Final Revision Content Flashcards
1
Q
fesWhat is labetalol used for?
A
Beta blocker which is a first-line antihypertensive for pregnant women.
2
Q
X ray features of COPD
A
Hyperinflated lungs
Flattened diaphragm
Bullae formation
3
Q
What is the management of HHS?
A
IV fluids (0.9% saline) + VTE prophylaxis with enoxaparin (LMWH) as there is hygher risk due to dehydration.
4
Q
Non-diabetic causes of hypoglycaemia
A
EXPLAIN
Exogenous insulin administration
Pituitary insufficiency
Liver disease
Addison’s disease (adrenal insufficiency)
Insulinoma
Non-pancreatic cancers e.g fibrosarcoma
5
Q
Acute management of SIADH <48 hours
A
IV hypertonic saline and fluid restriction/furosemide
6
Q
Management of >48 hours SIADH
A
IV hypertonic saline
Fluid restriction - NOT IF SAH
Demeclocycline (tetracycline antibiotic)
Tolvaptan - V2 receptor antagonist
7
Q
Causes of secondary hyperaldosteronism
A
Increased renin through:
Renal artery stenosis
Heart failure
8
Q
Aetiology of prmary hyperaldosteronism
A
Bilateral adrenal hyperplasia - most common
Adrenal adenoma - Conn’s syndrome
9
Q
Gold standard investigation for primary hyperaldosteronism
A
Adrenal vein sampling
10
Q
Examples of potassium sparing diuretics
A
Amiloride, spironolactone
11
Q
Investigation of Pituitary adenoma
A
Pituitary MRI
MEN1 gene testing
12
Q
Dermatoligical signs/symptoms of Addison’s disease
A
Hyperpigmentation - esp palmar creases/buccal mucosa
Vitiligo - loss of skin pigment due to androgen loss
Loss of pubic hair
13
Q
Prescription costs
A
9.65 pounds
14
Q
Management of Addisonian/adrenal crisis
A
Iv fluids
Iv hydrocortisone 5oomg
15
Q
Aetiology of hypercalcaemia
A
Calcium excess suplements
H
I
M
P
A
N
Z
E
E
Hyperparathyroidism
Milk-alkali syndrome
Sarcoidosis
Thyrotoxicosis
Thiazides, lithium
Squamous cell lung carcinoma
16
Q
Clinical Presentation of Hypocalcaemia
A
CATS go numb
Convilsions
Arrythmias (palpitations)
Tetani (spasms)
Dermatitis, impetigo herpetiformis in pregnancy.
17
Q
Causes of primary hypoparathyroidism
A
Surgical excision
Radiation exposure
DiGeorge syndrome
Polyglandular autoimmune syndrome T1
Haemochromatosis, Wilson’s Disease
18
Q
Clinical presentation of carcinoid syndrome
A
FADD
Flushing
Abdominal pain/cramps
Diarrhoea
Dyspnoea
19
Q
Management of carcinoid syndrome
A
Somatostatin analogues e.g ocreotide
20
Q
Investigation of pheochromcytoma
A
FL - 24 hour urinary metanephrine testing
GS - CT adrenal
21
Q
Management of pheochromocytoma
A
Alpha blockade before beta blockade to prevent hypertensive crisis
GS: Laporoscopic adrenalectomy
22
Q
Drugs that cause hyperkalaemia
A
NASH
NSAIDs
ACEi
Spironolactone, amiloride
Heparin
23
Q
How is ALP in parathyroid disorders?
A
All raised
24
Q
Lab values for pseudohypoparathyroidism
A
High PTH, low Ca, high Ph, high ALP
25
Which genetic condition is associated with pseudohypoparathyroidism?
T1 Alrbright hereditary osteodystrophy
26
What alpha antagonist is usually prescribed to treat pheochromocytoma
Phenoxybenzamine
27
Macrovascular complications of diabetes
Stroke, ischaemic heart disease, peripheral vascular disease
28
Management of haemhorroids
Non-surgical
Band ligation
Injection sclerotherapy
Surgical: Haemorrhoidectomy
29
Aetiology of anal fistula
Anorectal abscess - mc
Crohn's disease
TB
30
Which anal diseases have pruritus ani?
Haemhorroids, anal fistula
31
Which anal disease has pain during defecaetion?
Anal fissure
32
Which anal disease has pain during sitting?
Anal fistula
33
Which anal diseases can have smelly discharge?
Anal fistula or anal abscess.
34
Which epithelium is affected in an anal fissure?
Squamous keratinizing epithelium distal to dentate line.
35
Tx of anal fistula
Fistulotomy
36
Tx of anal fissure
FL = lidocaine
SL = botox
37
RF for diverticulitis
CONS
Constipation
Obesity
NSAIDs
Smoking
38
Tx of Crohn's to induce remission
FL = glucocorticoids such as prednisolone, budesonide
SL = DMDs such as azathioprine (5-ASA), or methotrexate.
TL = biologics e.g infliximab
39
Tx of Crohn's to maintain remission
FL = azathioprine (5-ASA) + methotrexate
40
Which MHC class is associated with Crohns and UC
Crohns is MHC 1
UC = MHC 2
41
What is the macroscopic appearance of UC & crohns bowel
Islandic pseudopolyps in UC, cobblestone in Crohn's
42
Dermatological lesions associated with coeliac disease
Dermatitis herpetiformis rash and angular stomatitis (sores in corner of mouth)
43
Histological features of Coeliac disease
Villous atrophy
Crypt hyperplasia
Lymphocyte infiltration
44
RF for oesophageal adenocarcinoma
Barret's oesophagus = MC
Obesity
GORD
Hiatus hernias
45
RF for oesophageal squamous cell carcinoma
Smoking - more so than oesphageal adenocarcinoma
Alcoholism
Plummer-vinson syndrome - web like membraneous growth on oesophagus.
Caustic ingestion e.g bleach
46
Extra-intestinal manifestations of IBD
A PIE SAC
Ankylosing spondylosis
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Apthous ulcers
Clubbing
47
Tx of mild ulcerative colitis
FL = 5-aminosalicylates e.g mesalazin
SL = steroids e.g prednisolone
48
Tx of moderate/severe ulcerative colitis
FL = IV hydrocortisone + biologics e.g infliximab.
