Exam Questions Flashcards
1
Q
What vitamin deficiencies can cause anaemia?
A
B12, B9 and C
2
Q
Which substance can be used to achieve the most accurate measurement of the glomerular filtration rate?
A
Insulin
3
Q
What are the antibodies associated with antiphospholipid syndrome?
A
Lupus anticoagulant, anticardiolipin, anti-beta 2 glycoprotein-1
4
Q
What are gram negative diplococci indicative of in microscopy of vaginal swab?
A
Neisseria gonorrhoea
5
Q
What are the common sites of carcinoid tumours?
A
Appendix, ileum, testis, ovary and bronchi
6
Q
What two medications have shown to improve fatigue in patients with MS?
A
Modafinil and amantadine
7
Q
What ECG change is indicative of supra ventricular tachycardia?
A
Delta waves - up slant at the beginning of the QRS complex diagnostic of wolf Parkinson white syndrome
8
Q
What is the first line class of antibiotic used for prostatitis? and give an example
A
Quinolone - ciprofloxacin
9
Q
What investigation is the most sensitive in diagnosing pancreatic cancer?
A
Endoscopic ultrasound
10
Q
What is a common cardiac defect in children with downs syndrome?
A
VSD
11
Q
What is an S4 heart sound and why does it occur?
A
Atrial Gallop - atria contracting forcefully to overcome an abnormally stiff ventricle
12
Q
What are blue markings on the gums a sign of?
A
Lead poisoning
13
Q
What results in ectopic ileal, gastric or pancreatic mucosa?
A
Meckel’s diverticulum
14
Q
What is the treatment for hyperkalaemia + ECG changes?
A
IV calcium gluconate
15
Q
What movement is typically spared in motor neurone disease?
A
Eye movements usually remain as usual
16
Q
What is retrosternal, sharp exacerbated chest pain exacerbated by lying flat and relieved by leaning forward a characteristic of?
A
Pericarditis
17
Q
What are classic findings of aortic sclerosis?
A
Ejection systolic murmur that does not radiate to the carotids with normal S2 pulse character and volume
18
Q
What antiemetic is contraindicated after gastrointestinal surgery?
A
Metoclopramide
19
Q
What is the classic triad of primary sjogren syndrome?
A
Dry mucosa especially in the eyes and mouth, fatigue and joint pain
20
Q
What is the most appropriate management in the treatment of carcinoid crisis?
A
Octreotide - somatostatin analogue
21
Q
What antibiotic should be avoided with an epileptic patient?
A
Ciprofloxacin
22
Q
What is the treatment for thyroid storm?
A
Antithyroid medication, potassium iodide, beta blockers and steroids
23
Q
Why are beta blockers given in thyroid storm?
A
Blocks the conversion of inactive T4 to active T3
24
Q
What is a common complication of hyperthyroidism?
A
Atrial fibrillation
25
What are the features of MEN 2A? and why does MEN2b differ?
Two or more specific endocrine tumours MEN 2b can be associated with marfans syndrome
26
What is a common side affect of gliclazide (a sulphonylurea)?
Hypoglycaemia and weight gain
27
What is the antibody present in most diagnosis of hashimotos thyroiditis?
Anti-TPO
28
What common medications can cause hyperprolactinaemia in patients with significant mental health?
Risperidone, haloperidol, tricyclics, SSRI
29
What causes type 2 renal tubular acidosis disorder?
Proximal RTA caused by failure of proximal tubular cells to reabsorb filtered bicarbonate leading to acidosis and alkaline urine with associated hypokalaemia - associated with fanconi syndrome
30
What causes type 1 renal tubular acidosis disorder?
Distal tubules being unable to secrete H+ into tubular lumen leading to normal anion gap with hypokalaemia, calcium precipitates and kidney stones form
31
What causes type 4 renal tubular acidosis disorder?
Mineralocorticoid deficiency - hyperkalaemia with normal urinary pH
Also caused by ACE inhibitors and NSAIDs leading to aldosterone resistance
32
What diabetic medications increase the risk of diabetic ketoacidosis?
Sodium-glucose cotransporter 2 inhibitors Dapagliflozin, empagliflozin and canagliflozin
33
What is the recommended protocol for a patient on warfarin with an INR of 9.1?
If INR >8 with minor bleeding, stop warfarin and give intravenous vitamin k
34
What type of testicular tumour would present with raised B-hcg?
