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finals Flashcards

1
Q

Bloods in IDA?

A

low serum iron, low transferrin <16%, High TIBC

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2
Q

Investigation of IDA?

A

Endoscopy and colonoscopy, biopsies for coeliac

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3
Q

Who to refer based upon Hb in iron deficiency anaemia?

A

Any age men <12 post menopause woman less than 10

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4
Q

When to check Hb again after treatment?

A

2-4 weeks should be rise >2g/l

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5
Q

Over age of what and IDA to refer?

A

> 60

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6
Q

If Hb not risen after 2-4 weeks then what?

A

Check compliance, refer

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7
Q

Normal endoscopies but IDA?

A

Consider H.pylori testing

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8
Q

Increased risk of what with pernicious anaemia?

A

Gastric cancer

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9
Q

Cause of pernicious anaemia?

A

Gastric parietal cell atrophy

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10
Q

Causes of B12 deficiency?

A

Gastrectomy, PPis, Metformin, reduced intake

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11
Q

Causes of folate deficiency?

A

Alcohol, low intake, Methotrexate and trimethoprim crohns

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12
Q

Bloods results b12/folate?

A

Macrocytic, can do lfts to look for alcoholic cause

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13
Q

How and how often replace B12?

A

1mg IM every 3 months

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14
Q

Folic acid doses?

A

5mg for 4 months

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15
Q

First sensory loss in sub acute degeneration of cord?

A

Proprioception

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16
Q

Classic features of migraine?

A

Unilateral behind eye, phonophobia, vomiting, photophobia +/- aura

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17
Q

Triggers for migraine?

A

Hypoglycaemia, cheese, chocolate, alcohol, stress, sleep lack, strong smells

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18
Q

Conservative measures for migraine?

A

Avoid triggers, headache diary 8 weeks

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19
Q

Preventative measures for Migraine?

A

propranolol (not asthma) Topirimate, accupuncture

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20
Q

Chronic tension headache time?

A

15 days or more

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21
Q

Chronic tension treatment?

A

Accupunture or amitryptiline(off label)

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22
Q

Cluster headache?

A

red watery eye, ice pick in eye (periorbital), sweating rhinorrhoea, eyelid oedema

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23
Q

Cluster headache duration?

A

1-3hrs often same time of day like early morning waking you up

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24
Q

Treatment of cluster headache?

A

High flow oxygen, subcut/intranasal triptan (oral not good)

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25
Q

Chronic cluster?

A

1 year no remission

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26
Q

Cluster headache history presents to GP?

A

referral to neuro or gpsi

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27
Q

prevention of cluster headache?

A

Verapamil

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28
Q

Single most important risk factor for ARMD?

A

Smoking

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29
Q

Myeloma what is it?

A

proliferation of plasma cells, which produce immunoglobulin

usually IgG too much and dopsition

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30
Q

Myeloma on blood film?

A

Roleaux formation and anaemia

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31
Q

Testing myeloma?

A

Bence jones, serum electrophoresis

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32
Q

CRAB acronym

A

calcium >2.6 Renal problems, Anaemia, Bone pain (back particularly) Can also have low WCC

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33
Q

First line imaging for myeloma?

A

Skeletal survey whole body MRI

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34
Q

Most diagnostic for myeloma?

A

Bone marrow trephine and biopsy

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35
Q

Treatment of myeloma?

A

Stem cell transplant

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36
Q

Pain in myeloma?

A

Lumbar and thoracic back pain

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37
Q

Most common pathogens for otitis media?

A

Strep pneu moniae and haemophillus

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38
Q

Symptoms of otitis media and onset?

A

Rapid onset, earache, membrane red, air fluid level or perforations

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39
Q

Otitis externa symptoms?

A

Aural fullness develops in 48hrs and causes eczematous, weeping soreness in canal

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40
Q

Acute otitis externa acute vs chronic?

A

3 weeks vs 3 months

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41
Q

Cause of otitis externa?

A

Usually swimming but can be soborrhoeic dermatitis

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42
Q

Treatment of otitis externa? Conservative?

A

abx drops and steroid, plus analgesia ear plugs avoiding swimming etc

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43
Q

Malignant otitis externa?