49
Tx for maintaing UC remission
Azathioprine
50
Which scoring system is used for UC?
Truelove and Witts
<4 bowel movements = mild
4-6 = moderate
>6 = severe
51
What are the 2 types of stomach cancer?
T1 (intestinal) & T2 (diffuse)
52
Histological appearance of T1 vs T2 stomach cancer
T2 - signet ring cells
T1 - well formed tubules
53
What do you do if you suspect gastric cancer?
2 week endoscopy referral
54
Which side of the colon is affected by FAP?
Left + rectum
55
Which side of the colon is affected by HNCC/lynch syndrome?
Transverse and right
56
What is Psoas sign
Pain in appendicitis is worsened with hip extension
57
What is obturator sign
Pain in appendicitis worsens with flexion and internal rotation of hip
58
Tx for giardia lamblia diarrhoea
Metronidazole
59
Tx for pseudo-obstruction
Tx: Neostigmine + nasogastric decompression
60
Aetiology of LBO
Malignancy = most common
Sigmoid Volvulus
Diverticulitis
61
FL Ix for LBO/SBO
Abdominal X-ray
62
Bowel sounds in SBO vs LBO
Tinkling in SBO, absent in LBO
63
Clinical presentation of diverticulitis
BBL
Bloating
Bowel habit change
Lower left quadrant pain
+ fever, haematochezia
64
Examination of diverticulitis
Rebound tenderness
Guarding
Bowel sounds absent
65
Ix of mesenteric ischaemia
GS: CT abdominal angiography
66
Ix of ischaemic colitis
GS: Colonoscopy
67
Sx of mesenteric ischaemia/ischaemic colitis
Colicky pain (left sided for ischaemic colitis)
Abdominal bruit heard
Shock symptoms - pallor, palpitations, etc.
68
RF for mesenteric ischaemia/ischaemic colitis
AF
Atherosclerosis
Obesity
Shock
69
Tx of mesenteric ischaemia/ischaemic colitis
Abx - metronidazole + heparin + bowel resection surgery.
70
Aetiology of pseudomembraneous colitis
C.diff infection
CMV infection
71
Ix of pseudomembraneous colitis
Stool culture for c.diff
Colonoscopy + biopsy - owl eye inclusion bodies if CMV infection.
72
Felty syndrome Sx
NAS
Neutropaenia (recurrent/increased infections)
Arthritis (joint pain/swelling)
Splenomegaly
73
Which hormones other than glucagon can increase glucose levels?
Cortisol, GH, adrenaline (epinephrine)
74
What can group B strep (s.agalacticae) cause
Neonatal meningitis and sepsis
75
Examples of non-lactose fermenting gram negative bacilli
SSPP
Shigella salmonella proteus pseudomonas
76
Appearance of VZV rash
Can occur in areas of compression like belt line, bra line etc.
Mostly localized to the trunk.
77
Which test can be used for detecting viral antibody levels in the blood?
ELISA
enzyme linked immunosorbent assay
78
What are the antibodies in EBV infection serology?
EBV viral capsid antibody (EBVA) IgM and IgG
Latest production is of EBV nuclear antigen (EBNA) antibody so presence = longer infection.
79
Aetiology of infective mononucleosis
Group A strep
EBV
80
Tx for glandular fevere (infectious mononucleosis)
No contact sports for 6 months due to risk of bursting spleen since there would be splenomegaly.
81
What blood markers are looked for in HIV testing?
HIV antibodies, HIV p24 antigen, HIV RNA
82
What vaccine is involved in the 8 week baby check?
6 in 1 - diptheria, tetanus, h.influenzae B, hep B, polio, pertussis
Meningococcal
Rotavirus
83
What screening form is used for depression?
PHQ9 questionnaire
84
Abdominal imaging findings for bowel obstruction
Dilated bowel, absence of gas distal to dilation.
85
Management of Osteoarthritis
FL: Topical analgesia e.g diclofenac, capsaicin paracetamol
SL: Topical analgesia + paracetamol
TL: NSAIDs + topical analgesia + paracetamol
86
RF for Osteoarthritis
Female gender, increasing age, manual labour, obesity
87
4 DMARDs that can be used in RA treatment
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflonomide
88
Side Effects of Methotrexate
Nausea, mouth ulcers, anaemia
89
GS imaging for Ank Spond
MRI spine - perarticular bone marrow oedema.
90
X-ray changes in psoriatic arthritis
Pencil-in cup
Osteolysis of bone
DIPJ erosion
91
Dermatological presentation of reactive arthritis
Keratoderma blenhorragica
92
What is Enteric Arthritis
Arthritis secondary to IBD
93
Sx of polyarteritis nodosa
Livedo reticularis
Subcutaneous nodules
Abdominal pain
94
Sx of granulomatosis with polyangitis
Saddle-shaped nose
Haempoptysis
Haematuria
Hearing loss
95
Advice on taking bisphosphonates
Take it on an empty stomach
Take it with a glass of water
Remain upright for 30 mins after
96
Sx of fibromyalgia
WIDE
Widespread pain
Intense fatigue
Dfficulty sleeping,
Exaggerated pain response
97
Tx of fibromyalgia
Regular exercise, physiotherapy, CBT,
98
Tx of antiphospholipid syndrome
LMWH + Warfarin if non-pregnant
If pregnant, aspirin + heparin
99
Ix of dermato/polymyositis
Raised CK, LDH
GS = muscle biopsy
100
Tx of dermato/polymyositis
Oral corticosteroids e.g prednisolone.
101
Which conditions have livedo reticularis
Polymyalgia rheumatica
Antiphospholipid syndrome
102
Antibodies in diffuse cutaneous scleroderma
Anti-Scl-70, topoisomerase, RNA polymerase III antibodies
103
Tx of systemic sclerosis
Immunosuppression e.g cyclophosphamide
104
What condition is paget's disease associated with
Osteosarcoma
105
Ix of osteosarcoma
X ray: Sunburst appearance
106
Where does ewing's sarcoma arise from
Mesenchymal stem cells
107
Ix of primary bone tumours
FL = x-ray
GS = bone biopsy
108
RF for osteomalacia
CKD
Dietary vitamin D deficiency
Reduced sunlight exposure
109
Sx of osteomalacia
Bone pain, pain worsens on exercise, fatigue, pathological fractures.
