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Year 3 revision > Core conditions - difficult things > Flashcards

Core conditions - difficult things Flashcards

1
Q

what does PANCREAS stand for in glasgow scoring system for pancreatitis

A 
P = pO2
A = age
N = neutrophilia 
C = calcium 
R = renal urea
E = enzymes (LDH)
A = albumin 
S = sugar
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2
Q

5 drugs increasing risk of pancreatitis

A 
thiazides
azathioprine
tetracyclines
oestrogens
valproic acid
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3
Q

why give PPI/H2 receptor antagonist in chronic pancreatitis

A

reduce HCO3 secretion

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4
Q

what is Ogilvie’s syndrome

A

intestinal pseudo-obstruction (massive dilation of colon)

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5
Q

type of drugs to give in severe IBD

A

immunosuppressant drugs

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6
Q

what is Rosvig’s sign

A

palpation of LLQ pain increases pain in RLQ in appendicitis

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7
Q

2 scoring systems for appendicitis

A

Alvarado

RIPASA

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8
Q

what is succussion splash a sign of

A

slow gastric emptying n PUD = distension

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9
Q

when to do an endoscopy in PUD

A

over 55, red flags

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10
Q

what is the triple therapy for H. pylori PUD

A

1 PPI and 2 antibiotics - e.g. omeprazole, metronidazole, clarithromycin

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11
Q

2nd line treatment for H. pylori PUD

A

H2 receptor antagonist (e.g. ranitidine) + 2 antibiotics

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12
Q

2 forms of treatment for NSAID PUD

A

8 weeks H2-receptor antagonist - raniditine, OR

2 months full dose PPI

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13
Q

2 antispasmodics to use in IBS

A

limetropium

hyoscine

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14
Q

4 drugs increasing risk of GORD

A

TCAs
anticholinergics
nitrates
CCBs

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15
Q

2 grading systems of GORD

A

Savary Miller

Los Angeles grading

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16
Q

treatment for GORD no RF symptoms

A

PPIs 1 month then step down

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17
Q

1 gene causing gastric adenocarcinoma

A

HDGC

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18
Q

what is Courvoisier’s sign

A

painless palpable gallbladder - sign of pancreatic cancer

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19
Q

what is Trousseau’s syndrome

A

migratory thrombophlebitis - sign of pancreatic cancer

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20
Q

2 LFTs in obstructive jaundice (can occur in pancreatic cancer)

A

increased ALP and bilirubin

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21
Q

3 electrolyte imbalances in pancreatic cancer

A

hyperglycaemia
hypercalcaemia
hypokalaemia

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22
Q

tumour marker in pancreatic cancer

A

CA19-9

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23
Q

what can Reye’s syndrome, Wilson’s disease and alpha-1 antitrypsin deficiency all cause

A

chronic liver disease

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24
Q

4 differential diagnoses for hepatic encephalopathy

A
  • Wernicke’s encephalopathy
  • ketoacidosis
  • hypercapnia
  • electrolyte imbalance
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25
Q

INR result in chronic liver disease

A

raised

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26
Q

bilirubin and ammonia result in chronic liver disease

A

raised

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27
Q

glucose result in chronic liver disease

A

low (give IV glucose)

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28
Q

2 drugs to decrease ammonia production in chronic liver disease

A

lactulose + neomycin

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29
Q

drug to decrease ICP in chronic liver disease

A

mannitol

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30
Q

2 serologic tests for coeliac disease

A

IgA antiboties to TTG

IgA/IgG to deactivated gliadin

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31
Q

which type of malnutrition is low energy

A

Marasmus

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32
Q

treatment of refractory ascites

A

therapeutic paracentesis

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33
Q

treatment of malignant ascites secondary to epithelial cancers

A

catumoxomab

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34
Q

antibiotic in infective pancreatitis

A

cefuroxime/aztreonam

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35
Q

LFTs in acute hepatitis vs gallstones

A

acute hepatitis = increased AST and ALP

gallstones = increased bilirubin, ALT and ALP

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36
Q

what is Dieulafoy’s disease

A

aneurysms in young people = gastric GI bleed?

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37
Q

cause of artoduodenal fistula

A

AAA repair - causes duodenal GI bleed

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38
Q

what can appendicectomy cause

A

CD

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39
Q

3 immunosuppressant drugs for IBD

A

cyclosporin
azathioprine
methotrexate

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40
Q

blood test for IBD

A

faecal calprotectin

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41
Q

treatment for GORD + oesophagitis

A

PPIs 2 months

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42
Q

most common location of pancreatic cancer

A

head

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43
Q

3 signs of pancreatic cancer

A

painless jaundice
pruritus
nausea

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44
Q

parasite increasing risk of CRC

A

schistosomiasis

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45
Q

drug protective for CRC

A

aspirin

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46
Q

what is Sister Mary Joseph nodule

A

nodule on umbilicus = sign of CRC

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47
Q

1 derm sign of coeliac

A

dermatitis herpetiformis

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48
Q

treatment of normal ascites

A

spironolactone, loop diuretics

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49
Q

2 leg signs of appendicitis

A

psoas sign - extend right thigh = pain RLQ

obturator sign - internally rotate flexed right thigh = pain RLQ

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50
Q

point of abdomen most tender in appenditicis

A

McBurney’s

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51
Q

gene increasing risk of CD

A

CARD15 (NOD2) gene

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52
Q

risk assessment for acute GI bleed

A

Rockall risk assessment

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53
Q

what is Murphy’s sign

A

painful RUQ on examination but NOT on LUQ = gallstones?