Choriocarcinoma - testicular germ cell tumour
35
What do yolk sac tumours typically show a raised level of?
Alpha feta-protein
36
What is a rare ANCA associated small vessel vasculitis?
Microscopic polyangiitis
37
What medication is associated with widespread downscoping ST segments on ECG?
Digoxin
38
What are the typical presenting features of multiple myeloma?
Age 72, anaemia, hypercalcaemia, bone pain, renal failure and rouleaux formation on blood film
39
What histological result is described as a Starry sky?
Burkitt lymphoma - non-hodgkin lymphoma
40
What would be seen on histological swab analysis and first line treatment for trichomoniasis?
Motile Flagellated Protozoa - metronidazole 2g PO STAT
41
What is a side effect of carbimazole that should be treated immediately?
Sore throat - presentation of bone marrow suppression causing agranulocytosis potentially leading to sepsis
42
What is the gold standard investigation for confirming pneumocystis pneumonia?
Bronchoalveolar lavage
43
What is cord sign and what is it a sign of on a CT?
Hyper-attenuation within the superior sagittal sinus
Dural venous sinus thrombosis
44
What is a sign of COPD on chest X-Ray?
Flattened semi diaphragms, thin heart and increased number of visible anterior ribs
45
What deficit is seen in damage to the optic nerve?
Monocular visual loss
46
What deficit is seen in damage to the optic tract?
Contralateral homonymous hemianopia
47
What deficit is seen in damage to the optic chiasm?
Bitemporal hemianopia
48
What deficit is seen in damage to the optic radiation?
Contralateral homonymous hemianopia
49
What antigen is associated with testicular cancer and undescended testis?
Lactate dehydrogenase
50
What medication can make raynauds phenomenon worse?
Propanalol
51
What cancers is MEN2a associated with and what is the inherited gene mutation alongside MEN2a?
RET Gene
Medullary thyroid cancers, phaeochromocytoma, parathyroid hyperplasia and adenomas
52
What is the classic presentation of renal colic?
Loin to groin pain, blood and protein in the urine
53
What is the use function of ALT and ALP?
ALT = marker of hepatocellular injury
ALP = useful marker of cholestasis
A greater than 10-fold increase in ALT and a less than 3-fold increase in ALP suggests a predominantly hepatocellular injury.
A less than 10-fold increase in ALT and a more than 3-fold increase in ALP suggests cholestasis.
54
What can be the causes of isolated rise of ALP?
Bony metastases or primary bone tumours
Vitamin D deficiency
Recent bone fractures
Renal osteodystrophy
55
What investigations are used to assess synthetic liver function?
Serum Bilirubin
Serum albumin
Prothrombin time
Serum blood glucose
56
What are the marker ranges seen in acute hepatocellular damage?
ALT: increased 10 fold
ALP: normal or increased 3 fold
GGT: normal or increased 3 fold
Bilirubin: increased 3 fold or 10 fold
57
What are the marker ranges seen in chronic hepatocellular damage?
ALT: normal or increase 3 fold
ALP: normal or increase 3 fold
GGT: normal or increase 3 fold
Bilirubin: normal or increase 3 fold
58
What are the marker ranges seen in cholestasis?
ALT: Normal or increase 3 fold
ALP: increased 10 fold
GGT: increased 10 fold
Bilirubin: increased 10 fold
59
What can a raised GGT be suggestive of?
Biliary epithelial damage
Bile flow obstruction
Response to alcohol and drugs
60
What antibody is associated with the atopic triad and what type of hypersensitivity reaction is it?
IgE - type 1 hypersensitivity
61
What is the treatment for a male with LUTI?
Nitrofurantoin/trimethoprim for 7 days
62
What is a typical presentation of mitral regurgitation?
Breathlessness, fatigue, palpitations, pan-systolic murmur loudest at the apex
63
What is a typical presentation of aortic regurgitation?
Early diastolic murmur, loudest over aortic area
collapsing pulse, wide pulse pressure, displaced apex beat
64
What is a typical presentation of mitral stenosis?
Mid-diastolic murmur, loudest at the apex
Malar flush, tapping apex beat, signs of right sided heart failure
65
What is a typical presentation of aortic stenosis?
Ejection systolic murmur, heard loudest over the aortic area
Syncope, chest pain and breathlessness
66
What is the CHA2DS2VASC score indicating consideration for anticoagulation for AF?
1 for men, 2 for women
67
Describe mobitz type 1 block?