110
Which drugs can cause osteomalacia
Anticonvulsants, rifampicin
111
X-ray appearance of Paget's diseaes
Cotton wool-skull
112
Tx for Paget's disease
Bisphosphonates
113
Most common cardiac complication of Marfan's
Mitral valve prolapse
114
Causes of Mechanical Lower Back Pain
Scoliosis
Lumbar spondylosis - loss of intervertebral disc compliance
Facet joint syndrome
Sciatica
Vertebral disc degeneration - can cause prolapse
Osteoarthritis
115
Pathophysiology of RA
Overproduction of TNF-a leads to synovitis.
Further cytokine release causes synovium to grow past joint margins to form a pannus.
The pannus destroyed articular cartilage and subchondral bone resulting in erosions.
Mutation in process of arginine to citrulline conversion causes presence of anti-CCP (citric citrullinated peptide) antibodies.
116
Sx of sarcoidosis
Fever, Fatigue
Dyspnoea
Dry cough
Anterior uveitis,
Lupus pernio - purple nodules on cheeks and nose.
Erythema nodosum
Lymphadenopathy
117
Diseases that can cause hilar lymphadenopathy
Sarcoidosis
TB
Silicosis
Hodgkin's lymphoma
118
Infectious aetiology of bronchiectasis
H.influenzae
P.aeruginosa
119
Ix of bronchiectasis
HRCT
Tram track airway apperance - bronchial thickening.
Signet ring sign - bronchial dilation.
120
Non-pharmacological airway clearance techniques for CF and bronchiectasis
Active breathing cycle, autogenic drainage
121
Pharmacological airway clearance for CF
Nebulised saline + dornase alfa
122
Pharmacological airway clearance for bronchiectasis
Nebulised saline + carbocisteine
123
Anti-inflammatory treatment for CF and bronchiectasis
Azithromycin/ibuprofen
124
Lung diseases with normal DLCO
Asthma, chronic bronchitis
125
Lung disease with reduced DLCO
Non-neurological restrictive lung diseases e.g IFP, sarcoidosis,
Emphysema.
126
Aetiology of exudative pleural effusion.
P.E
Pneumonia
Small cell lung carcinoma
Dressler's
127
GS Ix of pleural effusion
Thoracic ultrasound
128
X-ray signs of pleural effusion
Presence of meniscus
Costophrenic angle blunting
129
Thoracentesis results for pleural empyema
High LDH
Low pH <7.2
Positive culture
Turgid appearance
130
Specific signs of tension pneumothorax
Surgical emphysema
Distended neck veins - obstructive shock.
Pain worsening with inspiration
131
GOLD system for COPD grading
FEV1 percentage of predicted
1 = >80%
2 = 50-80%
3 = 30-50
4 = <30
132
Management of Acute COPD Exacerbation
O2 88-92
Nebulised SAMA + SABA
133
Contraindications of anti-muscarinics
BPH
134
Ix for hypersenstivity pneumonitis
Broncheoalveolar lavage + lung biopsy = lymphocytic infiltration
135
Ix for sarcoidosis
CXR - bilateral hilar lymphadenopathy + pulmonary infiltrates.
GS: Lung biopsy - non-caseating granulomas with schaumaunn and asteroid bodies.
Elevated serum ACE - marker for granulomatous inflammation.
136
Drug-induced causes of ILD
Nitrofurantoin
Methotrexate
Amiodarone
Bleomycin
137
Nature of cough for lung cancers
Ongoing for > 3 weeks
138
Paraneoplastic effect of large cell carcinoma
Produces hcG to result in gynaecomastia
139
Biopsy finding of squamous cell carcinoma
Keratin pearls
140
Sx of Horner's syndrome
Ptosis
Meiosis
Anhydrosis
Hoarse voice - RLN compression.
Pemberton’s sign - raising arms causes facial flushing and redness.
141
Asthma Ix
Testing for Airway Obstruction:
Spirometry
Bronchial Challenge Test
Peak Flow Test
Testing For Airway Inflammation:
Total Serum IgE
Eosinophil Count
Skin Prick Testing
FeNO MeasurementDLCO
DLCO is NORMAL in ASTHMA
142
What biologics can be used in asthma treatment
Omalizumab - anti Ige
143
Viral aetiology of pharyngitis
Rhinovirus
Adenoviruses
EBV, hepatitis
144
Bacterial aetiology of pharyngitis
N.gonnorhoea - oral sex
S.pyogenes
C.diptheriae
145
Tx of diptheriae infection
Clarithromycin
146
What is the centor critera
Indicates likelihood of a sore throat being of bacterial origin.
Tonsilar exudate (pus)
Tender anterior cervical adenopathy
Fever over 38°C (100.5°F) by history
Absence of cough.
147
Otitis media Ix
Otoscopy - inflamed tympanic membrane
148
2 Phases of Whooping Cough
Catarrhal Phase: Fever, mucosal inflammation.
Paroxysmal Phase: Periods of coughing followed by a long inspiration
149
Tx of whooping cough
Clarithromycin
150
Tx of croup
Nebulised adrenaline
151
Bacterial aetiology of CAP
S.pneumoniae
H.influenzae
K.pneumoniae
Moraxella catarrhalis
152
Bacterial aetiology of atypical pneumoniae
Leigonella pneumophiliae
Mycoplasma pneumoniae - Reynaud’s
Chlamydophila pneumoniae
Chlamydophila psittaci - birds, parrots
Coxiella burnetti - sheep
153
Examination of pneumonia
Localised coarse crackles
Increased tactile fremitus (vibration)
Bronchial breath sounds
154
Empirical Abx for HAP
Co-amoxiclav
155
Extra-Pulmonary Manifestations of TB
Bone: Pott’s disease, joint swelling.
Abdominal: Ascites, malabsorption.
