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Phase 2a > Cramming Qs > Flashcards

Cramming Qs Flashcards

1
Q

3 cardinal symptoms of HF

A

SOB

Fatigue

Ankle swelling

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2
Q

Fill in the gaps

A
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3
Q

When do we see saddle shaped ST waves?

A

Pericarditis (&PR depression)

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4
Q

Hyperkalaemia on ECG

A
  • Tall tented T waves
  • P wave flattening
  • PR prolongation
  • Wide QRS
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5
Q

Hypokalaemia on ECG

A
  • T wave inversion
  • ST depression
  • Prominent U wave
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6
Q

What abnormal heart rhythm does long QT syndrome predispose a patient to?

A

Torsades de pointes

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7
Q

1st line investigation of intermittent claudication

A

Ankle brachial pressure index

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8
Q

Acute management of stable patients with SVT (4 steps)

A
  • Valsalva manoeurve
  • Carotid sinus massage
  • Chemical cardioversion, eg adenosine
  • Direct current cardioversion - defibrillator
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9
Q

Example of group A streptococci

A

Streptococci pyogenes

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10
Q

Presentation of aortic dissection (3)

A
  • Sudden excruciating chest pain “tearing”
  • History of HTN
  • Absent pulses
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11
Q

Gold standard investigation for aortic dissection?

A

CT angiography

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12
Q

First line treatment of atrial fibrillation

A

Beta blocker

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13
Q

Murmur in aortic stenosis

A

Ejection systolic heard loudest over the aortic region and radiation to the carotids

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14
Q

Murmur in mitral regurgitation

A

Pansystolic heard loudest in the mitral area

Radiation to the axilla

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15
Q

Immediate management for STEMI

A

MONA

Morphine

O2

GTN

Aspirin

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16
Q

Treatment for atrial flutter

A

Catheter ablation

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17
Q

What does CHA2DS2-VASc stand for?

A

Assesses risk of stroke in patients with A Fib

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18
Q

Blood test to confirm HF

A

BNP

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19
Q

Clinical findings suggestive of HF on CXR

A

A. Alveolar oedema

B. Kerley B lines

C. Cardiomegaly

D. Dilated prominent upper lobe vessels

E. Pleural effusions

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20
Q

Pharmaceutical management of HF

A

ABAL

ACEi

Beta Blocker

Aldosterone antagonist, eg spironolactone

Loop diuretic, eg bendroflumethiazide

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21
Q

Prinzmetals/variant angina on ECG

A

ST elevation (but troponin not elevated so not STEMI)

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22
Q

Stable/unstable angina on ECG

A

Normal or ST depression

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23
Q

Most common cause of mitral stenosis?

A

Rheumatic fever

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24
Q

Gold standard investigation for ulcerative colitis

A

Colonoscopy

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25
Q

Gold standard investigation for coeliac

A

Duodenal biopsy

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26
Q

What will a duodenal biopsy show in Coeliac

A

Villous atrophy

Raised epithelial lymphocytes

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27
Q

Key presentation of diverticulitis

A

Older age

Fever

Left Lower Quadrant pain

Leukocytosis

Rectal bleeding

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28
Q

Biggest RF for diverticulitis

A

Low fibre diet

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29
Q

Define primary sclerosing cholangitis

A

Inflammation and fibrosis of intra and extra hepatic bile ducts

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30
Q

Common presentation of PSC

A

All ages

Jaundice

Itching

Pain in RUQ

Muscle atrophy & weight loss

Associated with IBD

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31
Q

Common presentation of PBC

A
  • Middle aged
  • Female
  • Not associated with IBD
  • Hx of autoimmune disease
  • Itch
  • Fatigue
  • Jaundice
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32
Q

Antibody present in PBC

A

Anti-mitochondrial Ab (AMA)

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33
Q

Management for PBC & PSC

A

PSC - conservative. No direct treatment

PBC - ursodeoxycholic acid & potential transplant

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34
Q

Gold standard investigation Mallory Weiss tear

A

Upper GI endoscopy

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35
Q

Gold standard investigation in oesphageal varices

A

Gastroscopy

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36
Q

Presentation of Mallory Weiss tear

A
  • Episodes of forceful retching, vomiting, coughing, straining
  • Black tarry stools - melaena
  • Hx alcohol abuse
  • Haematemesis
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37
Q

Mutation in haemachromatosis

A

C282Y

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38
Q

Presentation of haemachromatosis

A

Non-specific

  • Skin pigmentation “more tanned”
  • Lethargy
  • Weakness
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39
Q

Treatment of haemachromatosis

A

Bloodletting

Iron chelating drugs, eg deferoxamine or deferasirox

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40
Q

Presentation of Wilson’s disease (4)

A
  • Younger age 10-40
  • Dysdiadochokinesis / problems with fine motor movements
  • Eyes changing colour
  • Stiff & slow movements
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41
Q

Major presentation of pancreatitis (3)

A

‘severe epigastric pain that radiates to the back’

  • Abdo pain after meal
  • Steatorrhoea
  • Alcohol abuse
  • Diabetes is associated
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42
Q

Histology of Crohn’s

A

Transmural inflammation with granulomas and lymphoid aggregates

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43
Q

Histology of UC

A

Crypt abscesses

Pseudopolyps

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44
Q

Most common type of leukaemia in children

A

ALL

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45
Q

What would you suspect in a patient who is ‘lemon yellow’ colour

A

Pernicious anaemia

Mild jaundice + anaemia pallor

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46
Q

Reed sternberg cells indicate_____

A

Hodgkin’s lymphoma

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47
Q

Bence Jones protein indicates _____

A

Myeloma

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48
Q

Koilonychia (spoon-shaped nails) indicate ______

A

Iron deficiency anaemia

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49
Q

Treatment for pernicious anaemia

A

IM hydroxycobalamin (B12)

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50
Q

Where are iron, folate and B12 absorbed?

A

Iron - duodenum

Folate - jejenum

B12 - terminal ileum

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51
Q

B12 vs folate clinical

A

B12 - neuro symptoms, folate does not

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52
Q

Triplet change in sickle cell anaemia

A

GAG → GTG

adenine → thymine

glutamic acid → valine overall

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53
Q

What haematological condition can henna trigger?

A

G6PD

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54
Q

Chromosome in CML

A

Philadelphia chromosome

t[9:22]

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55
Q

Treatment for CML

A

Tyrosine kinase inhibitor = imatinib

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56
Q

Key presentation of achalasia

A
  • Difficulty swallowing solids
  • Regurg rather than reflux
  • Slow oesophageal movement
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57
Q

1st line investigation of Coeliac

A

Anti-tTg antibody - must keep gluten in diet for 6 weeks

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58
Q

Gastric vs duodenal ulcers

A

Gastric - worse with eating

Duodenal - improve after eating

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59
Q

RFs for oesophageal cancer

A
  • Achalasia
  • Barrett’s oesophagus
  • Diverticulitis
  • FHx
  • ↑ age
  • Male
  • GORD
  • Alcohol + smoking
  • Hiatal hernia
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60
Q

HLA-DQ2/DQ8 gene associated with___?

A

Coeliac

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61
Q

1st line treatment for Crohn’s

A

Prednisolone

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62
Q

C.diff infection occurs___

A

During or after a course of Abx

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63
Q

JAK2 mutation occurs in_____

A

Polycythaemia rubra vera

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64
Q

Dragging sensation around rectum/anus indicates

A

Rectal prolapse

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65
Q

Neoplasm = _____

A

Autonomous, abnormal, persistent, new growth

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66
Q

Rouleaux formation is seen in the blood smear from a patient with what?

A

Myeloma

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67
Q

Smudge cells are seen on a blood smear from a pt with

A

CLL

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68
Q

Auer rods are seen in a blood smear from a pt with

A

AML

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69
Q

Gold standard investigation of sickle cell anaemia

A

Hb electrophoresis

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70
Q

When does sideroblastic anaemia occur?

A

When RBCs fail to form haem

Iron deposits in the mitochondria

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71
Q

Which cell types are likely to be raised in CML?

A

Eosinophils, basophils, neutrophils

(all derived from myeloid progenitor cells)

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72
Q

What is Courvoisiers sign and what does a positive result indicate?

A

A palpable gallbladder in the presence of painless jaundice

Rules out gallstones

So likley to be an obstructing pancreatic or biliary neoplasm

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73
Q

X-ray finding in RA

A

LOES

Loss of joint space

Osteopenia

Erosion of bone

Swelling of soft tissue

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74
Q

Hand deformities in RA

A

Ulnar deviation

Swan neck fingers

Boutenniere deformity

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75
Q

Hand deformities in OA

A

Herberden’s node - distal

Bouchard’s node - proximal

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76
Q

What type of hypersensitivity is seen in lupus

A

Type III

(3 letter in SLE = type 3)

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77
Q

Pathophysiology of systemic sclerosis

A

Increased fibroblast activity

So increased collagen deposition

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78
Q

Presentation of systemic sclerosis

A

CREST

Calcinosis - calcium deposition in subcutaneous tissue

Raynauds

Eosophageal dysmotility or strictures

Sclerodactyly - local thickening/tightness of skin on fingers/toes

Telenagiectasia - spider veins

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79
Q

Mechanism of bisphosphonates

A

Inhibits osteoclasts

(1st line treatment in osteoporosis)

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80
Q

Most common nerve injury in a mid-shaft humerus fracture

A

Radial nerve

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81
Q

Earliest feature of ankylosing spondylitis seen on x-ray

A

Sacroilitis

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82
Q

In osteoporosis, levels of:

  • Serum calcium
  • Serum phosphate
  • ALP
  • PTH
A

All are normal

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83
Q

In osteomalacia, levels of:

  • Serum calcium
  • Serum phosphate
  • ALP
  • PTH
A
  • Serum calcium = LOW
  • Serum phosphate = LOW
  • ALP = HIGH
  • PTH = HIGH
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84
Q

Most common cause of osteomyelitis in sickle cell patients

A

Salmonella

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85
Q

Most common cause of osteomyelitis in IVDU and immunocompromised patients

A

E.coli or pseudomonas

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86
Q

Appearance of a joint fluid aspirate from a patient with gout

A

Long needle-shaped crystals

Negatively bifringent under plane polarised light

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87
Q

Appearance of a joint fluid aspirate from a patient with pseuogout

A

Rhomboid shaped crystals

Positively bifringent under plane polarised light

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88
Q

Pathophysiology of Paget’s disease

A

Localised disorder of bone remodelling

Leads to ↑ bone resorption followed by ↑ formation of weaker bone

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89
Q

Typical presentation of Paget’s (4)

A

Older male

Bone pain

Deafness

Skull thickening

Fractures

Osteosarcoma

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90
Q

Relevant blood test result in Paget’s

A

Raised ALP

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91
Q

Most sensitive and most specific antibody for SLE

A

Sensitive = ANA

Specific = anti-ds DNA

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92
Q

Inflammatory marker levels in SLE

A

CRP - normal

ESR - raised

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93
Q

Classic presentation of antiphospholipid syndrome

A

Thrombosis and or recurrent miscarriages

  • Coagulation defects
  • Thrombocytopenia
  • Obstetric issues
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94
Q

Classic features of Ewing’s sarcoma on x-ray

A

Lytic bone lesions

Onion skin appearance

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95
Q

Classic presentation of osteosarcoma on x-ray

A

Sunburst/sunray spiculation

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96
Q

Classic presentation of chrondrosarcoma on x-ray

A

Popcorn calficications

Lytic lesions

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97
Q

Risk factors for developing osteoporosis

A

SHATTERED

S - steroid use

H - hyperthyroidism & hyperparathyroidism

A - alcohol & tobacco

T - thin (low BMI)

T - Testosterone decrease

E - early menopause

R - renal or liver failure

E - erosive/inflammatory bone disease

D - dietary calcium decrease

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98
Q

ECG in atrial fibrillation

A

Irregularly irregular

Absent P waves

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99
Q

ECG in atrial flutter

A

Saw tooth with F waves between QRS complex

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100
Q

ECG in type 2 heartblock mobitz II

A

PR interval remains the same length

QRS complexes dropped

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101
Q

Gold standard investigation of pericarditis

A

ECG - saddle shaped ST elevation

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102
Q

Drug to treat AV block

A

Amlodipine

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103
Q

2 most common causes of pancreatitis

A

Alcohol abuse

Gallstones

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104
Q

Variations in the NOD-2 gene have been linked to what disease?

