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CC2 - exam preparation > Exam mistakes > Flashcards

Exam mistakes Flashcards

1
Q

What does this show

A

Pseudarthrosis is a bone fracture that has no chance of mending without intervention. In pseudarthrosis the body perceives bone fragments as separate bones and does not attempt to unite them.

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2
Q

How is trichomonas treated?

A

Metronidazole

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3
Q

What are the features of cardiac tamponade?

A

Cardiac tamponade is characterized by the accumulation of pericardial fluid under pressure.

Classical features - Beck’s triad: Pulsus alternans

hypotension

raised JVP

muffled heart sounds

Other features:

dyspnoea

tachycardia

an absent Y descent on the JVP - this is due to the limited right ventricular filling

pulsus paradoxus - an abnormally large drop in BP during inspiration

Kussmaul’s sign - much debate about this

ECG: electrical alternans

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4
Q

What is the Grace score for?

A

for known STEMI and know NSTEMI for risk of death

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5
Q

What drug for diabetics causes weight gain?

A

Glicazide

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6
Q

What drugs cause SIADH?

A

SIADH - drug causes: carbamazepine, sulfonylureas, SSRIs, tricyclics

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7
Q

What is chancroid?

A

Chancroid is a tropical disease caused by Haemophilus ducreyi. It causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.

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8
Q

How can MS present?

A

Multiple sclerosis is an autoimmune condition that affects the myelin within the brain and spinal cord. It can cause a wide array of different symptoms. Lethargy is a very common early symptom. The paraesthesia in the limbs would coincide with this but, in particular, she describes symptoms of optic neuritis which can often be the first presenting feature.

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9
Q

How is PCB treated?

A

Management

first-line: ursodeoxycholic acid

slows disease progression and improves symptoms

pruritus: cholestyramine

fat-soluble vitamin supplementation

liver transplantation

e.g. if bilirubin > 100 (PBC is a major indication)

recurrence in graft can occur but is not usually a problem

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10
Q

When is DOAC and enoxaparin used for patients with AF?

A

Current guidance supports the use of direct oral anticoagulants (DOACs) as first-line therapy for anticoagulation in patients with atrial fibrillation. In this patient, there are no identifiable contraindications to this. Therefore, apixaban is the most appropriate choice.

Enoxaparin is an example of low molecular weight heparin delivered subcutaneously that is often used for prophylaxis and treatment of venous thromboembolism in hospitalised patients. It is not typically used as a first-line anticoagulant in newly diagnosed atrial fibrillation. Therefore it is not the most appropriate choice on this occasion.

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11
Q

How should paroxsymal AF be treated?

A

APIXABAN

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12
Q

What is the GRACE score?

A

GRAM - GRACE ACS and mortality

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13
Q

What is the CHA2DS2VASC score?

A
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14
Q

What is the orbit score?

A

Bleeding with anticoagulation

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15
Q

How long does a cluster headache last?

A

A cluster headache can last between 15 minutes to 2 hours

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16
Q

How is refeeding syndrome treated?

A

Intravenous infusion of phosphate polyfusor is commonly used to treat acute hypophosphataemia in adults

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17
Q

What type of lung disease is caused by kyphosis?

A

Kyphoscoliosis (e.g. ankylosing spondylitis) can cause a restrictive lung defect on spirometry

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18
Q

How much can morphine be increased in palliative care?

A

In palliative patients increase morphine doses by 30-50% if pain not controlled

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19
Q

Should peraly penile paples be investigated?

A

Pearly penile papules are a normal variant of the glans. They are approximately 1-2mm in size and are distributed around the corona of the penis. They are asymptomatic and are often a cause of concern for patients, who should be reassured that no intervention is required.

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20
Q

What problems can glicazide cause?

A

Gliclazide overdose causes hyperinsulinemia and high C-peptide levels

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21
Q
A
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22
Q

Where is coal workers lung?

A

Upper zones

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23
Q

What pneumocosses are found in the upper lung?

A

Coal workers’ pneumoconiosis

Histiocytosis

Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis

Radiation

Tuberculosis

Silicosis (progressive massive fibrosis), sarcoidosis

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24
Q

What does GRACE stand for?

A

Global registry for acute coronary events

Takes in to account age, kilip score

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25
Q

What are the differnet Killip scores?

A

1 - no changes

2 - crackles

3 - oedema

4.cardiogenic shock

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26
Q

Treatments for STEMI?

A
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27
Q

How is unstable angina treated?

A
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28
Q

How is NSTEMI managed?

A
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29
Q

Symptoms of AF

A

Light headed

Irregular heart beat

Palpitations

SOB

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30
Q

What is Beck’s triad?