GU: Dysuria, haematuria
CNS: Meningitis, CN palsy
Miliary: Widespread diffuse TB
156
S.E of pyrazinamide
Hepatitis, arthralgia, rash
157
RF for goodpastures
CASH
Cocaine
Alport syndrome
Smoking
HLA-DR15
158
Prophylactic drugs for contacts of those with meningitis
Ciprofloxacin
159
Genetic component of ALS
SOD1 mutation
160
Tx of PH
Sildenafil
161
Example of competitive inhibitor drug
Naloxone
162
Example of non-competitive inhibitor drug
Clopidogrel
163
What is morphine metabolised to and what are it's complication.
Morphine 6 glucoronide, excess can cause respiratory depression.
164
Targets for drugs
TIRE
Transporters
Ion channels
Receptors
Enzymes
165
What to use if clopidogrel is contraindicated in TIA secondary prevention?
MA dipyradamole
166
DVLA rules for TIA
No driving cars for a month
167
Tx for SAH
IV nimodipine
168
Sick day rule for Addison's
Double glucocorticoid dose for 48 hours, keep fludrocortisone levels the same.
169
S.E of metformin
Lactic acidosis, weight loss, B12 deficiency, gastric disturbance
170
3 regions and aetiology of acanthosis nigricans
Back of neck, under armpit, groin hypergpigmentation which can occur due to increased glucose
171
Tx of hypocalcaemia
IV calcium gluconate
172
Which types of seizures have automatism
Complex partial, absence seizures
173
Which organisms can cause meningitis in those who are immunocompromised?
TB, HIV, cryptococcus neoformans,
174
Definition of status epilepticus
Seizures that last longer than 5 mintues, or having >2 seizures with no regaining consciousness in between.
175
Tx of status epilepticus
Benzodiazepines e.g lorazepam, diazepam
SL = phenobarbital
176
Diagnostic criteria for epilepsy
2 or more sizures > 24 hrs apart
177
Tx of cauda equina syndrome
Decompression surgery
178
DVLA rules for seizures
Isolated seizure = 6 months no driving
Epilepsy = 12 months no driving
179
Is bell's palsy an UMN or LMN lesion, and does it have forehead sparing?
Bell's = LMN lesion so no forehead sparing.
180
Sx of bell's palsy
Ptosis, facial weakness, loss of taste, difficulty chewing
181
Tx of trigeminal neuralgia
Carbamazepine
182
Sx of occulomotor nerve palsy
Down and out eye appearance
Ptosis
Pupil dilation
183
RF for myasthenia gravis
Other autoimmune conditions in women
Thymic hyperplasia in men
184
Sx of myasthenia gravis
Myasthenic snarl
Diplopia, dysarthria, dysphagia
Muscle weakness that gets better with rest and worse with exercise.
185
Antibodies in MG
Anti-muscle specific kinase (MusK) antibodies
Anti acetylcholine recepter antibodies
186
Moa of isoniazid
Prevent mycolic acid formation in bacteria
187
Moa of pyrazinamide
Inhibits fatty acid synthetase enzyme
188
Complication of Myasthenia gravis with Tx
Myasthenia crisis where there is respiratory muscle dysfunction which can lead to respiratory failure and aspiration pneumonia.
Tx = Mechanical ventilation with IV immunoglobulins
189
Tx of lambert eaton
Pyridostigmine + IV immunoglobulins + steroids
190
Infectious aetiology of GBS
Campylobacter jejuni, Mycoplasma pneumoniae
CMV
EBV
191
L5 radiculopathy vs CPN lesion
Can invert foot in CPN lesion, cannot in L5 radiculopathy.
192
Tx of carpal tunnel syndrome
FL = wrist splint + steroid injections
GS = wrist decompression surgery
193
Aetiology of syncope
Dehydration
Extended periods of standing
Vasovagal response to stimuli such as blood
Anaemia
194
Ix of MS
GS: MRI brain and spinal cord - disseminated periventricular plaques.
Lumbar puncture - oligoclonal bands, raised IgG and myelin basic protein.
Evoked potentials - conduction delay.
195
Tx of RR MS
Relapsing-remitting (2 or more relapses within 2 years)
DMD e.g IM/SC interferon beta 1A or 1B
Natalizumab - prevents T lymphocytes crossing BBB
196
Management of Progressive MS
Ocrelizumab - anti CD20
197
What hypersensitivity reaction is MS
T4 - t cell mediated.
198
COMT inhibitors example
Entacapone
199
How does metformin cause lactic acidosis
Inhibits pyruvate decarboxylase enzyme which causes increased lactic acid production through glycolysis.
200
What 2 conditions can have trinucleotide repeat
Huntington - CAG trinucleotide repeat on HTT gene
Freidrichsen's taxia - frataxin gene trinucleotide repeat on chromosome 9.
201
Which MND is UMNL?
PLS
202
Which MND is LMN?
PMA and PBP
203
Pathophysiology of PLS
Loss of betz cells in motor cortex
204
What enzyme is mutated in ALS?
Superoxide dismutase causing increased oxidative stress
205
Tx of MND
Riluzole - Na channel blocker and glutamate antagonist.
206
Sx of Alzheimer's disease
Amnesia - episodic recent memory loss
Apraxia - cannot carry out skiled motor tasks
Agnosia - word finding difficulties
Aphasia - difficulty with speaking
207
Sx of vascular dementia
Step-wise cognitive decline
Incontinence, apraxia
208
Sx of lewy body dementia
Parkinsonism
Hallucinations
Sleep disturbances
209
Which cranial nerves are affected by progressive bulbar palsy?
9-12
210
What is given as prophylaxis for migraine
Propanolol, amyltriptiline
211
Ix of post-streptoccal glomerulonephritis
Light microscopy - hypercellular and enlarged glomerulus
Immunofluoresence - starry sky appearance.
212
What is a complication of lung adenocarcinoma and squamous cell carcinoma
Hypertrophic pulmonary osteoarthropathy
213
Sx of hypertrophic pulmonary osteoarthropathy
Clubbing, arthritis, long bone swelling
214
Where does small cell carcinoma come from?
Arises from neuroendocrine Kulchitsky cells
215
Autonomics Sx of cluster headache
Lacrimation
Meiosis
Ptosis
Rhinorrhoea
216
Sx of Duchenne's muscular dystrophy
Gower's sign - have to use hands wehen getting up
Waddling gait
Pelvic girdle muscle weakness
217
Sx of essential tremor
Responds to alcohol
Worse with movement
Symmetrical
Can be specific to an action
218
Sx of functional tremor
Entrainability - can synchronise with movemnt of another body part
Distractibility - increases when attention is paid to it
Whack a mole sign where tremor moves throughout body depending on where attention is being paid.