PR interval gradually lengthens before QRS complex is dropped - pattern of progressively longer intervals followed by a skipped beat
68
What drug is known to have the potential to induce cholestasis?
Co-amoxiclav
69
What is a characteristic of trichomonas vaginalis?
Strawberry cervix
70
What is the first line therapy for longterm management of stable angina?
Verapamil
Beta blocker or rate limiting calcium channel blocker
71
What is the most common location for an atrial myxoma to be found in?
Left atrium
72
What is the most likely diagnosis of a small mobile hard breast lump in the breast with no other changes - rapid growth?
Phyllodes tumour
73
What medication can be contraindicated in use of viagra?
Nitrates
74
What antigen is used in colorectal cancer to monitor response to therapy?
Carcinoembryonic antigen (CEA)
75
What genetic mutation is associated with polycythaemia rubra vera?
JAK2 (V617F)
76
What is the Parkinson triad? and What occurs with a vertical gaze palsy added?
Tremor, hypertonia and bradykinesia
Progressive supra nuclear palsy - Parkinson plus syndrome
77
What is the first line investigation to confirm gout?
Joint aspiration
78
What is the classic presentation of menieres disease?
Recurrent attacks of vertigo, hearing loss, tinnitus, and sensation of aural fullness
79
What is a complication of coeliac disease that is thought to normalise within 2 years of a gluten free diet?
Small bowel lymphoma
80
What organism can cause a presentation of target shaped skin lesions?
Mycoplasma pneumonia
81
What is first line treatment for acute angle glaucoma?
IV acetazolamide
82
What is a pearly lesion on the eyelid with ulcerated centre most likely to be?
Basal Cell carcinoma
83
What is the first line treatment for open angle glaucoma and what are some side effects?
Latanoprost
Eye colour change, darkened eyelashes
84
What does pagets disease of the nipple present as?
Erythematous and scaly skin around the nipple resembling eczema
85
What is the first line treatment for absence seizures?
Sodium valproate or ethosuximide
86
What is the first line treatment for focal, tonic-clonic, and atonic seizures?
Lamotrigine
87
What would be seen in joint aspirate of a person with pseudo gout?
Positively birefringent rhomboid crystals
88
What is Waterhouse-friderichensens syndrome and where would you find a haemorrhage on post mortem?
Adrenal haemorrhage and consequent adrenal failure
89
What is a first line treatment for raynauds?
Nifedipine - CCB
90
What is the first line treatment for postural hypotension?
Fludrocortisone
91
What is the most common ecg change seen in pericarditis?
ST elevation
92
What is the first line treatment of dilated cardiomyopathy?
ACE inhibitors
93
Describe IgA nephropathy
IgA deposition in the glomeruli - haematuria and hypertension one or two days after URTI
94
ST elevation in what leads would indicate a lateral MI and what vessel would be occluded in this case?
I, AVL, V5, V6
Circumflex
95
ST elevation in what leads would indicate an inferior MI and what vessel would be occluded in this case?
II, III, AVF
Right coronary artery
96
ST elevation in what leads would indicate an anterior MI and what vessel would be occluded in this case?
V1, V2 septal, V3, V4
Left anterior descending
97
What are the shockable rhythms?
Ventricular tachycardia
Ventricular fibrillation
Torsades de pointes - polymorphic VT
Defibrillation
98
What are the non-shockable rhythms?
Pulseless electrical activity
Asystole
Ventricular standstill - p wave no QRS - complete heart block
99
What is the tumour marker commonly used for pancreatic cancer screening?
CA19-9
100
For temporal arteritis what medications are given until symptoms fully resolve?
High dose prednisolone and alendrotnic acid
101
What is the first line treatment for pseudo gout?
NSAIDs - naproxen
102
What is the first best initial treatment for acute hypertensive emergency?
IV labetalol 50mg
103
What are the ECG features seen in pericarditis?
Widespread upsloping saddle-shaped ST elevation, PR depression and downward sloping T-P line (spodick's sign)
104
How do you calculate Cha2ds2vasc score?
Age = 65(0), 65-74(1), 75+(2)
Sex = F(1)
CHF History = Yes(1)
Hypertension = Yes(1)
Stroke/TIA = Yes(2)
Vascular disease - MI/peripheral artery disease = Yes(1)
Diabetes = Yes(1)
105
What is the most common pathogen to cause tonsillitis?
Group A strep
106
What results would you expect to see for cranial diabetes insipidus during water deprivation test?
