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FFP Flashcards

1
Q

Cause of ischaemic hepatitis

A

Acute hypoperfusion eg low BP secondary to blood loss

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2
Q

Features of non proliferative diabetic retinopathy

A

No cupping of optic disc
No obvious pallor
Visible hard exudates
Haemorrhages
No sign of neovascularisation

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3
Q

How does proliferative diabetic retinopathy look different to pre proliferative on fundoscopy

A

Proliferative has neovascularisation

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4
Q

Triad of CRAO

A

Visual loss
RAPD
Red spot on the retina

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5
Q

What does high serum parathyroid level result in

A

Rule of E’s
Excess parathyroid results in excess phosphate ion excretion

Therefore fewer phosphate ions in circulation

Calcium raised

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6
Q

What (useful) side effects does mirtazapine have

A

Increased appetite
Increased sleep

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7
Q

Why is serum lipase more sensitive than amylase for a diagnosis of acute panc

A

Serum amylase may rise and fall quite quickly and lead to a false negative result

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8
Q

How can you differentiate spider naevi from telangiectasia

A

Spider naevi fill from the centre when pressed down on them
Telangiectasia fill from the edge

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9
Q

What medication can exacerbate psoriasis

A

B blockers
Lithium

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10
Q

How to differentiate between an upper and lower GI bleed

A

High urea levels indicates an upper GI bleed vs lower

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11
Q

Treatment of acute angle closure Glaucoma

A

IV acetazolamide (reduce aqueous secretions)
timolol (reduce aqueous humour productions)
Pilocarpine (open trabecular meshwork)
Apraclonidine eye drops ( alpha 2 agonist)

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12
Q

2nd line for bradycardia after atropine

A

External pacing

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13
Q

Why should you not give a CCI when B blocker is already being given

A

Can cause dangerous bradyarrhythmias including 3rd degree heart block

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14
Q

Features of optic neuritis

A

Subacute unilateral visual loss (colours)
Eye pain worse on movements

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15
Q

How to treat hypercalcaemia

A

Rehydration (3-4L of normal saline)
Then bisphosponates

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16
Q

Management of DKA

A

IV fluids
Then insulin infusion

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17
Q

Presentation of mitral regurgitation

A

High pitched holosystolic murmur
Palpable thrill at apex

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18
Q

What is the difference between a lobular carcinoma in situ and a ductal carcinoma in situ

A

Ductal carcinoma in situ is diagnosed by finding areas of microcalcification on mammogram - are confined to the mammary duct by the BM.

Lobular carcinoma in situ - no microcalcification, stromal reactions of palpable breast masses - usually an incidental finding on biopsy

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19
Q

DKA diagnostic criteria

A

Glucose >11 or known DM
PH <7.3
Bicarbonate <15
Ketones >3mmol/l or urine ketones ++

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20
Q

Management of diabetic ketoacidosis

A

Fluid replacement (IV isotonic saline)
Insulin IV
Correct electrolyte disturbance
Long acting insulin should be continued, short acting insulin should be stopped

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21
Q

Features of pericarditis

A

Sharp and pleuritic chest pain
Relieved by leaning forward
Exacerbated by deep breathing
Fever
Malaise
PR segment depression on ECG

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22
Q

Long term management of coeliac disease

A

Lifelong gluten free diet
Pneumococcal vaccine with booster every 5 years

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23
Q

Management of new onset AF

A

Begin anticoagulation
Immediate DC cardioversion

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24
Q

What level is low in t1 diabetes

A

C peptide

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25
Q

Management of heart failure with reduced ejection fraction

A

Beta blocker
ACEi
Spironolactone

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26
Q

What does trachea pulled towards white out indicate

A

Lung collapse

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27
Q

What does trachea pushed away from the white out suggest

A

Pleural effusion

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28
Q

Treatment of orthostatic hypotension

A

Fludrocortisone and midodrine

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29
Q

What features are seen in Graves’ disease that aren’t seen in other causes of thyrotoxicosis

