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EXAM PREP- YR 3 > EXAM QS I GET WRONG > Flashcards

EXAM QS I GET WRONG Flashcards

1
Q

What do you do if a patient is on 500mg metformin 3x a day and complaining of diarrhoea?

A

GI side effects are common with metformin and can occur in up to 20% patients.
This patient is on immediate release as he takes it 3x a day
We can switch it to the modified release variant which is usually given once daily instead

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2
Q

How to differentiate the causes of primary hyperaldosteronism?

A

Primary hyperaldosteronism =Conns syndrome
caused by adrenal adenoma secreting aldosterone, this is the most common cause
Other causes are bilateral adrenal hyperplasia
To differentiate these two causes, imaging (CT) is used- if this doesn’t produce adequate results-perform adrenal venous sampling
If the cause is bilateral hyperplasia: you’d have bilaterally increased aldosterone in adrenal veins
If it’s an adrenal adenoma- unilateral increased aldosterone in adrenal vein

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3
Q

Endocrine parameters reduced in stress response- which hormones are reduced during major surgery?

A

Insulin
Testosterone
Oestrogen

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4
Q

In suspected cases of Graves disease what medication can be used to manage symptoms whilst patient is waiting to see endocrinologist?

A

Propanalol- non-selective BB, prevents the adrenergic effects of hyperthyroid
Works quickly to help control the symptoms

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5
Q

What drugs do you prescribe for controlling htn in pheochromocytoma?

A

Alpha and beta blockers

Remember labetalol blocks both alpha and beta

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6
Q

Female pt with hypothyroidism, treatment during pregnancy?

A

Women with hypothyroidism may need to increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy

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7
Q

Is breast-feeding safe whilst on thyroxine?

A

Yes

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8
Q

Treatment of thyroid storm

A

Symptomatic- paracetamol
Treat cause
Beta blockers- IV propanolol
Anti-thyroid drugs- (thionamides)-methimazole or PTU
Lugol’s iodine
Dexamethasone- blocks conversion of T4 to T3

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9
Q

Role of steroids in thyrotoxic crisis

A

Blocks conversion T4 to T3

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10
Q

What is thyroid acropachy

A

Triad of digital clubbing, soft tissue swelling hands & feet, periosteal new bone formation
Specific to Graves’

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11
Q

Side effects of metaclopramide

A

Very common- diarrhoea, drowsy, hypotension, menstrual cycle irregularities, parkinsonism
Uncommon- arrhythmias
Rare- galactorrhoea, confusion, seizure

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12
Q

T1DM blood glucose targets

A

5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day

under 4 you hit the floor, over 7 you may go to heaven

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13
Q

Addison’s patient unwell- what to do about their medications?

A

Double the glucocorticoids (hydrocortisone)

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14
Q

Child with palpable abdominal mass or unexplained enlarged abdominal organ- what to do

A

Refer very urgently <48 hrs for specialist assessment for neuroblastoma and Wilms’ tumour
Malignancy until proven otherwise

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15
Q

What is primigravid

A

Pregnant for first time

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16
Q

Most common cause of primary hypothyroidism

A

In UK- Hashimoto’s thyroiditis

In the developing world- iodine deficiency

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17
Q

Hashimoto’s thyroiditis = ?

A

hypothyroidism + goitre + anti-TPO

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18
Q

What is sick euthyroid syndrome

A

Where TSH, thyroxine and T3 are all low
But most of the time TSH is normal
No treatment usually necessary-repeat TFTs in 6wks

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19
Q

What drug causes hyperCa

A

Thiazides- increase calcium reabsorption in DCT because they block NaCl on apical side, which reduces Na conc in DCT cells, which upregulates Na/Ca antiporter on basolat side, meaning more Na influx into the cells and calcium efflux into systemic circulation –> hyperCa and hypoNa

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20
Q

How to monitor recurrence in medullary thyroid cancers?

A

Medullary thyroid cancers often secrete calcitonin and monitoring the serum levels of this hormone is useful in detecting sub clinical recurrence.
They are a part of MEN-2

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21
Q

How to differentiate causes of diabetes insipidus

A

Water deprivation test: cranial DI
urine osmolality after fluid deprivation: low
urine osmolality after desmopressin: high

Nephrogenic DI;
Osmolality remains low

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22
Q

2 main causes of high calcium

A

malignancy and primary hyperPTH account for 90% cases

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23
Q

Treating thyrotoxic storm (3)

A

1- BB
2- PTU
3- hydrocortisone

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24
Q

Graves’ disease antibodies

A

TSH receptor stimulating antibodies

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25
Q

Most common cause of primary hyperaldosteronism

A

Bilateral idiopathic adrenal hyperplasia 70% cases

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26
Q

Anti coagulant of choice in AKI

A

Warfarin- generally safe to continue

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27
Q

Renal transplant complications

A

Early e.g. infection, urinary leak, haemorrhage, impaired graft function.
Late e.g. lymphocele, ureteric stenosis, renal artery thrombosis.