219
Sx of functional dystonia
Geste antagoniste - thinking about action can suppress the spasm.
220
Aetiology of cauda equina syndrome
Lumbar disc herniation
Lumbar vertebral tumour
221
Sx of wenicke's encephalopathy
Ataxia, confusion, opthalmoplegia
222
Sx of Korsakoff syndrome
Anterograde amnesia
Confabulation
223
What is the BP criteria in CURB-65
systolic < 90, diastolic < 60
224
FL drug for syphilis
Benzylpenicillin
225
Sx of tonic-clonic seizures other than the jerking
Eyes open
Post-ictal confusion
Loss of recall of events
226
Which hepatitis is most common in travelers?
Hep A
227
What is the more common inguinal hernia type?
Indirect inguinal hernia - passes through deep inbuinal ring into the inguinal canal
228
Which inguinal hernia can reduce easily and is not at risk for strangulation?
Direct inguinal hernia
229
Sx of colorectal cancer
Change in bowel habits
Anaemia
Weight loss
Iron deficiency anaemia - pallor, koilonychia
230
Triggerws for sickle cell crises
Parvovirus B19 vaccine
Grean beans
Anti-malarial medications
231
Criteria for stage 1 CKD
eGFR <60 ml/min/1.73 m for > 3 months
232
Tx of localised prostate cancer
Radical prostatectomy if <70yrs - excellent disease free survival
Radiotherapy = brachytherapy (implantation of radioactive material targeted at tumour)
Active surveillance if >70yrs and low risk
233
Tx of metastatic prostate cancer
Surgical castration
GnRH antagonists - goserelin
Androgen receptor antagonists - abiraterone
234
Tx of acute pulmonary oedema
High flow oxygen , IV furosemide, IV mprphine
235
ECG appearance of WPW syndrome
Wide QRS
Shortened PR
Delta wave
236
Achalasia vs Oesophageal cancer Sx
Achalasia = difficulty swallowing solids and liquids from the start
Oesophageal cancer - first difficulty with solids then liquids.
237
Ix for testicular cancer
Same day testicular US - GS
Tumour markers - AFP, Beta HCG, lactate dehydrogenase
238
Which testicular germ cell tumours are most associated with AFP as a tumour marker
Embryonal carcinoma
Yolk sac tumour
Teratoma
239
Tx for testicular cancer
Radical inguinal orchidectomy
240
What Sx can differentiate prostate cancer from BPH?
Constitutional symptoms + bone pain (e.g back pain) in prostate cancer.
241
Tx of nephrolithiases
Symptomatic: IV diclofenac, fluids
If < 5mm, excrete as passing
If > 5mm,
Extracorporeal shock wave lithotripsy
Percutaenous nephrolithectomy
242
RF for bladder cancer
Smoking
Age > 55
Male
Occupational exposure to chemicals e.g napthylamine
Drugs like cyclophosphamide
Schistosomiasis
243
Imaging for bladder cancer
CT urogram
244
3 most common sites for kidney stone formation
Vesicoureteric junction
Pelvic brim
Pelvi-ureteric junction
245
Causes of secondary nephrotic syndrome
Diabetes, amyloidosis, pyelonphritis
246
Contraindications of statins
Pregnancy, when taking macrolides due to risk of myopathy.
247
Adverse effects of statins
Myopathy, myalgia,
248
RF for focal segmental glomerulusclerosis
HIV, heroin, lithium
249
Aetiology of membraenous nephropathy
SLE
NSAID use
Schistosomiasis
250
RF for prostate cancer
BRCA2 gene
Smoking
Increasing age
High saturated fat diet
251
Ix of prostate cancer
FL: DRE hard, lumpy prostate
GS: Trans-rectal ultrasound
252
Tx of pyelonephritis
Co-amoxiclav + ciprofloxacin for min 7 days
if non responsive, co-amoxiclav + gentamicin
253
Tx of PKD
Tolvaptan and ocreotide - reduce cAMP for cyst growth
Nephrectomy
254
FL Tx for prostatitis
Oral ciprofloxacin
255
Ix for STI
NAAT
256
Ix for urethritis
Urine dip
MSUMC - GS
If STI suspected - NAAT
257
Sx of testicular torsion
Severe unilateral testicular pain
Nausea/vomiting
Negative Prehn's sign
Negative cremasteric reflex
258
Epididymo-orchitis vs testicular torsion
Prehn's sign and cremasteric reflex are negative in EO
259
Murmur of mitral stenosis
Mid-diastolic murmur with loud S1 snap
260
Murmur of mitral regurgitation
Pan-systolic murmur that radiates to the axilla
261
How does warfarin cause an initially pro-coagulant state?
It inhibits protein C,S,Z which are involved in preventing clotting.
262
Which herbal medicine can be used to treat depression and interacts with antidepressantsh?
St.John's Wort
263
X ray signs of TB
Dense homogenous opacities
Bilateral hilar lymphadenopathy
Ghon focus/complex
Pleural effusion
264
RF for berriliosis
Aerospace work
265
Methods to decrease carbon footprint of inhalers
Use dry powder/mist inhalers as they do not contain propellants
Return used inhalers to pharmacies
Use stronger inhalers with single doses rather than multiple doses.
Use non-pharmacological methods to reduce inhaler usage need.
266
Methods to increase medicine concordance
Make sure to check in with the patient that they have understood everything.
Demonstrate how to use certain devices like inhalers etc.
Give information on how to minimise side effects.
Provision of meditation reminder sheets.
267
Reasons for medicine non-concordance
Lack of understanding of the significance/process of taking the medication.
Not seeing an immediate improvement in symptoms.
Side effects
News/media influence.
Forgetting to take them.
268
What is social prescribing?
Involves use of a link worker to connect patient to social organisations such as volunteering services, etc.