A

Crohn’s

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105
Q

A lumbar puncture has granulocytes, high protein and low glucose - what is the likely cause of illness

A

Bacterial

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106
Q

A lumbar puncture has lymphocytes, high protein and low glucose - what is the likely cause of illness

A

Fungal or TB

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107
Q

A lumbar puncture has lymphocytes, high protein and normal glucose - what is the likely cause of illness

A

Viral

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108
Q

Overall function of calcitonin

A

Reduces level of calcium in the blood

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109
Q

Diagnostic antibody for goodpasture’s syndrome

A

Anti-GBM

(anti-glomerular basement membrane)

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110
Q

Gold standard treatment for very active RA

A

Methotrexate

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111
Q

1st line treatment for acute gout

A

Modify RFs

(or) Pharmacological:

NSAIDs

or Colchicine

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112
Q

1st line treatment for chronic gout

A

Allopurinol

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113
Q

Difference between rickets and osteomalacia?

A

Rickets is osteomalacia in children

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114
Q

Pathophysiology of osteomalacia

A

Defective mineralisation of newly formed bone matrix or osteoid in adults

Due to low phosphate or calcium and ↑ bone resorption

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115
Q

First line treatment of ischaemic stroke

A

Loading dose of aspirin

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116
Q

Treatment of epilepsy

A

Sodium valproate

In pregnant women give Imotrigine

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117
Q

Specific drug to treat myoclonic seizures

A

Levetiracetam or topiramate

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118
Q

Specific drug to treat absence seizures

A

Ethosuximide

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119
Q

Gold standard investigation of Parkinson’s

A

DaT scan

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120
Q

Genetic cause of Huntington’s

A

Mutation on chromosome 4 leading to repeated CAG

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121
Q

Key features of Alzheimer’s on scans

A

Beta-amyloid plaques

Neurofibrillary tangles

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122
Q

Management of Alzheimer’s

A

Cholinesterase inhibitors

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123
Q

Key feature of Lewy body’s dementia on scans

A

Lewybodies in occipito-parietal region

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124
Q

Management of Lewy body’s demention

A

Cholinesterase inhibitors

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125
Q

Classic presentation of cluster headache

A

Excruciating pain - localised around one eye

  • Watery blood shot eye
  • Facial flushing
  • Rhinorrhoea
  • Miosis/ptosis
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126
Q

Management of cluster headache

A

Sumatriptan

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127
Q

How to spot MS on an MRI

A

GD-enhancing plaques

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128
Q

Management of motor neurone disease

A

Supportive care

Riluzole - delays need for respiratory assistance

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129
Q

Management of myaesthenia gravis

A

Symptom control - reversible ACHesterase inhibitors, eg pyridostigmine

Immunosuppression

Thymectomy

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130
Q

Diagnostic test for myaesthenia gravis?

A

Tensilon test will be positive

A person tests positive for myasthenia gravis if their muscles get stronger after being injected with Tensilon.

Tensilon prevents the breakdown of ACh

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131
Q

Which antibody is a patient with myasthenia gravis most likely to be positive for?

A

Antibodies to post-synaptic acetylcholine receptors (anti-ACh)

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132
Q

Patient is diagnosed with MG. What scan do you order & why?

A

CT neck scan - thymoma is common in MG patients

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133
Q

Which two signs will be positive in meningitis

A

Kernig’s and Brudzinski’s

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134
Q

Describe Kernig’s sign

A

Positive = resistance to extension of leg while hip is flexed

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135
Q

Describe Brudzinski’s sign

A

Flexion of the hips and knees in response to neck flexion

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136
Q

First line investigation in meningitis

A

Blood cultures = first line

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137
Q

Which organism is the most common trigger of Guillain-Barre syndrome

A

Campylobacter jejenum

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138
Q

Presentation of Guillain-Barre syndrome

A

Sudden growing weakness up to 6 weeks after an infection

Weakness spreads proximally

Glove & stocking distribution

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139
Q

Investigation of GBS

A

Slow conduction velocities

Protein in CSF

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140
Q

Important parameter to monitor in a pt with GBS with ascending neuropathy

A

FVC - monitor pulmonary function

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141
Q

Antibody present in GBS

A

Antiganglioside antibodies (anti-GM1)

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142
Q

Prophylaxis for cluster headaches

A

Verapamil

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143
Q

Prophylaxis for migraine - first, second and third line

A

1 - propanolol (not in asthmatic)

2 - topiramate (not in pregnancy)

3 - amitryptilline

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144
Q

Gold standard investigation of SAH

A

Head CT

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145
Q

Most common clinical presentation of fronto-temporal (Pick’s dementia)

A

Personality change

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146
Q

Which nerves tend to be affected in cauda equina syndrom

A

S1-S5

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147
Q

Gold standard investigation for kidney stones

A

Non-contrast CT of kidneys, ureter and bladder

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148
Q

Stages of CKD based on GFR

A

1: GFR>90
2: 60-89
3a: 45-59
3b: 30-44
4: 15-29
5: <15

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149
Q

Classic triad of symptoms in pyelonephritis

A
  • Loin pain
  • Fever
  • Pyuria
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150
Q

Treatment of pyelonephritis

A

Ciprofloxacin or co-amoxiclav

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151
Q

Causes of pre-renal AKI (3)

A
  • Hypotension
  • Hypovolaemia
  • Low cardiac output (ie HF)
  • Low renal perfusion
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152
Q

Causes of renal/intrinsic AKI (3)

A
  • Glomerulonephritis
  • Vasculitis
  • Rhabdomyolysis
  • Acute tubular necrosis
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153
Q

Causes of post-renal AKI (3)

A
  • Stones
  • BPH
  • Prostate cancer
  • Bladder cancer
  • Blood clots
  • Urethral stricture
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154
Q

Antibiotic to treat gonorrhoea

A

IM ceftriaxone

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155
Q

Clasic presentation of bladder cancer

A
  • Painless haematuria
  • Weight loss
  • UTI symptoms with bacteriuria
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156
Q

Gold standard investigation of bladder cancer

A

Flexible cystoscopy

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157
Q

Most common cause of nephritic syndrome

A

IgA nephropathy

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158
Q

Most common cause of nephrotic syndrome

A

Focal segmental glomerulosclerosis

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159
Q

Drug to treat urge incontinence

A

Oxybutynin

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160
Q

Gold standard diagnosis of prostate cancer

A

Transrectal US guided biopsy

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161
Q

Nephrotoxic drug examples (3)

A

NSAIDs

ACEi

Aminoglycides

ARB

Loop diuretics

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162
Q

CKD management

A

Slow the progression of the disease

    • DM treatment
    • HTN treatment

Reduce risk of CVD

    • Statin

Manage complications

    • Give vit D
    • Treat anaemia
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163
Q

Presentation of prostate cancer

A

LUTS

Haematuria

Back pain

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164
Q

Management of epididymitis

A

IM ceftriaxone

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165
Q

Presentation of testicular cancer (3)

A

Painless lump

Hydrocele

Gynacomastia

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166
Q

Diagnosis of testicular cancer

A

US

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167
Q

Presentation of IgA nephropathy

A

Generally asymptomatic

Microscopic haematuria

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168
Q

Presentation of Goodpasture’s

A

Oliguria

SOB

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169
Q

Gold standard investigation of Goodpasture’s

A

Anti-GBM antibodies in blood

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170
Q

Management of Goodpasture’s (3)

A
  • Plasma exchange
  • Steroids
  • Cyclophosphamide
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171
Q

Presentation of post-strep glomerulonephritis

A
  • Haematuria
  • Evidence of strep infection
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172
Q

Presentation of IgA vasculitis

A
  • Purpuric rash on legs
  • Nephritic symptoms - haematuria etc
  • Joint pain
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173
Q

Treatment of focal segmental glomerulosclerosis

A
  • Steroids
  • ACEi/ARB
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174
Q

Antibody found in most patients with membranous nephropathy

A

Anti phospholipase A2 receptor antibody

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175
Q

Classic presentation of renal cancer

A
  • Haematuria
  • Flank pain
  • Palpable abdo mass
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176
Q

Investigations to diagnose renal cancer (5)

A
  • Bloods - polycythaemia
  • Raised BP - due to renin secretion
  • US
  • CT/MRI
  • CXR - cannonball mets
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177
Q

Aetiology of UTI

A
  • Klebsiella
  • E.coli
  • Enterococci
  • Proteus
  • Staphylococcus coagulase -ve
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178
Q

Gold standard investigation of pyelonephritis

A

Mid-stream urine and culture

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179
Q

1st line treatment for pyelonephritis

A
  • Cefalexin
  • Analgesia
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180
Q

Gold standard investigation for cystitis

A

Urine culture & sensitivity

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181
Q

Most common cause of prostatitis

A

E.coli

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182
Q

Management of prostatitis

A

Ciprofloxacin or levofloxacin

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183
Q

Management of chlamydia

A

Azithromycin 1g dose

Doxycycline

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184
Q

Presentation of chlamydia in men

A
  • Testicular pain
  • Dysuria
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185
Q

3 places to find urolithiasis

A
  • Pelvicoureteric junction
  • Pelvic brim
  • Vesicouretal junction
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186
Q

Risk factors for urolithiasis

A

Dehydration

High salt intake

Obesity - lowers bodily pH

Oxalate rich diet

Gout

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187
Q

1st line investigation of urolithiasis

A

KUBXR

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188
Q

Gold standard investigation of urolithiasis

A

Non-contrast CT of KUB

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189
Q

Diagnostic test for STIs

A

Nucleic acid amplification test (NAAT)

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190
Q

Best treatment for proteinuria in CKD

A

ACEi/ARB

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191
Q

Complications of uraemia

A

High urea

  • Pericarditis
  • Encephalopathy
  • Renal colic
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192
Q

Most common cause of acute epididymitis

A

Chlamydia trachomatis

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193
Q

1st & 2nd line treatment of T2DM

A
  1. Diet & lifestyle changes
  2. Metformin
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194
Q

Presentation of hyperosmolar hyperglycaemic state

A
  • Severe dehydration
  • Decreased level of consciousness
  • Hyperglycaemia
  • Hyperosmolality
  • No ketones in blood or urine
  • Stupor or coma
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195
Q

Treatment of hyperosmolar hyperglycaemic state

A
  • Replace fluid - IV saline
  • Insulin - low rate of infusion
  • Restore electrolytes
  • LMWH
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196
Q

Treatment of DKA (4)

A
  • ABC management
  • Replace fluid with 0.9% IV saline
  • IV insulin
  • Restore electrolytes, eg K+
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197
Q

Presentation specific to Grave’s disease (rather than hyperthyroidism as a whole)

A
  • Orbital inflammation & swelling of extra-ocular muscles
  • Eye discomfort
  • Grittiness
  • Increased tear production
  • Diplopia
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198
Q

Treatment of De Quervain’s thyroiditis

A

Aspirin

(in v v symptomatic cases give prednisolone)

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199
Q

Grave’s specific antibody

A

TSH receptor stimulating antibodies (TSHR-Ab)

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200
Q

1st line treatment of hyperthyroidism

A

Carbimazole

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201
Q

Investigation specific to Hashimoto’s thyroiditis

A

TPO antibody will be present

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202
Q

Presentation of thyroid carcinoma

A

Thyroid nodules

Cervical lymphadenopathy

Thyroid gland ↑ in side, is hard or irregular in shape

Dysphagia

Hoarseness of voice

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203
Q

1st line investigation of acromegaly

A

IGF-1 will be raised

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204
Q

Gold standard investigation of acromegaly

A

Oral glucose tolerance test

  • No suppression of glucose
  • Since normally glucose should inhibit GH release & this isn’t happening
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205
Q

Aside from surgery, how can acromegaly be treated?

