemia Treat underlying cause Manage complications STOP NEPHROTOXICS

463
Q

Causes of small bowel obstruction?

A

Adhesions, hernias

464
Q

Causes of dementia?

A

AD, vascular, lewy-body, frono-temporal, mixed dementia, parkinson’s disease

465
Q

Who does pneumonia affect?

A

Very old and very young

466
Q

Presentation of chronic liver failure?

A

Mental state - drowsiness and possible confusion. Jaundice, hyperdynamic circulation with multiple organ failure.
Abdominal distension and abdominal mass: possible massive ascites.
Cerebral oedema with raised ICP
Palms are red and hepatic flap may present
Hepatic encephalopathy

467
Q

Signs of phrenic nerve palsy and possible causes?

A

Orthopnoea with raised hemidiaphragms on CXR

Lung cancer, myeloma, thyoma, cervical spndylosis/trauma, c3-5 zoster, HIV, big left atrium, phrenic muscle lesion

468
Q

Buttock claudication and impotence imply what?

A

Leriche’s syndrome

469
Q

Classical skin manifestation of coeliac disease?

A

Dermatitis herpetiformis

471
Q

Symptoms of septic arthritis?

A

Single swollen joint with pain on active or passive movement

Fevers and rigors present in majority of cases

Bacteraemia a common finding, may cause prostration, vomiting or hypotension.

472
Q

Presentation of peptic ulcer?

A

Epigastric pain related to hunger, specific foods or time of day - fullness after meals, heartburn, tender epigastrium

473
Q

What causes stroke?

A

Ischaemic infarction or bleeding into part of the brain

474
Q

What causes MS?

A

Autoimmune - repeated episodes of inflammation of the nervous tissue in the CNS, causing loss of the myelin sheath.

475
Q

Cause of T2DM?

A

Reduced insulin secretion and/or increased insulin resistance, leading to increased blood glucose.

476
Q

Risk factors for infective endocarditis?

A

Valvular heart disease with stenosis or regurgitation; valve replacement; structural congenital heart disease; previous IE; hypertrophic cardiomyopathy.

477
Q

Presentation of anxiety?

A

Free floating anxiety and depression are main symptoms.

Fatigue, insomnia, irritability, worry.
Obsessions, compulsions, somatisation.
Trembling, sense of impending doom, poor concentration, ‘butterflies in stomach’, hyperventilation, headaches, sweating, palpitations, poor appetite, nausea, ‘lump in throat’ unrelated to swallowing

ALL MORE INTENSE THAN THE STRESS PRECIPITATING THEM WOULD WARRANT

478
Q

Primary prevention of stroke?

A

Control risk factors - hypertension, DM, lipids, cardiac disease, do exercise

Folate supplements

Quit smoking

Lifelong anticoagulation if rheumatic or prosthetic heart valves on left side and consider in chronic non-rheuamtic AF.

479
Q

Treatment of BPH?

A

Alpha-blockers - tamsulosin 5-alpha-reductase inhibitors - finasteride Surgery - TURP, TUIP, retropubic prostatectomy

480
Q

Prognosis of Hodgkin’s lymphoma?

A

Can be cured in most. Five year survival 81%

482
Q

Signs of radial nerve palsy?

A

Wrist and finger drop

Sensory loss most reliably in anatomical snuffboxes

BEST - brachioradialis, extensors, supinator, triceps.

483
Q

Symptoms of acute pancreatitis?

A

Gradual or sudden epigastric or central abdominal pain (radiates to back, sitting forward may relieve); vomiting prominent

484
Q

What is somatisation?

A

When mental factors such as stress cause physical symptoms. People often convinced that their symptoms have a physical cause.

485
Q

What is delerium?

A

Impaired consciousness with onset over hours or days, usually reversible.

486
Q

Signs of cushing’s syndrome?

A

Central obesity, plethoric moon face, buffalo neck hump, supraclavicular fat distributon, skin and muscle atrophy, bruises, purple abdominal striae, osteoporosis, increased BP, hyperglycaemia, infection-prone, poor healing

487
Q

Who does migraine affect?

A

Adults and children - more common in women than men

488
Q

Treatment of peptic ulcers?

A

Lifestyle - purge stress. Reduce alcohol and tobacco use, avoid aggravating foods H.pylori eradication via triple therapy Drugs to reduce acid - PPIs/H2 blockers

489
Q

Treatment for septic arthritis?

A

If in doubt start IV abx:

Flucloxacillin (clindamycin if penicillin allergic)
Vancomycin if MRSA
Cefotaxime if gonococcal or gram -ve organism suspected.
Abx required for prolonged period.

Ask for orthopaedic advice for consideration of arthrocentesis, lavage and debridement, esp if prosthetic joint involved.

490
Q

Risk factors for AKI?

A

Age > 75 CKD Cardiac failure Chronic liver failure Diabetes Drugs Sepsis Poor fluid intake/increased losses History of urinary symptoms

491
Q

Treatment for hospital acquired pneumonia?

