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Year 5 > February > Flashcards

February Flashcards

1
Q

Pulmonary oedema is an indication for what in a patient with acute kidney injury?

A

Haemodialysis

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2
Q

Proliferative diabetic retinopathy is treated with…

A

Panretinal laser photocoagulation

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3
Q

What are the main features of secondary syphilis and when does it occur?

A

Secondary features - occurs 6-10 weeks after primary infection
systemic symptoms: fevers, lymphadenopathy, rash on trunk, palms and soles buccal ‘snail track’ ulcers (30%) condylomata lata (painless, warty lesions on the genitalia)

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4
Q

Stop sertraline when?

A

6 months after RESOLUTION

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5
Q

Common symptoms of early lymes disease?

A

Symptoms include joint pains, facial nerve palsy, palpitations, headaches and fever.

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6
Q

What rash is caused by Borrelia burgdorferi?

A

Erythema migrans (Bulls eye rash)

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7
Q

When to perform HIV testing:

A

Testing for HIV in asymptomatic patients should be done at 4 WEEKS AFTER SUSPECTED EXPOSURE.

If this result is NEGATIVE offer a repeat test at 12 weeks

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8
Q

What is the screening performed for all diabetic patients to assess for nephropathy?

A

All diabetic patients require annual screening for albumin:creatinine ratio (ACR) in early morning specimens.

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9
Q

Smoking cessation in pregnancy give?

A

NRT

Pregnant women who smoke: nicotine replacement therapy should be offered, varenicline and bupropion are contraindicated

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10
Q

What iron studies are seen in iron deficiency anaemia?

A

Low transferrin saturation, low ferritin, high TIBC

Low transferrin saturation can be thought of as fewer binding spots taken up by iron, low ferritin can suggest less iron has been stored, and a high TIBC means there are more binding spots free for iron to take up, therefore suggesting low iron in the body.

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11
Q

Treatment for oesophageal varicies:

A

Variceal band ligation is the NICE recommended method of stopping oesophageal variceal bleeding. Sengstaken tube and TIPSS is recommended if this fails. Propranolol is used as bleeding prophylaxis.

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12
Q

Contralateral homonymous hemianopia with macular sparing and visual agnosia which artery is occluded?

A

Posterior cerebral artery

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13
Q

First line test for acromegaly?

A

Serum IGF-1 levels are now the first-line test for acromegaly

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14
Q

Gonorrhoea tx

A

Intramuscular ceftriaxone is the treatment of choice for Gonorrhoea

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15
Q

PE treatment if pregnant?

A

LMWH

Apixaban is teratogenic

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16
Q

How does hypophosphataemia present?

A

May result in significant muscle weakness, including myocardial muscle (→ cardiac failure) and the diaphragm (→ respiratory failure).

Cardiac Dysfunction: Hypophosphatemia can impair myocardial contractility, leading to heart failure. It may also cause arrhythmias due to its role in maintaining normal cellular electrophysiology.

Respiratory Failure: Phosphate is essential for ATP production, necessary for respiratory muscle function. Severe hypophosphatemia can lead to muscle weakness, including the diaphragm and intercostal muscles, potentially resulting in acute respiratory failure.

Neurological Complications: These can range from confusion and seizures to coma, attributable to disturbed ATP metabolism in the central nervous system.

Haematological Effects: Reduced 2,3-diphosphoglycerate levels in erythrocytes affect oxygen release from haemoglobin, leading to tissue hypoxia. Hypophosphatemia can also result in hemolysis.

Rhabdomyolysis: Phosphate depletion impairs ATP production in muscles, which can lead to muscle breakdown and rhabdomyolysis.

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17
Q

Patients with GORD being considered for fundoplication surgery require what first?

A

Oesophageal pH and manometry studies

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18
Q

Antibiotic treatments for meningitis?

A

Less than three months or over 50yrs = IV cefotaxime + amoxicillin

3months - 50yrs give IV cefotaxime (or ceftriaxone).

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19
Q

If two pills are missed, between days 8-14 of the cycle, no emergency contraception is required, as long as the previous 7 days of COCP have been taken correctly

A

If two pills are missed, between days 8-14 of the cycle, no emergency contraception is required, as long as the previous 7 days of COCP have been taken correctly

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20
Q

If a patient with a STEMI is too far from a PCI centre how should the be managed?