A
  • Somatostatin analogue
  • GH receptor antagonist
  • Dopamine agonist
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206
Q

2 main points in clinical presentation of Conn’s

A

Hypertension

Hypokalaemia

  • Weakness/cramps
  • Paraesthesia
  • Polyuria
  • Polydipsia
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207
Q

1st line treatment of Conn’s

A

Spironolactone

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208
Q

Gold standard treatment of Conn’s

A

Laparoscopic adrenalectomy

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209
Q

Clinical presentation of Addison’s

A
  • Female
  • Fatigue
  • Anorexia & weight loss
  • Skin more pigmented
  • Diarrhoea, constipation, abdo pain
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210
Q

1st line investigation of Addison’s & the results

A

U+Es

  • Hyponatraemia
  • Hyperkalaemia
  • Hypoglycaemia
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211
Q

Gold standard investigation of Addison’s

A

Short synACTHen test

Result = low cortisol

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212
Q

Causes of primary, secondary and tertiary hyperparathyroidism

A

10 = parathyroid gland produces excess PTH

20 = caused by low calcium → excess PTH to compensate

30 = autonomous PTH secretion

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213
Q

Causes of primary and secondary hypoparathyroidism

A

10 = parathyroid gland failure - autoimmune or idiopathic

20 = following parathyroidectomy or thyroidectomy

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214
Q

Clinical presentation of hypoparathyroidism

A

Low PTH → low Ca

  • Convulsions
  • Arrhythmias
  • Tetany
  • Spasms
  • Hand numbness
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215
Q

Clinical presentation of hypercalcaemia

A

Stones, moans, groans etc

  • Kidney stones
  • Constipation
  • Abdo pain
  • Depression & other psychiatric problems
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216
Q

Serum sodium level in diabetes insipidus

A

Hypernatraemia

(excess water lost so sodium levels in blood not ‘watered down’)

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217
Q

FEV1/FVC ratio in asthma

A

<0.7

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218
Q

Asthma management ladder

A

SABA

SABA + ICS

SABA + ICS + LTRA

SABA + ICS + LABA (+LTRA in adults)

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219
Q

COPD management in non-asthmatics

A

SABA & LABA + LAMA

SABA & LABA + LAMA + ICS

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220
Q

COPD management in asthmatics

A

SABA or SAMA & LABA + ICS

SABA & LABA + LAMA + ICS

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221
Q

Pneumothorax presentation

A
  • Usually following trauma (or underlying condition)
  • Young, male, tall, thin
  • Chest pain
  • Dyspnoea
  • Absent breath sounds on auscultation
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222
Q

Diagnostic investigation of pneumothorax

A

CXR - area devoid of lung markings periperhal to the edge of the collapsed lung

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223
Q

Management of a primary pneumothorax >2cm

A

Aspirate or chest drain

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224
Q

Management of secondary pneumothorax: <1cm, 1-2cm and >2cm

A

<1cm = O2 & admit

1-2cm = aspirate

>2cm = chest drain

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225
Q

Diagnosis of active TB

A

CXR - upper lobe cavitation

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226
Q

Gold standard diagnosis of active TB

A

Sputum sample - Ziehl Niehsen stain

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227
Q

Management of active TB

A

RIPE

Rifampacin

Isonazid

Pyrazinamide

Ethambutol

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228
Q

Side effect of TB drugs

A

Rifampacin - orange urine

Isonazid - neuropathy

Pyrazinamide - gout

Ethambutol - optic neuritis

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229
Q

Presentation of cystic fibrosis

A
  • Neonatal jaundice
  • Recurrent chest infections
  • Steatorrhoea
  • Malabsorption
  • DM
  • Male infertility
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230
Q

Management of cystic fibrosis

A
  • Postural drainage & chest physio
  • High calorie, high fat diet
  • Pancreatic supplementation
  • Minimise contact with other infective patients
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231
Q

Causes of bronchiectasis

A
  • Cystic fibrosis
  • Post-infection
  • Lung cancer
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232
Q

Presentation of bronchiectasis

A
  • Cough - khaki coloured sputum
  • Dyspnoea
  • Haemoptysis
  • Recurrent chest infections
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233
Q

Diagnosis of bronchiectasis

A

CXR: dilated bronchi with thickened walls

Sputum: H.influenzae most common

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234
Q

Management of bronchiectasis

A
  • Physical training
  • Postural drainage
  • Prophylactic abx
  • Surgery (localised disease)
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235
Q

Commonest cause of pneumonia in immunocompromised

A

Pneumocystitis jiroveci

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236
Q

Atypical cause of pneumonia & how this would show in the Hx?

A

Legionella

  • Hx of travel abroad eg to Spain
  • Dodgy AC
  • Multiple people from same event with the illness
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237
Q

Presentation of pneumonia

A
  • SOB
  • Productive cough
  • Fever
  • Pleuritic chest pain
  • Dull to percus
  • Increased vocal resonance
  • Coarse crackles on auscultation
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238
Q

1st line investigation of pneumonia

A

CURB-65

  • Confusion
  • Urea >7
  • RR >30
  • BP<90 systolic &/or <60 diastolic
  • Age ≥ 65yrs
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239
Q

Management of pneumonia

A
  • Abx
  • O2
  • Analgesia
  • Fluid
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240
Q

2 examples of NSCLC

A
  • Adenocarcinoma
  • Squamous cell carcinoma
  • Large cell & differentiated tumours
  • Carcinoid tumours
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241
Q

Most common primary lung cancer

A

Adenocarcinoma

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242
Q

Squamous cell carcinoma is most strongly associated with ___?

A

Cigarette smoking

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243
Q

What cells does a squamous cell carcinoma typically arise from?

A

Epithelial cells

in the central bronchus

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244
Q

Which cancer types commonly spread to the lungs

A

Breast

Bowel

Bladder

Kidney

Prostate

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245
Q

1st line investigation of lung cancer & what do you see?

A

CXR

  • Opacified lesion
  • Hilar enlargement
  • Pleural effusion
  • Collapse
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246
Q

2 exudative causes of pleural effusion?

A

Usually related to inflammation so local

  • Lung cancer
  • Pneumonia
  • Rheumatoid arthritis
  • TB
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247
Q

2 transudative causes of pleural effusion

A
  • Congestive HF
  • Fluid overload
  • Hypoalbuminaemia

(fluid shifting)

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248
Q

Presentation of pleural effusion

A
  • SOB
  • Cough
  • Stony dull percussion over effusion
  • Reduced breath sounds
  • Tracheal deviation away from effusion
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249
Q

1st line investigation of pleural effusion & what is the result?

A

CXR

  • Blunting of costophrenic angle
  • Fluid in lung fissures
  • Meniscus
  • Tracheal and mediastinal deviation if large effusion
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250
Q

Treatment of pleural effusion

A

If fluid overload or CHF cause: diuretic

Infective: antibiotics

Large effusions: aspiration or drainage

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251
Q

Presentation of pulmonary embolism

A
  • Acute onset SOB
  • Cough +/- haemoptysis
  • Pleuritic chest pain
  • DVT
  • Hypoxia
  • Tachycardia
  • Low grade fever
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252
Q

Scoring for PE

A

WELLS score

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253
Q

Management of PE

A

1st line - Apixaban or rivaroxaban DOAC

2nd line - or LMWH

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254
Q

Presentation of haemothorax

A
  • Chest pain
  • Haemoptysis
  • Dyspnoea
  • Auscultation - hyperresonant breath sounds
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255
Q

Landmarks for a chest drain

A

Mid-axillary line of 5th intercostal space

  • Anterior/lateral edge of latissimus dorsi
  • Lateral edge of pectoralis major
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256
Q

What do you hear on auscultation of patient with pneumonia

A

Increased vocal resonance

Coarse crackles

Dull to percus

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257
Q

What do you hear on auscultation of patient with pulmonary fibrosis

A

Fine respiratory crackles

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258
Q

What paraneoplastic syndromes are associated with sclc

A

High ADH → hyponatraemia

High ACTH → Cushing’s

High PTH → hyperparathyroidism

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259
Q

Major presentation of Wegner’s granulomatosis

A
  • cANCA positive
  • Hearing loss, sinusitis, nose bleeds
  • Saddle shaped nose due to perforated septum
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260
Q

Investigation of Sjogren’s

A

Anti-LA & Anti-Ro are specific to Sjogren’s

Schirmer test

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261
Q

3 x-ray findings in ankylosing spondylitis

A
  • Squaring of vertebral bodies
  • Subchondral sclerosis and erosions
  • Syndesmophytes
  • Ossification of the ligaments, discs and joints
  • Fusion of the facet, sacroiliac and costovertebral joints
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262
Q

Management of RA (1-4 line)

A
  1. DMARD, eg methotrexate or sulfasalazine
  2. 2 of the above
  3. Methotrexate + biologic (usually anti-TNF)
  4. Rituximab
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263
Q

Complications of rheumatoid arthritis

A
  • Felty’s syndrome (RA, neutropenia, splenomegaly)
  • Anaemia of chronic disease
  • Pulmonary fibrosis
  • Amyloidosis
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264
Q

Explain Felty’s syndrome

A

RA

Neutropenia

Splenomegaly

→ repeated infections

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265
Q

Typical presentation of dermatomyositis

A
  • V high creatinine kinase
  • Gottron lesions
  • Photosensitive erythematous rash on back & neck
  • Purple rash on face & eyelids
  • Subcutaenous calcinosis
  • Anti-Jo-1 antibodies
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266
Q

Antibodies present in dermatomyositis and/or polymyositis

A

Dermatomyositis

  • Anti-Jo-1
  • Anti-Mi-2
  • ANA

Polymyositis

  • Anti-Jo-1
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267
Q

Dermatomyositis vs polymyositis?