Low urine osmolality after water deprivation, normal post desmopressin injection IM
107
What is the classic presentation of episcleritis?
Mild acute onset, unilateral eye pain and redness
108
How do you calculate CURB-65?
Confusion - AMTS <8
Urea >7mmol/L
RR>30
BP - <90 systolic or <60 diastolic
65> age
109
What is the firstling treatment for Crohn's disease?
Azathioprine
110
What is a common side effect of long term steroid use?
Reduced proximal strength - myopathy induction
111
What medication can induce both hypo and hyperthyroidism?
Amiodarone
112
What blood level is likely to be significantly elevated in eosinophilic granulomatosis with polyangiitis?
Eosinophils
113
What is the management of supra ventricular tachycardia when vasovagal manoeuvres have not been successful?
IV adenosine
114
What is the most common organism to cause encephalitis?
Herpes Simplex Virus
115
What marker present in CSF is indicative of subarachnoid haemorrhage?
Xanthochromia
116
When is complete heart block diagnosed?
What there is no relationship between p waves and QRS complexes
117
What is nitrous oxide known to deplete?
B12 levels
118
What medication is used for rate control in atrial fibrillation when the patient also has heart failure?
Digoxin
119
What is a pancoast tumour and what symptoms would you see if it was right sided?
Tumour of the lung apex usually adenocarcinoma
Can interrupt the sympathetic nerve therefore disrupt supply to eye and facial muscles - ptosis, miosis and anhidrosis
120
What factor would make a patient eligible for lung reduction surgery for COPD?
Predominant upper lobe emphysema
121
What is a common drug used in psoriasis management?
Ciclosporine
122
What skin condition is associated with TB?
Erythema nodosum
123
What is the treatment for actinic keratosis?
Topical 5-fluorouracil
124
What is fusic acid used to treat?
Bacterial skin infections - impetigo/cellulitis
125
What is yellow frothy vaginal discharge a sign of?
Trichomoniasis
126
What is koebner's phenomenon?
Formation of skin lesion at a prior injury site
127
What is the antibody seen in myasthenia gravis?
Post synaptic acetylcholine receptors
128
What is the most common mouth cancer?
Squamous cell carcinoma
129
What are the three cardinal features of Menieres disease?
Tinitus, deafness and vertigo
130
What is a cholesteatoma?
Growth of keratinising squamous cells forming in the attic of the ear, produce chronic foul smelling discharge
131
What type of medication is midodrine?
alpha-1-agonist - used for postural hypotension
132
What is chonedrocalcinosis indicative of?
Pseudogout
133
What is dresslers syndrome?
Secondary pericarditis occurring 1-6 weeks post MI, pleuritic chest pain, low grade fever and pericarditis, worse lying down can show widespread st elevation on ECG
Treat with aspirin
134
What condition of hearing loss allows hearing to improve when there is background noise?
Otosclerosis
135
What is a classic presentation of acoustic neuroma?
Unilateral deafness, vertigo and left sided lesions of cranial nerves V, IX and X
136
What are steps 1,2 and 3 of the WHO pain ladder?
1 - NSAID of paracetamol ( contraindicated in liver impairment)
2 - Codeine/dihydrocodeine
3 - Oral morphine
137
What are the features of CREST syndrome?
Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, calcinosis, telangiectasia
138
What is typical presentation of reactive arthritis?
Dysuria, arthralgia and iritis
139
What is a cobblestone ulcer appearance diagnosis of? Also associated inflamed mucosa with interspersed regions of normal mucosa?
Crohn's
140
What are the values of eGFR for chronic kidney disease stages 1,2, 3a,3b, 4 and 5?
1 - <90
2 - 60-89
3a - 45-59
3b - 20-44
4 - 15-20
5 - <15
141
What are the classic symptoms of polymyalgia rheumatica?
Shoulder and hip girdle stiffness and pain
142
What medication is used for paracetamol overdose?
N-acetylcysteine - for staggered overdose or present later than 1 hour after taking
Activated charcoal - presentations within 1 hour of overdose
143
What hypertension medication should be stopped during hyperkalaemia treatment?
Ramipril - causes increase potassium
144
What antidepressant should be stopped during treatment of hyponatraemia?
Sertraline / SSRIs
145
What is the classic presentation of myasthenia gravis?
Fatiguable weakness that improves upon rest
146
What is a bulls eye rash indicative of?