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54
Q

blood test for acute hep C

A

HCV

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55
Q

2 tests for acute hep A

A

lab IgM

serum aminotransferase + AST

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56
Q

3 stages in acute hep A

A 
prodromal = flu and GI
icteric = jaundice, pale faeces, hepatomegaly
convalescent = weight loss, tenderness, muscle weakness
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57
Q

3 monoclonal antibodies to determine stage of breast cancer

A

ER
PR
HER2

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58
Q

biopsy to determine stage of breast cancer

A

Sentinel LN biopsy

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59
Q

4 presentations of ductal papilloma

A

bloody discharge
palpable mass within 4cm of nipple
inversion/retraction
microcalcification on mammogram

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60
Q

biopsy for non-palpable breast lump

A

core needle, open

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61
Q

biopsy for a palpable breast lump

A

FNA, core needle, excision (<4cm), incision (<4cm)

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62
Q

4 hormonal therapies for breast cancer if +ve for hormonal receptors

A

tamoxifen
SERMs
aromatase inhibitor
hormone antagonists e.g. anastrozole

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63
Q

thing increasing fibroadenoma

A

oestrogen

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64
Q

type of ductal papilloma more common in young women (usually in older women)

A

multiple (central types more common in older)

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65
Q

type of cardiomyopathy causing stable angina

A

hypertrophic

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66
Q

2 drugs increasing risk of AF

A

bronchodilators

thyroxine

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67
Q

syndrome increasing risk of AF

A

diabetes

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68
Q

2 drugs for thromboprophylaxis in AF

A

DOACs

vit K agonist - warfarin

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69
Q

monotherapy in AF

A

beta blockers or CCBs

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70
Q

what to do if monotherapy in AF is unsuccessful

A

either 2 of beta blocker, digoxin or dilimiazem

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71
Q

when to use UFH in DVT (usually use LMWH, fondaparinux and warfarin)

A

CKD 4/5

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72
Q

beta blocker to use in CCF

A

carvedilol

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73
Q

what is cardiorenal syndrome a complication of

A

CCF

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74
Q

what can IE cause

A

MI - from coronary embolus

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75
Q

3 signs on auscultation in MI

A

3rd and 4th heart sound
systolic murmur
pericardial rub

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76
Q

2 times there is a systolic murmur in MI

A

mitral regurgitation

ventricular septal defect

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77
Q

when to give GTN in MI

A

hypertensive

acute LVF

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78
Q

2 anticoagulants to inject in MI treatment

A

bivalirudin

enoxaparin (LMWH)

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79
Q

when to do immediate angiography in MI

A

STEMI or high risk NSTEMI (otherwise before 3 days)

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80
Q

when to give ACEi after MI

A

if LV dysfunction, hypertension or DM

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81
Q

2 conditions associated with severe postural hypotension

A

multiple system atrophy (Shy-Drager syndrome)

pure autonomic failure (Bradbury-Eggleston syndrome)

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82
Q

how to treat paroxysmal AF

A

monotherapy digoxin

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83
Q

what is post-thrombotic syndrome

A

chronic venous hypertension - may develop after DVT

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84
Q

when to give CCB or thiazide in 1st line hypertension treatment

A

if >55 or black (otherwise ACEi or ARB)

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85
Q

when to give thiazide instead of CCB in 2nd line hypertension treatment

A

heart failure

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86
Q

cause of delayed femoral pulses in hypertension

A

coarctation of aorta

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87
Q

what is graves

A

autoimmune TSH receptor stimulating antibodies = increased T3 and T4

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88
Q

what can increased iodine and smoking cause

A

graves

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89
Q

4 symptoms of thyroid storm

A

fever
D+V
jaundice
seizures

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90
Q

4 drugs to treat thyroid storm (thyrotoxicosis)

A

beta blockers
antithyroid drugs
potassium iodide
corticosteroids

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91
Q

what can palmar erythemabe a sign of

A

hypertyhyroidism

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92
Q

TSH and T4/T3 levels in hyperthyroidism

A

TSH low

T4/T3 high

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93
Q

result of Tc99m scan in GD vs multinodular goitre

A 
GD = diffuse uptake 
MNG = nodular uptake
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94
Q

1st line antithyroid drug to use in hyperthyroidism

A

carbimazole - decreases action of perixodase enzyme = decreased output of T4/T3

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95
Q

2 types of hypothyroidism

A

atrophic (T cell mediated cytotoxicity)

Hashimotos (goitre)

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96
Q

what can iodine deficiency cause

A

hypothyroidism = goitre

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97
Q

what can hypopituitarism cause

A

hypothyroidism (isolated TSH deficiency)

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98
Q

2 causes of primary thyroid disease (causing hypothyroidism)

A

autoimmune

radio iodine damage

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99
Q

5 conditions associated with Hashimotos

A 
T1 DM 
Addisons
SLE 
CD 
pernicious anaemia
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100
Q

when is there increased levels TPO in blood

A

Hashimotos

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101
Q

what can deep voice and carpal tunnel be a sign of

A

hypothyroidism

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102
Q

TSH level in hypothyroidism

A

high

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103
Q

what is normal/low TSH and T4 deficiency a sign of

A

non-autoimmune hypothyroidism

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104
Q

2 drugs increasing risk of thyroid lump

A

amiodarone

lithium

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105
Q

type of thyroiditis occuring after a viral infectino

A

De Quervains

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106
Q

why do basal plasma calcitonin and carcinoembryonic antigen (CEA) test for thyroid lumps

A

medullary cancer

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107
Q

type of biopsy for thyroid lumps

A

FNA

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108
Q

3 antibodies for T1 DM

A

HLADR3
HLADR4
islet cell

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109
Q

drugs increasing risk of T2 DM

A

combined use thiazide + beta blocker

statins

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110
Q

2 derm symptoms of all types of diabetes

A

boils

pruritus vulvae

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111
Q

random and fasting plasma glucose levels in diabetes

A 
random = >11.1
fasting = >7

only one needed in symptomatic, 2 fasting samples in asymptomatic

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112
Q

what is OGTT

A

2 hour venous plasma glucose >11.1 2 hours after 75g glucose

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113
Q

2 types of insulin if you dont want to inject much

A 
2X daily (isoprene insulin)
long-acting insulin analogues
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114
Q

3 features of DKA

A

acidosis
hyperglycaemia
ketonuria

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115
Q

3 treatments for DKA

A

fixed rate IV insulin infusion (FRIII)
IV 0.9% saline
replace K+ if 3.5-5.5

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116
Q

4th step in T2 DM treatment

A

lifestyle + metformin + secondary drug + insulin

add on each one with each step

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117
Q

secondary drug in T2 DM

A

sulphonylurea e.g. gliclazide

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118
Q

type of Cushing’s syndrome causing increased ACTH

A

ACTH-dependent

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119
Q

what is Cushing’s disease

A

ACTH-dependent Cushing’s - pituitary

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120
Q

2 other causes of ACTH-dependent Cushings (apart from cushings disease)

A
  • ectopic ACTH-producing tumours e.g. lung cancer

- excess ACTH administration

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121
Q

2 causes of non-ACTH dependent Cushing’s syndrome

A
  • excess glucocorticoid administration (most common)

