Exam Questions Flashcards
What vitamin deficiencies can cause anaemia?
B12, B9 and C
Which substance can be used to achieve the most accurate measurement of the glomerular filtration rate?
Insulin
What are the antibodies associated with antiphospholipid syndrome?
Lupus anticoagulant, anticardiolipin, anti-beta 2 glycoprotein-1
What are gram negative diplococci indicative of in microscopy of vaginal swab?
Neisseria gonorrhoea
What are the common sites of carcinoid tumours?
Appendix, ileum, testis, ovary and bronchi
What two medications have shown to improve fatigue in patients with MS?
Modafinil and amantadine
What ECG change is indicative of supra ventricular tachycardia?
Delta waves - up slant at the beginning of the QRS complex diagnostic of wolf Parkinson white syndrome
What is the first line class of antibiotic used for prostatitis? and give an example
Quinolone - ciprofloxacin
What investigation is the most sensitive in diagnosing pancreatic cancer?
Endoscopic ultrasound
What is a common cardiac defect in children with downs syndrome?
VSD
What is an S4 heart sound and why does it occur?
Atrial Gallop - atria contracting forcefully to overcome an abnormally stiff ventricle
What are blue markings on the gums a sign of?
Lead poisoning
What results in ectopic ileal, gastric or pancreatic mucosa?
Meckel’s diverticulum
What is the treatment for hyperkalaemia + ECG changes?
IV calcium gluconate
What movement is typically spared in motor neurone disease?
Eye movements usually remain as usual
What is retrosternal, sharp exacerbated chest pain exacerbated by lying flat and relieved by leaning forward a characteristic of?
Pericarditis
What are classic findings of aortic sclerosis?
Ejection systolic murmur that does not radiate to the carotids with normal S2 pulse character and volume
What antiemetic is contraindicated after gastrointestinal surgery?
Metoclopramide
What is the classic triad of primary sjogren syndrome?
Dry mucosa especially in the eyes and mouth, fatigue and joint pain
What is the most appropriate management in the treatment of carcinoid crisis?
Octreotide - somatostatin analogue
What antibiotic should be avoided with an epileptic patient?
Ciprofloxacin
What is the treatment for thyroid storm?
Antithyroid medication, potassium iodide, beta blockers and steroids
Why are beta blockers given in thyroid storm?
Blocks the conversion of inactive T4 to active T3
What is a common complication of hyperthyroidism?
Atrial fibrillation
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
What is a common side affect of gliclazide (a sulphonylurea)?
Hypoglycaemia and weight gain
What is the antibody present in most diagnosis of hashimotos thyroiditis?
Anti-TPO
What common medications can cause hyperprolactinaemia in patients with significant mental health?
Risperidone, haloperidol, tricyclics, SSRI
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
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
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
What diabetic medications increase the risk of diabetic ketoacidosis?
Sodium-glucose cotransporter 2 inhibitors Dapagliflozin, empagliflozin and canagliflozin
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
What type of testicular tumour would present with raised B-hcg?
Choriocarcinoma - testicular germ cell tumour
What do yolk sac tumours typically show a raised level of?
Alpha feta-protein
What is a rare ANCA associated small vessel vasculitis?
Microscopic polyangiitis
What medication is associated with widespread downscoping ST segments on ECG?
Digoxin
What are the typical presenting features of multiple myeloma?
Age 72, anaemia, hypercalcaemia, bone pain, renal failure and rouleaux formation on blood film
What histological result is described as a Starry sky?
Burkitt lymphoma - non-hodgkin lymphoma
What would be seen on histological swab analysis and first line treatment for trichomoniasis?
Motile Flagellated Protozoa - metronidazole 2g PO STAT
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
What is the gold standard investigation for confirming pneumocystis pneumonia?
Bronchoalveolar lavage
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
What is a sign of COPD on chest X-Ray?
Flattened semi diaphragms, thin heart and increased number of visible anterior ribs
What deficit is seen in damage to the optic nerve?
Monocular visual loss
What deficit is seen in damage to the optic tract?
Contralateral homonymous hemianopia
What deficit is seen in damage to the optic chiasm?
Bitemporal hemianopia
What deficit is seen in damage to the optic radiation?
Contralateral homonymous hemianopia
What antigen is associated with testicular cancer and undescended testis?
Lactate dehydrogenase
What medication can make raynauds phenomenon worse?
Propanalol
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
What is the classic presentation of renal colic?
Loin to groin pain, blood and protein in the urine
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.
What can be the causes of isolated rise of ALP?
Bony metastases or primary bone tumours
Vitamin D deficiency
Recent bone fractures
Renal osteodystrophy
What investigations are used to assess synthetic liver function?
Serum Bilirubin
Serum albumin
Prothrombin time
Serum blood glucose
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
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
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
What can a raised GGT be suggestive of?
Biliary epithelial damage
Bile flow obstruction
Response to alcohol and drugs
What antibody is associated with the atopic triad and what type of hypersensitivity reaction is it?
IgE - type 1 hypersensitivity
What is the treatment for a male with LUTI?
Nitrofurantoin/trimethoprim for 7 days
What is a typical presentation of mitral regurgitation?
Breathlessness, fatigue, palpitations, pan-systolic murmur loudest at the apex
What is a typical presentation of aortic regurgitation?