A

Fibrinolysis (with streptokinase) + fondaparinux.

Fibrinolysis is given immediately with fibrinolytic agents e.g. streptokinase. An antithrombin like fondaparinux is given with fibrinolysis.

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21
Q

Severe campylobacter infection give…

A

Clarithromycin

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22
Q

Adverse effects of tamoxifen:

A

Menstrual disturbance: vaginal bleeding, amenorrhoea
Hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
Venous thromboembolism
Endometrial cancer

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23
Q

Hydroxychloroquine - may result in a severe and permanent retinopathy

A

Hydroxychloroquine - may result in a severe and permanent retinopathy

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24
Q

H.pylori is associated with what haematological malignancy?

A

MALT lymphoma: this is a cancer that arises from the mucosal-associated lymphoid tissue. It is a response to chronic Helicobacter pylori infection.

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25
Q

Coeliacs disease is associated with what haematological malignancy?

A

EATL: Coeliac disease increases the risk of developing enteropathy-associated T cell lymphoma

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26
Q

Anti-GBM disease typically presents with what?

A

Anti-GBM disease typically presents with haemoptysis + AKI/proteinuria/haematuria

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27
Q

TB diagnosis

A

Sputum culture

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28
Q

Chvostek’s sign =

A

Hypocalcaemia, tapping over parotid (CN7) causes facial muscles to twitch

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29
Q

Reducing dietary sodium is a key intervention in patients with ascites

A

Reducing dietary sodium is a key intervention in patients with ascites

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30
Q

When is Tamsulosin recommended for use in kidney stones?

A

NICE recommend these are considered for distal ureteric stones less than 10 mm in size

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31
Q

Renal stones management:

A

Simplified first-line NICE guidance (please see guidelines for more details) NICE
Renal stones
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy

Uretic stones
shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy

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32
Q

Hba1c range for pre-diabetes

A

prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol)

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33
Q

Reducing dietary sodium is a key intervention in patients with ascites + alcohol cessation.

A

Reducing dietary sodium is a key intervention in patients with ascites + alcohol cessation.

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34
Q

CML tx

A

Imantinib

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35
Q

Assessing correlation

A

Correlation
parametric (normally distributed): Pearson’s coefficient
non-parametric: Spearman’s coefficient

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36
Q

Treatment for vaginal vault prolapse

A

The treatment for vaginal vault prolapse is sacrocolpoplexy

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37
Q

Primary hyperparathyroidism is most commonly due to what?

A

A solitary adenoma`

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38
Q

A wide-based gait with loss of heel to toe walking =

A

Ataxic gait

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39
Q

Most common location of an ectopic

A

97% are tubal, with most in ampulla

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40
Q

Thiazide diuretics cause what electrolyte abnormalities?

A

Hyponatraemia
Hypokalaemia
Hypercalcaemia

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41
Q

Infectious diseases case: fever on alternating days, think what…?

A

Malaria

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42
Q

Sepsis ABG shows what?

A

Metabolic acidosis with a raised anion gap.

Patients who have sepsis often have a raised serum lactate due to the hypoperfusion of their peripheries. This gives them a metabolic acidosis with a raised anion gap.

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43
Q

Explain the most common inherited bleeding disorder:

A

The most common inherited bleeding disorder is Haemophilia A which is caused by a deficiency in factor VIII.

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44
Q

Treat what first in folate and B12 deficiency?

A

B12

The vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of spinal cord

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45
Q

Publication bias

A

When studies with negative results aren’t published.

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46
Q

Urinary 5-HIAA is the investigation of choice for…

A

Carcinoid tumours

  • Usually occurs when metastases are present in the liver and release serotonin into the systemic circulation. Presents with flushing diarrhoea and bronchospasm.
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47
Q

Cocaine causes chest pain give what?

A

Benzodiazepines + GTN

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48
Q

Causes of drug induced lupus?