A
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31
Q

What is the S3 gallop?

A

Physiological / pregnancy/ venTRIcle stiffiness

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32
Q

What is S4?

A

Atrial gallop Aortic stenosis (AGAS)

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33
Q

What can chronic cocaine use lead to?

A

Coronary artery spasm

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34
Q

How is STEMI treated?

A
  1. Aspirin only
  2. Send for PCI
  3. Thrombolytic, PCI (prasugrel), medical treatment ticagrelor (unless high risk of bled)
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35
Q

How is NSTEMI treated?

A
  1. Aspirin and fondaparinux (antithrombin)
  2. GRACE score
  3. <3% mortality in 6 months ticagrelor, or >3% mortality in 6 months PCI
36
Q

How is unstable angina treated?

A

Coronary rehabilitation programme: life style + stress management

BANCS

Drug titration max dose ACEi and Beta blocker

37
Q

If an asthmatic has SVT, what drug is contraindicated? What can be used alternatively?

A

Adenosine, verapamil

38
Q

What else is contraindicated for adenosine?

A

Asthma, chronic obstructive pulmonary disease, and decompensated heart failure are some of the contraindications for using Adenosine.

39
Q

How should SVT be treated?

A

In regular narrow complex tachycardias (SVTs) the first step is to trial vagal manoeuvres (carotid sinus massage or Valsalva manoeuvre).

If vagal manoeuvres fail, adenosine should be administered (initially as a 6 mg intravenous bolus, and if this fails 12 mg followed by a further 18 mg is trialled).

In irregular narrow complex tachycardias the most likely diagnosis is atrial fibrillation.

Atrial fibrillation with onset <48 hours is typically managed with rhythm control (LMWH followed by flecainide if there is no structural heart disease, or amiodarone if there is structural heart disease).

Atrial fibrillation with onset >48 hours is typically managed with rate control (i.e. metoprolol or bisoprolol or verapamil, or digoxin if there are signs of heart failure) and anticoagulation.

40
Q

How is acute asthma treated?

A

Oxygen

Salbutamol

41
Q

What is ARDS?

A

ARDS presents with acute onset respiratory failure which fails to improve with supplemental oxygen, the symptoms of which include severe dyspnoea, tachypnoea, confusion, and presyncope.

Physical examination typically reveals fine bibasal crackles, but no other features of heart failure.

42
Q

What is dangerous in acute asthma?

A

A normal CO2

43
Q

What score is used for UC?

A

True Love and Witts

(BFHE)

Blood/ bowel movements

Fever

Heart rate

Hb

ESR

44
Q

Signs of meningitis

A

The cardinal features of meningitis are:

headache

fever

neck stiffness

photophobia

nausea and vomiting

focal neurology

seizures

reduced conscious level

features of overwhelming sepsis (including the often reported non-blanching petechial rash of impending DIC).

Eponymous clinical signs such as Kernig’s and Brudzinski’s are insensitive, but specific for meningitis.

45
Q

What is given first: thiamine or pabrinex?

A

P then T

46
Q

What starts the engine?

A

Rifampcin revs

Isoniazid inhibits

47
Q

c difficle morphology

A

yellow plaques

48
Q

anti-emetics

A

ReceptorDrug

H1 receptor antagonistCyclizine

D2 receptor antagonistDomperidone, metoclopramide

5HT3 receptor antagonistOndansetron

Anti-muscarinicHyoscine hydrobromide

49
Q

test for coeliac

A

Total IgA and IgA tissue transglutaminase (tTG).

50
Q

what is dapsone for

A

dermatitis herpetiformis

51
Q

How do you treat this?

A

Dapsone

52
Q

How is campylobacter jejuni treated?

A

Erythromycin

53
Q

What condition may cause someone to develop icterus if they are stressed, fasting or exercising?

A

Gilberts syndrome

54
Q
A
55
Q

How does nephrotic syndrome present?

A

. Further workup reveals hyponatraemia, proteinuria and hypoalbuminaemia. <20 urinary sodium. Oedema and periorbital sweling

56
Q

What is a normal anion gap

what is a disease with normal anion gap and acidosis

A

10—16 mEq/L

severe diarrohea

57
Q

What is base excess

A

the amount of acid needed

58
Q

what is a high anion gap

A

severe acidosis

59
Q

What effect does PSGN have on C3?

A

n PSGN, a humoral response is mounted against Streptococcus pyogenes, resulting in antibody-antigen binding and the formation of immune complexes. This depletes complement components and lowers C3 levels. Over time, the immune complexes deposit within the glomerulus and disrupt the glomerular basement membrane, causing a nephritic syndrome in certain individuals a few weeks after the initial Streptococcal infection.