A

Exposed bone and granulation, very high fever, facial nerve paralysis, progressive hearing loss

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44
Q

Treatment of malignant otitis externa?

A

ABX tazocin, cipro for 6-8 weeks oral too

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45
Q

What is stable angina?

A

Stable predictable chest pain on exertion, lasting no more than 10mins when using gtn or resting

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46
Q

First line for angina?

A

BB or rate limiting CCB

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47
Q

anti-platelets for angina?

A

usually low dose aspirin 75mg if not on clopidogrel already for other problems

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48
Q

Peripheral arterial disease anti platelets?

A

Clopidogrel

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49
Q

Unstable angina?

A

Chest pain at rest or ecg changes such as t wave inversion etc in the absence of biochemical features of damage (trop)

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50
Q

Unstable angina treatment?

A

Aspiring 300mg

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51
Q

When to offer fondaparinux to patients?

A

NSTEMI and unstable angina if not planned to go to PCI

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52
Q

GRACE score?

A

Risk of future cardiovascular problems in hospital 6 month and 3 year mortality

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53
Q

Unstable angina secondary prevention considerations?

A

BB, ACEi and High dose statin,

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54
Q

NSTEMI?

A

Non ST ecg ischaemic changes such as T wave abnormalities or ST depression, with a rise in troponin

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55
Q

NSTEMI treatment?

A

Aspirin 300 & Clopidogrel 300, Morphine, GTN, 02 maintain normal sats
Fondaparinux unless PCI planned in which case unfractionated heparin used and in renal issues

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56
Q

Who to offer oxygen to in MI?

A

Sats <94%

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57
Q

What to offer after NSTEMI platelet wise?

A

Clopidogrel 12 months after event, aspirin indefinitely

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58
Q

Features of STEMI?

A

ST elevation and or new onset LBBB

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59
Q

Q waves normal in which leads?

A

Small ones in msot leads bigger acceptable in III or AVR

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60
Q

Q waves abnormal where?

A

Chest leads usually and if contiguous

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61
Q

When is PCI undertaken?

A

Within 12 hrs or thrombolysis if PCi cannot be delivered within 2 hrs

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62
Q

Do fibrinolysis then ECG 1 hr later and STEMI still there then what?

A

Then sent for immediate angiography with follow on PCI if needed

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63
Q

STEMI management?

A

Aspirin, Morphine, TN, 02 if needed Anti emetic too
Ticagrelor 180mg loading
If going for PCi need LMWH or unfractionated - Check with cardio

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64
Q

ACS conservative measures?

A

Weight loss, alcohol, smoking, diet, cardiac rehab, exercise, flu vaccine

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65
Q

Type of hearing loss is presbycussis?

A

Sensorineural

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66
Q

Audiogram in bilateral sensorineural and where affected in ear?

A

drops off at high frequency- inner ear affected

Conductive and bone is affected

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67
Q

Labrynthitis signs and symptoms?

A

Spinning room, vertigo nausea vomiting, Tinnitus/hearing loss (sensorinerual)

Nystagmus- unidirectional

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68
Q

Conductive hearing loss causes?

A

Tumours, cholesteatome, otosclerosis, wax perforation

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69
Q

Menieres disease?

A

Episodic vertigo, roaring tinnitus, can have hearing loss, sometime the episodes are preceded by a change in tinnitus. Refer to ENT

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70
Q

Acoustic neuroma/schwannoma investigation?

A

MRI gadolinium enhanced

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71
Q

Treatment of acoustic neuroma?

A

Small observe or not radiation/surgery

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72
Q

Bone disease presenting with hearing loss?

A

Pagets

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73
Q

BPPV?

A

short episodic, not tinnitus associated with rolling over in bed use dix hallpike to diagnose.

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74
Q

Cause of BPPV? What treats?

A

Otoliths use epley manouvre review 4 weeks

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75
Q

How do carbonic anhydrase inhibitors work in glaucoma?

A

Reduce production of aqueous fluid

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76
Q

What drugs to use in acute glaucoma?

A

Acetazolomide, timolol, pilocarpine

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77
Q

Procedure to treat acute angle closure?

A

iridotomy

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78
Q

iridotomy complication?