A

Most common causes
Procainamide
hydralazine

Less common causes
isoniazid
minocycline
phenytoin

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49
Q

Rates of breast cancer screening:

A

Every 3 years for women 50-70yrs

50
Q

Tx for type A aortic dissection

A

Labetalol + surgery

51
Q

Extra renal manifestations of ADPKD:

A

liver cysts (70% - the commonest extra-renal manifestation): may cause hepatomegaly
berry aneurysms (8%): rupture can cause subarachnoid haemorrhage
cardiovascular system: MITRAL VALVE PROLAPSE, mitral/tricuspid incompetence, aortic root dilation, aortic dissection
cysts in other organs: pancreas, spleen; very rarely: thyroid, oesophagus, ovary

52
Q

Management of TIA on a patient on warfarin:

A

If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be admitted immediately for imaging to exclude a haemorrhage

53
Q

Red eye - glaucoma or uveitis?

A

glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush

54
Q

Whooping cough tx

A

Whooping cough - azithromycin or clarithromycin if the onset of cough is within the previous 21 days

55
Q

Peripheral arterial disease with critical limb ischaemia: high-risk patients with short segment stenosis are more suited to endovascular revascularization rather than open bypass.

  • what’s the cut off?
A

> 10cm stenosis

56
Q

High risk of pre-eclampsia give what when?

A

A woman at moderate or high risk of pre-eclampsia should take aspirin 75-150mg daily from 12 weeks gestation until the birth.

57
Q

DVLA advice post MI rules?

A

Cannot drive for 4 weeks
One week for successfully treated by angioplasty.

58
Q

What murmur is seen in HOCM?
- what are it’s features?

A

HOCM may present with ejection systolic murmur, louder on performing Valsalva and quieter on squatting

59
Q

What is meant by a ‘subcapital fracture’

A

A subcapital fracture is the commonest type of intracapsular fracture of the proximal femur.

60
Q

What determines severity in tetralogy of fallot?

A

Tetralogy of Fallot: the severity of the right ventricular outflow tract obstruction (pulmonary stenosis) determines the degree of cyanosis and clinical severity.

61
Q

What bloods are seen in antiphospholipid syndrome?

A

Antiphospholipid syndrome: (paradoxically) prolonged APTT + low platelets

62
Q

What anaesthetic agent is preferred in haemodynamically unstable patients?

A

Ketamine

63
Q

Dry ARMD tx

A

High dose of beta-carotene, vitamins C and E, and zinc can be given to slow deterioration of visual loss.

Anti-veg F for wet amd only!!!!

64
Q

IgA deficiency increases the risk of anaphylactic blood transfusion reactions

A

IgA deficiency increases the risk of anaphylactic blood transfusion reactions

65
Q

Mild rosacea give…

A

Brimonidine gel

For patients with rosacea with predominant flushing but limited telangiectasia, consider prescribing brimonidine gel.

66
Q

PSC is associated with what antibodies?

A

PSC is associated with anti-neutrophil cytoplasmic antibodies (ANCA) and anti-smooth muscle cell antibodies.

67
Q

Limited systemic sclerosis antibodies…?

A

Limited (central) systemic sclerosis = anti-centromere antibodies

68
Q

Key features of polymyalgia rheumatic:
- features
- inv
-management

A
  • Stiff and painful but 5/5 power!
  • Raised ESR, normal CK!
  • Pred - should have dramatic responseH
69
Q

Haemochromatosis monitoring

A

Ferritin and transferrin saturation

70
Q

Why does a varicocele develop in RCC?

A

Left sided varicocele (due to occlusion of left testicular vein)

71
Q

Haematuria 2ww guidelines

A

Aged >= 45 years AND:
unexplained visible haematuria without urinary tract infection, or
visible haematuria that persists or recurs after successful treatment of urinary tract infection

Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test

72
Q

Management of a ‘septated ovarian cyst’

A

Complex (i.e. multi-loculated) ovarian cysts should be biopsied with high suspicion of ovarian malignancy.

73
Q

COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features, do what?

A

→ add a LABA + LAMA

74
Q

Disproportionate microcytic anaemia - think

A

Beta-thalassaemia trait
Raised HbA2

75
Q

ECG finding for cardiac tamponade

A

cardiac tamponade will have a phenomenon called ‘electric alternans’- beat to beat variation in electrical amplitude.

76
Q

Posterior MI ECG presentation?