Lymes Disease
147
What is first line treatment of rhabdomyolysis?
IV fluids
148
What is Becks triad and what is it used to indicate?
Cardiac Tamponade
Distended Neck veins
Low BP
Muffled heart sounds
149
What is the conversion rate for oral morphine to subcutaneous?
2:1
150
What type of arthritis is associated with skin and nail changes?
Psoriatic arthritis
151
What is the first line medication for hypertension if the patient is above 55 and has diabetes?
Ramipril/ACE inhibitor
152
What are yellow plaques and inflammation of bowel mucosa indicative of and how is it treated?
Clostridium Difficile
Vancomycin
153
What are epithelial crescents in the glomeruli indicative of?
Rapidly progressive glomerularnephritis
154
What are J waves on ECG associated with diagnosis?
Hypothermia
155
What is a urea breath test used for?
To rule out H.Pylori in cases of dyspepsia which hasn't improved with lifestyle measures and antacids
156
What is a sharp p wave indicative of?
Atrial flutter
157
What presents as a stormy sunset on fundoscopy?
Central retinal vein occlusion
158
What medication can never be prescribed with verapamil and why?
Beta blockers, causes complete heart block
159
What would an ischaemic stroke in the right posterior cerebral artery present as visually?
Left homonymous hemianopia with macular sparing
160
Where would a lesion be seen presenting as right homonymous hemianopia with macular sparing?
Left occipital cortex lesion
161
Where would a lesion be seen in right and left homonymous hemianopia?
Left and right middle cerebral arteries
162
What is the treatment for pneumocystis pneumonia?
Co-trimoxazole
163
What is a renal stone likely made up of if it is radiolucent?
Uric acid
164
When is a Parkinson tremor worse?
At rest
165
What does hyperaldosteronism usually present as?
Mineralocorticoid excess, hypertension that is resistant to multiple agents and hypokalaemia, muscle weakness
166
What is given for tricyclic antidepressant overdose?
Sodium bicarbonate
167
What is a surgical third nerve palsy with pupillary involvement caused by?
Posterior communicating artery aneurysm
168
What blood level would be raised in statin induced myopathy?
Creatine kinase
169
What ophthalmology condition is associated with autoimmune conditions?
Episcleritis
170
What are the common causes of sensory peripheral neuropathy?
Alcohol toxicity, b12/Folate deficiency, Chronic Renal Failure, Diabetes, vasculitis
171
What is the first line treatment for tornadoes de pointes?
Magnesium sulphate
172
What coagulation factors are blocked by warfarin?
II, VII, IX, X
173
What clotting factor is haemophilia A associated with?
VIII
174
Describe how to calculate the Glasgow score for pancreatitis
P - PO2 <8Kpa
A - Age>55
N - Neutrophils WCC 15x109/L
C - Calcium <2mmol/L
R - Renal Function Urea>16mmol/L
E - Enzymes LDH>60iu/L or AST>200iu/L
A - albumin <32g/L
S - Sugar glucose>10mmol/L
175
What does a LABA have to be prescribed with?
Inhaled corticosteroid
176
What blood results would you expect to see with primary hyperaldosteronism?
Hypernatraemia, hypokalaemia, raised bicarbonate
177
What antibodies are linked to hashimotos thyroiditis?
Thyroid peroxidase antibodies
178
What is the treatment for TB?
RIPE
Rifampicin
Isoniazid
Pyridoxine
Ethambutol
179
What heart murmur is pan systolic heard loudest in inspiration over the lower sternal edge border?
Tricuspid Regurgitation
180
What are the manoeuvres used to examine vertigo and then treat?
Examination: Dix-hallpike
Treatment: Emply manoeuvre
181
What are the typical features of chronic pancreatitis?
Epigastric pain radiating to the back
Exacerbated by fatty foods + alcohol
Relieved by sitting forwards
Associated with steatorrhoea, weight loss and diabetes
182
What are auer rods on blood film indicative of?
Acute myeloid leukaemia
183
What is associated with a bird beak appearance of the oesophagus?
Alchalasia
184
What test would be done for confirmation and diagnosis of cystic fibrosis?
Sweat test - sweat chloride level >60 mEq/L
185
What HLA is associated with ankylosing spondylitis?
HLA-B27
186
What is the first line treatment for idiopathic or viral pericarditis?
Colchicine and ibuprofen
187
What is the classic triad of normal pressure hydrocephalus?