A

Exophthalmos
Ophthalmoplegia
Pretibial myxoedema
Digital clubbing
Soft tissue swelling of the hands and feet
Periosteal new bone formation

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30
Q

Management of acute heart failure not responding to treatment

A

CPAP

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31
Q

CF of acute angle closure glaucoma

A

Acute, painful, non reactive, red left eye
Loss of pupillary reaction to light
Corneal oedema

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32
Q

Management of acute angle closure glaucoma

A

Direct parasympathomimetic and B blocker eye drops

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33
Q

When is verapamil contraindicated

A

In ventricular tachycardia as can cause severe hypotension, ventricular fibrillation or cardiac arrest

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34
Q

What does persistent ST elevation with no chest pain following an MI indicate

A

Left ventricular aneurysm

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35
Q

Which medications are a risk factor for C diff infection

A

PPI’s

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36
Q

Which statin should be given for secondary prevention of CVD

A

Atorvastatin 80

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37
Q

How to differentiate between pericarditis and myocarditis

A

Both present with viral symptoms, raised inflammatory markers and chest pain in a younger person

Pericarditis doesn’t cause signs and symptoms of left ventricular dysfunction, doesn’t cause raised troponin and there will be global ST elevation

Myocarditis: pulmonary oedema, raised troponin, non specific ST segment and T wave changes

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38
Q

How long is carbimazole given in Graves’ disease

A

12-18 months as it induces remission

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39
Q

ABCDE features of heart failure on a CXR

A

Alveolar oedema (bats wings)
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)

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40
Q

How to differentiate between gastric and duodenal ulcers

A

Gastric ulcers worsen with food
Duodenal ulcers relieved with food

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41
Q

MOA of loperamide

A

Reduction in gastric motility through stimulation of opioid receptors

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42
Q

Hepatocellular disease pattern in LFTs

A

ALT raised at least 2 fold
ALP normal
ALT/ALP 5+

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43
Q

Cholestatic disease pattern in LFTs

A

ALT: normal
ALP: raised at least 2 fold
ALT/ALP <2

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44
Q

Mixed disease pattern in LFTs

A

ALT: raised at least 2 fold
ALP: raised at least 2 fold
ALT /ALP: 2-5

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45
Q

What is the target oxygen levels for patients with COPD

A

Aim for 88-92 when giving oxygen therapy before obtaining blood gas results
Adjust target range to 94-98% if the pCO2 is normal

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46
Q

How to differentiate between iron deficiency anaemia and anaemia of chronic disease

A

Total iron binding capacity is high in iron deficiency anaemia
Total iron binding capacity is low / normal in anaemia of chronic disease

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47
Q

1st line treatments for neuropathic pain

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

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48
Q

How does UC look on barium enema

A

Lead pipe colon
Loss of haustral markings in the distal part of the bowel

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49
Q

Which biomarker shows re-infarction after MI

A

CK-MB
Troponin stays elevated for 10 days after MI so is not useful indicator of re-infarction

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50
Q

Causes of lower zone fibrosis (ACID)

A

Asbestos
Connective tissue disease
Idiopathic pulmonary fibrosis
Drugs eg methotrexate, nitrofurantoin

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51
Q

When is bilateral hilar lymphadenopathy seen

A

Tuberculosis

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52
Q

Management of alcoholic ketoacidosis

A

Saline infusion
Thiamine

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53
Q

How does pancreatic Ca present on LFTs

A

Cholestatic eg normal ALT but raised ALP

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54
Q

Treatment to maintain remission in UC

A

Oral azathioprine
If a patient has had a severe relapse or >2 exacerbations in the past