A

Retinal vein occlusion/vision loss

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79
Q

Blood pressure aim for SAH?

A

High normal

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80
Q

SAH CT features?

A

Blood in sulci etc and if really bad in ventricles

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81
Q

Common electrolyte problem in SAH?

A

Hyponatraemia from SIADH

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82
Q

Most common cause of subdural bleed? Damaging what?

A

Trauma Damaging bridging veins

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83
Q

Risks for subdural?

A

Alcoholism, atrophy of brain

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84
Q

Signs of subdural haematoma?

A

Fluctuating GCS, unsteadiness and headaches

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85
Q

GCS score eyes?

A

4 eyes- open spont
3-open to voice
2- open to pain

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86
Q

What should never be done in a patient with an extradural haematoma?

A

Lumbar puncture

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87
Q

GCS scores for head CT’s?

A

<13 initial assessment and <15 2hrs post injury

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88
Q

Other than GCS what indications for immediate head CT scan?

A

Suspected depressed skull, or basal skull (panda or battles)
Post traumatic seizure
Focal neuro
>1 vomit

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89
Q

CT head in 8 hrs?

A 
Warfarin
Any bleeding disorders
dangerous mechanism (>1metre fall)
>30mins retrograde amnesia
>65 years
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90
Q

When is unfractionated heparin preferred for prophylaxis of VTE

A

When eGFR less than 30mls

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91
Q

Rules for meals and Variable insulin for operations?

A

If only one meal missed can be managed with modification of regime. If expected to miss>1 meal should have variable rate.
If managed by lifestyle or OD metformin only variable rate if glucose >12 on 2 occasions

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92
Q

When should variable rate insulin be used peri-op in patients taking metformin once daily or lifestyle managed t2dm?

A

Only if glucose >12 on two occasions

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93
Q

Instructions for metformin when having operation?

A

Take as normal if only taken once or twice daily

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94
Q

Instructions for gliclazide/sulphonyureas when having operation?

A

Take before day of operation, omit dose on day if once a day and omit morning dose if twice daily.

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95
Q

What to do when starting variable rate re-drugs?

A

Stop all and only resume when eating and drinking

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96
Q

Pioglitazone, exenitide and gliptin rules for operations?

A

Take as normal regardless

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97
Q

Warfarin stopped before op?

A

Yes 5 days and LMWH if high risk

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98
Q

NOAC stopped when if normal renal and bleeding risk?

A

Day before

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99
Q

Main causes of heart failure?

A

Ischaemia, HTN, cardiomyopathy and valve disease, pericarditis

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100
Q

Drugs to avoid in Heart failure?

A

Morphine, pioglitazone, NSAIDS, Diltiazem and verapamil

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101
Q

Left sided heart failure?

A

Orthopnea, PND, Pink/white frothy sputum, bibasal creps,SOB

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102
Q

Right sided heart failure?

A

JVP raised, hepatosplenomegaly, Pitting peripheral oedema, Ascites

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103
Q

Criteria for heart failure diagnosis?

A

Framingham- 2 major or 1 major +2 minor

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104
Q

Major criteria heart failure-

A

third heart sound, PND, raised JVP, cardiomegaly, weight loss

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105
Q

Minor criteria heart failure?

A

Bilat ankle oedema, nocturnal cough, SOBE

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106
Q

BNP value >400?

A

Refer for echo 2 weeks

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107
Q

BNP value >100-400

A

Refer 6 weeks echo

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108
Q

Who to measure NT-BNP in?

A

All patients suspecting HF not just those who did not have MI in past.

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109
Q

CCF ecg?

A

Axis deviation and LVH strain, AF

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110
Q

HF management?

A

ACEi, Beta blockers, Spironolactone- (nitrates and hydralazine) reduce mortality
Statins used and loop diuretics for symptom management but do not alter course of disease

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111
Q

Acute heart failure treatment?

A

Oxygen, sit them up, diuretics, CPAP consider Morphin and nitrates (not routinely)- monitor weight renal urine output

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112
Q

Severe aortic stenosis and HF?

A

Consider for valve replacement

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113
Q

Loss of central vision, blurring of lines crooked or bent?

A

ARMD

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114
Q

VEGF useful in which ARMD?

