FFP Flashcards
1
Q
Cause of ischaemic hepatitis
A
Acute hypoperfusion eg low BP secondary to blood loss
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
3
Q
How does proliferative diabetic retinopathy look different to pre proliferative on fundoscopy
A
Proliferative has neovascularisation
4
Q
Triad of CRAO
A
Visual loss
RAPD
Red spot on the retina
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
6
Q
What (useful) side effects does mirtazapine have
A
Increased appetite
Increased sleep
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
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
9
Q
What medication can exacerbate psoriasis
A
B blockers
Lithium
10
Q
How to differentiate between an upper and lower GI bleed
A
High urea levels indicates an upper GI bleed vs lower
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)
12
Q
2nd line for bradycardia after atropine
A
External pacing
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
14
Q
Features of optic neuritis
A
Subacute unilateral visual loss (colours)
Eye pain worse on movements
15
Q
How to treat hypercalcaemia
A
Rehydration (3-4L of normal saline)
Then bisphosponates
16
Q
Management of DKA
A
IV fluids
Then insulin infusion
17
Q
Presentation of mitral regurgitation
A
High pitched holosystolic murmur
Palpable thrill at apex
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
19
Q
DKA diagnostic criteria
A
Glucose >11 or known DM
PH <7.3
Bicarbonate <15
Ketones >3mmol/l or urine ketones ++
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
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
22
Q
Long term management of coeliac disease
A
Lifelong gluten free diet
Pneumococcal vaccine with booster every 5 years
23
Q
Management of new onset AF
A
Begin anticoagulation
Immediate DC cardioversion
24
Q
What level is low in t1 diabetes
A
C peptide
25
Management of heart failure with reduced ejection fraction
Beta blocker
ACEi
Spironolactone
26
What does trachea pulled towards white out indicate
Lung collapse
27
What does trachea pushed away from the white out suggest
Pleural effusion
28
Treatment of orthostatic hypotension
Fludrocortisone and midodrine
29
What features are seen in Graves’ disease that aren’t seen in other causes of thyrotoxicosis
Exophthalmos
Ophthalmoplegia
Pretibial myxoedema
Digital clubbing
Soft tissue swelling of the hands and feet
Periosteal new bone formation
30
Management of acute heart failure not responding to treatment
CPAP
31
CF of acute angle closure glaucoma
Acute, painful, non reactive, red left eye
Loss of pupillary reaction to light
Corneal oedema
32
Management of acute angle closure glaucoma
Direct parasympathomimetic and B blocker eye drops
33
When is verapamil contraindicated
In ventricular tachycardia as can cause severe hypotension, ventricular fibrillation or cardiac arrest
34
What does persistent ST elevation with no chest pain following an MI indicate
Left ventricular aneurysm
35
Which medications are a risk factor for C diff infection
PPI’s
36
Which statin should be given for secondary prevention of CVD
Atorvastatin 80
37
How to differentiate between pericarditis and myocarditis
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
38
How long is carbimazole given in Graves’ disease
12-18 months as it induces remission
39
ABCDE features of heart failure on a CXR
Alveolar oedema (bats wings)
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
40
How to differentiate between gastric and duodenal ulcers
Gastric ulcers worsen with food
Duodenal ulcers relieved with food
41
MOA of loperamide
Reduction in gastric motility through stimulation of opioid receptors
42
Hepatocellular disease pattern in LFTs
ALT raised at least 2 fold
ALP normal
ALT/ALP 5+
43
Cholestatic disease pattern in LFTs
ALT: normal
ALP: raised at least 2 fold
ALT/ALP <2
44
Mixed disease pattern in LFTs
ALT: raised at least 2 fold
ALP: raised at least 2 fold
ALT /ALP: 2-5
45
What is the target oxygen levels for patients with COPD
Aim for 88-92 when giving oxygen therapy before obtaining blood gas results
Adjust target range to 94-98% if the pCO2 is normal
46
How to differentiate between iron deficiency anaemia and anaemia of chronic disease
Total iron binding capacity is high in iron deficiency anaemia
Total iron binding capacity is low / normal in anaemia of chronic disease
47
1st line treatments for neuropathic pain
Amitriptyline
Duloxetine
Gabapentin
Pregabalin
48
How does UC look on barium enema
Lead pipe colon
Loss of haustral markings in the distal part of the bowel
49
Which biomarker shows re-infarction after MI
CK-MB
Troponin stays elevated for 10 days after MI so is not useful indicator of re-infarction
50
Causes of lower zone fibrosis (ACID)
Asbestos
Connective tissue disease
Idiopathic pulmonary fibrosis
Drugs eg methotrexate, nitrofurantoin
51
When is bilateral hilar lymphadenopathy seen
Tuberculosis
52
Management of alcoholic ketoacidosis