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55
Q

Which acid base imbalance is expected in Cushing’s syndrome

A

Hypokalaemia metabolic alkalosis

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56
Q

Key LFT finding in alcoholic hepatitis

A

AST/ALT ratio is 2:1

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57
Q

H pylori eradication triple therapy

A

Lansoprazole + amoxicillin + clarithromycin

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58
Q

Investigation for vitamin B12 deficiency

A

Intrinsic factor antibody titre

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59
Q

What spirometry results are indicative of asthma

A

An increase in FEV1 of 12% or more after inhalation of a SABA

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60
Q

How to differentiate between HHS and DKA

A

HHS has no acidosis / signficant ketosis
HHS has a longer history
HHS has more significantly raised glucose eg >30

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61
Q

How to differentiate between periorbital and orbital cellulitis

A

Periorbital has an absence of painful movements, absence of Diplopia and absence of visual impairment

62
Q

What is SCC associated with

A

Non healing painless ulcer associated with scar

63
Q

What is the AST to ALT ratio in alcoholic hepatitis

A

2:1

64
Q

What antibiotic is used as prophylaxis in COPD patients who continue to have exacerbations

A

Axithromycin

65
Q

What visual field defect is most likely to be present in a prolactinoma

A

Bi temporal superior quadrantanopia

66
Q

How long are people with shingles infective for

A

5-7 days until the vesicles have crusted over

67
Q

What is the range for impaired fasting glycaemia

A

6.1-6.9

68
Q

What is a lung volume reduction surgery

A

Used in treatment of alpha-1 antitrypsin deficiency as it removes the worst affected part of the lungs in order to improve airflow and alveolar gas exchange in the remaining portion of the lung

69
Q

Conditions that cause fibrosis of the upper lobes (CHARTS)

A

Coal workers pneumoconiosis
Histocytosis
Ankylosing spondylitis
Radiation
Tuberculosis
Silicosis / sarcoidosis

70
Q

What is used in the prophylaxis of oesophageal bleeding

A

A non cardio selective BB eg propranolol

71
Q

What is re-expansion pulmonary oedema

A

Interstitial damage plus hydrostatic imbalance that occur following rapid expansion of the underlying collapsed lung eg if a pleural effusion is drained to quickly

72
Q

Management of cholesteatoma

A

Referral to ENT for consideration of surgical removal

73
Q

What causes atopic eczema

A

A genetic defect in the skin barrier
Loss of function of the protein filaggrin that has a role in maintaining the skin barrier

74
Q

What is the management of otosclerosis

A

Hearing aid

75
Q

Thrombolysis contraindication

A

INR >2

76
Q

Management of femoral hernia

A

High risk of strangulation
If asymptomatic: urgent elective low approach femoral hernia repair

77
Q

What type of inguinal hernia is more likely to strangulate

A

Indirect

78
Q

Management of symptomatic inguinal hernia

A

Open mesh repair

79
Q

What type of hernia comes through hasselbachs triangle

A

Direct inguinal

80
Q

Which nerve is most likely to be compromised in an inguinal hernia

A

Ilioinguinal

81
Q

Where does a para-umbilical hernia pass through

A

The side of the umbilicus

82
Q

When do you check lithium levels

A

12 hours post dose

83
Q

Contraindication to cochlear implant

A

Chronic infective otitis media

84
Q

What type of hearing loss does ear wax cause

A

Conductive

85
Q

What is the difference between critical limb ischaemia and acute limb ischaemia

A

Critical limb ischaemia is due to chronic arterial occlusion so symptoms are usually there for >2 weeks
Acute limb ischaemia has acute onset: pale, pulseless, pain, paralysis, paraesthesia, perishingly cold

86
Q

Management of chronic anal fissure

A

Topical glyceryl trinitrate

87
Q

What condition is toxic megacolon seen in

A

UC

88
Q

Important complication of scleritis

A

Perforation of the globe
Requires ophthalmology input within 24hrs

89
Q

What is the management of GCA

A
  1. Measure ESR / CRP
  2. If these are raised and there is clinical context, give high dose steroids
  3. Do a temporal artery biopsy
90
Q

What is the management of lithium toxicity

A

Haemodialysis

91
Q

What is dilated cardiomyopathy

A

Caused by sporadic genetic mutations
No real risk factors
Common in 30-60 yr
Has signs and symptoms of heart failure in addition to an arrhythmia eg AF