Urinary incontinence, dementia and gait abnormality
188
If a patient presents to the GP with a dry cough after starting an ACE what medication do you switch it to?
Angiotensin Receptor blocker
189
What is the ecg abnormality seen in hypercalcaemia?
Shortening of the QT interval
190
What heart failure medication is known to cause ototoxicity?
Loop Diuretics
191
What is an example of a medication that can cause Syndrome of Inappropriate ADH Release (SIADH)
SSRI - sertraline
192
What would you see on a bone profile on an osteoporotic patient?
Normal levels of: calcium, phosphate, alkaline phosphate and PTH
193
What are the two most common valves in infective endocarditis?
Tricuspid and Mitral
194
What is the most common cause of spontaneous intracerebral haemorrhage?
Hypertensive vasculopathy
195
What are signet ring cells found on biopsy indicative of?
Gastric adenocarcinoma
196
What is the statin dose for secondary prevention of cardiovascular disease?
80mg
197
What is the triad for haemolytic uraemia syndrome?
Raised creatinine, haemolytic anaemia and thrombocytopenia
198
What is the most common cause of encephalitis and the treatment given?
HSV - IV acyclovir
199
What is a peripheral neuropathy that has a strong association with diabetes?
Mononeuritis Multiplex
200
What are gottrons papules a sign of?
Dermatomyositits
201
What is given in a case of aspirin overdose?
IV sodium bicarbonate
202
What are alpha blockers used for along side BPH and what may a side effect be if the patient is also taking an antihypertensive?
Drop in blood pressure as alpha blockers can also be used to treat high blood pressure
203
How many half lives of a drug does it take to reach a steady state?
4-5
204
What bacteria is the most common cause of food poisoning in the UK and how does it arise?
Undercooked chicken
Campylobacter jejuni
205
What does clostridium perfringens infection result from?
Incubation of 12-24 hours, source is red meat and gravy
206
What is the bacteria in rice that can cause food poisoning and the time frame after eating it?
Bacillus cereus
30 mins - 6 hours after eating
207
What does a rubbery non tender lymph node in the neck indicate?
Hodgkin Lymphoma
208
What is a crescent shaped area on head CT indicative of?
Subdural haematoma
209
What is the treatment for acute diverticulitis?
Fluids and antibiotics
210
How long does a person have to have depressive symptoms to be diagnosed with depression?
2 weeks
211
What is a double heart border a sign of?
Pneumomediastinum
212
What can isoniazid cause as a side effect?
Drug induced lupus
213
What is charcots triad and what is it used to diagnose?
Fever, jaundice, epigastric pain
Ascending cholangitis
214
What is the initial treatment of lymes disease when a patient is stable?
Oral doxycycline 14-21 day course
215
What medication is given for grade 2 oesophageal varicies?
Non- selective beta blocker
216
What is the first line prevention for cluster headaches?
Verapamil
217
What blood results if raised would indicate sarcoidosis?
ESR and hypercalcaemia
218
Where are femoral hernias typically found?
Inferiorlateral to pubic tubercle
219
Where are inguinal hernias typically found?
Superiormedial to pubic tubercle
220
What are the two medications for the first line treatment of gout?
Colchicine and NSAIDs however NSAIDs are contraindicated in renal disease
221
What is the primary site of metastasis of renal cancer?
Blood
222
What medication is indicated to reduce cerebral oedema in hepatic encephalopathy?
IV mannitol
223
What amount of glucose would be given to an unconscious patient with IV access who has a bm of 1.7 mmol/L?
100ml of 20% glucose IV
224
What is the concentration of adrenaline given in anaphylaxis?
1:1000
500microgramms
IM
225
What would an aspirin overdose present as and what is the treatment?
Respiratory alkalosis
Metabolic Acidosis
Activated charcoal if ingested <1 hour previous
Fluids
Sodium bicarbonate
Potassium chloride
226
What would methylmalonic acid and anti-intrinsic factor antibody be used to assess and why?
Measure of functional B12 status - can be used to help diagnose pernicious anaemia when serum B12 is normal
227
What is the difference between Supraventricular tachycardia and atrial fibrillation on ECG?
Both are narrow complex tachycardia with no p waves
Key difference is AF is irregular rhythm whereas SVT is regular
228
What stage of sympathetic transmission does cocaine interfere?
Reuptake of noradrenaline into presynaptic neurone
229
What blood test is the most sensitive for acute pancreatitis?