269
Drugs that can interact with St.John's wort
Oral contraceptive pill, warfarin, statins, digoxin
270
S.E of antidepressants
Acid reflux - take with food
Vivid dreams - take in the morning
Constipation
271
What should be done if a patient on metformin is having a procedure with contrast?
Check creatinine levels a month before
If intra-arterial/IV, stop taking 48 hours prior.
272
What is the significance of water-soluble beta blockers
Less likely to cross BBB to cause vivid dreams.
273
MOa of mesalazine
Prevent leukocyte recruitment into the bowel wall to prevent inflammation.
274
How to monitor mesalazine
Is nephrotoxic so check urine dipstick, U + E, eGFR
275
Which specific alpha 1 receptors does tamsulosin block?
Alpha 1A and 1D
276
Why is tamsulosin contraindicated in cataract surgery?
Can cause intraoperative floppy iris syndrome (IFIS)
277
How to moniter methotrexate
Check FBC, renal function tests, liver function tests.
278
What diseases have shistiocytes?
TTP
HUS
DIC
279
Triad for HUS
Microangiopathic haemolytic anaemia
Thrombocytopaenia
AKI
280
What would be seen on BF for iron def anaemia?
Microcytic, hypochromic RBCs, pencil-shaped polikocytes, target cells.
281
What type of contraception should be used in women with epilepsy and why?
Progesterone only or intra-uterine because COCP has reduced effectiveness with anticonvulsants.
282
What 2 scoring systems are used for pancreatitis
Glasgow and Apache II
283
3 cancers that can produce ADH
Prostate cancer
Lymphoma
Small cell lung carcinoma
Thymic cancer
284
RF for pancreatic cancer
Smoking
Excessive aspirin usage
Alcohol
T2DM
285
Tx of chronic pancreatitis
Pancreatic enzyme replacement + PPI
286
Ix for chronic pancreatitis
FL Abdominal ultrasound
GS: Abdominal CT
- Pancreatic calcifications, pancreatic duct dilation, pancreatic atrophy
287
Ix for alcoholic steatohepatitis
Liver biopsy: Mallory bodies
FBC: Macrocytic anaemia
LFT: AST > ALT
288
Pathophysiology of NAFLD
Insulin resistance can cause decreased hepatic fatty acid oxidation leading to increased FA synthesis and steatosis. This eventually results in reactive oxygen species release which causes oxidative damage and inflammation = steatohepatitis.
289
RF for NAFLD
T2DM
Hypertension
Obesity
High fat diet
Increasing age
290
Pathophysiology of liver cirrhosis
Liver injury releases free radicals which promote stellate and kupffer cell activation, leading to further inflammation and fibrosis.
291
Pre-hepatic causes of portal HTN
Portal vein thrombosis
292
Intrahepatic cause of portal HTN
Cirrhosis
Schistosomiases
293
Post-hepatic causes of portal HTN
RH failure
Budd-Chiari syndrome
294
What are the phases of Hepatitis A infection
Incubation
Prodromal - rash, fever, RUQ pain
Icteric - Jaundice, SPUDS
Convalescent - recovery
295
What would LFTs show in viral hepatitis?
ALT > AST
296
What can be seen on serology for an acute hepatitis infection?
Anti-Hepatitis X Virus core IgM (e.g Anti-HBc IgM)
Hepatitis X Virus Surface Antigen (e.g HBsAg) - indicates ongoing infection
Hepatitis X e Antigen (e.g HBeAg) - indicates active viral replication and high transmissibility.
297
What can be seen on serology for a chronic hepatitis infection?
Anti-Hepatitis X core IgG
Hepatitis B surface antigen
Hepatitis X e antigen
298
What can be seen on serology for a patient who is vaccinated against hepatitis?
Anti-Hepatitis X surface antigen antibodies
299
What can be seen on serology for a patient who has hepatitis immunity through a past infection?
Anti-hepatitis X surface antigen antibodies
Anti-hepatitis X core IgG
300
Tx of Hep B
Pegylated IFN a + tenofovir/entecavir
301
Tx of hep E
Rivabarin
302
Tx of hep D
Pegylated IFN a
303
Tx of hep C
Direct acting antiviral therapy - elbasvir + ribavarin
304
Antibodies in T1 Autoimmune hepatitis
ANA, ASMA, Anti soluble liver antigen (ASLA)
305
Antibodies in T2 Autoimmune hepatitis
Anti Liver Kidney Microsome (Anti LKM1) and anti liver cytosol (anti-LC)
306
Ix of Autoimmune hepatitis
Serology - raised IgG
Liver biopsy - piecemeal necrosis
307
Tx of autoimmune hepatitis
Prednisolone + azathioprine
308
Moa of azathiprine
Inhibits purine synthesis
309
Sx of haemochromatosis
Arthralgia
Greying/bronzing of skin
Loss of libido
Malaise
310
Which gene is involved in Wilson's
ATP7B gene, chromosome 13
311
Pathophysiology of Wilson's Disease
Mutation cause increased copper absorption and dysfunction in ceruloplasmin transport causes decreased copper excretion into bile
312
Ix for wilson's disease
Decreased ceruloplasmin
Increased free copper
Decreased total copper
GS = liver biopsy
313
Sx of pancreatic adenocarcinoma
Courvoisier's sign - painless jaundice with palpable GB
SPUDS
Weight loss
Epigastric pain that radiates to the back
314
Ix of pancreatic adenocarcinoma
Raised serum Ca 19-9
FL imaging = abdo US
GS = abdominal CT with pancreatic protocol
315
Tx of pancreatic adenocarcinoma
Whipples procedure pancreaticoduodenectomy for head of pancreas.
316
GS Ix for PSC
MRCP - beaded appearance
NOT ERCP
317
What antibiotics can be used in ascending cholangitis and appendicits?
Metronidazole and cefuroxime
318
Tx of PBC
Ursodeoxycholic acid
Cholestyramine
319
What score is used to asess severity of liver cirrhosis?
Child-Pugh
320
Tx of hepatic encephalopathy
Lactulose - reduces colon pH to inhibit NH3 absorption.
Rifaximin - antibiotic that reduces NH3 producing gut bacteria.
321
Tx of paracetamol overdose
Activated charcoal if presenting within an hr
IV N-acetylcysteine if presenting longer.
322
What artery supplies AV node?