A

Dermatomyositis is chronic inflammation of the skin and muscles

Polymyositis = chronic inflammation of the muscles only

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268
Q

Cola coloured urine and muscle pain suggests what?

A

Rhabdomyolisis

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269
Q

Risk factors for fibromyalgia

A
  • Low income
  • Being divorced
  • Low education status
  • Depression
  • Overprotective family or lack of support
  • Middle age
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270
Q

First line treatment of septic arthritis (before organism has been confirmed)

A

Flucloxacillin

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271
Q

Presentation of reactive arthritis

A
  • Hx infection, eg tonsilitis
  • Conjunctivitis
  • Urethritis
  • Enthesitis

‘can’t see, can’t pee, can’t climb a tree’

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272
Q

What disease is very closely associated with osteosarcoma

A

Hereditary retinoblastoma

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273
Q

Young patient (10-20yrs), with bone pain or fracture that commonly wakes them in the night. FHx of an eye disease. What diagnosis do you suspect?

A

Osteosarcoma

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274
Q

2 conditions associated with PSC

A

Ulcerative colitis

Cholangiocarcinoma

275
Q

2 conditions associated with PBC

A
  • Hepatocellular carcinoma
  • RA (or other autoimmune condition)
276
Q

First line treatment for trigeminal neuralgia

A

Carbamazepine

277
Q

Presentation of progressive bulbar palsy

A

Dysarthria

Dysphagia

Nasal regurgitation of fluids and choking

LMN lesions of tongue & muscles of talking or swallowing → absent jaw jerk reflex

Flaccid fasciculating tongue

Change in speech

278
Q

Symptoms of raised ICP

A

Drowsy

Headache

Vomiting

279
Q

Most common cause of septic arthritis in a young, sexually active patient

A

N. gonorrhoeae (S.aureus in whole population)

280
Q

1st line & gold standard investigations of gallstones

A

1st line = USS

Gold standard = MRCP

281
Q

Gold standard investigation of acute pancreatitis

A

CT abdomen

(US = first line)

282
Q

Lucid interval following trauma suggests what type of haemorrhage?

A

Extra-dural

283
Q

What test monitors progression of diabetes?

A

HbA1c (level >48 indicates dabetes

284
Q

Mechanism of action of sulfonylurea

A

Increases insulin production:

  • Binds to K+ channels in ß cells
  • Increases depolarisation
285
Q

Most common cause of Cushing’s syndrome?

A

Exogenous steroids

286
Q

Signs of peritonitis (4)

A
  • Rebound tenderness
  • Shoulder tip pain
  • Localised guarding
  • Rigidity
287
Q

Hx of chronic Hep C, fevers, rigors, distended abdomen and shifting dullness indicate what?

A

Spontaneous bacterial peritonitis

288
Q

Slate grey skin suggests? What would be your 1st and gold standard line treatment?

A

Haemachromatosis

  1. Venesection

Gold = liver transplant

289
Q

What antibiotic commonly causes AKI?

A

Gentamicin

290
Q

Types of adverse drug reaction summarised

A

Augmented - predictable, dose dependent, common

Bizarre - not predictable and not dose dependent

Chronic - due to a cumulative dose, time-related

Delayed - become apparent a while after using the medication

End of use - occur after abrupt drug withdrawal

291
Q

Example of Type A ADR

A

Morphine & constipation (eg predictable)

292
Q

Example of type B ADR

A

Not predictable and not dose dependent

eg anaphylaxis & penicillin

293
Q

Example of type C ADR

A

Osteoporosis and steroids

294
Q

Example of type D ADR

A

Thalidomide and limb abnormalities in babies

295
Q

Example of type E ADR

A

Opiate withdrawal syndrome

296
Q

First line of investigation of autosomal dominant PKD

A

Renal USS

297
Q

Which zone of the prostate is most commonly abnormal in prostate cancer?

A

Peripheral zone

298
Q

Which zone of the prostate is most commonly abnormal in BPH?

A

Transitional zone

299
Q

Schistosomiasis causes what type of bladder cancer?

A

Squamous cell carcinoma

300
Q

Most common type of bladder cancer?

A

Urothelial carcinoma

301
Q

RFs for sub-dural haemorrhage

A

Older age

Alcoholism

Hx of recurrent head trauma

302
Q

Investigations of sub-arachnoid haemorrhage

A

CT head

Lumbar puncture

303
Q

What will a lumbar puncture done 12 hours after suspected SAH show to confirm the diagnosis?

A

Xanthrochromic (straw coloured due to breakdown of bilirubin in RBCs)

304
Q

Triad of symptoms in Horner’s syndrome

A

Ptosis (drooping upper eyelid)

Miosis (pupil constriction)

Anhidrosis (ipsilateral loss of sweating)

305
Q

What is budenoside an example of?

A

Inhaled corticosteroid

306
Q

CT findings in bronchiectasis

A
  • Signet-ring sign = prominent dilated airway compared to accompanying vessel
307
Q

Which way does the trachea deviate from a pneumothorax

A

Away from the affected lung

308
Q

3 causes of pulmonary hypertension

A

Pulmonary embolism

COPD

Obstructive sleep apnea

Obesity

CVD

309
Q

Presentation of pulmonary HTN

A
  • Chest pain
  • Signs of cor pulmonale, eg oedema, hepatomegaly
  • Lethargy
  • Fatigue
  • Exertional dyspnoea
310
Q

Typical presentation of sarcoidosis

A
  • Young, black female
  • Dry cough
  • SOB
  • Erythema nodosum
  • Fever
  • Fatigue
  • Weight loss
  • Polyarthralgia

Lofgren’s triad = bilateral hilar lymphadenopathy, erythema nodosum, polyarthralgia

311
Q

Gold standard investigation of sarcoidosis and what will confirm the diagnosis

A

US guided biopsy of mediastinal lymph nodes

  • Non-caseating granulomas with epithelioid cells
312
Q

Management of sarcoidosis

A

1st line = no treatment

2nd line = steroids (if treatment required)

3rd = methotrexate

Final: lung transplant

313
Q

3 signs of COPD on x-ray

A
  • Flattened hemidiaphragm
  • Hyperinflation
  • Bullae
314
Q

Least likely lung cancer to metastasise

A

Mesothelioma

315
Q

3 examples of restrictive lung disorders

A

Intrapulmonary

  • idiopathic pulmonary fibrosis
  • extrinsic allergic alveolitis
  • coal worker’s pneumoconiosis/progressive massive fibrosis
  • silicosis
  • sarcoidosis
  • drug-induced fibrosis: amiodarone, bleomycin, methotrexate
  • asbestosis

Extrapulmonary

  • neuromuscular disease: polio, myasthenia gravis
  • obesity
  • scoliosis
316
Q

Summarise type 1 hypersensitivity

A

Immunological memory to something causing an immediate and often severe allergic response

317
Q

Example of type 1 hypersensitivity

A

Hayfever

Anaphylaxis

318
Q

Summarise type 2 hypersensitivity

A

Cytotoxic, antibody dependent

Immunoglobulins bound to surface antigens on a target cell which is actually a host cell

319
Q

Example of T2 hypersensitivity

A

Goodpasture’s

320
Q

Summarise T3 hypersensitivity

A

Immune complex disease

Antibodies bind to soluble antigen forming a circulating immune complex

Little lumps get deposited in skin, lung etc activating immunity → local inflammation

321
Q

Example of T3 hypersensitivity reaction

A

SLE

322
Q

Summarise T4 hypersensitivity

A

Delayed T cell mediated

TH cells activated by APC

When antigen appears again, macrophages are activated → inflammatory response

323
Q

Example of T4 hypersensitivity

A

Exposure to poison ivy → contact dermatitis

324
Q

You suspect DVT in a patient. How does their Well’s score impact first line investigation

A

If ≤1, first line = quantative D-dimer

If ≥2, first line = proximal leg vein USS

325
Q

You suspect PE in a patient. How does their Well’s score impact first line investigation

A

If score ≤4, first line =quantative D-dimer test

If score >4, first line = immediate CT pulmonary angiogram

326
Q

Which 2 types of cancers spread transcoelomically? (through body wall)

A

Mesothelioma

Ovarian carcinoma

327
Q

Example of cancers which typically spread haematogenously

A

Bone and soft tissue tumours

328
Q

Example of cancers which typically spread lymphatically

A
  • Melanoma
  • Breast
  • Lung
  • GI tumours
329
Q

Example of a SAMA drug

A

Ipatropium

330
Q

Example of a LAMA drug

A

Tiotropium

331
Q

What is the name given to not being able to extend the knee when the hip is flexed?

A

Kernig’s sign

332
Q

What is the name given to the hips and knees needing to flex when the neck is flexed?

A

Brudzinski’s neck sign

333
Q

As well as blood cultures & CSF analysis, what investigations can be done if you suspect meningitis

A
  • Head CT
  • Throat swabs
  • Bloods: FBC, CRP
  • Pneumococcal and meningiococcal PCR
334
Q

Gram negative diplococci that causes meningitis

A

Neisseria meningitidis

335
Q

Treatment of a meningitis patient in hospital

A

Urgent cefotaxime IV

Consider amoxicillin if pt immunocompromoised or over 55

336
Q

Treatment of a meningitis patient in primary care

A

Benzylpenicillin

337
Q

Mechanism of action of COMT inhibitors & MAO-B inhibitors

A

Act to stop the breakdown of dopamine clearance, increases dopamine available

338
Q

Symptoms specific to a MCA stroke

A
  • Contralateral motor weakness of upper limbs
  • Contralateral sensory loss of upper limbs
  • Hemianopia
  • Face drop
  • Aphasia
  • Dysphasia
339
Q

Symptoms specific to an ACA stroke

A
  • Contralateral weakness and sensory loss of the lower limb
  • Incontinence
  • Drowsiness
  • Truncal ataxia - drunken sailor gait
340
Q

Symptoms specific to a PCA stroke

A
  • Loss of peripheral vision
  • Cortical blindness - eye healthy, but vision lost
  • Prosopagnosia - cannot see faces
  • Unilateral headache
341
Q

Red flag symptoms associated with headaches

A
  • New headache with hx cancer
  • Cluster headache
  • Seizure
  • Altered: consciousness, memory, co-ordination, confusion
342
Q

Drug to reduce a raised ICP

A

Mannitol

343
Q

3 signs of lower MND

A

Decreased tone/flaccid

Decreased reflexes

Muscle wasting

Fasciculations

344
Q

3 signs of upper MND

A
  • Increased tone
  • Brisk reflexes
  • Minimal muscle atrophy
  • Babinski’s sign
345
Q

Describe Babinski’s sign & explain what a positive result might indicate

A

Occurs after the sole of the foot has been firmly stroked.