Lipase
230
What medication is used to treat a tricyclic overdose?
Intravenous bicarbonate
231
What are the lobes causing superior vs inferior homonymous quadrantonopias?
Parietal- Inferior
Temporal - Superior
PITS
232
What type of dementia causes a personality change and what would be seen histologically in the persons brain?
Frontal Lobe dementia - Tau bodies
233
Where in the brain would an injury result in homonymous hemianopia?
Occipital
234
What symptoms make up a Total anterior circulation stroke?
All 3 of:
- Unilateral and or sensory deficit of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction - dysphasia, visuospatial disorder
235
What symptoms make up a partial anterior circulation stroke?
Two of:
- Unilateral and or sensory deficit of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction - dysphasia, visuospatial disorder
236
What symptoms would diagnose a posterior circulation stroke?
1 of:
- Cranial nerve palsy and contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder
- Cerebellar dysfunction
- Isolated dysfunction - ataxia, nystagmus, vertigo
- Isolated homonymous hemianopia or cortisol blindness
237
Which TB medication causes toxic optic neuropathy?
Ethambutol
238
What bacteria is the most common to cause an infective exacerbation of COPD?
Haemophilus Influenzae
239
What antibodies would be present in primary biliary cholangitis/cirrhosis?
Antimitochondrial antibodies
240
What antibodies are present in dermatomyositis and polymyositis?
Anti-Jo antibodies
241
What disease is associated with anti centromere antibodies?
CREST syndrome
242
What electrolyte abnormality is the most important direct consequence of refeeding syndrome ?
Hypophosphataemia
243
What are the features of multiple myeloma?
CRAB
Calcium - raised
Renal failure
Anaemia
Bone lesions
244
What pattern of oedema is associated with nephrotic syndrome ?
Scrotal and occular oedema
245
What is the management of molluscum contagiosum?
Watch and wait
246
What is the most common tumour of the parotid gland ?
Pleomorphic adenoma
247
What part of the QRS complex is used for synchronisation?
R wave
248
What medication is used for migraine prophylaxis?
Propranolol
249
What is the score used to assess pancreatitis?
Modified Glasgow coma score
250
What ecg change is seen in myocarditis?
T wave inversion, ST changes and sinus tachycardia
251
What is given to treat an acute flair up of MS to reduce the severity olf attack?
IV methylprednisolone
252
What can give urine a very red appearance after a fall with a long lie?
Myoglobinuria
253
What type of brain haemorrhage is associated with autosomal dominant polycystic kidney disease?
Subarachnoid
254
What herpes virus is most likely to form cold sores on the lips/mouth?
HSV1
255
What herpes virus is most likely to form ulcers on the genitals?
HSV2
256
How would molluscum contagiosum be described?
Small round pearly lesions with a central area of umbilication
257
What are the normal ECG intervals?
R-R = 0.6-1.2 seconds
PR = 120-200 milliseconds
258
What medication is useful in the treatment of involuntary fasciculations seen in Huntingtons?
Tetrabenazine
259
What is flumnazenil used for?
Reverse action of benzodiazepines
260
What is ancanthosis nigricans associated with?
Insulin resistance and stomach cancer
261
What skin condition is associated with IBD?
Pyoderma Gangrenosum
262
What is a 'bamboo spine' on X-ray indicative of?
Ankylosing spondylitis
263
What method is used to decrease confounding variables in research ?
Randomisation
264
What is the time frame from onset of stroke symptoms to thrombolysis ?
4.5 hours
265
What medication is used for urge incontinence?
Oxynbutynyn
266
What medication is used for stress incontinence?
Duloxetine
267
What is a classic distinguishing feature of bacterial conjunctivitis?
Purulent discharge
268
What cell is type 4 hypersensitivity mediated by?
T-lymphocytes
269
What investigation would be used for PE if the patient has kidney disease?
VQ scan
270
What is used as treatment for hepatic encephalopathy?
Lactulose
271
What is the treatment for acute angle closure glaucoma?
Pilocarpine 4% eye drops
272
What are urinary bence jones proteins a sign of?
Multiple myeloma
273
What common side affect are calcium channel blockers known to have?
Leg swelling
274
What is the preffered treatment for subarachnoid haemorrhage from burst PCA aneurysm?
Endovascular coiling
275
What heart affect is strongly associated with cocoaine use?
Coronary artery vasospasm
276
What tb medication causes changes to urine and sweat colour?