- adrenal adenomas/carcinomas

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122
Q

ACTH levels in dependent vs non-dependent cushings syndrome

A 
dependent =  increased ACTH
non-dependent = no ACTH but increased serum cortisol
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123
Q

2 types of endogenous Cushings i.e. ACTH-dependent but from inside body

A 
corticotropin dependent (most common)
corticotropin independent
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124
Q

2 types of corticotropin dependent Cushings

A 
pituitary adenomas (Cushings disease - 80%)
ectopic corticotropin syndrome (20%)
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125
Q

2 types of corticotropin independent Cushings

A 
adrenal adenoma (60%)
adrenal carcinoma (40%)
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126
Q

lipid profile in Cushings

A

decreased lipids

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127
Q

syndrome sometimes caused by Cushings

A

diabetes = thirst etc

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128
Q

3 diagnostic tests for Cushings

A
  • 24hour urinary free cortisol (2+ collections, >3x upper limit)
  • 1mg overnight dexamethasone suppression test
  • late night salivary cortisol (11pm-1am)
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129
Q

4 tests for ACTH-dependent Cushings

A
  • high dose dexamethasone suppression test
  • inferior petrosal sinus sampling (IPS)
  • MRI pituitary
  • chest and abdo CT - ectopic?
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130
Q

result of dexamethasone suppression test in Cushing’s disease (pituitary adenoma) and ectopic ACTH

A

> 90% decreased

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131
Q

IPS result in ectopic ACTH

A

<1.8

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132
Q

IPS result in pituitary adenoma (Cushings disease)

A

> 2

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133
Q

2 drugs for Cushings to decrease cortisol

A

metyrapone

ketoconazole

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134
Q

complication of surgery to remove adrenal glands in Cushing’s disease

A

Nelson’s syndrome = enlargement of pituitary, development of adenomas

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135
Q

what is secondary HPT

A

hyperplasia + increased PTH in response to hypocalcaemia

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136
Q

usual cause of secondary HPT

A

renal failure

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137
Q

most common cause of primary HPT

A

single adenoma

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138
Q

calcium levels in primary HPT

A

high = osteoporosis, kidney stones, increase in 24 hour urinary calcium excretion

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139
Q

phosphate levels in HPT

A

low

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140
Q

3 syndromes associated with parathyroid adenoma (most common cause of PHPT)

A

MEN1
MEN2
jaw tumour syndrome

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141
Q

3 causes of primary addison’s disease

A

adrenal dysgenesis/destruction
autoimmune adrenalitis
TB

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142
Q

cause of secondary Addisons

A

decreased ACTH secretion

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143
Q

treatment of secondary Addisons

A

long term steroids

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144
Q

what can postural hypotension and hyponatraemia be a sign of

A

Addisons

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145
Q

what can decreased RBC synthesis cause

A

macrocytosis

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146
Q

what can decreased Hb production cause

A

microcytosis

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147
Q

3 signs of macrocytosis

A

high output HF
bounding pulse
systolic murmur

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148
Q

what can decreased B12/folate cause

A

megaloblastic anaemia (macrocytic - from decreased DNA synthesis)

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149
Q

drug causing non-megaloblastic anaemia

A

azathioprine (affects DNA)

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150
Q

4 other causes of non-megaloblastic anaemia

A

alcohol
liver disease
hypothyroidism
reticulocytosis

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151
Q

most common cause of B12 deflciency

A

autoimmune Addisonian pernicious anaemia

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152
Q

2 other causes of pernicious anaemia

A

diabetes

hypothyroidism

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153
Q

4 drugs causing folic acid deficiency

A

alcohol
anticonvulsants
methotrexate
trimethoprim

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154
Q

treatment of B12 deficiency

A

injection continued for life -(hydroxocobalamin)

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155
Q

why start B12 injections before folate if deficient in both

A

increases SCDC

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156
Q

Hb cut offs for ID anaemia

A 
men = 13 (<11 = 2ww)
women = 12 (<10 = 2ww if not menstruating)
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157
Q

4 drugs decreasing iron absorption

A

tetracyclines
quinolones
antacids
PPIs

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158
Q

2 head and neck signs of anaemia

A

glossitis

tinnitus

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159
Q

what is Paterson-Brown-Kelly syndrome

A

dysphagia from ID anaemia

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160
Q

nail symptom of ID anaemia

A

koilonychia

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161
Q

what is anisocytosis

A

variation in RBC size (ID anaemia)

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162
Q

what is poikilocytosis

A

abnormal RBC shape (ID anaemia)

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163
Q

poisoning showing symptoms similar to ID anaemia

A

lead poisoning

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164
Q

2 locations of mets in lymphoma

A

liver

breast

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165
Q

CXR in Hodgkin lymphoma

A

mediastinal widening (hilar LNs)

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166
Q

2 types of non-Hodgkin lymphoma

A

indolent (not curable)

aggressive

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167
Q

2 types of indolent nHL

A

follicular

marginal zone

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168
Q

2 types of aggressive nHL

A

DLBCL (B cell)

Burkitt

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169
Q

chemotherapy for low grade lymphoma

A

chlorambucil

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170
Q

CHOP chemo for aggressive nHL

A

cyclophosphamide
doxorubicin
vincristine
prednisolone

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171
Q

drug to treat DLBCL

A

rituximab (monoclonal antibody)

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172
Q

2 signs of nerve root compression

A

clonus

positive Babinski

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173
Q

what drug to use to reduce muscle spasms in prolapsed disc

A

benzodiazepines

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174
Q

most common organism causing septic arthritis

A

s. aureus

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175
Q

2 conditions showing similar symptoms to septic arthritis

A

lyme disease

IE

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176
Q

antibiotic for normal septic arthritis

A

flucloxacillin (clindamycin if allergic)

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177
Q

antibiotic for ?MRSA septic arthritis

A

vancomycin

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178
Q

antibiotic for gonococcal septic arthritis or gram =ve

A

cefotaxime

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179
Q

3 drug risk factors for gout (increase uric acid)

A

diuretics
chemotherapy
low-dose salicylate e.g. aspirin

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180
Q

4 condition risk factors for gout

A

hypertension
CHD
DM
hyperlipidaemia

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181
Q

1 derm condition risk factor for gout

A

psoriasis

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182
Q

what is chronic tophaceous gout

A

large crystal deposits produce firm nodules around extensor surfaces

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183
Q

what confirms diagnosis of gout

A

MSU crystals in synovial fluid or tophi

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184
Q

3 XR findings in chronic gout

A

tophi
sclerosis
punched out lesions

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185
Q

2 first line drugs for gout

A

NSAIDs

colchicine

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186
Q

when to use canakinumab in gout (inhibitor of IL-1)