Big toe moves upwards in a positive result

Can indicate

  • UMN lesion
  • Stroke
  • Brain injury or tumour
  • MS
  • Meningitis
  • Spinal cord tumour or injury
346
Q

What scoring tool measures risk of stroke following TIA

A

ABCD2

347
Q

Which nerve is compressed in carpal tunnel syndrome

A

Median nerve

348
Q

Most common cause of cauda equina syndrome

A

Herniated disc

349
Q

Treatment of myasthenia gravis

A

Reversible AChsterase inhibitors (usually pyridostigmine)

Immunosuppression (prednisolone)

Thymectomy

350
Q

Mechanism of pyridostigmine

A

Reversible acetylcholinesterase inhibitor

  • Increases amount of ACh in NMJ
  • Improves symptoms of MG
351
Q

Management of Huntington’s chorea

A

No treatment option to slow or stop disease progression

  • Speech & language therapy
  • Genetic counselling

Symptom relief:

  • Antipsychotics
  • Benzodiazepines
  • Dopamine depleting agents
352
Q

Management of GBS

A
  • IV immunoglobulins
  • Plasma exchange
  • Supportive care
  • Venous thromboembolism prophylaxis
353
Q

What condition is strongly linked to Lambert-Eaton syndrome

A

Small cell lung cancer

354
Q

How to differentiate LEMS & MG

A

Autonomic dysfunction is not caused by MG, but is caused by LEMS

Presence of acetylcholine receptor (AChR) antibodies strongly suggests MG

355
Q

Management of LEMS

A

Amifampridine

Investigate for SCLC

356
Q

Mechanism of drug used to treat LEMS

A

Amifampridine

  • Allows more ACh to be released in the NMJ synapses
  • Prolongs depolarisation of cell membranes
  • Improves symptoms in LEMS
357
Q

Pathophysiology of Charcot-Marie-Tooth disease

A

Inherited mutations

Typically affect Schwann cells & myelin → demyelination

358
Q

Classical features of Charcot-Marie-Tooth disease

A
  • High foot arches
  • Distal muscle wasting
  • Weakness in lower legs → ankle dorsiflexion
  • Weakness in the hands
  • Reduced tendon reflexes
  • Reduced muscle tone
  • Peripheral sensory loss
359
Q

Typical cause of Wernicke’s encephalopathy

A

Deficiency of thiamine

360
Q

Describe Gower’s sign

A

Suggests muscular dystrophy

Children with proximal muscle weakness use a specific technique to stand up from a lying position:

  • They get onto their hands and knees
  • Then push their hips up and backwards like the “downward dog” yoga pose.
  • They then shift their weight backwards and transfer their hands to their knees.
  • Whilst keeping their legs mostly straight they walk their hands up their legs to get their upper body erect.
361
Q

Inheritance pattern of Duchenne’s muscular dystrophy

A

X-linked recessive

362
Q

Typical presentation of Duchenne’s muscular dystrophy

A
  • Boys
  • Aged 3-5 years
  • Vague symptoms of muscle weakness

?FHx

363
Q

Management of muscular dystrophy

A
  • Oral steroids can slow progression
  • Creatine supplementation
  • OT
  • Physio
  • Surgical & medical management of complications eg scoliosis
364
Q

Most common viral cause of encephalitis

A

Herpes simplex virus

365
Q

Management of viral encephalitis

A

Aciclovir

366
Q

Typical presentation of herpes zoster

A
  • Localised pain in a dermatome
  • Erythematous maculopapular rash - in affected dermatome
  • Fever, headache etc
367
Q

Management of herpes zoster

A
  • Reduce pain using analgesics
  • Aciclovir
368
Q

How does ramipril affect potassium levels?

A

Increases them

ACEi → reduces aldosterone & ADH so more Na+ lost so more K+ retained

369
Q

How does nebulised salbutamol affect potassium levels?

A

Lowers them

370
Q

Gold standard investigation for phaeochromocytoma

A

Elevated plasma free metanephrines (made when body breaks down adrenaline & noradrenaline - has longer half life than them)

371
Q

Mechanism of action of sulfonylurea

A
  • Bind to an ATP-dependent K+ channel on the cell membrane of beta cells
  • Increasing insulin secretion
372
Q

Levels of glucose, sodium and potassium in Addisonian crisis

A

Glucose - low

Sodium - low

Potassium - high

373
Q

What type of cells secrete PTH

A

Chief cells

374
Q

What condition is associated with TSH-R antibodies

A

Grave’s disease

375
Q

Give signs of a patient with Hashimoto’s thyroiditis

A
  • Bradycardia
  • Reflexes relax slowly
  • Ataxia
  • Dry/thin hair & skin
  • Yawning, drowsiness, coma
  • Cold hands
  • Ascites
  • Round puffy ‘moon’ face
  • Immobile
376
Q

Presentation of phaeochromocytoma

A
  • Palpitations
  • Headache
  • Episodic sweating
  • Anxiety
  • HTN
377
Q

Most common site for carcinoid tumours to metastasise to

A

Liver

Carcinoid tumour = a rare, slow growing tumour

378
Q

Main side effect of metformin

A

Lactic acidosis

379
Q

Main side effect of sulfonylurea

A

Frequent hypoglycaemia

Weight gain

380
Q

Main side effect of pioglitazone

A

Bladder cancer (rare)

381
Q

Main side effect of SGLT-2 inhibitors

A

DKA

382
Q

Nerve roots associated with carpal tunnel syndrome

A

C5/6-T1 median nerve

383
Q

Describe the appearance of pre-tibial myxoedema

A

Waxy discolouration - ‘orange peel’ appearance

384
Q

Diagnostic criteria of DKA

A

Ketones >3mmol/L

Glucose >11mmol/L

pH <7.3

385
Q

Arrange the drugs used to treat acromegaly in order of effectiveness

A
  1. Somatostatin analogue
  2. Dopamine agonist
  3. GH receptor antagonist
  4. Radiotherapy
386
Q

1st & 2nd line drug in hypertensive crisis due to phaeochromocytoma

A
  1. Phentolamine
  2. Sodium nitroprusside
387
Q

Most common causes of hypothyroidism in developing vs developed world

A

Developing = iodine deficiency

Developed = Hashimoto’s

388
Q

What is the severity of COPD assessed by?

A

FEV1 percentage of predicted

389
Q

Give an example of a respiratory condition which almost always reduces TLCO

A

Pulmonary fibrosis

390
Q

Example of a condition that leads to T1 respiratory failure

A

Pneumonia

Asthma

Pulmonary embolism

COPD

391
Q

Example of a condition that leads to T2 respiratory failure

A

COPD (both T1&T2)

Neuromuscular disease

392
Q

Which tumour marker is likely to be raised in suspected testicular cancer?

A

Alpha-feto protein (AFP)

393
Q

What does PKD give an increased risk? (3)

A

Brain aneurysms → SAH

Liver cysts

Pregnancy complications

Mitral valve prolapse

Diverticulitis

394
Q

Site most commonly affected by Crohn’s?

A

Terminal ileum

395
Q

Mechanisms of action of steroid inhaler

A
  • Decrease formation of cytokines
  • Decrease microvascular permeability
  • Inhibit influx of eosinophils
  • Reduce bronchial hyper-responsiveness
396
Q

Which structure does the right testicular vein drain into?

A

IVC

397
Q

Which structure does the left testicular vein drain into?

A

Left renal vein (so varocele more common on this side)

398
Q

Biomarker most commonly associated with Ovarian cancer

A

CA-125

399
Q

Mechanism of action of beta-lactams

A

Inhibit cross-linking of peptidoglycan in bacterial cell walls

400
Q

Mechanism of action of macrolides

A

Inhibit bacterial protein cell synthesis by binding to the 50S subunit of the ribosome

401
Q

Which lobe of the lung is most likely to be affected in an aspiration pneumonia

A

Right lower lobe

402
Q

Cognitive screening test used to support dementia diagnosis

A

MOCA - Montreal cognitive assessment

MMSE - mini mental state exam

ACE3 - Addenbrooke’s cognitive exam 3

403
Q

Where are biopsies typically taken from to confirm diagnosis of coeliac

A

Lining of small intestine

404
Q

Drug to treat syphilis

A

Benzanthine penicillin or azithromycin

405
Q

Prevention of recurrent kidney stones?

A

Thiazide diuretics

Modify RFs - stay hydrated, lose weight, less oxalate in diet (eg red meat)

406
Q

Define decubitus angina

A

Angina worse on lying down

407
Q

Describe Dressler’s syndrome

A

Pericarditis about 2-8/12 weeks after an MI

408
Q

Pansystolic murmur with clear sounding lungs indicates?

A

Tricuspid regurgitation

409
Q

Test to assess the adequacy of arterial supply to the leg

A

Buerger’s test

410
Q

First/most important step in treating septic shock?

A

Fluids

411
Q

ECG changes in hyperparathyroidism

A

Tall T waves & short QT interval

412
Q

Most common cause of IE in: IVDU, general population, people with prosthetic valves?

A

IVDU - s.aureus

General - S.viridans

Prosthetic valves - Staph epidermis

413
Q

What does a seminoma secrete?

A

ALP

414
Q

What does a choriocarcinoma secrete?

A

hCG

415
Q

What does an endodermal yolk sac secrete?

A

AFP

416
Q

Describe uric acid stones & calcium/magnesium stones appearance on x-ray

A

Uric acid = Radiolucent (not visible)

Calcium/magensium = radiopaque or radiodense

417
Q

What age does a female child need to be for a UTI to be considered complicated?

A

Less than 2 months old

418
Q

Define sensitivity

A

No. true positives

419
Q

Define specificity

A

No. true negatives

420
Q

Define prevalence

A

No. cases in a given day

421
Q

Define incidence

A

No. new cases in a given day

422
Q

Define primary, secondary and tertiary care

A

Primary = prevention

Secondary = early detection & stop progression (treat)

Tertiary = reduce/treat complications

423
Q

Which hep infection is associated with being transmitted by sex?

A

Hep B

424
Q

If IgG antibody persists in a hep screen, what does this suggest?

A

Either a resolved or chronic infection

425
Q

If IgM antibody persists in a hep screen, what does this suggest?

A

Acute infection

426
Q

Causes of peritonitis

A

Ectopic pregnancy

Bowel obstruction

Peptic ulcer perforation

Gastritis from H.pylori

427
Q

Triad of symptoms in Wernicke’s encephalopathy

A
  • Ataxia
  • Opthalmoplegia
  • Confusion
428
Q

When is Lofgren’s triad seen & what does it involve?

A

Sarcoidosis

  • Fever
  • Erythema nodosum
  • Bilateral hilar lymphadenopathy
429
Q

Appearance of a melanoma

A

Dark

430
Q

Appearance of BCC

A

Pink, waxy, flat

431
Q

Appearance of an SCC

A

Red, scaly, firm

432
Q

Antibodies present in Wegener’s granulomatosis

A

c-ANCA

433
Q

What is Felty’s triad?

A

RA, low WCC, splenomegaly

434
Q

3 major organ systems affected by SLE & a consequence of each

A

Brain - seizures

Heart - pericarditis

Kidneys - kidney failure

435
Q

1st line treatment for hypercalcaemia

A

Calcitonin & bisphosphonates

436
Q

Cause of megaloblastic anaemia

A

B12 or folate deficiency

437
Q

Most common cause of meningitis in infants under 3 months

A

Group B strep

438
Q

Most common cause of meningitis in children 3 months to 12 years

A

S. pnuemoniae

439
Q

Most common cause of meningitis in teenagers

A

N. meningitidis

440
Q

Most common cause of meningitis in over 55 or immune compromised

A

Listeria monocytogenes

441
Q

What is MRC scoring used for?

A

Characterising baseline dyspnoea in patients with resp diseases such as COPD

442
Q

PVD vs cauda equina clinically

A

PVD has no loss of bowel control, cauda equina does

443
Q

What is Rovsing’s sign?