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28
Q

Key blood test for rhabdomyolysis

A

creatine kinase - elevates in first 12 hrs and remains high for 1-3 days

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29
Q

Complications AKI

A

Metabolic acidosis, hyperkalaemia, uraemia, pulmonary oedema

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30
Q

What is the cause of renal artery stenosis in young pts

A

Fibromuscular dysplasia

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31
Q

Causes to remember of sterile pyuria

A

renal TB, partially treated UTI, drug causes (antibiotics, NSAIDs, PPI, cyclophosphamide), urinary tract stones, and papillary necrosis.

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32
Q

Assessment of sleepiness (OSA)

A

Epworth sleepiness scale- done by patient +/- partner

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33
Q

Pigmented gallstones are associated with…

A

Sickle cell anaemia

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34
Q

Drugs causing pancreatitis

A

azathioprine, mesalazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

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35
Q

Where does breast cancer metastasise…

A

Lungs, Liver, Bones, Brain

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36
Q

Gastric MALT lymphoma…

A

H Pylori eradication

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37
Q

Sudden onset abdominal pain, very intense and severe- out of proportion with clinical findings… has AF and htn

A

Mesenteric ischaemia

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38
Q

Who gets urgent colorectal 2WW referral

A

patients >= 40 years with unexplained weight loss AND abdominal pain
patients >= 50 years with unexplained rectal bleeding
patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces (see below)

39
Q

Caecal volvulus associations

A

all ages
adhesions
pregnancy

40
Q

Duke staging

A

A- mucosa
B- bowel wall
C- lymph node mets
D- distant mets

41
Q

Acute limb ischaemia in age <50 what ix to do

A

Thrombophilia screen

42
Q

Gynaecomastia- which lung cancer

A

Adenocarcinoma

43
Q

Features of Addisonian crisis

A

Hyponatraemia
Hyperkalaemia
Hypoglycaemia

44
Q

Galactorrhoea drugs

A

Metaclopramide, domperidone

Haloperidol

45
Q

Painful shin rash + cough → ?

A

sarcoidosis

46
Q

NIV for COPD pts when?

A

NIV should be considered in all patients with an acute exacerbation of COPD in whom a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment

47
Q

Facial rash plus lymphadenopathy think?

A

Sarcoidosis

48
Q

Can alpha1 anti trypsin deficiency be diagnosed prenatally?

A

Yes

via Amniocentesis

49
Q

bronchiectasis and eosinophilia…?

A

Allergic bronchopulmonary asperigillosis

50
Q

Vaccinations for COPD pt?

A

Annual influenza + one-off pneumococcal

51
Q

Where is the triangle of safety?

A

The triangle of safety for chest drain insertion involves the base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi

52
Q

Causes of ILD

A

Drugs- methotrexate, amiodarone, nitrofurantoin, cyclophosphamide
Other causes- idiopathic pulmonary fibrosis, extrinsic allergic alveolitis, sarcoidosis, systemic sclerosis, asbestosis

53
Q

Gold standard ix for ILD

A

High resolution CT scan- ground glass appearance

54
Q

Kartagener’s syndrome

A

triad of bronchiectasis, sinusitis (Primary ciliary dyskinesia), and situs
inversus (all organs are on opposite side- heart on R, stomach bubble seen on R)
+ subfertility

55
Q

Young’s syndrome

A

triad of bronchiectasis, sinusitis, and reduced

fertility

56
Q

Bronchiectasis- who gets pulm rehab

A

MRC >3 (breathless walking flat, has to walk slower than everyone else)

57
Q

Causes of upper zone lung fibrosis

A

CHARTS
Coal workers’ pneumoconiosis
Histiocytosis
Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis (progressive massive fibrosis), sarcoidosis

58
Q

Treatment of allergic bronchopulmonary aspergillosis

A

First line is prednisolone

Second line is itraconazole

59
Q

How is asthma diagnosed?