60
Q

Why does nephrotic syndrome increase risk of coagulation?

A

Complications

increased risk of thromboembolism related to loss of antithrombin III and plasminogen in the urine

deep vein thrombosis, pulmonary embolism

renal vein thrombosis, resulting in a sudden deterioration in renal function

hyperlipidaemia

increasing risk of acute coronary syndrome, stroke etc

chronic kidney disease

increased risk of infection due to urinary immunoglobulin loss

hypocalcaemia (vitamin D and binding protein lost in urine)

61
Q

What are the different levels of UC severity?

A

mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

62
Q
A
63
Q

How is mild to severe UC treated?

A

extensive disease

topical (rectal) aminosalicylate and a high-dose oral aminosalicylate:

if remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid

Severe colitis

should be treated in hospital

intravenous steroids are usually given first-line

intravenous ciclosporin may be used if steroid are contraindicated

if after 72 hours there has been no improvement, consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery

64
Q

What is the difference between Iga neprhopathy and glomerulonephritis?

A
65
Q

What might precipitate a headache?

A

This question is asking about the precipitating factors for migraines. The mnemonic CHOCOLATE is useful for remembering the common precipitants.

Chocolate

Hangovers

Orgasms

Cheese

Caffeine

The oral contraceptive pill

Lie-ins

Alcohol

Travel

Exercise

66
Q

Triad in HUS?

A

microangiopathic haemolytic anaemia

acute kidney injury

thrombocytopenia

67
Q

How should a fistula be imaged?

A

MRI

68
Q

What is pulsus alternans a sign of?

A

Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis

69
Q

What is pulsus paradoxus almost always a sign of?

A

Severe asthma

70
Q

What is ABPM reading for >80?

A

145/85 mmHg

blood pressure target (> 80 years, ABPM/HBPM)

71
Q

Symptoms of syphillis?

A

Primary - painless ulcers

Secondary - systemic

Tertiary - tricky

72
Q
A
73
Q

How should complicated urinary tract infection be treated in men?

A

An immediate antibiotic prescription should be offered to men with lower UTI (unlike in women who are not pregnant where a back-up antibiotic prescription can be considered)

74
Q

What virus is more likely to occur in a kidney transplant?

A

CMV

75
Q

How can you image the root of the aorta in ascending aortic dissection?

A

TOE

76
Q

How is assymptomatic hyperuricemia treated?

A

Gout is associated with high levels of serum uric acid however it is possible to have hyperuricaemia with no noticeable effects. In such cases, NICE recommends against primary prevention of gout as it has been shown to be neither cost-effective nor beneficial to patients. Lifestyle changes (less red meat, alcohol and sugar) can reduce uric acid levels without drug treatment and so can be advised.

77
Q

What does this show?

A

Hickman line

78
Q

A 69-year-old woman presents with a 3 week history of a headache which is worse on the right side. She is generally unwell and feels ‘weak’, noting particular difficulty in getting up from a chair.

A

Temporal arteritis is linked with polymyalgia rheumatica

79
Q

What is the most inherited colorectal cancer?

A

HNPCC is the most common form of inherited colorectal cancer. It accounts for around 5% of all colorectal cancer cases, and is also strongly associated with endometrial cancer.

80
Q

How is COPD score calculated?

A

FEV1 (of predicted)Severity

< 0.7> 80%Stage 1 - Mild - symptoms should be present to diagnose COPD in these patients

< 0.750-79%Stage 2 - Moderate

< 0.730-49%Stage 3 - Severe

< 0.7< 30%Stage 4 - Very severe

81
Q

What is the most common cause of viral meningitis?

A

Coxsackie

82
Q

What disease is associated with thymoma?

A

Myasthenia gravis is an autoimmune condition that is characterised by autoantibodies directed at the post-synaptic anticholinergic receptors. Thymomas are present in a subset of MG patients and CT’s are done to exclude this. The CT mass is a thymoma and local invasion of this mass is causing the patient’s dry cough and breathlessness. The increased lethargy throughout the day and dysphagia are common symptoms of MG sufferers.

83
Q

What type of drug is this?

A

Isphagula husk

84
Q

What does GET SMASHED stand for?

A

Popular mnemonic is GET SMASHED

Gallstones

Ethanol

Trauma

Steroids

Mumps (other viruses include Coxsackie B)

Autoimmune (e.g. polyarteritis nodosa), Ascaris infection

Scorpion venom

Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia

ERCP

Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

85
Q

What is a scrotal swelling you can’t get above?

A

Hernia

86
Q

What causes foot drop?

A

Common peroneal nerve

CC2 - exam preparation (76 decks)

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