A

Indicates appendicitis

Pain in right abdo on palpating left

444
Q

If a patients abdo pain is relieved by defaecation, what does this suggest?

A

IBS

445
Q

What does high faecal calprotectin suggest?

A

IBD

446
Q

Management of UC

A

Corticosteroids - prednisolone

Ciclasporins - in very severe cases

5-ASA - Aspirin

Thiopurines - azathioprine

Biologics - infliximab, adalimumab

447
Q

Extraintestinal manifestations of UC

A

PSC

Ankylosing spondylitis

Uveitis

Erythema nodosum

NAFLD

448
Q

Describe the appearance of a blood film of a patient with beta thalassemia?

A

Large & small irregular hypochromic RBCs

449
Q

What do oval macrocytes on a blood film indicate?

A

Megaloblastic anaemia

450
Q

Cause of CML?

A

Translocation of a gene between chromosome 9&22 → philadelphia chromosome

451
Q

Levels of potassium, urate, phosphate and calcium in tumour lysis syndrome

A

K+ = high

Urate = high

Phosphate = high

Calcium = low

452
Q

How to treat tumour lysis syndrome

A
  • IV fluids
  • Medication to decrease uric acid
  • Replacement of electrolyte balance
453
Q

What do you see on a blood film to confirm ALL

A

Blast cells >20%

454
Q

What is the more common mutation in PKD?

A

PKD1 gene on chromosome 16

455
Q

What type of immune complex is involved in T1 hypersensitivity

A

IgE

456
Q

Diagnostic criteria for PKD

A

At least 2 cysts either uni or bilaterally if aged <30yrs

At least 2 cysts in each kidneys age 30-59yrs

At least 4 cysts in each kidney age >60yrs

457
Q

What does a combination of acute kidney injury and haemoptysis suggest. How can you tell between the differentials?

A

Goodpasture’s - anti-GBM

Wegener’s - c-ANCA

458
Q

What level does serum albumin need to be for a nephrotic syndrome diagnosis?

A

<25g/L

459
Q

Renal cell carcinoma stages?

A
  1. Tumour <7cm and only in the kidney
  2. >7cm and only in the kidney
  3. Tumor is growing into a major vein, eg IVC
  4. Tumour is growing beyond Gerota’s fascia and might’ve reached the adrenal gland
460
Q

Most common type of bladder cancer?

A

Transitional cell carcinoma

461
Q

RFs for transitional cell carcinoma

A

Aromatic amines found in dyes, rubber, cigarette smoe

462
Q

Most common type of testicular cancer

A

Teratoma

463
Q

Staging of testicular cancers

A

Royal Marsden Staging System

464
Q

RFs for UTI

A

Female, sexual activity, pregnancy, DM, menopause, catheterisation

465
Q

Amount of bacteria in MSU to be diagnostic

A

10^5 per ml

466
Q

Abx for a pregnant women with a lower UTI?

A

1st/2nd trimester = nitrofurantoin

3rd = amoxicillin/cefalexin

467
Q

Sepsis 6?

A

Blood cultures

Urine output

Fluid

Abx

Lactate

Oxygen

468
Q

What level of lactate is indicative of sepsis

A

More than 2mmol/L

469
Q

Scoring in BPH?

A

International prostate scoring system (IPSS)

470
Q

Signs on investigation specific to an inguinal hernia

A

Reducible

Separate to testis

Bowel sounds present

471
Q

If pt has a left varicocele which doesn’t disappear when they lie down, what does this suggest?

A

Renal cell carcinoma

  • Should usually disappear on lying down so if it doesn’t there is likely a blockage in the renal vein → ?cancer
472
Q

Differentiating between anal fissures and haemorrhoids

A

Both - fresh red blood & chronic constipation

Fissures only - sharp anal pain on defaecation, haemorrhoids are painful all of the time

473
Q

Gold standard investigation of acute diverticulitis

A

Contrast CT colonography

474
Q

Red flag symptoms of oesophageal cancer

A

Weight loss

Cervical lymphadenopathy

Anorexia

Vomiting

475
Q

Describe Dupytren’s contracture

A

Abnormal thickening of the skin in the palm of your hand and at the base of your fingers

→ one or more fingers curl/contract

  • sign of chronic liver disease
476
Q

Commonest cause of oesophageal varices in the UK?

A

Livver cirrhosis

477
Q

Name the types of diarrhoea

A
  • Infectious
  • Secretory
  • Osmotic
  • Dysentry
  • Exudative
478
Q

Clinical tool used to classify faeces

A

Bristol stool chart

479
Q

Signs on a radiograph suggestive of small bowel obstruction

A

Dilated jejenum or ileum

Absence of gas in bowel distal to the obstruction

480
Q

Initial supportive management of bowel obstruction

A
  • Nil by mouth
  • Insert NG tube to decompress the bowel
  • Analgesia
  • IV fluids & correct electrolytes
  • Urinary catheter
  • Suitable anti-emetics
481
Q

Complication of bowel obstruction

A

Ischaemia or strangulation

482
Q

Causes of gastritis

A
  • Helicobacter pylori infection
  • NSAIDs
  • Alcohol abuse
483
Q

2 types of haemorrhoids & the differences between them

A

Internal: painless covered in mucus, can also prolapse

External: form at the anal opening, painful, covered with skin

484
Q

Non-pharmacological management of heartburn following eating

A
  • Weight loss
  • Healthy eating
  • Smoking cessation
  • Eat smaller meals
  • Eat evening meals 3-4 hours before going to bed
  • Reduce alcohol consumption
  • Raise the head of the bed/use more pillows
485
Q

Macroscopic and microscopic features of Crohn’s

A

Macroscopic: skip lesions, mouth to anus, cobblestone mucosa

Microscopic: transmural, granuloma, goblet cells, fewer crypt abscesses than UC

GALS:Granuloma; All; Layers and Levels; Skip lesions

486
Q

3 tests for H.pylori

A

Urea breath test

Stool antigen test

Blood IgG antibody detection

487
Q

Complications of diverticulitis

A
  • Large bowel perforation
  • Fistual formation
  • LBO
  • Bleeding
  • Mucosal inflammation
488
Q

First and second line drugs to treat haematemesis from ruptured oesophageal varices

A

IV terlipressin

IV somatostatin

489
Q

Differentials for appendicitis

A
  • Crohn’s
  • Ectopic pregnancy
  • UTI
  • Diverticulitis
  • Perforated ulcer
  • Food poisoning
490
Q

Features of Reynold’s pentad

A

Mental changes

Sepsis

(plus RUQ pain, jaundice & fever)

491
Q

3 medications given to manage H.pylori infection in a patient with dyspepsia

A

Amoxicillin

  • Clarithromycin
  • Omeprazole
492
Q

A patient presents with slate-grey skin, several signs of chronic liver disease & ferritin >1mg. What is their diagnosis?

A

Haemachromatosis

493
Q

ECG changes hours to days after STEMI?

A

Hours after: tall T waves, ST elevation

Days after: T wave inversion, pathological Q waves

494
Q

4 stages of chronic limb ischaemia

A
  1. Asymptomatic
  2. Intermittent claudication
  3. Rest pain/nocturnal pain
  4. Necrosis
495
Q

What level do O2 sats need to be to indicate giving O2 following an MI

A

<94%

496
Q

How can renal artery stenosis cause secondary hypertension

A

Stenosis → reduced renal perfusion → ↑ renin → ↑ RAAS = higher BP

497
Q

Signs & symptoms of MI

A
  • Severe crushing chest pain that radiates to left arm & shoulder
  • Nausea & vomiting
  • Sweating
  • Pallor
  • SOB
  • Dizzy
498
Q

Infarction vs ischaemia

A

Infarction = death of heart muscles cells due to a reduced or absent blood supply

Ischaemia = restriction in blood supply to tissues causing a shortage of oxygen that is needed for cell function

499
Q

5 types of shock

A

Cardiogenic

Hypovolaemic

Anaphylactic

Septic

Neurogenic

500
Q

Cause of each type of shock

A

Cardiogenic - heart problems

Hypovolaemic - too little blood volume

Anaphylactic - allergic reaction

Septic - infection

Neurogenic - damage to NS

501
Q

Which type of shock leads to increased CO

A

Septic

502
Q

Which type of shock leads to decreased HR

A

Neurogenic

503
Q

Which type of shock leads to increased O2 saturation

A

Septic

504
Q

Adverse effects seen with atropine use?

A
  • Tachycardia
  • Mydriasis
  • Dry mouth
  • Hypohidrosis
  • Constipation
  • Urinary retention
505
Q

How can urea levels help to differentiate between GI bleeds?

A

Upper GI bleed → high urea level

506
Q

Causes of osteomalacia

A
  • Vit D deficiency
  • Renal failure
  • Inherited
  • Liver disease
507
Q

Which test can be used to help diagnose AS?

A

Schober’s test

508
Q

How does allopurinol work to prevent gout?

A
  1. Xanthine oxidase inhibitor
  2. So xanthine is not metabolised into uric acid
  3. Inhibiting XO lowers plasma uric acid
  4. And precipitation of uric acid in joints/kidneys
509
Q

3 phases of Paget’s

A

Lytic: excessive osteoclast resorption

Mixed: excessive osteoclast resorption and formation of disorganised bone

Blastic: osteoblasts lay down excess disorganised weak bone

510
Q

Marker used to monitor SLE

A

ESR

511
Q

Pain in PVD means ischaemia of which artery? In the…

a. Buttocks
b. Thigh
c. Upper 2/3 of calf
d. Lower 1/3 of calf
e. Foot

A

a. Buttocks = lower aorta or iliac
b. Thigh = iliac or common femoral
c. Upper 2/3 calf = superficial femoral
d. Lower 1/3 = popliteal
e. Foot = tibial or peroneal artery

512
Q

Primary and secondary causes of nephrogenic diabetes insipidus

A

Primary - inherited/genetic muation

Secondary - PKD, hydronephrosis, fanconi syndrome, renal amyloidosis, hypercalcaemia, HIV infection, iatrogenic

513
Q

Levels of serum sodium, potassium, glucose & serum osmolality in diabetes insipidus

A

Glucose - normal

Sodium - high

Potassium - low

Serum osmolality - high

514
Q

3 things seen on duodenal biopsy in Coeliac disease

A
  • Raised intraepithelial lymphocytes
  • Crypt hyperplasia
  • Villous atrophy
515
Q

Complications of pancreatitis

A
  • Acute renal failure - due to dehydration!!
  • Sepsis
  • ARDs
  • Pancreatic abscess
  • Ascites
  • Enteric fistula
  • Chronic pancreatitis
  • Abdo compartment syndrome
516
Q

Causes of pancreatitis

A

I GET SMASHED

  • Idiopathic
  • Gallstones
  • Ethanol
  • Trauma
  • Scorpion venom
  • Mumps/malignancy
  • Autoimmune
  • Steroids
  • Hyperlipidaemia
  • ERCP
  • Drugs = NSAIDs + diuretics + steroids
517
Q

Presentation of dermatomyositis

A
  • Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees
  • Photosensitive erythematous rash on the back, shoulders and neck
  • Purple rash on the face and eyelids
  • Periorbital oedema (swelling around the eyes)
  • Subcutaneous calcinosis (calcium deposits in the subcutaneous tissue)
518
Q

Investigations for dermatomyositis

A
  • Creatine kinase
  • Electromyography
  • Muscle biopsy = gold standard
  • Autoantibodies
  • Spirometry
519
Q

What is Charcot’s neurological triad and when is it seen?