A

Aminoglycoside + antipseudomonal penicillin IV or 3rd gen cephalosporin IV

492
Q

Incidence of delerium higher in whom?

A

Elderly, those with previous cognitive impairment, malignancy and HIV

494
Q

Who does depression affect?

A

1 in 4 women, 1 in 10 men

495
Q

What is epilepsy?

A

Recurrent tendency to spontaneous, intermittent abnormal electrical activity in part of the brain, manifesting as seizures.

496
Q

Presentation of DVT?

A

Limb pain/tenderness along line of deep veins Swelling of calf or thigh (unilateral Distension of superficial veins increase in skin temperature Skin discoloration Palpable cord (hard, thickened palpable vein)

497
Q

Management of aortic stenosis?

A

Aortic valve replacement, TAVI if not fit for surgery

498
Q

In which groups is self-harm common?

A

Young people - 10% girls 3% boys aged 15-16

499
Q

Treatment of Parkinsons?

A

Levodopa - late start may be wise due to SEs (dopamine-induced dyskinesias)

treatment for associated neuropsychiatric complications

Deep brain stimulation

Surgical ablation of overactive basal ganglia circuits

500
Q

How to ilicit Murphy’s sign?

A

Lay 2 fingers over RUQ and ask patient breathe in - causes pain and arrest of inspiration as inflamed GB impinges on fingers. Only positive if same test doesn’t cause tenderness in LUQ

501
Q

Causes of stroke?

A

Small vessel occlusion, cardiac emboli (AF), atherothromboembolism (carotids), CNS bleeds, sudden drop in BP (sepsis), carotid artery dissection, vasculitis, SAH, venous sinus thrombosis, antiphospholipid syndrome, thrombophilia, Farby’s disease

502
Q

Investigations in hyperT?

A

Low TSH, high T3 and T4

ESR high, hypercalcaemia, high LFT

503
Q

secondary prevention of stroke?

A

Risk factor control

Antiplatelet agents after stroke (if no haemorrhage) - clopidogrel

Anticoagulation after stroke from AF - warfarin 2 weeks after stroke, use antiplatelet therapy until anticoagulated.

505
Q

Presentation of generalised disease in OA? (Primary OA)

A

Heberden’s nodes (commonly - DIPJs)

May be joint tenderness, derangement and bony swelling (heberden’s nodes DIP, bouchard’s nodes PIP), reduced ROM, mild synovitis.

Occupation, family duties, hobbies and lifestyle often affected.

506
Q

Complications of gallstones in gallbladder and cystic duct?

A

Biliary colic, acute and chronic cholecystitis, mucocele, empyema, carcinoma

507
Q

Cause of TIDM?

A

Insulin deficiency from autoimmune destruction of insuilin secreting beta cells

508
Q

Risk factors for malnutrition in elderly people?

A

Living alone, institutionalisation, severe learning difficulties or mental health problems, diseases that affect appetite, eating/swallowing or GI function, catabolic states

509
Q

Post-renal?

A

Urinary tract obstruction Luminal - stones, clots Mural - malignancy, BPH, stricutres Extrinsic compression - malignancy, retroperitoneal fibrosis

510
Q

Other causes of hospital acquired pneumonia?

A

Pesudomonas, klebsiella bactriodes, clostridia

512
Q

Causes of primary autoimmune hypoT?

A

Primary atrophic hypoT - 6:1 FM. Lymphocyte infiltration, atrophy. Not goitre.

Hashimoto’s thyroiditis - GOITRE

513
Q

Causes of meningitis in elderly and immunocompromised?

A

S. pneumoniae, L.monocytogenes, TB, gram -ve organisms

514
Q

What is OA characterised by?

A

Localised loss of cartilage, remodelling of adjacent bone and associated inflammation

515
Q

Complications of pancreatic ca?

A

Hypercalcaemia, portal hypertension, nephrosis

516
Q

Presentation of pulmonary fibrosis?

A

Gradual onset of dyspnoea and/or nonproductive cough. Wheezing, haemoptysis, chest pain.

Signs = central cyanosis, fine end-inspiratory crackles, finger clubbing. Signs of pulmonary hypertension and RHF occur late in disease.

CXR - reticular and/or nodular opacities. Honeycombing a late sign.

517
Q

Presentation of Burkitt’s lymphoma?

A

Abdominal mass and symptoms of bowel obstruction

518
Q

Treatment of femoral embolism?

A

EMERGENCY

Needs open surgery or angioplasty. Surgical embolectomy or local intra-arterial thrombolysis. After successful embolectomy, anticoagulation with heparin to prevent reoccurrence.

519
Q

Where are berry aneurysms?

A

Junction of posterior communicating with the internal carotid, of the anterior communicating with the anterior cerebral artery or bifurcation of middle cerebral artery.