RCA
323
Tx of hereditry spherocytosis
Phototherapy/exchange blood transfusion
324
Diagnostic Ix for Sickle cell anaemia and thalassaemia
Haemoglobin electrophoresis
325
Blood film for Sickle Cell Disease
Sickle cells, howell-Jolly bodies due to splenic damage.
326
Sx of B12 deficiency anaemia
Lemon-yellow skin
Angular stomatitis
Glossitis
Confusion, parasthesia, muscle weakness/cramps
Pallor
327
Diagnostic investigation for leukaemias
Bone marrow trephine biopsy
328
Aetiology of non-megaloblastic anaemia
Hypothyroidism
Liver disease
Alcoholism
Drugs e.g azathiprine
329
Which translocation is associated with acute pro-myelocytic leukaemia?
t(15,17)
330
What translocation is associated with ALL
t(12,21)
331
Tx for acute promyelocytic leukaemia
All trans retinoic acid
332
WHat class of drug can be used for chemo treatment of AML?
Anthracyclines e.g daunorubicin whcih destroy mailgnant cell DNA through preventing DNA intercalation.
333
Sx specific to AML
Normal leukaemia signs + gum hypertrophy
334
What is a complication of CLL?
Richter's transformation where there is accumulation of B cells in lymph nodes causing lymphadenopathy and transformation into NHL>
335
Ann Arbor Staging for Lymphomas
1 - single lymph node spread
2 - multiple lymph nodes, same side of diaphragm
3 - spread to lymph nodes on both sides of diaphragm
4 - extra-nodal spread
336
Tx of HL
ABVD
Adriamicin
Bleomycin
Vinblastine
Dacarbazine
337
Tx for NHL
R-CHVP
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Vincristine
Prednisolone
338
Tx for ALL
PCVD
Prednisolone
Cyclophosphamide
Vincristine
Daunorubicin
339
General presentation os Leukaemia
Anaemia - dyspnoea, pallor, fatigue
Neutropaenia - infection, mouth ulcers
Thrombopaenia - easy bleeding,
High WCC - visual problems
Hepatosplenomegaly
Lymphadenopathy
340
Tx of multiple myeloma
Bortezomib (proteosome inhibitor) + dexamethasone
341
X-ray finding of multiple myeloma
Raindrop-skull
342
Urine electrophoresis findings of Multiple Myeloma
Bence-Jones proteins
343
What are the 2 phases of Malaria Life cycle
Erythrocytic and exo-erythrocytic
344
Describe exo-erythrocytic phase of malaria life cycle
Sporozoites present in mosquito saliva.
Get injected into blood after feeding and infect hepatocytes where they become merozoites.
Some merozoites in p.vivale and ovaxe infections become hypnozoites and remain latent in the hepatocyte.
345
Describe erythrocytic phase of malaria life cycle
With p.falciparum infection the merozoites get released into the blood and infect RBCs - become trophozoites.
Trophozoites mature into a schizont and then are released into the blood as merozoites.
Some merozoites infect other blood cells, others begin to mature as gametocytes which are taken up by mosquitoes.
346
What drug do you supply with isoniazid to prevent peripheral neuropathy
Pyridoxine - B6 supplement.
346
S.E of pyrazinamide
Arthralgia, rash, gout, hepatitis
347
What agar is used to culture TB
Lowenstein Jensen
348
What is used to culture neisseria
Thayer-Martin
349
Sx of malaria
Fever
Anaemia symptoms
350
RF for testicular torsion
Belt-clapper deformity
Trauma to the testicle
Anal intercourse
351
Why does p.falciparum cause the worst malaria disease?
Infected RBCs are coated by an adhesive protein that prevents splenic destruction and causes cytoadhesion.
352
Ix for malaria
Thick blood film to detect disease and thin blood film to detect specific species
Needs to be done 3x
353
Tx of uncomplicated malaria
Hydroxychloroquine
354
Tx of complicated malaria
IV artesunate + quinine
355
Tx of complicated malaria
IV artesunate + quinine
356
Examples of complications of malaria
Cerebral malaria - seizures
DIC
Bilious malaria - jaundice
357
Sx of polycythaemia vera
Post-bathing itching
Erythromelagia
Splenomegaly
358
Tx of polycythaemia vera
FL: venesection
SL: Low does aspirin, ruxolitinib
359
Tx of haemophilia
IV clotting factor infusion
Desmopressin to stimulate vWf release
360
Genetic aetiology of VWD
Autosomal dominant mutation on VW gene on chromosome 12
361
What clotting factor is VWD a carrier for?
VIII
362
Cushing's triad for raised ICP
Widened pulse pressure - increased systolic to maintain cerebral perfusion
Bradycardia,
irregular respiration
363
Which valve pathology causes narrow pulse pressure?
Aortic stenosis
364
Tx of VWD
Administer desmopressin
365
Aetiology of DIC
Trauma, acute pancreatitis, meningococcal septicaemia
366
Complication of MG and GBS
Respiratory depression and ARDS
367
What gene is mutated in TTP?
ADAMTS13
368
Pathphysiology of TTP
Gene inactivates vWF, mutation = vWf multimer formation & overactivity = increased clot formation = thrombocytopaenia.
369
Tx of TTP
Plasma exchange
370
Causes of secondary hypertension
Hyperaldosteronism
Pheochromocytoma
Renal artery stenosis - increased RAAS activation
371
Tx of ITP
IV immunoglobulins, prednisolone
372
What does alpha thalassaemia/sickle cell anaemia protect against?
Malaria
373
Tx of thalassaemia
Regular blood transfusions
Iron chelating agents - desferroxamine
374
Which antibiotics are nephortioxic
Vancomycin
Gentamicin
375
Which chromosomes are alpha and beta thalassaemia associated with?
Alpha = chromosome 16
Beta = chromosome 11
376
Complications of multiple myeloma
AKI
Spinal cord compression
377
Sx of left heart failure
Bi-basal crackles on auscultation
Paroxysmal nocturnal dyspnoea
Orthopnoea
Frothy sputum when coughing
Dyspnoea
378
Is aspirin a reviersible or irreversible COX enzyme inhibitor?