A

Wet

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115
Q

Paroxysmal AF ?

A

> 30sec but <7 days self terminating

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116
Q

Persistent AF?

A

> 7 days

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117
Q

Permanent AF?

A

Fails to terminate with cardioversion or longstanding >1year

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118
Q

Causes of AF?

A

Infection, Alcohol, Structural heart disease- Aortic stenosis, Ischaemic heart disease, Hyperthyroidism

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119
Q

ECG AF?

A

Irregularly irregular, no P waves

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120
Q

Fast AF?

A

> 160bpm

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121
Q

Chadsvasc items?

A

Cardiac failure, stroke(2), diabetes, age 2 points >75 1 point 64+, HTN, female(1 point)

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122
Q

Chadsvasc score for anticoagulation?

A

> 2 everyone or 1 or greater in men consider

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123
Q

INR range for AF?

A

2-3

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124
Q

DOAC considerations in elderly?

A

Kidney issues can cause bleeding

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125
Q

Strategy for Paroxsysmal AF?

A

Anticoag if needed and consider pill in pocket if cardiovascularly well

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126
Q

When to consider rhythm control?

A

With new-onset AF.
Whose AF has a reversible cause (for example a chest infection).
Who have heart failure thought to be primarily caused, or worsened, by AF.
With atrial flutter who are considered suitable for an ablation strategy to restore sinus rhythm

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127
Q

If the onset of AF is within 48 hours with non-life threatening haemodynamic instability

A

Offer rate, or admit for consideration of cardioversion <48hrs no need for anticoag

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128
Q

Arrhythmia >48hrs but want to cardiovert?

A

Need to anticoag for ~3 weeks before

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129
Q

First line treatment in AF?

A

Beta blocker or if contraindicated (asthma) rate limiting calcium channel blocker (contra in HF)

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130
Q

unilateral polyps? or unusual/bleeding

A

Refer 2 week

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131
Q

Stage 1 hypertension <80 years when to offer drugs?

A 
target organ damage
established cardiovascular disease
renal disease
diabetes
10-year cardiovascular risk equivalent to 20% or greater
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132
Q

Stage 2 hypertension treatment?

A

Any age offer

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133
Q

Cant tolerate ACEi what next?

A

ARb

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134
Q

Target BP (clinic) for treatment?

A

140/90

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135
Q

Black or african on calcium channel blocker needs intensifying consider what?

A

ARB not ACEi

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136
Q

Step 2 htn?

A

Offer treatment with a CCB in combination with either an ACE inhibitor or an ARB - id ccb not good eg oedema offer diuretic

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137
Q

Step 3 HTN?

A

ACE inhibitor or angiotensin II receptor blocker, a calcium-channel blocker, and a thiazide-like diuretic.

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138
Q

HTN in diabetes?

A

Give ACEi

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139
Q

Statin therapy in type 1?

A

> 10 years, >40 years or nephropathy

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140
Q

Qrisk and statins?

A

10% consider statin and lifestyle is >20% offer statin 20mg atorvo

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141
Q

Which Tb drugs given for only 2 months?

A

Pyrizimide, ethambutol

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142
Q

Which Tb drugs continued for whole of 6 months?

A

Rifamp and

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143
Q

GCS scores for voice?

A

5-speech- Oriented
4-confused
3-Inappropriate words
2-incoherent mumbling

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144
Q

GCS scores for motor

A 
6-Movement- Obeys 
5-Localises to pain
4-Withdraws from pain
3-flexes to pain
2-extends pain
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145
Q

Anaphylaxis process?

A

Adrenaline 0.5ml 1/1000 IM
Fluid challenge
Chlorphenamine 10mg
Hydrocortisone 200mg

Check Tryptase - Initially then 1-2hrs then 24hrs

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146
Q

How often parkinsons reviews?

A

6-12 months

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147
Q

What can be used to prevent breakdown of dopamine peripherally?

A

co-benaldopa

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148
Q

Dopamine agonist example?

A

Ropinirole

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149
Q

Anaphylaxis process?

A

Adrenaline 0.5ml 1/1000 IM
Fluid challenge
Chlorphenamine 10mg
Hydrocortisone 200mg

Check tryptase - Initially then 1-2hrs then 24hrs

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150
Q

Most commonly affected joints in OA?