92
Q

When is the GRACE score used

A

To assess risk in patients with ACS

93
Q

When is PCI indicated

A

In patients with acute STEMI if:
A) presentation is within 12h of onset of symptoms
B) can be delivered within 120mins of when fibrinolysis could’ve been given

94
Q

When is cardiac resynchronisation therapy indicated

A

LBBB on ECG
LVEF <30%
NYHA class III

95
Q

When should edoxaban not be used

A

In patients with good kidney function as it is cleared too quickly

96
Q

Treatment for malignant HTN with evidence of end organ damage eg encephalopathy and papilloedema

A

IV labetalol

97
Q

Which parameter indicates haemodynamic instability

A

Hypotension

98
Q

What is a low pressure headache

A

Headache caused by a LP where a small volume of CSF is removed which reduces pressure

  • is treated with caffeine and fluids
99
Q

Adverse effects of sodium valproate

A
  • increased appetite and weight gain
  • alopecia
  • P450 enzyme inhibitor
  • ataxia
  • tremor
  • hepatitis
  • pancreatitis
  • thrombocytopaenia
  • teratogenic
100
Q

Management of acute asthma attack (OSHITME)

A

Oxygen
Salbutamol (neb 2.5-5)
Hydrocortisone (100mg IV or prednisolone 40-50PO)
Ipratropium bromide (500mcg)
Theophylline (aminophylline) 1g in 1L saline 0.5ml/kg/hr
Magnesium sulphate (2g IV over 2mins)
Estimate care (intubation and ventilation)

101
Q

How should recurrent C diff be treated

A

Oral fidaxomicin

102
Q

When is an ABG recommended in acute asthma

A

O2 sats <92

103
Q

How can glucocorticoids affects blood results

A

Can induce neutrophilia
Hypernatraemia

104
Q

What is first line therapy in idiopathic pulmonary fibrosis

A

Pirfenidone / nintedanib
Pulmonary rehabilitation

105
Q

What is the most common anatomical origin of epistaxis

A

Anterior nasal septum (Little’s area) as it is the confluence of 4 arteries

106
Q

What to think of when there is a rash and pain combined

A

Shingles

107
Q

Management of shingles

A

Antivirals within 72hrs unless <50 with mild truncal rash with mild pain

Analgesia

Infective until vesicles are crusted over usually 5-7days

108
Q

Management of hydronephrosis

A

Urethral catheter

109
Q

What type of incontinence is found with gonorrhoea infection

A

Urethral stricture

110
Q

Grading of internal haemorrhoids

A

Grade I Do not prolapse out of the anal canal
Grade II Prolapse on defecation but reduce spontaneously
Grade III Can be manually reduced
Grade IV Cannot be reduced

111
Q

What is the triad for a gastric volvulus

A

Vomiting
Pain
Failed attempts to pass an NG tube

112
Q

Where does biliary colic pain radiate to

A

Interscapular region

113
Q

Management of varicocele

A

Reassure and Observe

114
Q

Management of bladder cancer

A

Transurethral resection of the superficial lesions

115
Q

When is partial neprectomy indicated over radical nephrectomy

A

Partial if tumour is <7cm
Radical if >7cm

116
Q

How is aspirin sensitivity related to nasal polyps

A

Aspirin exacerbates respiratory symptoms by inhibiting the COX pathway of arachidonic acid metabolism leading to overproduction of leukotrienes

117
Q

Appearance of seborrhoeic keratosis

A

Brown, black or light tan colour
Growth looks waxy, scaly and slightly raised

118
Q

How to differentiate between a perforated eardrum and a base of skull fracture

A

Perforated eardrum is conductive hearing loss on the affected side

Base of skull fracture is sensorineural hearing loss

119
Q

How long should you wait before starting a second course of corticosteroids in psoriasis patients