A

if no response with 1st line drugs or 3+ attacks in 12 months

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187
Q

3 drugs for gout prophylaxis

A

allopurinol
febuxostat
uricosurics (increase secretion)

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188
Q

side effect of febuxostat

A

anaphylaxis

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189
Q

when to use drug prophylaxis for gout

A

NOT during acute attack - 2+ in 1 year, tophi, renal impairment, need diuretics

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190
Q

2 nerve complications of gout

A

nerve impingement

carpal tunnel

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191
Q

steroid dose increasing risk of osteoporosis

A

prednisolone >7.5 mg/day for >3 months

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192
Q

2 haematological causes of osteoporosis

A

myeloma

haemoglobinopathies

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193
Q

2 respiratory causes of osteoporosisq

A

COPD

CF

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194
Q

1 metabolic cause of osteoporosis

A

homocystinuria

195
Q

4 drugs causing osteoporosis

A

heparin
ciclosporin
anti-convulsants
aromatase inhibitors (breast cancer)

196
Q

1 anabolic treatment for osteoporosis

A

teriparatide (PTH analogue)

197
Q

3 antiresorptive treatments for osteoporosis

A

SERMS e.g. raloxifine
bisphosphonates
RANK-L inhibitor e.g. denosumab

198
Q

2 genes increasing risk of RA

A

HLADR1

DR1

199
Q

3 hand deformities in RA

A 
ulnar deviation
piano key deformity (wrist)
Z deformities (thumbs)
200
Q

when is there a +ve ANA result in RA

A

if also has SLE

201
Q

urinalysis result in RA

A

microscopic haematuria/proteinuria

202
Q

4 drugs for RA

A

NSAIDs
DMARDs
corticosteroids
COX-2 drugs e.g. celexobib, etoricoxib

203
Q

4 XR findings in OA

A

osteophytes
joint space narrowing
bone cysts
subarticular sclerosis

204
Q

3 conditions DDs for OA (apart from obvious ones)

A

ankylosing spondylitis
sarcoidosis
IE

205
Q

topical adjunct treatment for knee and hand OA

A

topical capsaicin

206
Q

what is delirium tremens

A

delirium from alcohol withdrawal

207
Q

type of seizures from alcohol withdrawal

A

tonic clonic

208
Q

what type of drug is librium (for alcohol)

A

benzodiazepine - chlordiazepoxide

209
Q

what can liver cirrhosis cause

A

diabetes

210
Q

why can alcohol cause oedema

A

decrease albumin levels

211
Q

5 consequences of alcohol on blood

A 
atherosclerosis
hypertension
increased MCV
folic acid and B12 deficiency 
BM damage
212
Q

consequence of alcohol on heart

A

alcoholic cardiomyopathy (= AF?)

213
Q

2 consequences of alcohol on nervous system

A

Korsakoff’s syndrome

peripheral neuropathy

214
Q

what is Korsakoff syndrome

A

irreversible cerebellar damage from thiamine deficiency

215
Q

type of diuretics to give in alcohol withdrawal

A

K+ sparing

216
Q

CAGE questions for alcohol abuse

A

CUT down
ANNOYED you by criticising drinking
GUILTY about drinking
EYE-OPENER (needing a drink first thing in the morning)

217
Q

5 features of dementia with Lewy bodies

A 
fluctuations in consciousness
hallucinations
sleep disruption
falls
Parkinsonian features
218
Q

6 treatable causes of dementia

A 
substance abuse
hypothyroidism
SoLs
normal pressure hydrocephalus
B12 and folate deficiencies
pellagra
219
Q

what is pellagra

A

B3 deficiency

220
Q

treatment for mild to moderate AD

A

AChE inhibitors e.g. donepezil

221
Q

treatment for moderate-severe AD

A

NMDA antagonists e.g. memantine

222
Q

2 treatments for somatisation

A

CBT

antidepressants e.g. duloxetine

223
Q

2 antipsychotics sometimes used in delirium psychotics

A

haloperidol
olanzapine

NEVER in LB dementia or PD

224
Q

6 drugs which can cause delirium

A 
benzos
analgesics
anticholinergics
anticonvulsants
anti-parkinsonism
steroids
225
Q

4 toxic substances which can cause delirium

A

CO
alcohol
heavy metals
barbituate withdrawal

226
Q

3 deficiencies which can cause delirium

A

B1 (thiamine)
B2
B3 (niacin)

227
Q

3 diagnostic criteria for GAD

A

4+ symptoms with 1+ autonomic arousal symptom

anxiety more days than not for 6+ months

exclusion of panic disorder, phobic anxiety disorder, OCD

228
Q

2 drugs for GAD

A

SSRIs (pregabalin if cant tolerate)

SNRI (venlaxafine)

229
Q

3 self report symptom scales for depression

A

patient health questionnaire (PHQ-9)
hospital anxiety and depression (HAD) scale
Beck’s depression inventory

230
Q

diagnostic criteria for depression

A

5+ symptoms 2+ weeks, one of which is a core symptom

231
Q

2 core symptoms depression

A

feeling down

little pleasure

232
Q

7 other symptoms of depression

A 
fatigue
worthlessness
thoughts of suicide
decreased ability to concentrate
psychomotor changes
insomnia/hypersomnia
appetite increased/decreased
233
Q

what is dysthymia

A

sub-threshold depression (2-5 symptoms) present >2 years

234
Q

5 other types of antidepressants

A 
NaSSA e.g. mirtazapine
moclobemide
reboxetine
SNRI e.g. venlaxafine, duloxetine
TCA e.g. amitriptyline
235
Q

when to take antidepressants for >2 years (usually 6+ months)

A

2+ depressive episodes

236
Q

3 types of partial seizures

A

simple
complex
secondary generalised

237
Q

lobe of brain in complex partial seizures

A

temporal

238
Q

2 features of simple partial seizures

A

conscious

weakness of limbs (Todd’s paralysis)

239
Q

duration of complex partial seizures

A

> 30 seconds

240
Q

consciousness level in complex partial seizures

A

decreased

241
Q

4 symptoms of complex partial seizures

A

deja vu/jamais vu
vertigo
hallucinations
tachycardia

242
Q

3 signs of tonic phase in tonic clonic

A

rigidity
incontinence
hypoxia

243
Q

3 signs of clonic phase in tonic clonic

A

convulsing
eye rolling
tachycardia

244
Q

ECG in absence seizures

A

3Hz spike

245
Q

2 features of absence seizures

A

conscious but unresponsive

muscle jerking

246
Q

why do do bloods for seizures

A

diabetes?