Irreversible
379
Blood electrolyte values for tumour lysis syndrome
Hyperkalaemia, hyperuricaemia, hyperphosphataemia, hypocalcaemia
380
Tx of tumour lysis syndrome
Allopurinol
381
What are the classes of T2DM treatment drugs you can use
Sulfonylureas - gliclazide
Thazodeneliones - pioglitazone, rosiglitazone
DPP4 inhibitors - sitagliptin,
GLP 1 agonists - semaglutide
SGLT2 inhibitors - dapagliflozin, canagliflozin
382
S.E of thazodeneliones
Increased risk of heart failure, fractures, weight gain
383
S.E of GLP-1 agonsits
Respiratory and urinary infections
384
What is the Sepsis Six
Give IV fluids, BS antibiotics, oxygen
Take blood cultures, measure serum lactate, and urine output
385
What is the diagnostic critera for HHS?
Severe hyperglycaemia >30mmol
Serum Osm <320 mOsm
No acidosis
No ketosis
386
Translocation for multiple myelome
t(11,14)
387
Tropical sprue vs coeliac diseaese
Can occur after returning from an exotic location, and presents like coeliac diseaes symptomatically and histoligically but no Hx of eating gluten.
388
Complications of chemotherapy
Myelosuppression
Alopecia
Infertility
Neutropaenic sepsis
389
Sx & Tx of toxic megacolon
Severe, frequent diarrhea with abdominal distension and widened colon
Treat with colectomy.
390
Meaning of S1Q3T3
Large S wave in lead I, Large Q wave in lead III, T wave inversion in lead III
391
Complications of Cushing's disease
Osteoporiss
T2DM
Hypogonadism
Increased risk of osteoporosis
392
Complications of Acromegaly
Obstructive sleep apnoea
Stroke
Colorectal cancer
Carpal tunnel syndrome
Arthritis
T2DM
Cardiomyopathy
393
Moa of Ribavarin
Nucleotide analogue so prevents RNA nucleotide binding.
394
Sx of hepatic encephalopathy
Asterixis, delirium, ataxia
395
Presentation of IgA nephropathy vs Post-Strep Nephropathy
Iga presents a couple of days after infection
Post strep presents a couple of weeks after infection.
396
Which organism most commonly costs meningitis infants and why?
GBS e.g strep agalacticae because it can colonize the birth canal.
397
Tx for meningococcal septicaemia
Dexamethasone + ceftriaxone if on a hospital setting
IM benzylpenicillin in the community setting
398
What artery is affected of a patient with quadripelegia
Basilar - locked in syndrome
399
Respiratory complications of stroke
Aspiration pneumonia - stroke can cause bulbar paralysis which can lead to unsafe swallowing and aspiration
400
When can lumbar puncture be done after suspected cerebral haemhorrage?
Post-12 hours because that is how long it takes RBCs to break down aand appear in CSF as bilirubin (xanthochromia).
401
Surgical management of haemhorragic stroke
Endovascular coiling
402
Sx of subdural haematoma
Slow onset symptoms, FLUCTUATING LEVEL OF CONSCIOUSNESS
403
What are parkinson's plus syndromes
Lewy body dementia
Multi-system atrophy - autonomic sx such as sweating, incontinence, constipation, can also have postural HTN.
Progressive supranuclear palsy - vertical gaze
404
Tx of Parkinson's disease
Levodopa - given in combo with a decarboxylase inhibitor as co-benyldopa.
405
Moa of decarboxylase inhibitors
Prevent conversion of L-dopa into dopamine.
406
GS Ix for aortic dissection
CT coronary angiogram
407
Types of obstructive shock
Hypovolemic, cardiogenic
408
Types of distributive shock
Neurogenic, anaphylactic, septic
409
Sx of obstructive shock
Hypovolemic - clammy, cold skin, pallor, tachycardia
Cardiogenic: Raised JVP, pulmonary oedema
410
Murmur of ASD
Ejection systolic with split S2
411
Murmur of VSD
Pan-systolic murmur
412
Aetiology of dilated cardiomyopathy
Alcoholism
413
Aetiology of RHD
Group A strep infection
414
Pathophysiology of RHD
T2 hypersensitivity reaction due to molecular mimicry of M protein in bacteria.
415
Sx of RHD
Joint pain
Organ inflammtion
Noduluse subcutaenously
Erythema marginatum rash
Sydenham's chorea
416
Tx of essential tremor
Primidone and propanalol (BB)
417
What region does pseudogout mainly present in ?
The knee vs gout which is the first metatarsal (big toe)
418
How is the diurnal variation of peak flow in asthma?
Lower in morning, higher in the night.
419
Tx of neutropaenic sepsis
IV piperacillin/tazobactam
420
X-ray sign for sigmoid volvulus
Coffee bean sign,
421
SIgns of ascites
Abdominal distension
Fluid thrill
Shifting dullness to percusission
422
What would EMG show for MNDs
Fibrillation potentials
423
4 Organisms that can cause Epidimo-Orchitis
Mumps
E.coli
Chlamydia trachomatis
N.gonnorhoea
424
What is the GRACE score used for
Calculates the 6 month mortality rate for patients with ACS.
425
Examples of drugs that potentiate each other -
Amoxicillin + clavulanate
Alcohol + sedatives
426
Causes of clubbing
Cyanotic heart disease, Cystic fibrosis
Lung abscess, lung cancer
Ulcerative Colitis
Bronchiectasis
Biliary cirrhosis (PBC)
IPF, infective endocarditis
Neurogenic tumours
Gastroenteritis
427
Factors that can exacerbate angina
Exercise, emotion, temperature
428
WHat is Alport syndrome?
X-linked dominant
CKD + hearing loss
429
Antibodies in dermatomyositis
Anti-MI2 and ANA
430
GS Ix for Portal hypertension
Hepatic venous pressure gradient.
431
Ix for prostate cancer
FL: DRE, multiparametric MRI
GS: Prostate biopsy.
432
Blood markers for sarcoidosis
Raised ACE
Hypercalcaemia
Raised ESR/CRP
433
Which receptors does HIV target when binding to T cells?
CXC4, CCR5
434
What are features of the latent phase of HIV?
Persistent lymphadenopathy
Fevers
Infections by opportunitist organisms.