Saline infusion
Thiamine
53
How does pancreatic Ca present on LFTs
Cholestatic eg normal ALT but raised ALP
54
Treatment to maintain remission in UC
Oral azathioprine
If a patient has had a severe relapse or >2 exacerbations in the past
55
Which acid base imbalance is expected in Cushing’s syndrome
Hypokalaemia metabolic alkalosis
56
Key LFT finding in alcoholic hepatitis
AST/ALT ratio is 2:1
57
H pylori eradication triple therapy
Lansoprazole + amoxicillin + clarithromycin
58
Investigation for vitamin B12 deficiency
Intrinsic factor antibody titre
59
What spirometry results are indicative of asthma
An increase in FEV1 of 12% or more after inhalation of a SABA
60
How to differentiate between HHS and DKA
HHS has no acidosis / signficant ketosis
HHS has a longer history
HHS has more significantly raised glucose eg >30
61
How to differentiate between periorbital and orbital cellulitis
Periorbital has an absence of painful movements, absence of Diplopia and absence of visual impairment
62
What is SCC associated with
Non healing painless ulcer associated with scar
63
What is the AST to ALT ratio in alcoholic hepatitis
2:1
64
What antibiotic is used as prophylaxis in COPD patients who continue to have exacerbations
Axithromycin
65
What visual field defect is most likely to be present in a prolactinoma
Bi temporal superior quadrantanopia
66
How long are people with shingles infective for
5-7 days until the vesicles have crusted over
67
What is the range for impaired fasting glycaemia
6.1-6.9
68
What is a lung volume reduction surgery
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
Conditions that cause fibrosis of the upper lobes (CHARTS)
Coal workers pneumoconiosis
Histocytosis
Ankylosing spondylitis
Radiation
Tuberculosis
Silicosis / sarcoidosis
70
What is used in the prophylaxis of oesophageal bleeding
A non cardio selective BB eg propranolol
71
What is re-expansion pulmonary oedema
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
Management of cholesteatoma
Referral to ENT for consideration of surgical removal
73
What causes atopic eczema
A genetic defect in the skin barrier
Loss of function of the protein filaggrin that has a role in maintaining the skin barrier
74
What is the management of otosclerosis
Hearing aid
75
Thrombolysis contraindication
INR >2
76
Management of femoral hernia
High risk of strangulation
If asymptomatic: urgent elective low approach femoral hernia repair
77
What type of inguinal hernia is more likely to strangulate
Indirect
78
Management of symptomatic inguinal hernia
Open mesh repair
79
What type of hernia comes through hasselbachs triangle
Direct inguinal
80
Which nerve is most likely to be compromised in an inguinal hernia
Ilioinguinal
81
Where does a para-umbilical hernia pass through
The side of the umbilicus
82
When do you check lithium levels
12 hours post dose
83
Contraindication to cochlear implant
Chronic infective otitis media
84
What type of hearing loss does ear wax cause
Conductive
85
What is the difference between critical limb ischaemia and acute limb ischaemia
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
Management of chronic anal fissure
Topical glyceryl trinitrate
87
What condition is toxic megacolon seen in
UC
88
Important complication of scleritis
Perforation of the globe
Requires ophthalmology input within 24hrs
89
What is the management of GCA
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
What is the management of lithium toxicity
Haemodialysis
91
What is dilated cardiomyopathy
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
When is the GRACE score used
To assess risk in patients with ACS
93
When is PCI indicated
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
When is cardiac resynchronisation therapy indicated
LBBB on ECG
LVEF <30%
NYHA class III
95
When should edoxaban not be used
In patients with good kidney function as it is cleared too quickly
96
Treatment for malignant HTN with evidence of end organ damage eg encephalopathy and papilloedema
IV labetalol
97
Which parameter indicates haemodynamic instability
Hypotension
98
What is a low pressure headache
Headache caused by a LP where a small volume of CSF is removed which reduces pressure
- is treated with caffeine and fluids
99
Adverse effects of sodium valproate
- increased appetite and weight gain
- alopecia
- P450 enzyme inhibitor
- ataxia
- tremor
- hepatitis
- pancreatitis
- thrombocytopaenia
- teratogenic
100
Management of acute asthma attack (OSHITME)
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
How should recurrent C diff be treated
Oral fidaxomicin
102
When is an ABG recommended in acute asthma
O2 sats <92
103
How can glucocorticoids affects blood results
Can induce neutrophilia
Hypernatraemia
104
What is first line therapy in idiopathic pulmonary fibrosis
Pirfenidone / nintedanib
Pulmonary rehabilitation
105
What is the most common anatomical origin of epistaxis