A

Posterior MI typically present on ECG with tall R waves V1-2

77
Q

Restless leg syndrome tx

A

Restless leg syndrome - management includes dopamine agonists such as ropinirole

78
Q

A 19-year-old lady is admitted with lower abdominal pain. On examination she is diffusely tender. A laparoscopy is performed and at operation multiple fine adhesions are noted between the liver and abdominal wall. Her appendix is normal.

  • diagnosis?
A

This is Fitz Hugh Curtis syndrome in which pelvic inflammatory disease (usually Chlamydia) causes the formation of fine peri hepatic adhesions.

79
Q

Indications for steroids in sarcoidosis

A

Indications for corticosteroid treatment for sarcoidosis are: parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement.

80
Q

Liver disease + ANA/SMA/LKM1 antibodies, raised IgG levels =

A

Auto-immune hepatitis

81
Q

What is considered a normal anion gap?

A

10-18mmol

82
Q

Pathophysiology of seborrhoeic dermatitis

A

Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population.

83
Q

Treatment of seborrhoeic dermatitis:

A

Scalp disease management
First-line treatment is ketoconazole 2% shampoo
over the counter preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’) may be used if ketoconazole is not appropriate or acceptable to the person.

Face and body management
Topical antifungals: e.g. ketoconazole
Topical steroids: best used for short periods
Difficult to treat - recurrences are common

84
Q

Baby under 3 months old needs what inv?

A

Full blood count
Blood culture
C-reactive protein
Urine testing for urinary tract infection
Chest radiograph only if respiratory signs are present
Stool culture, if diarrhoea is present

85
Q

Management of thyrotoxic crisis

A

Thyrotoxic storm is treated with beta blockers, propylthiouracil and hydrocortisone

86
Q

BRCA2 mutation is associated with what cancer in men?

A

Prostate

87
Q

Pepperpot skull is a characteristic X-ray finding of

A

Hyperparathyroidism

88
Q

Management of primary hyperaldosteronism

A

Spironolactone

89
Q

Growth failure, tachycardia and tachypnoea in the context of weak femoral pulses think

A

CoA

90
Q

What is TACO and what is TRALI and how to differentiate them?

A

Transfusion-associated circulatory overload (TACO) - pulmonary oedema + HYPERtension = slow / stop transfusion, consider oxygen and furosemide.

Transfusion-related acute lung injury (TRALI) - Hypoxia, pulmonary infiltrates on chest x-ray, fever, HYPOtension = oxygen and escalate.

91
Q

When to use CPAP or BIPAP in an exacerbation of COPD?

A

CPAP maintains open airways and supports oxygenation through constant air pressure delivery but does not assist in carbon dioxide removal as effectively as BiPAP, which mimics natural breathing patterns and thus aids both in oxygenation and CO2 elimination. CPAP is more suited for managing type 1 respiratory failure—defined by a PaO2 less than 8 kPa with normal PaCO2 levels—as seen in conditions such as acute heart failure or moderate-to-severe obstructive sleep apnoea.

This patient exhibits respiratory acidosis, characterised by a pH of less than 7.35 and a PaCO2 greater than 6 kPa, alongside type 2 respiratory failure, indicated by normal or reduced PaO2 with a PaCO2 exceeding 6 kPa. Given that these conditions have persisted despite optimal medical management, non-invasive ventilation (NIV) is warranted. The patient’s current ventilatory support is inadequate for the elimination of excess CO2. BiPAP is the most frequently utilised form of NIV for acute exacerbations of chronic obstructive pulmonary disease (COPD), as it prevents the rebreathing of exhaled gases, facilitates the reduction of CO2 retention, and more effectively ameliorates acid-base disturbances compared to continuous positive airway pressure (CPAP). Thus, BiPAP stands as the preferred modality for managing type 2 respiratory failure in this context. A pH below 7.25 would necessitate consideration for either intubation or admission to a high-dependency unit (HDU); however, this patient’s clinical parameters do not indicate such measures.

92
Q

Severe cellulitis tx

A

Severe cellulitis should be treated with co-amoxiclav, cefuroxime, clindamycin or ceftriaxone

93
Q

What type of ovarian pathology leads to Meig’s syndrome?

A

Fibroma

Meigs’ syndrome is a benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion

94
Q

Most common organism that causes SBP?