Rifampicin
277
What bacteria causes rheumatic fever?
Streptococcus pharyngitis
278
What is the most common type of melanoma?
Superficial
279
What bacteria is causative of guillan barre syndrome?
Campylobacter jejuni
280
What is important testing to be completed before biologics initiation?
Quantiferon test for TB
281
What electrolyte disturbance can be seen with PPI use?
Hyponatraemia and hypomagnesemia
282
What is the treatment pathway for a patient that is haemodynamically unstable with broad complex ventricular tachycardia?
Synchronised DC shocks followed by Amiodarone
283
What medication can be used to manage beta blocker overdose?
Glucagon
284
Describe secondary hyperthyroidism
High TSH, T3 and T4
Feedback loop to reduce TSH has been lost
285
How can pancreatic abscess and pancreatic pseudocyst be differentiated?
Pseudocyst 4 weeks post pancreatitis
Abscess 3 weeks post pancreatitis
286
What other electrolyte abnormality is seen alongside severe hypokalaemia?
Hypomagnesiaemia
287
What is coffee bean sign indicative of?
Sigmoid volvulus
288
What is the most likely organism to cause haemolytic uraemic syndrome?
E.Coli
289
What is first line treatment for trigeminal neuralgia?
Carbemapezine
290
What is the staging system for melanoma called?
Breslow
291
What medication is given in severe hypoglycaemia?
IV 10% Dextrose
292
What is a factor that gives a better prognosis for ALL?
Hyperdiploid Blast cells
293
What is the most common visual defect for optic neuritis?
Central scotoma
294
What is the management of a non-haemolytic transfusion reaction?
Slow down transfusion and add paracetamol
295
What lobes of the brain are brocas and wernickes areas?
Brocas - frontal
Wernickes - temporal
296
What is the treatment regime for acute limb ischaemia?
Intravenous heparin bolus followed by infusion
Then urgent embolectomy if required
297
What is riglers sign/double wall sign of the bowel indicative of?
Pneumoperiteneum
Both sides of the bowel wall are visualised
298
What is the treatment for acute ottitis externa?
Acetic acid drops
299
What medication can be given during cardiac arrest if amiodarone isn't present?
Lidocaine
300
What is the most common ECG change in acute PE?
Sinus Tachycardia
301
What dermatological condition is described as having a christmas tree pattern of distribution?
Pityriasis rosacea
302
What opthalmology condition is characterised by mild photophobia and blurred vision alongside wearing contact lenses and the management?
Bacterial keratitis
Topical broad spectrum antibiotics and urgent opthalmology refferal
303
What test is used to identify haemolytic anaemia?
Direct Coombs test
304
What is the first line treatment for autoimmune haemolytic anaemia?
Corticosteroids
305
What is the inheritance pattern of polycystic kidney disease?
Autosomal dominant
306
What are the histological features of barrets oesophagus?
Columnar epithelium in the gastro-oesophageal junction with evidence of metaplasia
307
What tests should be performed before starting statins?
Thyroid function tests - hypothyroidism is an irreversible cause of high cholesterol
308
What is the mechanism of action of viagra?
cGMP activation
309
What is the mechanism of action of viagra?
cGMP activation
310
What conditions is adenosine contraindicated in?
Asthma, COPD, third degree heart block, decompensated heart failure
311
What level of blood pressure is contraindicated in thrombolysis?
180/110 and above
312
Which lobe in the brain would a seizure present with fidgeting ie playing with clothes and lip smacking?
Temporal lobe
313
Which lobe in the brain would a seizure present with fidgeting ie playing with clothes and lip smacking?
Temporal lobe
314
Which lobe in the brain would a seizure present with visual hallucinations and temporary blindness?
Occipital
315
Which lobe in the brain would a seizure present with uncontrollable extreme emotions, todds paralysis and urinary incontinence post seizure?
Frontal Lobe
316
Which lobe in the brain would a seizure present with tingling, numbness or auditory hallucinations?
Parietal Lobe
317
If a hernia protrudes on coughing when there is a hand between the pubic tubercle and ASIS what type of hernia does it indicate?
Direct inguinal hernia
318
What is the first line treatment in myasthenia gravis?
Cholinesterase inhibitor
319
What does rusty sputum colour indicate?
Pneumococcal Pneumoniae
320
What is the composition of a staghorn renal calculus?
Striuvate
321
What investigation is used to diagnose optic neuritis?
MRI