247
Q

1st line treatment for status epilepticus

A

benzos

248
Q

2nd line treatment for status epilepticus

A

phenobarbital

249
Q

3rd line treatment for status epilepticus

A

phenytoin IV

250
Q

2 drugs for absence seizures

A

ethosuximide

sodium valproate

251
Q

what drug not to use for absence seizures

A

phenytoin

252
Q

1st line treatment for partial seizures

A

carbamazepine

253
Q

1st line treatment for generalised seizures

A

sodium valproate

254
Q

definition of chronic migraine

A

15+ days per month, or 8+ if other symptoms, includes menstrual migraine

255
Q

mnemonic for remembering triggers or migrinaes

A

CHOCOLATE

Ch = chocolate and cheese
O = OCP
C = caffeine/withdrawal
Ol = alcohol 
A = relaxation 
T = travel
E = exercise
256
Q

4 diagnostic criteria of migraines if there is no aura

A

5+ attacks
no secondary cause
2+ of unilateral pain, pulsing, from decreased activity
1+ of N+V, photophobia, phonophobia

257
Q

6 symptoms of migraine aura

A 
depression
tiredness
stiff neck 
food cravings
visual disturbance
sensory symptoms (moving from hands to arms then face)
258
Q

3 types of drugs for migraine during an attack

A

antiemetics e.g. metoclopramide
5-HT agonists
anticonvulsants e.g. lamotrigine

259
Q

3 prophylactic drugs for migraines

A

antihistamines
propanolol
amitriptyline

260
Q

most common cause of SAH

A

aneurysm rupture

261
Q

3 complications of SAH

A

TIA/stroke (from vasospasm)
secondary hydrocephalus
re-bleeding (<7 days)

262
Q

what is sentinel headache

A

headache prior to SAH in 6%

263
Q

5 grades of SAH

A 
1 = no signs
2 = neck, CN
3 = drowsy
4 = hemiplegia
5 = coma

3-5 = 50% mortality

264
Q

CT result in SAH

A

star-shaped lesions

265
Q

drug to use in SAH to decrease vasospasm

A

CCB - e.g. nimodipine

266
Q

mnemonic for causes of peripheral neuropathy

A 
DAVID:
D - diabetes
A - alcohol
V - vit B12 deficiency 
I - infection/inherited
D - drugs
267
Q

drug causing peripheral neuropathy

A

isoniazid

268
Q

2 inherited disorders causing peripheral neuropathy

A

Guillain Barre

Charcot-Marie-Tooth

269
Q

2 biopsies for peripheral neuropathy

A

nerve

skin

270
Q

4 treatments for peripheral neuropathy

A

anticonvulsants e.g. gabapentin
TCAs
elastic stocking
self-catheterisation

271
Q

4 bacteria causing chronic cervical lymphadenopathy

A

non-TB mycobacteria
TB mycobacteria
Bartonella
toxoplasma gondii

272
Q

what can connective tissue disorders cause in the neck

A

cervical lymphadenopathy

273
Q

why do serology in cervical lymphadenopathy

A

cat scratch?

274
Q

why do tuberculin test in cervical lymphadenopathy

A

TB - chronic

275
Q

antibiotic for CL

A

clindamycin

276
Q

what is Kernig’s sign (meningitis, SAH)

A

cant straighten leg when hip at 90 degrees

277
Q

what is Brudzinskis sign (meningitis)

A

hips and knees flex when neck is flexed

278
Q

4 viruses causing viral meningitis

A

herpes
mumps
echo
influenza

279
Q

3 bacteria causing meningitis when 0-3 months

A

E. coli
group B strep
Listeria

280
Q

3 bacteria causing meningitis when 3 months +

A

n. meningitidis (meningococcal)
s. pneumoniae
h. influenzae

281
Q

2 features of meningococcal meningitis

A

cold peripheries

no fever or increased WCC

282
Q

when to give prophylaxis for meningococcal meningitis

A

rifampicin to household contacts of patient

283
Q

4 cancers causing malignant meningitis

A

leukaemia
lymphoma
breast (met)
bronchial (met)

284
Q

lumbar puncture results in viral vs bacterial meningitis

A 
viral = lymphocytes (colourless)
bacterial = polymorphs
285
Q

type of antibiotic for bacterial meningitis

A

3rd gen cephalosporin - e.g. cefotaxime, cephalexin IV

286
Q

drug to lower risk of complications of bacterial meningitis

A

dexamethasone

287
Q

4 complications of bacterial meningitis

A

hearing loss
vasculitis
cerebral infarct/abscess = epilepsy
hydrocephalus/subdural effusion

288
Q

type of drugs causing drug-induced Parkinsonism

A

tranquillisers for psychosis

289
Q

2 toxins causing Parkinsonism

A

CO

carbon disulphide

290
Q

Hz of resting tremor in PD

A

4-6

291
Q

gait in PD

A

festinating

292
Q

what is PD dementia

A

1+ year after onset of PD

293
Q

6 diagnostic criteria for PD alongside exclusion criteria

A 
unilateral
rest tremor
progressive
response to L-dopa
hyposmia
visual hallucinations
294
Q

isotope scan for PD

A

daTSCAN

295
Q

2 dopadecarboxylase inhibitors for PD

A

carbidopa

cocareldopa

296
Q

example of a dopamine agonist for PD

A

apomorphine

297
Q

2 MOA inhibitors for PD

A

selegiline

rasigiline

298
Q

most common cause of infarct stroke

A

arterial embolism (usually carotid, sometimes heart valves)

299
Q

drug causing infarct stroke

A

cocaine

300
Q

5 other causes of infarct stroke

A 
venous/fat/air infarct
MS
mass lesion
migraine
amyloidosis
301
Q

inherited cause of stroke

A

cadasil (defective NOTCH3 gene)

302
Q

what is a lacunar infarct

A

deep artery infarct stroke

303
Q

4 symptoms of lacunar infarct

A

aphasia
hemiparesis
hemisensory loss
unilateral ataxia

304
Q

what is Webers syndrome

A

infarct on one side of midbrain

305
Q

2 symptoms of Webers syndrome

A

ipsilateral CNIII paralysis

contralateral hemiplegia

306
Q

why do ESR for stroke

A

check for GCA

307
Q

3 treatments for ischaemic stroke

A

thrombolysis OR aspirin
dipyridamole
carotid entarterectomy

308
Q

3 optic signs of MS

A

neuritis
disc swelling
RAPD

309
Q

what is Uthoffs phenomenon

A

MS symptoms worse on hot days

310
Q

what is Lehrmitte sign

A

MS - electric shock on flexing head

311
Q

CSF result in MS

A

oligoclonal bands

312
Q

VEP result in MS

A

lesions in visual pathway

313
Q

diagnostic criteria for MS

A

1+ attack and >1 plaque MRI
OR
1 attack, >1 plaque MRI and VEP etc.