A

Spontaneous bacterial peritonitis: most common organism = E. coli

95
Q

Slapped cheek = organism

A

Parvovirus B19

96
Q

Inv for palps?

A
  1. Initial bloods and ECG
  2. Holter monitor
97
Q

Coa presentation
- murmur?

A

Coarctation of the aorta: acute circulatory collapse at 2 days of age when the duct closes- heart failure & absent femoral pulses. Systolic murmur heard under the left clavicle and over the back.

98
Q

Superficial thrombophlebitis tx

A

Compression stockings

99
Q

Intravenous drug users with infective endocarditis and back pain.
- what’s causing the back pain?

A

Discitis

100
Q

Treatment for seborrhoeic dermatitis?

A

Seborrhoeic dermatitis - first-line treatment is topical ketoconazole
(SD is caused by an inflammatory reaction to Malassezia furfur).

101
Q

There are two main tests used to compare two sets of observations. What are they and when is each used?

A

Non-normally distributed data → Wilcoxon signed-rank test
Normally distributed data → Paired t-test

102
Q

Absence of blast cells indicates what with regards to haematological malignancies?

A

Absence of blast cells indicates this is not acute leukaemia.

103
Q

How does kawasaki disease typically present?

A

Kawasaki disease is a systemic vasculitis that generally presents in the under 5s. Typical findings, as seen in this case, include an acute febrile illness lasting over 5 days, bilateral non-purulent conjunctivitis, unilateral cervical lymphadenopathy, a polymorphic rash, and mucosal erythema with a strawberry tongue. Swelling of the hands and feet can occur in the acute stage with desquamation in the second week. Coronary aneurysms can develop in up to one-quarter of untreated patients.

104
Q

How can carcinoid syndrome affect the heart?

A

Carcinoid syndrome can affect the right side of the heart. The valvular effects are tricuspid insufficiency and pulmonary stenosis.

TIPS!

105
Q

What is Kocher’s criteria?

A

Likelihood of septic arthritis in children:
Inability to bear weight - 1 point
Fever > 38.5ºC - 1 point
White blood cell count (WCC) > 12 10^9/L - 1 point
Erythrocyte sedimentation rate (ESR) > 40 mm/hr - 1 point

106
Q

What is topical chloramphenicol?

A

Eye drop antibiotic - given in cases of abraison.

107
Q

Overdose with a wide QRS suspect…

A

Tricyclic overdose - give IV sodium bicarb

108
Q

When should statins be taken?

A

Statins should be taken at night as this is when the majority of cholesterol synthesis takes place. This is especially true for simvastatin which has a shorter half-life than other statins.

109
Q

How is Boerrhaaves syndrome diagnosed?

A

CT contrast swallow is the investigation of choice for suspected Boerhaave’s syndrome.

110
Q

How is Boerrhaaves syndrome treated?

A

Treatment is with thoracotomy and lavage, if less than 12 hours after onset then primary repair is usually feasible, surgery delayed beyond 12 hours is best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin.

111
Q

Approach to insulin in DKA?

A

Start FIXED-rate insulin, continue regular long-acting insulin, and stop regular short-acting insulin

112
Q

A rare but recognised complication of corticosteroid therapy is steroid psychosis

A

A rare but recognised complication of corticosteroid therapy is steroid psychosis

113
Q

PLS check what pulses?

A

Paediatric BLS: In an infant, the appropriate places to check for a pulse are the brachial and femoral arteries.

114
Q

Describe the rash seen in dermatitis herpetiformis.

  • you struggle to identify it from photos
A

Itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)

  • manage with gluten free diet and dapsone.
115
Q

Subclinical hyperthyroidism is associated with what?

A

Atrial fibrillation
Osteoporosis
Dementia

116
Q

Avoid what antiemetic in bowel obstruction?

A

Avoid metoclopramide in bowel obstruction

117
Q

Cholangiocarcinoma tumour marker?

A

Ca 19-9

118
Q

Unfractionated heparin does what?

A

Activates antithrombin III

119
Q

Abdominal pain, constipation, neuropsychiatric features, basophilic stippling =

A

Lead poisoning

120
Q

What are the features of juvenile myoclonic epilepsy?

A

Juvenile myoclonic epilepsy is classically associated with seizures in the morning/following sleep deprivation.

Year 5 (9 decks)

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