Associations - PKD, coarction of aorta, Ehlers-Danlos syndrome

520
Q

Presentation of protein energy malnutrition in children?

A

Poor weight gain, slowed linear growth, behavioural changes (irritability, apathy, anxiety, attention deficit).

Classically apathetic and quiet when lying in bed but cry when picked up with a typical monotonous bleat or loud groan.

521
Q

Treatment of Crohn’s?

A

Mild attacks - prednisolone Severe - IV steroids (hydrocortisone), then oral prednisolone

522
Q

Management of mitral stenosis?

A

if in AF, rate control. Anticoagulate with warfarin. Diuretics reduce preload and pulmonary venous congestion. Balloon valvuloplasty.

523
Q

Prevention of gout?

A

Lose weight, avoid prolonged fasts, alcohol excess, purine rich meats and low dose aspirin.

524
Q

Presentation of salivary gland tumours?

A

Slowly enlarging painless mass.

Parotid - most commonly occur in tail as discrete mass in otherwise normal gland.
Submandibular - diffuse enlargement of gland.
Sublingual - palpable fullness in floor of mouth

Airway obstruction, dysphagia, hoarseness, nasal obstruction, sinusitis.

525
Q

Causes of macrocytic anaemia?

A

B12/folate deficiency is the biggest

Megaloblastic - B12 deficiency, folate deficiency, cytotoxic drugs

Non-megaloblastic - alcohol, reticulocytosis, liver disease, hypothyroidism, pregnancy

Other haematological disease - myelodysplasia, myeloma, myeloproliferative disorders, aplastic anaemia

526
Q

In whom does pneumothorax most commonly occur?

A

Healthy young adults with no lung disease - common in tall thin people, more common in men than women, rare in people over 40, more common in cigarette smokers

527
Q

Common causative organisms for mastitis and breast abscess?

A

Staph aureus, E.coli, bacteeriodes, streptococci

528
Q

management of anxiety?

A

Symptom control - reassurance about worries.
Regular exercise
Meditation
CBT
Behavioural therapy
Drugs - benzos, SSRIs, azapirones, old-style antihistamines, beta-blockers, pregabalin and venlafaxine

529
Q

Symptoms of unruptured AAA?

A

Often none - may cause abdominal/back pain, often discovered incidentally on abdo exam

530
Q

What are you looking for in a CXR of pneumothorax?

A

Areas devoid of lung markings, peripheral to edge of collapsed lung

531
Q

Causes of acute pancreatitis?

A

I GET SMASHED Iatrogenic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion venom Hyperlipidaemia, hypothermia, hypercalcaemia ERCP Drugs

532
Q

Risk factors for AAA?

A

Severe atherosclerotic damage of the aortic wall;

Family history - strong genetic factors

Tobacco smoking, male sex, increasing age, hypertension, COPD, hyperlipidaemia

533
Q

Three types of pulmonary fibrosis?

A

Replacement fibrosis secondary to lung damage - infarction, TB, pneumonia.

Focal fibrosis in response to irritants - coal dust and silica.

Diffuse parenchymal lung disease - occurs in fibrosing alveolitis and extrinsic allergic alveolitis.

534
Q
A
535
Q

How does perforated viscus present on CXR?

A

Air under diaphragm (pneumoperitoneum)

536
Q

What is a SAH?

A

Spontaneous bleeding into the subarachnoid space

537
Q

Presentation of tension headache?

A

Featureless, often generalised headache.

Described as pressure or tightness, like a tight band around head. Often relationship to neck. Lacks specific features and associated features of migraine.

538
Q

Presentation of urinary tract stones?

A

Renal/ureteric colic - sudden severe pain. Pain starts in loin and moves to groin, with tenderness of renal angle, sometimes with haematuria.
Moving stone more painful than static stone. Radiation to testis, scrotum, labia or anterior thigh.

Pain of renal colic more constant than biliary or intestinal colic, but periods of relief or just a dull ache before it returns.
Rigors, fever, dysuria, haematuria, urinary retention, nausea, vomiting.
Writhing around in agony

539
Q

Interventions in PAD?

A

Percutaneous transluminal angioplasty (PTA) - disease limited to a single arterial segment

Surgical reconstruction - femoral-popliteal bypass, femoral-femoral crossover, aorto-bifemoral bypass grafts

Amputation - (

540
Q

Prevalence of PVD?

A

10%

541
Q

Important investigation in LVF?

A

Echocardiogram

542
Q

Three types of gallstones?

A

Pigment stones, cholesterol stones, mixed stones

543
Q

Signs of acute pancreatitis?

A

Tachycardia, fever, jaundice, shock, ileus, rigid abdomen, local/general tenderness. Cullen’s/Grey Turner’s sign from blood vessel autodigestion or retroperitoneal haemorrhage.

544
Q

6 Ps of critical ischaemia?

A

Pale, pulseless, painful, paralysed, paraesthetic and perishingly cold

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