314
Q

3 drugs for preventing MS relapse

A

beta interferon
natatizumab
baclofen

315
Q

drug to use during an acute MS attack to induce remission

A

steroids

316
Q

what can spermicide, DM and pregnancy increase risk of

A

cystitis

317
Q

2 postmenopausal syndromes which are DDs for cystitis in women

A

atrophic vaginitis

urethritis

318
Q

when to do urine culture for cystitis

A

high risk

male

319
Q

3 times to refer for cystitis

A

haematuria
women with recurrence
men 2+ 2 months

320
Q

3 complications of asymptomatic bacteruria in pregnancy

A

UTI
preterm delivery
anaemia

321
Q

1st line treatment for adults with pyelonephritis

A

ciprofloxacin/co-amoxiclav 7 days

322
Q

1st line treatment children with pyelonephritis

A

co-amoxiclav

323
Q

2nd line treatment children with pyelonephritis

A

cefixime

324
Q

when to give prophylactic trimethoprim for pyelonephritis

A

women 3+ per year

325
Q

USS result chronic pyelonephritis

A

thin and small

326
Q

3 IV pyelogram results chronic pyelonephritis

A

small
dilatation
cortical scarring

327
Q

t99m result chronic pyelonephritis

A

scars

328
Q

what can secondary hypertension, CKD and pyonephrosis be a complication of

A

chronic pyelonephritis

329
Q

urine test result hydropnephrosis

A

haematuria

330
Q

definition of AKI

A

<0.5ml/kg/hr for 6+ hours

increased creatinine and urea

331
Q

most common type of AKI

A

pre-renal

332
Q

3 causes of pre-renal AKI from hypotension

A

septic shock
LVF
anaphylaxis

333
Q

3 causes of pre-renal AKI from oedema

A

HF
cirrhosis
nephrotic syndrome

334
Q

3 causes of pre-renal AKI from hypoperfusion

A

NSAIDs, ACEis, ARBs
AAA
renal artery stenosis

335
Q

8 signs of AKI

A 
increased BP
large painless bladder
postural hypotension
oedema/pulmonary oedema
increased JVP
pallor/bruising
vascular disease/emboli/DIC
pericardial rub
336
Q

what can be a cause of metabolic acidosis and hyperkalaemia

A

AKI

337
Q

what can use of iodinated contrast agents increase risk of

A

AKI (if also unwell)

338
Q

when to do doppler USS renal artery and veins

A

AKI

339
Q

7 causes of CKD

A 
arteriopathic renal disease
hypertension
high calcium
glomerulonephritis
SLE
DM 
neoplasms, myeloma
340
Q

drugs increasing risk of CKD

A

chronic NSAIDs

341
Q

derm symptom of CKD

A

pruritus

342
Q

4 groups of signs of CKD

A
  • skin: pigmentation/pallor
  • BP: hypertension, PH
  • heart: LVH, peripheral oedema, pleural effusions
  • neuro: PVD, peripheral neuropathy, RLS
343
Q

Ca2+ result in CKD

A

decreased

344
Q

Phosphate and PTH result in CKD

A

increased

345
Q

5 urinalysis results in CKD

A 
proteinuria
haematuria
glycosuria
WCC 
decreased creatinine clearance
346
Q

why use statins in CKD

A

for CVD

347
Q

what is renal replacement therapy

A

dialysis + transplant

348
Q

symptom score for BPH

A

international prostate symptom score (IPSS) - 0-7 = mild, 8-19 = moderate, 20-35 = severe

349
Q

width of prostate in BPH

A

2+ fingers

350
Q

cut off PSA values

A

40-49 = 2
50-59 = 3
60-69 = 4
70+ 5

screening 50+

351
Q

e.g. of an alpha-adrenergic antagonist for BPH

A

tamsulosin for IPSS >8

352
Q

2 e.g.s of 5-alpha reductase inhibitors for BPH

A

finasteride

dutasteride

353
Q

gene increasing risk of prostate cancer

A

BRACA

354
Q

what can haematospermia, symptoms of AKI/CKD, impotence and tenesmus be a symptom of

A

locally invasive prostate cancer

355
Q

where can prostate cancer met to

A

bones = bone pain/sciatica

356
Q

why can prostate cancer cause loin pain/anuria

A

LN obstruction of ureter if metastatic

357
Q

what is palpable in DRE for prostate cancer

A

seminal vesicles

358
Q

urine test for prostate cancer

A

PCA3

359
Q

what does TRUS show in prostate cancer

A

hypo echoic area in preipheral zone

360
Q

grading system for PC

A

gleason

361
Q

gold standard anti-androgen therapy for PC

A

bilateral orchiectomy - castration

362
Q

2 drugs for anti-androgen therapy for PC

A

enzalutamide

abiraterone + prednisolone

363
Q

composition of struvite stones

A

magnesium ammonium phosphate

364
Q

what can sarcoidosis cause

A

hypercalcaemia

365
Q

when to do USS For kidney stones

A

pregnancy (otherwise non-contrast CT)

366
Q

2 smooth muscle relaxants for kidney stones

A

alpha receptor blockers (tamsulocin)

CCBs (nifedipine)

367
Q

treatment if kidney stones dont pass

A

extracorporeal shock wave lithotripsy

368
Q

3 syndromes associated with RCC

A

cushings
hypercalcaemia (PTH)
polycythaemia (erythropoietin)