A

Knee, Hip, hands (DIPS, PIPS, Thumb) lumbar and cervical spine

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151
Q

Joint pain and stiffness when and worse with?

A

Morning but only for ~ 30 mins Activity or use of joints

152
Q

Radiographical features of OA?

A 
LOSS:
Loss of joint space(asymetrical)
Osteophytes
Sclerosis
Cysts
153
Q

Which nodes seen in OA and where?

A

Heberdens DIP

Bouchards PIP

154
Q

Plantar spur and pencil in cup deformity?

A

Psoriatic arthritis

155
Q

Rheumatoid Xray changes?

A

LESS:
Loss of joint space symetrical
Erosions
Soft bones and soft tissue

156
Q

Ankylosing spondylosis pelvic xray?

A

Sacroilitis

157
Q

Carpal tunnel syndrome which MSk problem can be find with this?

A

RA

158
Q

A 35-year-old female presents with pain on the radial side of the wrist and tenderness over the radial styloid process.

abduction of the thumb against resistance is painful?

A

De quervains, common in 30-50yrs

159
Q

When to consider urgent referal to rheum in 3 days?

A

Affects small joints of hands or feet
More than one joint
delay of >3 months

160
Q

Cant make a fist which arthritis more likely?

A

Rheumatoid

161
Q

Elderly female polydipsia, polydipsia, aches and pains ?

A

Hyperparathyroidism

162
Q

Most common cause of hyperparathyroidism

A

Solitary adenoma

163
Q

Bloods in hyperparathyroid?

A

Raised calcium Raised PTH low phosphate

164
Q

Pyoderma gangrenosum associated what looks like?

A

IBD looks like margherita pizza

165
Q

What is marjolins ulcer

A

SCC at site of inflammation

166
Q

typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
aching, morning stiffness in proximal limb muscles

A

PMR

167
Q

Xray described linear calcification of articular cartilage plus an effusion?

A

Pseudo gout xray describes calcinosis

168
Q

5 A’s of ank spon?

A 
Anterior uveitis, 
Achilles tendinopathy
Aortic regurg
Atlanto instability
Apical fibrosis
169
Q

Risk factors for Osteporosis?

A

Early menopause, Rheumatoid arthrtiis

170
Q

Femoral nerve compression may cause referred pain?

A

In hip

171
Q

Can gout be seen on xray?

A

No only pseudo gout chondrocalcinosis of cartilage

172
Q

Limited cutaneous CREST?

A

Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

173
Q

Anti-body for Limited cutaneous sclerosis?

A

Anti-centromere
Crest (C)
Cutaneous (C)

174
Q

Mcmurrays test for what?

A

Meniscal tear

175
Q

Advise to give in OA conservative?

A

Lose weight and do exercise particularly muscle strengthening

176
Q

Normal straight leg raise makes what less likely in back pain?

A

Prolapsed disc

177
Q

Which nerve root fr foot drop?

A

L5

178
Q

Most common complication of measles?

A

Otitis media

179
Q

Lymphoma associated with ebv?

A

Burkitts

180
Q

Most common cause of non hodgkins?

A

Diffuse large b cell

181
Q

Upper zone fibrosis (CHARTS)

A 
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
182
Q

High calcium with normal/high PTH?

A

Hyperparathyroidism

183
Q

Bloods in primary hyperparathyroidism?

A

High or inappropriately normal PTH with a HIGH Calcium

184
Q

Secondary hyperparathyroidism?

A

High PTH and low calcium

185
Q

Low TSH High T4?

A

Hyperthyroidism

186
Q

Most common cause of hyperthyroidism? Other causes?

A

Graves, toxic multinodular goitre, de quervains(initially)

Amiodarone

187
Q

Most common cause of Hypothyroidism?

A

Hashimotos

188
Q

secondary hypothyroidism bloods?

A

Low TSH Low T4

189
Q

Primary hypothyroidism?

A

High TSH low T4

190
Q

Poor compliance thyroid functions?

A

Normal T4 but high TSH

191
Q

Anti bodies in graves?

A

TSH receptor

192
Q

Antibodies hashimotos?