Anterior nasal septum (Little’s area) as it is the confluence of 4 arteries
106
What to think of when there is a rash and pain combined
Shingles
107
Management of shingles
Antivirals within 72hrs unless <50 with mild truncal rash with mild pain
Analgesia
Infective until vesicles are crusted over usually 5-7days
108
Management of hydronephrosis
Urethral catheter
109
What type of incontinence is found with gonorrhoea infection
Urethral stricture
110
Grading of internal haemorrhoids
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
What is the triad for a gastric volvulus
Vomiting
Pain
Failed attempts to pass an NG tube
112
Where does biliary colic pain radiate to
Interscapular region
113
Management of varicocele
Reassure and Observe
114
Management of bladder cancer
Transurethral resection of the superficial lesions
115
When is partial neprectomy indicated over radical nephrectomy
Partial if tumour is <7cm
Radical if >7cm
116
How is aspirin sensitivity related to nasal polyps
Aspirin exacerbates respiratory symptoms by inhibiting the COX pathway of arachidonic acid metabolism leading to overproduction of leukotrienes
117
Appearance of seborrhoeic keratosis
Brown, black or light tan colour
Growth looks waxy, scaly and slightly raised
118
How to differentiate between a perforated eardrum and a base of skull fracture
Perforated eardrum is conductive hearing loss on the affected side
Base of skull fracture is sensorineural hearing loss
119
How long should you wait before starting a second course of corticosteroids in psoriasis patients
4 weeks
120
What is a sign of aortic dissection on CT angiography
False lumen
121
How to differentiate between a syncope and a seizure
Syncopal episodes are associated with a rapid recovery and short post ictal period
122
How to wean off medications in a medication overuse headache
Stop simple analgesia and triptans abruptly
Withdraw opioid analgesia gradually
123
What are 6 complications of gallstones
Small bowel obstruction
Gall bladder Ca
Acute panc
Porcelain gallbladder
Mucocele of the gallbladder
Ascending cholangitis
124
Why are varicoceles associated with male infertility
Raise scrotal temperature and lead to sperm dysfunction
125
What is orchitis associated with
Mumps
126
Management of keloid scars
Intra-lesional steroids
Sometimes excision but be wary can cause extra scarring
127
What are the liver findings in RHF
Firm, smooth, tender and pulsatile liver edge
128
Adverse effect of isoniazid
Peripheral neuropathy eg burning sensation of feet due to vitamin B6 deficiency
129
Which cranial nerves are affected in vestibular schwannomas
V, VII and VIII
130
Management of severe urticaria
Non sedating antihistamine eg cetirizine
+ 5 day course oral prednisolone
131
What is the differnece between myocarditis and pericarditis
Pericarditis the pain is changed with movement and breathing
Myocarditis pain does not change with position or breathing
132
What clinical finding indicates a tension pneumothorax over a simple pneumothorax
Hypotension
133
How to differentiate between a dermatofibroma and a sebaceous cyst
Dermatofibroma dimples when pinches
Sebaceous cyst doesn’t
134
Epistaxis last resort treatment
Ligation of the sphenopalatine artery
135
What does radiotherapy for PCa increase risk of
Bladder, colon and rectal cancer
136
Biggest risk factor for malignant otitis externa
Diabetes
137
In diabetic retinopathy what do cotton wool spots represent
Areas of retinal infarction (pre-capillary arteriolar occlusion)
138
What auto-antibodies are specific for Graves’ disease
Anti TSH receptor antibodies
139
TFT expected to be seen in thyrotoxicosis
Low TSH
Raised free T4 and T3
140
What should be done regarding insulin whilst recovering from DKA
Continue the patients usual subcut insluin detemir whilst on IV insulin
141
How should long term benzodiazepines be withdrawn
Reduce the dose in steps of 1/8th of the daily dose every fortnight
142
Major risk factor for HCC
Hep B
143
MOA of antipsychotics
Dopamine receptor antagonism
144
How can RCC lead to pedal oedema
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
Low levels of which neurotransmitter are associated with the development of anxiety
GABA
146
How to differentiate between anal fissure and haemorrhoids
Haemorrhoids present as painless rectal bleeding - often self limiting
Anal fissure - very painful rectal bleeding on defecation
147
When are pseudocysts likely to be found
More than 4 weeks after an acute attack of panc
Associated with raised amylase
148
MOA of metformin
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
What is double duct sign
Dilatation of the pancreatic and common bile ducts due to obstruction seen on US / CT / MRI and is indicative of pancreatic cancer
150
What are the classic features of IBS (ABC)
Abdominal pain
Bloating
Change in bowel habit
151
Treatment of thyrotoxic storm
B blockers
Propylthiouracil
Hydrocortisone