A

4 weeks

120
Q

What is a sign of aortic dissection on CT angiography

A

False lumen

121
Q

How to differentiate between a syncope and a seizure

A

Syncopal episodes are associated with a rapid recovery and short post ictal period

122
Q

How to wean off medications in a medication overuse headache

A

Stop simple analgesia and triptans abruptly
Withdraw opioid analgesia gradually

123
Q

What are 6 complications of gallstones

A

Small bowel obstruction
Gall bladder Ca
Acute panc
Porcelain gallbladder
Mucocele of the gallbladder
Ascending cholangitis

124
Q

Why are varicoceles associated with male infertility

A

Raise scrotal temperature and lead to sperm dysfunction

125
Q

What is orchitis associated with

A

Mumps

126
Q

Management of keloid scars

A

Intra-lesional steroids
Sometimes excision but be wary can cause extra scarring

127
Q

What are the liver findings in RHF

A

Firm, smooth, tender and pulsatile liver edge

128
Q

Adverse effect of isoniazid

A

Peripheral neuropathy eg burning sensation of feet due to vitamin B6 deficiency

129
Q

Which cranial nerves are affected in vestibular schwannomas

A

V, VII and VIII

130
Q

Management of severe urticaria

A

Non sedating antihistamine eg cetirizine
+ 5 day course oral prednisolone

131
Q

What is the differnece between myocarditis and pericarditis

A

Pericarditis the pain is changed with movement and breathing
Myocarditis pain does not change with position or breathing

132
Q

What clinical finding indicates a tension pneumothorax over a simple pneumothorax

A

Hypotension

133
Q

How to differentiate between a dermatofibroma and a sebaceous cyst

A

Dermatofibroma dimples when pinches
Sebaceous cyst doesn’t

134
Q

Epistaxis last resort treatment

A

Ligation of the sphenopalatine artery

135
Q

What does radiotherapy for PCa increase risk of

A

Bladder, colon and rectal cancer

136
Q

Biggest risk factor for malignant otitis externa

A

Diabetes

137
Q

In diabetic retinopathy what do cotton wool spots represent

A

Areas of retinal infarction (pre-capillary arteriolar occlusion)

138
Q

What auto-antibodies are specific for Graves’ disease

A

Anti TSH receptor antibodies

139
Q

TFT expected to be seen in thyrotoxicosis

A

Low TSH
Raised free T4 and T3

140
Q

What should be done regarding insulin whilst recovering from DKA

A

Continue the patients usual subcut insluin detemir whilst on IV insulin

141
Q

How should long term benzodiazepines be withdrawn

A

Reduce the dose in steps of 1/8th of the daily dose every fortnight

142
Q

Major risk factor for HCC

A

Hep B

143
Q

MOA of antipsychotics

A

Dopamine receptor antagonism

144
Q

How can RCC lead to pedal oedema

A

RCC invades major blood vessels through renal veins, extending from the inferior vena cava to the RA
This leads to reduced venous drainage and the development of bilateral pedal oedema

145
Q

Low levels of which neurotransmitter are associated with the development of anxiety

A

GABA

146
Q

How to differentiate between anal fissure and haemorrhoids

A

Haemorrhoids present as painless rectal bleeding - often self limiting
Anal fissure - very painful rectal bleeding on defecation

147
Q

When are pseudocysts likely to be found

A

More than 4 weeks after an acute attack of panc
Associated with raised amylase

148
Q

MOA of metformin

A

Reduces hepatic gluconeogenesis and improves glucose uptake and utilisation in peripheral tissues

Should be reviewed in those with liver failure as tissue hypoperfusion may increase risk of lactic acidosis

149
Q

What is double duct sign

A

Dilatation of the pancreatic and common bile ducts due to obstruction seen on US / CT / MRI and is indicative of pancreatic cancer

150
Q

What are the classic features of IBS (ABC)

A

Abdominal pain
Bloating
Change in bowel habit

151
Q

Treatment of thyrotoxic storm

A

B blockers
Propylthiouracil
Hydrocortisone

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