Early diastolic murmur, loudest over aortic area
collapsing pulse, wide pulse pressure, displaced apex beat
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
What is a typical presentation of aortic stenosis?
Ejection systolic murmur, heard loudest over the aortic area
Syncope, chest pain and breathlessness
What is the CHA2DS2VASC score indicating consideration for anticoagulation for AF?
1 for men, 2 for women
Describe mobitz type 1 block?
PR interval gradually lengthens before QRS complex is dropped - pattern of progressively longer intervals followed by a skipped beat
What drug is known to have the potential to induce cholestasis?
Co-amoxiclav
What is a characteristic of trichomonas vaginalis?
Strawberry cervix
What is the first line therapy for longterm management of stable angina?
Verapamil
Beta blocker or rate limiting calcium channel blocker
What is the most common location for an atrial myxoma to be found in?
Left atrium
What is the most likely diagnosis of a small mobile hard breast lump in the breast with no other changes - rapid growth?
Phyllodes tumour
What medication can be contraindicated in use of viagra?
Nitrates
What antigen is used in colorectal cancer to monitor response to therapy?
Carcinoembryonic antigen (CEA)
What genetic mutation is associated with polycythaemia rubra vera?
JAK2 (V617F)
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
What is the first line investigation to confirm gout?
Joint aspiration
What is the classic presentation of menieres disease?
Recurrent attacks of vertigo, hearing loss, tinnitus, and sensation of aural fullness
What is a complication of coeliac disease that is thought to normalise within 2 years of a gluten free diet?
Small bowel lymphoma
What organism can cause a presentation of target shaped skin lesions?
Mycoplasma pneumonia
What is first line treatment for acute angle glaucoma?
IV acetazolamide
What is a pearly lesion on the eyelid with ulcerated centre most likely to be?
Basal Cell carcinoma
What is the first line treatment for open angle glaucoma and what are some side effects?
Latanoprost
Eye colour change, darkened eyelashes
What does pagets disease of the nipple present as?
Erythematous and scaly skin around the nipple resembling eczema
What is the first line treatment for absence seizures?
Sodium valproate or ethosuximide
What is the first line treatment for focal, tonic-clonic, and atonic seizures?
Lamotrigine
What would be seen in joint aspirate of a person with pseudo gout?
Positively birefringent rhomboid crystals
What is Waterhouse-friderichensens syndrome and where would you find a haemorrhage on post mortem?
Adrenal haemorrhage and consequent adrenal failure
What is a first line treatment for raynauds?
Nifedipine - CCB
What is the first line treatment for postural hypotension?
Fludrocortisone
What is the most common ecg change seen in pericarditis?
ST elevation
What is the first line treatment of dilated cardiomyopathy?
ACE inhibitors
Describe IgA nephropathy
IgA deposition in the glomeruli - haematuria and hypertension one or two days after URTI
ST elevation in what leads would indicate a lateral MI and what vessel would be occluded in this case?
I, AVL, V5, V6
Circumflex
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
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
What are the shockable rhythms?
Ventricular tachycardia
Ventricular fibrillation
Torsades de pointes - polymorphic VT
Defibrillation
What are the non-shockable rhythms?
Pulseless electrical activity
Asystole
Ventricular standstill - p wave no QRS - complete heart block
What is the tumour marker commonly used for pancreatic cancer screening?
CA19-9
For temporal arteritis what medications are given until symptoms fully resolve?
High dose prednisolone and alendrotnic acid
What is the first line treatment for pseudo gout?
NSAIDs - naproxen
What is the first best initial treatment for acute hypertensive emergency?
IV labetalol 50mg
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)
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)
What is the most common pathogen to cause tonsillitis?
Group A strep
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
What is the classic presentation of episcleritis?
Mild acute onset, unilateral eye pain and redness
How do you calculate CURB-65?
Confusion - AMTS <8
Urea >7mmol/L
RR>30
BP - <90 systolic or <60 diastolic
65> age
What is the firstling treatment for Crohn’s disease?
Azathioprine
What is a common side effect of long term steroid use?
Reduced proximal strength - myopathy induction
What medication can induce both hypo and hyperthyroidism?
Amiodarone
What blood level is likely to be significantly elevated in eosinophilic granulomatosis with polyangiitis?
Eosinophils
What is the management of supra ventricular tachycardia when vasovagal manoeuvres have not been successful?
IV adenosine
What is the most common organism to cause encephalitis?
Herpes Simplex Virus
What marker present in CSF is indicative of subarachnoid haemorrhage?
Xanthochromia
When is complete heart block diagnosed?
What there is no relationship between p waves and QRS complexes
What is nitrous oxide known to deplete?
B12 levels
What medication is used for rate control in atrial fibrillation when the patient also has heart failure?
Digoxin
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
What factor would make a patient eligible for lung reduction surgery for COPD?
Predominant upper lobe emphysema
What is a common drug used in psoriasis management?
Ciclosporine
What skin condition is associated with TB?
Erythema nodosum
What is the treatment for actinic keratosis?
Topical 5-fluorouracil
What is fusic acid used to treat?
Bacterial skin infections - impetigo/cellulitis
What is yellow frothy vaginal discharge a sign of?
Trichomoniasis
What is koebner’s phenomenon?
Formation of skin lesion at a prior injury site
What is the antibody seen in myasthenia gravis?
Post synaptic acetylcholine receptors
What is the most common mouth cancer?
Squamous cell carcinoma