369
Q

cancer syndrome associated with RCC

A

von hippel lindau

370
Q

most common risk factor for RCC

A

smoking

371
Q

why can RCC cause anaemia

A

tumour suppresses EPO = increased ESR

372
Q

why can RCC cause hypertension

A

renin secreted by tumour

373
Q

4 carcinogens for UCC

A

smoking
arylamines
cyclophosphamide
radiotherapy

374
Q

most common sign of UCC

A

painless haematuria, negative for bacteria

375
Q

treatment of bladder tumours depending on tumour size

A 
pTa = transurethral resection
pT1 = immunotherapy (intravesical BCG) 
pT2+ = radical cystectomy (<70), radiotherapy (>70)
376
Q

2 bacteria causing HAP

A

gram -ve bacilli

s aureus

377
Q

bacteria causing pleural rub in pneumonia

A

s. pneumoniae

378
Q

CURB score

A 
confusion (AMTS <8)
urea >7
RR >30
BP <90/<60
>65

> 3 = severe, IV abx

379
Q

4 lung complications of pneumonia

A

pleural effusion
empyema
lobar collapse
pneumothorax

380
Q

cause of PSP

A

rupture of pleural bleb - congenital

381
Q

connective tissue disorder increasing risk of PSP

A

marfans

382
Q

3 signs of all pneumothorax

A

decreased breath sounds
hyper resonance
hypoxia no hypercapnia

383
Q

complication of tension pneumothorax

A

cardiac arrest

384
Q

3 haemodynamic signs of tension pneumothorax

A

hypotension
tachycardia
increased RR

385
Q

type of alkalosis in pneumothorax

A

respiratory

386
Q

treatment of PSP (>2cm and SOB) and secondary pneumothorax

A

O2
chest drain
aspiration then chest drain if unstable

387
Q

treatment of tension pneumothorax

A

aspirate before CXR and chest tube ASAP

388
Q

difference between transudate and exudate pleural effusion

A 
transudate = not inflammation, protein <25m/L
exudate = inflammation, protein >35g/L

determine using pleural aspiration/tap

389
Q

4 causes of transudate pleural effusion

A

hypoalbuminaemia
Meig’s syndrome
hypothyroidism
cardiovascular (overload, HF, constrictive pericarditis)

390
Q

3 causes of exudate pleural effusion

A

inflammation e.g. RA, SLE, infarction
malignancy
infection

391
Q

1 infection causing chronic exudate pleural effusion

A

TB

392
Q

horizontal pleural effusion?

A

coexisting pneumothorax

393
Q

2 causes of high amylase in pleural effusion

A

carcinoma

pancreatic disease of oesophageal rupture

394
Q

treatment for exudate effusion

A

treat cause and drain (dont drain for transudate)

395
Q

surgical treatment for exudate effusion

A

pleurodesis - pleural spaces removed and stuck together with tetracycline, talc or bleomycin drugs

396
Q

4 types of bronchial carcinoma

A

small cell
adeno
squamous
large cell

397
Q

cells causing small cell BC

A

endocrine (Kulchitsky) - secrete polypeptides

398
Q

cells causing adeno BC

A

mucous cells in bronchial epithelium

399
Q

why does squamous BC cause infection and hypercalcaemia

A

obstructs bronchus

400
Q

why does large cell BC met early

A

less differentiated version of SCC and adeno

401
Q

3 endocrine complications of small cell BC

A

bad ADH secretion = hyponatraemia
ectopic ACTH = cushings
hypercalcaemia (PTH

402
Q

3 neurological complications of BC

A

polyneuropathy
cerebellar degeneration
Lambert-Eaton

403
Q

does small cell BC cause clubbing

A

no

404
Q

2 signs OE if BC is in large bronchi

A

lung collapse

obstructive emphysema

405
Q

when can’t you operate BC

A

if in the 1st 2cm of the main bronchi

406
Q

chemotherapy for small cell BC

A

cyclophosphamide + doxorubicin + vincristine + etoposide

OR

cisplatin + radiotherapy

407
Q

is T1 and T2 BC operable

A

yes

408
Q

2 chemo drugs for T4 BC

A

gemcitabine

carboplatin

409
Q

blood test result in acute asthma

A

peripheral blood eosinophilia

410
Q

FEV1/FVC ratio in acute asthma

A

> 15% improvement + volume increase of >200ml after beta 2 agonist

411
Q

2nd step in asthma treatment

A

inhaled steroid 200-800mcg/day beclomethasone (+ SABA)

412
Q

3rd step in asthma treatment

A

add on therapy (LABA) not in addition to inhaled steroid - add steroid if doesn’t help

413
Q

what to do if 3rd step asthma treatment doesnt work

A

leukotriene receptor antagonist or sustained release theophylline

414
Q

4th step in asthma treatment

A

increase steroid to 2000mcg/day and/or add 4th drug (leukotriene receptor antagonist, SR theophylline or beta 2 agonist tablet)

415
Q

5th step in asthma treatment

A

oral steroids + inhaled

416
Q

investigation for Wells 2+

A

CTPA (D-dimer if <2)

417
Q

what can chronic thromboembolic pulmonary hypertension (complication of PE) cause

A

HF

418
Q

type of shock in PE

A

cardiogenic

419
Q

why can PE cause pyrexia

A

WBC break down clot

420
Q

3 heart sounds in PE

A

gallop heart rhythm
widely split 2nd heart sound
tricuspid regurgitant murmur

421
Q

ECG in PE

A

might have ST depression

422
Q

what is alpha-1 antitrypsin deficiency a risk factor for

A

COPD

423
Q

spirometry result in COPD

A

FEV1/FVC <0.7 post-bronchodilator

FEV1 <80%

424
Q

4 classifications of COPD

A 
1 = mild - FEV1 >80%
2 = moderate - FEV1 50-79%
3 = severe - FEV1 30-49%
4 = very severe - FEV1 <30% or <50% and respiratory failure
425
Q

dyspnoea scale for COPD

A

MRC (1-5)

426
Q

what can secondary polycythaemia be a complication of

A

COPD

427
Q

2 vaccines to give in COPD

A

pneumococcal

influenza

428
Q

treatment for COPD if exacerbations despite SABA and FEV1 <50%

A

LABA + inhaled steroid (prednisolone 30mg/day for 7-14 days), or LAMA

if still = LAMA and LABA + inhaled corticosteroid

429
Q

when to use theophylline for COPD

A

after SABA/LABA or can’t inhale

430
Q

FEV1/FVC in pulmonary fibrosis

A

> 80% - decreased compliance (restrictive)