A

Seen in patients with MS

  • Dysarthria
  • Nystagmus
  • Inattention tremor
520
Q

Signs of TB on x-ray

A
  • Ghon complex
  • Ghon focus
  • Dense homogenous opacity
  • Hilar lymphadenopathy
  • Pleural effusion
521
Q

Lesion present in TB

A

Caseating granuloma

522
Q

Pathophysiology of chronic asthma

A
  • Mucus secretion/production
  • Smooth muscle contraction
  • Thickening of airways
523
Q

What lesion does sarcoidosis produce in the body

A

Non-caseating granuloma

524
Q

Causes of bronchiectasis

A
  • Cystic fibrosis
  • Infection, eg whooping cough, TB
  • Immunodeficiency
  • Airway obstruction
  • Idiopathic
525
Q

Signs of patient with bronchiectasis on exam

A
  • Coarse crackles heard in early inspiration
  • Wheeze
  • Clubbing
526
Q

Complications of bronchiectasis

A
  • Repeated infection & deteriorating lung function
  • Empyema
  • Lung abscess
  • Pneumothorax from repeated coughing
  • Life-threatening haemoptysis
  • Respiratory failure
527
Q

RFs for pneumothorax

A
  • COPD
  • Genetics
  • Smoking
  • Trauma
  • Previous pneumothorax
  • Resus patients
528
Q

Symptoms of PE

A
  • SOB
  • Chest pain
  • Haemoptysis
  • Sweating
  • Anxiety
  • Dizziness
  • Palpitations
  • Arrythmias
529
Q

Pneumothorax vs pleural effusion on exam

A

Pneumothorax = hyperresonant on percussion

Pleural effusion = dull to percus

530
Q

Pneumothorax vs pleural effusion based on the history

A

Pleural effusion – slower onset, PMH including congestive heart failure, cancer, pneumonia and PE

Pneumothorax – rapid onset, history of trauma, family history of pneumothorax, smoking

531
Q

How long after an MI can you give PCI

A

12 hours

532
Q

Secondary MI management

A

BACAS

Beta blocker

ACEi

Clopidogrel

Aspirin

Statins

(+RF management)

533
Q

1st line & gold standard investigations of cardiac failure?

A

1st = NT-pro-B-type natriuretic peptide

Gold = echo

534
Q

Level of NT-proBNP = urgently refer?

A

>2000ng/l

535
Q

1st, 2nd & 3rd line management of heart failure

A

1st - ACEi or beta blocker

2nd - aldosterone antagonist

3rd - sacubitril valsartan or digoxin

536
Q

Classification system used for chronic PVD

A

Fontaine classification

537
Q

Define shock

A

Circulating failure resulting in inadequate organ perfusion

538
Q

What is Eisenmenger’s syndrome

A

Complication for ASD & VSD

Reversal of L→R to R→L

539
Q

Murmur in patent ductus arteriosus

A

Continuous machinery murmur

540
Q

What feature on clinical exam suggests aortic stenosis is now severe?

A

A small volume and slow rising pulse

541
Q

How does lithium affect the thyroid gland

A

Elevates TSH

Inhibits T3&T4

542
Q

What causes the symptoms in a TIA

A

Ischaemia of cerebral neurones

543
Q

What is Turner’s syndrome

A

Occurs when a female has a single X chromosome

544
Q

What to give to reverse the effects of warfarin ASAP

A

IV Prothrombin complex concentrate

IV Vitamin K

545
Q

Myeloma is a neoplasm of what cell type?

A

Plasma cells

546
Q

Management of chronic limb ischaemia

A

RF management

Antiplatelet, eg clopidogrel

Intervention, eg percutaenous transluminal angioplasty bypass

547
Q

What is the most common electrolyte disturbance found in a blood test result for a patient with Addison’s disease

A

Hyponatraemia = most common

(also see ↓glucose & ↑K+)

548
Q

2 examples of sickle cell crises explained

A

Vaso-occlusive crisis → swelling of hands and feet

Splenic sequestration → blood flow in spleen is compromised → acute splenomegaly & pain. Pooling of blood which can lead to anaemia & circulatory collapse → hypovolaemic shock

549
Q

What do chromaffin cells secrete?

A

Adrenaline and noradrenaline

550
Q

What cells are found in CSF in bacterial & viral infections

A

Bacterial: granulocytes, eg neutrophils, eosinophils, basophils

Viral: B&T lymphocytes

551
Q

Describe IgA antibodies

A

Secreted into mucous, tears, saliva and colostrum

552
Q

Describe the role of IgE antibodies

A

Antibody of allergens and antiparasitic activity

553
Q

Describe the role of IgM antibodies

A

Made at the beginning of infection

  • Involved in primary infection response
554
Q

Describe the role of IgD antibodies

A

B cell receptor

555
Q

Describe the role of IgG antibodies

A

Highly specific molecules targeting single ‘epitopes’. Primary immunoglobulin

556
Q

What is carcinoid syndrome

A

A rare syndrome caused by the metastasis of carcinoid tumours that secrete high levels of serotonin

557
Q

Symptoms of carcinoid syndrome

A
  • Cutaenous flushing
  • Recurrent diarrhoea
  • Abdo cramps
  • Asthma-like wheezing
558
Q

Management of carcinoid syndrome

A

Surgical resection or octreotide

559
Q

Signs in hypocalcaemia

A

Chvostek’s sign

  • Facial twitch on tapping the facial nerve

Trousseau’s sign

  • Positive when a carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure a few minutes.
560
Q

AKI staging

A

KDIGO staging

CK 1.5-1.9x baseline. Urine: <0.5ml/kg/h for 6-12hrs

CK 2.0-2.9x baseline. Urine: <0.5ml/kg/h 12hrs

CK 3.0x baseline. Urine: <0.5ml/kg/h for 24hrs or no urine for >12hrs

561
Q

Example of an SSRI?

A

Fluoxetine

562
Q

Most appropriate antiplatelet therapy following an MI

A

Aspirin + P2Y12 inhibitor eg clopidogrel

563
Q

HTN clinical & home BP thresholds

A

Clinical: 140/90

Home: 135/85

564
Q

Stages of HTN: home & clinical

A

Low

  • Home = 135/85 - 150/95
  • Clinical = 140/90 - 160/100

High

  • Home >150/95
  • Clinical > 160/100

Severe

  • Clinical systolic >180 or diastolic >110
565
Q

What do each of the following cells secrete

  • Parietal
  • Mucous neck
  • ECL
  • Chief
  • D
  • G
A
  • Parietal = gastric acid & intrinsic factor
  • Mucous neck = mucous & bicarb
  • ECL = histamine
  • Chief = pepsin & gastric lipase
  • D = somatostatin
  • G = gastrin
566
Q

Medication licensed for use in the UK to treat heroin addiction

A

Methadone

567
Q

Which drug can be prescribed to a patient with a pheochromocytoma in preparation for surgery & why?

A

Phenoxybenzamine

  • During the surgery, it is possible for large amounts of catecholamine release → refractory HTN
  • So pre-blocks α receptors to prevent this
568
Q

Complication of C. diff infection?

A

Pseudomembranous colitis

569
Q

Bacteria likely to cause diverticulitis

A

E.coli (enteric bacteria)

570
Q

Medication used to control jerky movements in Huntington’s

A

Risperidone

571
Q

Medication used to treat psychosis in Huntington’s?

A

Haloperidol

572
Q

Which electrolyte disturbance is most indicative of sarcoidosis?

A

Hypercalcaemia

573
Q

Are fasciculations a symptom of UMN or LMN disease

A

LMN

574
Q

Risk framework used to calculate risk of an MI following HTN diagnosis

A

QRISK2

575
Q

What demographic is bronchiolitis most commonly found in

A

Children under 1 year

576
Q

2 signs that appear on the abdomen during acute pancreatitis

A

Cullen’s = blue/purple discolouration around the umbilicus

Grey Turner’s = flank discolouration

577
Q

Mechanism of N-acteyl cysteine

A

Replenishes the supply of glutathione that conjugates NAPQI to non-toxic compoounds

578
Q

What can the AST/ALT ratio tell you?

A

If ALT>AST = chronic liver disease

If AST>ALT = cirrhosis and acute alcoholic hepatitis

579
Q

Signs of portal HTN

A

ABCDE

  • Ascites
  • Bleeding
  • Caput medusae = cluster of swollen veins in abdo
  • Diminished liver function
  • Enlarged spleen
580
Q

Drugs used to treat acute bleeding in patients with portal HTN before endoscopy

A

Octreotide or terlipressin

581
Q

Investigation of ascites

A

Diagnostic aspiration

582
Q

Management of ascites

A
  • Salt restrict
  • Diuretics
583
Q

What does a liver biopsy show in liver cirrhosis

A
  • Mallory bodies
  • Neutrophil infiltrates
584
Q

Questions used to screen for alcohol dependency

A

CAGE

Cut down? Ever thought you should?

Annoyed? Do you get annoyed at others commenting on your drinking?

Guilty? Ever feel guilty about drinking?

Eye opener? Ever drink in the morning to help your hangover/nerves?

585
Q

What is Wernicke’s triad?

A

Indicates Wernicke’s encephalopathy

  • Confusion
  • Ataxia
  • Encephalopathy
586
Q

What is the mutation in haemachromatosis

A

C282Y

HFE gene mutation on chromosome 6

587
Q

Tumour markers for liver cancers

A
  • Alpha feto-protein = hepatocellular carcinoma
  • CA1909 = cholangiocarcinoma
588
Q

If a patient has a high IgG and a negtaive HBs-Ag, what does this indicate?

A

Indicates past infection

IgG - immunity

Negative HBs-Ag so not current infection

589
Q

Fill in the gaps

A
590
Q

2 types of gallstone & which is more common in the West?

A

Cholesterol & bile pigment

Cholesterol is more common

591
Q

Stool tests to investigate diarrhoea

A
  • Stool culture
  • Faecal calprotectin
  • Faecal occult blood
592
Q

In foot drop, if eversion is weak, which nerve is likely to have been damaged?

A

Common peroneal nerve palsy

(L5 radiculopathy if INversion is weak)

593
Q

What defect is a collapsing pulse associated with? Describe the murmur.

A

Aortic regurgitation

  • Early diastolic decrescendo murmur
594
Q

Describe the murmur in mitral stenosis

A
  • Mid diastolic rumble
595
Q

How can you differentiate between the murmurs in aortic and pulmonary stenosis

A

Both are ejection systolic

Aortic stenosis = crescendo decrescendo loudest on expiration

Pulmonary stenosis = loudest on inspiration

596
Q

What are xanthelasma & when are they seen?

A

Cholesterol deposits in the skin & eyes

Seen in PBC

597
Q

4 causes of peptic ulcers

A
  • H.pylori
  • Increased stomach acid production
  • Recurrent NSAID use
  • Mucosal ischaemia
598
Q

Where are the majority of colon cancers found?

