Disease Facts

Question 1

Which species of E.coli can cause bloody diarrhoea? (And kidney failure via haemolytic ureamic syndrome!)

Answer 1

Escherichia coli O157 causes bloody diarrhoea in roughly 50% cases

Question 2

Which histological classification of breast cancer is most common ?

Answer 2

Invasive ductal carcinomas form 80% of breast cancer

Question 3

What is the most likely site of perforation in complete large bowel obstruction?

Answer 3

Caecum - most distensible part of the colon and in complete large bowel obstruction with a competent ileocaecal valve the most likely site of eventual perforation

Question 4

Which hormone is released into systemic circulation in carcinoid syndrome?

Answer 4

Serotonin (from liver)

Question 5

What investigations are needed for carcinoid syndrome? (2)

Answer 5

urinary 5-HIAA

plasma chromogranin A y

Question 6

5 most common causes of CKD

Answer 6

DM, Glomerulonephritis, Idiopathic, HTN or renovascular disease, stasis - pyelonephritis or reflux nephropathy
(Diabetic Gloom Is Highly Static)

Question 7

GFR values for boundaries of each CKD stage

Answer 7

≥90 G1 (normal)
≥60 G2
≥45 G3a
≥30 G3b
≥15 G4
GFR <15 = G5 (established failure)

Question 8

How much protein in urine = proteinuria?

Answer 8

3.5g protein in 24hrs

Question 9

What is the prognosis for sarcoidosis when first diagnosed?

Answer 9

50% go into remission, 50% have chronic disease

Question 10

PEFR % changes for asthma attack severity classification

Answer 10

≥75% mild,
≥50% moderate,
≥33% severe,
<33% life-threatening or near fatal (in near fatal pCO2 will be raised)

Question 11

Management of tension pneumothorax

Answer 11

Large bore IV cannula into 2nd intercostal space mid-clavicular line

Question 12

list the criteria of the CURB-65 score

Answer 12

Confusion - new?
Urea >7mmol
RR ≥30 breaths/min
BP <90 systolic or <60 diastolic
aged 65 or over?

Question 13

Management of CAP according to CURB65

Answer 13

0-1 out-patient
2 - consider admission
≥3 admit and consider ITU

Question 14

How is respiratory failure classified ?

Answer 14

hypoxaemic / type 1 / gas exchange failure : low pO2 and normal or low pCO2
Or
hypercapnic/type 2/ventilatory failure - normal or low pO2, high pCO2

Question 15

Signs of diabetic retinopathy seen on fundoscopy (5)

Answer 15

Neovascularisation
Cotton wool spots
Microaneurysms, oedema and exudates

Question 16

Which type of ANCA is most likely to be raised in granulomatosis with polyangitis ?

Answer 16

cANCA is raised in >90% patients with granulomatosis with polyangitis

Question 17

Which 5 cancers commonly metastasise to bone?

Answer 17

Kidney,
Lung,
Thyroid,
Breast,
Prostate.

(Kindly Loose This Bone Please)

But spinal mets Should be considered in every patient with known malignancy developing new/worsening of back pain

Question 18

Commonest organism, other than TB, causing infection in spine?

Answer 18

Staphlococcus aureus

Question 19

What is the rescue therapy for UC?

(if patient not improving after day 3-5 inpatient treatment with IV hydrocortisone 100mg QDS)

Answer 19

Ciclosporin

Question 20

What is the rescue therapy for Crohn’s ?

if patient not improving after day 3-5 inpatient treatment with IV hydrocortisone 100mg QDS

Answer 20

Biologics or surgery

Question 21

What drug is used to maintain remission in UC?

Answer 21

Mesalazine

Question 22

causes of hypocalcaemia (7)

Answer 22

chronic kidney disease,
hypoparathyroidism,
massive blood transfusion,
magnesium deficiency,
rhabdomyolysis,
pseudohypoparathyroidism,
vitamin D deficiency

Question 23

causes of microcytic anaemia (5)

Answer 23

iron-deficiency anaemia,
thalassaemia*
congenital sideroblastic anaemia,
anaemia of chronic disease (more commonly a normocytic, normochromic picture),
lead poisoning

Question 24

causes of LOWER lobe lung fibrosis (4)

Answer 24

(the more common ones)
idiopathic pulmonary fibrosis,
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE,
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis

Question 25

causes of fibrosis affecting UPPER lobes of lungs (6)

Answer 25

C - Coal worker's pneumoconiosis,
H - Histiocytosis/ hypersensitivity pneumonitis,
A - Ankylosing spondylitis,
R - Radiation,
T - Tuberculosis,
S - Silicosis/sarcoidosis

Question 26

What is the classic presentation of Primary Biliary Cholangitis

Answer 26

itching in a middle-aged woman

Question 27

What is the most specific test for Primary Biliary Cholangitis?

Answer 27

anti-mitochondrial antibodies (AMA) M2 subtype are present in 98% of patients and are highly specific

Question 28

Complications of Primary Biliary Cholangitis

Answer 28

cirrhosis
osteomalacia and osteoporosis
significantly increased risk of hepatocellular carcinoma

Question 29

Management of Primary Biliary Cholangitis

Answer 29

pruritus: cholestyramine
fat-soluble vitamin supplementation
ursodeoxycholic acid
liver transplantation e.g. if bilirubin > 100 (PBC is a major indication) - recurrence in graft can occur but is not usually a problem

Question 30

Which immunoglobulin is raised in PBC?

Answer 30

IgM raised in serum

Question 31

4 diseases associated with PBC

Answer 31

Sjogren’s syndrome (seen in up to 80% of patients)
rheumatoid arthritis
systemic sclerosis
thyroid disease

Question 32

Causes of hypocalcaemia (7)

Answer 32

vitamin D deficiency (osteomalacia)
chronic kidney disease
hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
pseudohypoparathyroidism (target cells insensitive to PTH)
rhabdomyolysis (initial stages)
magnesium deficiency (due to end organ PTH resistance)
massive blood transfusion