431
Q

4 Ds in the symptoms of pulmonary fibrosis

A

dry cough
dyspnoea
digital clubbing
diffuse inspiratory crackles

432
Q

2 treatments for pulmonary fibrosis

A

prednisolone - high dose 6 weeks then reduce

immunosuppression including azathioprine and cyclophosphamide and steroids

433
Q

cause of secondary varicose veins

A

pelvic/abdominal masses

434
Q

3 symptoms of varicose veins

A

prutitus
night cramps, heavy, aching
RLS

435
Q

5 complications of varicose veins from venous hypertension

A 
oedema
venous ulceration
pigmentation
lipodermatosclerosis
varicose eczema
436
Q

2 examinations for varicose veins

A

cough impulse - saphenofemoral junction

trendelenbergs

437
Q

investigation for varicose veins

A

colour doppler venous scans

438
Q

screening for AAA

A

one USS for men 65+

439
Q

weird risk factor for AAA

A

not having diabetes

440
Q

what can hydronephrosis and limb ischaemia (embolism?) be a sign of

A

unruptured AAA

441
Q

when to do AAA surgery

A

ruptured/rapid expansion or >5.5cm

442
Q

4 drugs to reduce expansion/monitor AAA

A

doxycycline/erythromycin
ACEIs/ARBs
statins
low dose aspirin

443
Q

4 infections causing AAA

A

brucellosis
salmonellosis
TB
HIV

444
Q

2 inflammatory disorders causing AAA

A

Behçets

Takayaus

445
Q

3 signs of AAA on CT

A

mural thrombus
crescent sign (imminent rupture)
para-aortic inflammation

446
Q

what is Leriche syndrome

A

erectile dysfunction from PVD

447
Q

main test for diagnosing PVD

A

doppler USS

448
Q

ABPI values for PVD

A

0.6-0.9 = claudication
0.3-0.6 = rest pain
<0.3 = gangrene

449
Q

2 tests to do for PVD if under 50 years old

A

thrombophilia screen

serum homocysteine levels

450
Q

condition associated in 60% of people with PVD

A

CHD

451
Q

most common valvular disease

A

aortic stenosis - hypertrophy + dilatation

452
Q

murmur in aortic stenosis

A

ejection systolic

453
Q

3 causes of aortic stenosis

A

<65 = calcified bicuspid valve
>65 = senile calcification
rheumatic fever/congenital

454
Q

4 risk factors for aortic stenosis

A

age
congenital bicuspid valve
rheumatic disease
CKD

455
Q

9 symptoms of aortic stenosis

A 
angina
exertional dyspnoea
chest pain
syncope
plateau pulse
narrow pulse
low systolic BP
heave apex
systolic thrill + radiation to carotids
456
Q

treatment for aortic stenosis stable vs unstable

A 
stable = valve replacement 
unstable = valvuloplasty
457
Q

why are most drugs contraindicated in aortic stenosis

A

vasodilatory effects

458
Q

3 complications of aortic stenosis

A

CHF
prosthetic valve infection
thrombosis (mechanical valve)

459
Q

murmur in aortic regurgitation

A

diastolic murmur

460
Q

6 causes of aortic regurgitation

A 
bicuspid valve (most common)
infective endocarditis
rheumatic fever
arthropathies 
aortic stenosis
Marfans
461
Q

9 symptoms of aortic regurgitation

A 
dyspnoea
orthopnoea
PND
mottled extremities 
increased JVP 
lung crepitations
head bobbing 
collapsing pulse
wide pulse pressure
462
Q

3 treatments for acute regurgitation

A

inotropes
vasodilators
aortic valve replacement

463
Q

3 treatments for chronic regurgitation

A

reassure
vasodilator
TAVI (transcatheter aortic valve replacement)

464
Q

murmur in mitral stenosis

A

diastolic murmur (more common than mitral regurgitation)

465
Q

3 heart features in mitral stenosis

A

congestion
decreased cardiac output
right ventricular overload

466
Q

5 risk factors for mitral stenosis

A 
streptococcal infection
female
rheumatic fever
small volume AF
pulmonary hypertension
467
Q

6 symptoms of mitral stenosis

A 
malar flush
dyspnoea on exertion
orthopnoea
PND
cough 
haemoptysis
468
Q

5 differentials for mitral stenosis

A 
obstruction
atrial myxoma
cardiomyopathy
atrial regurgitation
tricuspid stenosis
469
Q

3 treatments for mitral stenosis

A

valve repair
diuretic
anti-coagulants

470
Q

3 complications of mitral stenosis

A

AF
stroke
IE

471
Q

murmur in mitral regurgitation

A

pan systolic murmur (throughout systole - merge over 2nd heart sound)

472
Q

5 casues of mitral regurgitation

A 
rheumatic fever
floppy valves (prolapse?)
rupture after infective MI
hypertrophic cardiomyopathy
connective tissue disorders
473
Q

6 symptoms of mitral regurgitation

A 
exertional dyspnoea
palpitations
fatigue 
extremity oedema
pulmonary oedema 
bibasal fine crackles?
474
Q

5 DDs for mitral regurgitation

A 
ACS
IE
mitral stenosis
aortic stenosis 
atrial myxoma
475
Q

5 treatments for. mitral regurgitation

A

surgery
diuretics
chronic = ACEis, BB, surgery

476
Q

3 complications of mitral regurgitation

A

pulmonary hypertension
LV dysfunction
CHF

477
Q

diagnostic criteria for infective endocarditis

A

Duke’s

478
Q

most common organism in IE

A

staph aureus

479
Q

3 organisms in IE if own valve

A

viridians group strep
S. aureus
enterococci

480
Q

3 organisms in IVDU IE

A

s aureus
strep
gram negative bacilli

481
Q

3 organisms in prosthetic valve IE

A

coagulase negative staph
s aureus
enterococci

482
Q

symptoms in IE (FROM JANE)

A

F - fever
R - roth spots
O - oslers nodes
M - murmur (new)

J - janeway lesions
A - anaemia
N - nails (splinter haemorrhages)
E - emboli

483
Q

blood cultures to do in IE

A

3 sets 1 hour apart before abx

484
Q

3 differentials for IE

A

rheumatic fever
atrial myxoma
Libman-Sacks endocarditis (SLE)

Year 3 revision (9 decks)

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