A

An exhaled FeNO of 40 parts per billion or greater
A post-bronchodilator improvement in lung volume of 200 ml
A post-bronchodilator improvement in FEV1 of 12% or more
A peak expiratory flow rate variability of 20% or more
An FEV1/FVC ratio <70% (it is an obstructive lung disease)

60
Q

Contraindications to lung cancer surgery

A

SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis

61
Q

Acute respiratory distress syndrome is a complication of what?

A

Acute pancreatitis

62
Q

Does biliary colic radiate?

A

Yes interscapular region

63
Q

Fluctuating cognition- which dementia?

A

Lewy Bodies

64
Q

Differentiating LB dementia from Parkinson dementia?

A

Lewy body dementia can be differentiated from idiopathic Parkinson’s disease dementia by the time of onset of the dementia compared to the motor symptoms- LB 1year before parkinsonian symptoms

65
Q

How is orthostatic hypotension diagnosed

A

a. A drop in systolic BP of 20mmHg or more (with or without symptoms)
b. A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms)
c. A drop in diastolic BP of 10mmHg with symptoms (although clinically much less significant than a drop in systolic BP).

66
Q

Causes of delirium

A 
PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration

Medications
Environment/ Electrolytes

67
Q

When is S3 normal

A

<30years

68
Q

Causes of S3

A

Diastolic filling of ventricle
Normal < 30 (can persist up to age 50 in female)
heard in LV failure (eg dilated cardiomyopathy), constrictive pericarditis (pericardial knock) and MR

69
Q

Causes of S4

A

Aortic stenosis, HOCM, htn

Caused by atrial contraction against a stiff ventricle therefore coincides with P wave on ECG

70
Q

What valvular pathology is associated with PCKD

A

Mitral valve prolapse

71
Q

Most common ECG sign for PE

A

Sinus tachycardia

72
Q

Less common ECG signs for PE

A

RBBB
T wave inversion and ST depression in V1 and V2
S1Q3T3- indicating right heart strain- it is the ECG pattern that most likely suggests PE but it is not the most common its quite rare

73
Q

Causes of VT

A

HypoK is the most important clinical cause

hypoMg next

74
Q

DVLA advice post MI

A

cannot drive for 4 weeks

75
Q

First line gout

A

NAPROXEN- NSAIDs

76
Q

Second line gout

A

COLCHICINE

77
Q

Prophylaxis gout

A

ALLOPURINOL- URATE LOWERING THERAPY

78
Q

Name some vaccines you shouldn’t give to immunocompromised

A

LIVE VACCINES AKA MI BOOTY

MMR
Intranasal Influenza

BCG
Oral Rotavirus
Oral polio (double check this one)
Typhoid
Yellow Fever
79
Q

Maintaining remission for Crohns

A

Azathioprine or mercaptopurine first line

80
Q

Mx of C diff

A

Oral metronidazole 10-14 days

stop opioids

81
Q

Severe flare UC

A

IV corticosteroids - hydrocortisone or methylprednisolone

82
Q

Diagnosis of SBP

A

Paracentesis

Confirmed by neutrophil count >250 cells /ul

83
Q

side effects PPI

A

Hyponatraemia
hypoMg
osteoporosis
C diff infections

84
Q

Gold standard diagnosis of Coeliac disease

A

Endoscopic intestinal biopsy

Perform in all pts if suspecting following pathology

85
Q

Ankylosing spondylitis X-ray

A

Sacroiliitis-Subchondral erosions, sclerosis
Squaring lumbar vertebrae
Bamboo sign- late, uncommon
syndesmophytes

CXR- apical fibrosis

86
Q

Which antibodies to test to rule out SLE

A

ANA

87
Q

which RA drug can cause reactivation of TB

A

Etanercept

88
Q

Features of PM

A

Age 60+
rapid onset <1mnth
Aching, morning stiffness proximal limb muscles

Raised inflamamtory markers

Normal CK

89
Q

Tennis elbow

A

Lateral epicondylitis

Worse on resisted wrist extension/suppination when elbow extended

90
Q

Which immunoglobulin is passed to baby in breast milk

A

IgA

91
Q

Septic arthritis abx

A

IV flucloxacillin

92
Q

Pt about to be put on long term steroid, what is your approach to bone protection

A

Oral alendronate
ensure calcium and vit D supplements
immediately

93
Q

Imaging for alkylosing spondylitis

A

Sacro-ilitis on pelvix X ray

94
Q

Which TB drug causes drug-induced lupus

A

isoniazid

EXAM PREP- YR 3 (4 decks)

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