A

Distal colon

599
Q

4 causes of diverticulum

A
  • Low fibre diet
  • Obesity
  • NSAIDs
  • Smoking
600
Q

What is Reiter’s triad

A

Reactive arthritis

  • Conjunctivitis
  • Urethritis
  • Arthritis
601
Q

Treatment of TTP

A

Plasma exchange asap

602
Q

Ideal 1st line treatment for severe or complicated malaria

A

IV artesunate

603
Q

Define a granuloma

A

An aggregate of epithelioid histiocytes

604
Q

What is asterixis

A
  • Also known as liver flap = flapping of the hand due to abnormal liver function
605
Q

Most common side effect of alendronic acid

A

Oesophagitis

606
Q

X-ray sign in psoriatic arthritis

A

‘pencil in cup’ - only in severe cases

607
Q

Reactive arthritis typically follows what type of infection?

A

GI or GU

608
Q

Most common bacterial cause of a COPD exacerbation

A

Haemophilus influenzae

609
Q

Stages in formation of atherosclerotic plaque

A
  1. Endothelial dysfunction
  2. Fatty streak formation
  3. Migration of leukocytes & smooth muscle
  4. Foam cell formation
  5. Degradation of extracellular matrix
610
Q

Features of acute liver failure

A
  • Nausea
  • Vomiting
  • Confusion
  • Pain/discomfort in RUQ
  • Jaundiced skin
611
Q

Prophylactic abx for COPD patient

A

Azithromycin

612
Q

Vocal resonance in tension pneumothorax

A

Decreased

613
Q

Moderate vs acute severe vs life-threatening asthma in terms of PEFR

A

Moderate

PEFR more than 50-75% best or predicted.

Acute severe

PEFR 33-50% best or predicted

Life-threatening

PEFR less than 33% best or predicted

614
Q

Drug to maintain remission in Crohn’s disease

A

Azathioprine

615
Q

Extraintestinal manifestations of IBD

A

A PIE SAC

  • Ankylosing spondylitis
  • Pyoderma gangrenosum
  • Iritis
  • Erythema nodosum
  • Sclerosing cholangitis (PSC)
  • Apthous ulcers
  • Clubbing
616
Q

First line management of UC?

A

5-aminosalicyclic acid (then steroids & then biologics)

eg sulfasalazine

617
Q

Define acute mesenteric ischaemia

A

Inadequate blood flow through mesenteric vessels → ischaemia

Due to thrombosis

618
Q

Triad of symptoms in mesenteric ischaemia

A
  • Acute severe abdo pain
  • No abdo signs on exam
  • Hypovolaemic shock
619
Q

Treatment of mesenteric ischaemia

A
  • Fluid resus
  • IV heparin to reduce clot
  • ABx - metronidazole
620
Q

Where are duodenal ulcers most common

A

1st part of duodenum - duodenal cap

621
Q

Most common cause of SBO

A

Adhesions from recent surgery

622
Q

Causes of pseudo-obstruction

A

Trauma

Paralytic ileus (following surgery)

623
Q

Difference between true & false diverticula?

A

True - diverticula contains all layers of the gut

False - only mucosa and submucosa

624
Q

Virchow’s node?

A

Indicates stomach cancer

Found near L subclavian vein

625
Q

RFs for colorectal cancer?

A

Red meat

UC

FHx

Age

Alcohol

Polyps

626
Q

Red flag symptoms for colorectal cancer

A
  • Weight loss
  • Night sweats
  • Dysphasia
  • Unexplained vomiting
  • Haematemesis
627
Q

Explain the hospital management for a STEMI

A

If within 2 hours - PCI

If within 12 hours - thrombolysis (alteplase) and then consider PCI

628
Q

Abx given immediately to a patient with suspected meningiococcal septicaemia (in primary care)

A

IM benpen

629
Q

Gold standard investigation of unstable angina

A

Coronary angiogram

630
Q

First line treatment for unstable angina symptoms

A

GTN spray

& either ß blocker or CCB

631
Q

Extra-intestinal manifestations of ankylosing spondylitis

A
  • Uveitiis
  • IBD
  • Apical lung fibrosis
  • Aortic regurgitation
  • Amyloidosis
632
Q

NICE guidelines for moderate asthma attack

A

SABA

Steroids

Consider O2

633
Q

NICE guidelines for acute severe asthma attack

A

SABA

Steroids

Consider O2 & Mg sulphate

634
Q

NICE guidelines for life-threatening asthma attack

A

ITU

SABA on O2

Steroids

Consider O2

Magnesium sulfate

Aminophylline

Abx

Mechanical ventilation

635
Q

Indicators of good asthma control

A
  • No nighttime symptoms
  • Inhaler used no more than 3 times per week
  • No breathing difficulties, cough or wheeze on most days
  • Able to exercise without symptoms
  • Normal lung function test
636
Q

Define prodrome

A

Symptoms that precede the onset of a disease/illness

Typical in migraine

637
Q

1st line management of an acute episode of migraine

A

Oral sumitriptan = best (or paracetamol or ibruprofen)

638
Q

Mechanism of action of adrenaline

A

Stimulation/agonist of beta adrenergic receptors

639
Q

Complications of Cushing’s

A

Bone fractures

Depression & mood changes

HTN

Infections

Diabetes

640
Q

Explain ABCD2 scoring

A

Risk of stroke following TIA

  • Age >60 = 1 point
  • BP>140/90 = 1 point
  • Clinical features:
    • speech disturbance without weakness = 1
    • unilateral weakness = 2
  • Duration of symptoms
    • 10-59mins = 1 point
    • 60mins = 2 points
  • DM in PMH = 1 point

0-3 = low risk, 4-5 = moderate, 6-7 = high risk

641
Q

Where are the respiratory centres

A

Medulla

642
Q

Complications of pneumonia

A
  • Abscess
  • Empyema
  • Resp failure
  • Septicaemia
  • Pericarditis
643
Q

Which chromosome is affected in CF?

A

7

644
Q

Medication given as prophylaxis for meningitis

A

Ciprofloxacin

645
Q

Define PPV

A

The proportion of patients who test positive who have the condition

646
Q

What type of anaemia does alcoholism cause

A

Macrocytic

647
Q

Commonest type of renal cell carcinoma

A

Clear cell

648
Q

First line medical treatment of prostate cancer

A

GnRH - goserelin

649
Q

ECG in Wolff-Parkinson-White syndrome

A
  • Wide QRS
  • Short PR
  • Delta wave
650
Q

What does HASBLED scoring determine the risk of

A

Risk of bleeding in patients on anticoagulants

651
Q

Nerves affected in PBP

A

CN IX-XII

652
Q

Diagnosing motor neurone disease

A

El Escorial criteria

  • Definite = signs in 3+ regions
  • Probable = signs in 2+ regions
653
Q

Pathology of ankylosing spondylitis

A

Excessive bone remodelling → fusion

654
Q

Grading of ankylosing spondylitis

A

New York criteria

655
Q

Levels of FEV1 & FEV1/FVC ratio in an obstructive picture

A

FEV1 <0.8

FEV1/FVC <0.7

656
Q

How is rheumatoid arthritis monitored

A

ESR & CRP levels

657
Q

Extra-articular manifestations of RA

A
  • Nodules
  • Vasulitis
  • Sjogren’s
  • Pleuritis
  • Glomerulonephritis
  • Peripheral neuropathy
  • Pericarditis
  • MI
658
Q

Scoring used to risk stratify patients with upper GI bleeds

A

Glasgow Blatchford Score

659
Q

Signs on x-ray of a patient with aortic stenosis

A

Calcification of aortic valve

Cardiomegaly

Dilated ascending aorta

Pulmonary oedema

660
Q

Symptoms of septic infection

A

Fever

Rigors

Night sweats

Weight loss

Anaemia

Splenomegaly

Clubbing

661
Q

Excessive alcohol abuse can lead to deficiency in which vitamin? Resulting in which syndrome?

A

Vitamin B1/thiamine

Wernicke Korsakoff

662
Q

What are delirium tremens associated with? Give some possible presentations

A

Alcohol withdrawal

  • Acute confusion
  • Severe agitation
  • Delusions & hallucinations
  • Tremor
  • Tachycardia
  • HTN
  • Hyperthermia
  • Ataxia
  • Arrhytmias
663
Q

Signs of iron deficiency anaemia

A
  • Pallor
  • Koilonychias
  • Angular chelitis
  • Atrophic glossitis
  • Tachycardia
664
Q

Which chromosome is the gene mutation in sickle cell on?

A

Chromosome 11

(glutamic acid → valine)

665
Q

Complications of MI

A

Death

Arrhythmias

Ruptured septum

Tamponade

Heart failure

Valve disease

Aneurysm of ventricles

Dressler’s syndrome

Embolism

Reoccurence of ASC

666
Q

Symptoms of chronic limb ischaemia

A
  • Dry brittle nails
  • Hair loss
  • Atrophic skin
  • Absent pulses
  • Intermittent claudication
667
Q

Arterial vs venous ulcers

A
668
Q

Where is aortic stenosis heard loudest

A

2nd intercostal space

Left sternal border

669
Q

Inheritance of G6PD

A

X-linked recessive

670
Q

S&S of SLE

A

A RASH POINts MD

  • ANA positive (in 90% of patients)
  • Renal nephritis
  • Arthritis
  • Serositis (pleuritis, pericarditis, myocarditis)
  • Hematological eg anemia, leukopenia, thombrocytopenia
  • Photosensitivity
  • Oral/mucosal ulcers
  • Immunology eg ANA, RHf, Anti-dsDNA (most specific)
  • Neurological symptoms (eg psychosis, depression, anxiety, siexures)
  • Malar rash
  • Discoid rash
671
Q

What condition do you see Owl’s eye appearance on a blood film

A

Hodgkin’s lymphoma

672
Q

Management of TIA in terms of driving

A

Do not notify the DVLA, but no driving for 1 month

673
Q

Mechanism of SGL2 inhibitors

A

Block reabsorption of glucose in the kidneys

674
Q

What type of hypersensitivity is hypersensitivity pneumonitis

A

III

675
Q

Type of bone cancer more common in younger groups

A

Osteosarcoma

676
Q

Which sided heart failure is ascites associated with

A

Right

677
Q

Appearance of haemophilus influenzae under a microscope?

A

Gram negative bacilli

678
Q

What causes crepitations in the lungs?

A

When collapsed or fluid filled air sacs in the lungs open when you breath

Caused by: inflammation, fluid or infection in air sacs in the lung, eg pulmonary oedema

679
Q

Which Abx are MRSA resistant to?

A

β-lactams, gentamicin, tetracycline and erythromycin

680
Q

Complications of AKI

A

Hyperkalaemia

Fluid overload, heart failure and pulmonary oedema

Metabolic acidosis

Uraemia (high urea) can lead to encephalopathy or pericarditis

681
Q

Pathophysiology of anaphylaxis

A

T1 hypersensitivity.

(IgE) stimulates mast cells to rapidly release histamine and other pro-inflammatory chemicals.

This is called mast cell degranulation.

This causes a rapid onset of symptoms, with airway, breathing and/or circulation compromise.

682
Q

How to diagnose anaphylaxis

A

Measure mast cell tryptase within 6 hours

683
Q

Complication of CLL

A

Richter’s syndrome - transformation of CLL to aggressive lymphoma

Phase 2a (12 decks)

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