A

Anti TPO

193
Q

Patchy uptake thyroid scan?

A

Toxic multinodular

194
Q

Signs of lobar collapse Xray?

A

tracheal deviation towards the side of the collapse
mediastinal shift towards the side of the collapse
elevation of the hemidiaphragm

195
Q

Electrolyte disturbance causing digoxin toxicity?

A

hypokalaemia

196
Q

3 s’s plus an | for erythema nodosum?

A

Strep, Sulphonamines, Sarcoid, IBD

197
Q

burning sensation over the antero-lateral aspect of her right thigh which nerve?

A

Lat cutaneous

198
Q

Section 3 mental health act?

A

Treatment

199
Q

Section 2 mental health act?

A

Admission for assessment 28days

200
Q

Section 5 2 mental health?

A

Doctors holding 72hrs

201
Q

Hip dislocation ?

A

Internal rotation (usually posterior) Ext with ant and prostheses

202
Q

Increased risk of what in RA?

A

IHD

203
Q

IVDU ill, and pain in back and hip extension?

A

Psoas abscess

204
Q

Classic history for PCL injury?

A

Car crash

205
Q

PCL injury what sign?

A

Tiba is displaced backwards

206
Q

Loss of knee jerk and sensory loss over knee which nerve root?

A

L4

207
Q

On examination, he has tenderness over the proximal part of his forearm, and has severely restricted supination and pronation movements?

A

Frac of radial head

208
Q

A T-score less than -1.5

A

Start bisphos, if going to be on steroids long term

209
Q

A FRAX score of 10% or greater do what?

A

Order DEXA

210
Q

Hiatus hernia types?

A

Sliding most common, rolling uncommon (paraoesophageal)

211
Q

Hiatus hernia treatment?

A

PPI rarely surgery

212
Q

Vagus nerve lesion what happens?

A

Uvula deviates away from side of lesion, loss of gag reflex

213
Q

Cranial nerve palsy in stroke, likely area of infarction?

A

Posterior/brainstem

214
Q

Deviation of tongue which nerve palsy which side?

A

12th nerve towards lesion

215
Q

PMR commonly associated with?

A

GCA/Temp art

216
Q

Capillaroscopy used fro?

A

Systemic sclerosis

217
Q

TACS stroke?

A

Homonymous hemianopia

Unilat sensory or motor loss

Dyphasia or higher functioning loss

218
Q

PACS stroke?

A

Two from:
Homonymous hemianopia

unilat sensory or motor loss

Dyphasia or higher functioning loss

219
Q

Tacs and pacs vessels?

A

Middle cerebral and anterior

For pacs, smaller branches affected

220
Q

Lacunar infarct ?

A

one of:

Unilateral weakness

Pure sensory loss

Ataxic hemiparesis

221
Q

Where are lacunar infarcts?

Which arteries?

A

involves perforating arteries around the internal capsule, thalamus and basal ganglia

222
Q

POCI stroke?

A

LOC
or Cerebellar brainstem syndromes
or isolated homonymous hemianopia

223
Q

Arteries for posterior stroke?

A

Vertebrobasilar

224
Q

ABCD2 score > what for high risk?

A

> 4

225
Q

When to give NAC in paracetamol overdose?

A

> 150mgḱg,
if taken >4g over >1hour
If at 4 hrs they are above treatment line

226
Q

When to take paracetamol levels?

A

At 4 hrs post ingestion

227
Q

Tricyclic overdose management ?

A

Acidosis correction, magnesium if torsades

Cannot dialyse

228
Q

Crescendo TIA how treated?

A

As high risk

229
Q

The combination of deranged LFTs combined with secondary amenorrhoea ?

A

Autoimmune hepatitis

230
Q

Colorectal cancer increased risk with which IBD?

A

UC

231
Q

No inflammation beyond submucosa which IBD?

A

UC

232
Q

Leadpipe colon on xray

A

Chronic UC

233
Q

Extraintestinal features of IBD?

A 
Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis
Clubbing, 
pyoderma
Uveitis
234
Q

bloody diarrhoea
urgency
tenesmus
abdominal pain, particularly in the left lower quadrant

A

UC

235
Q

Screening for type 1 diabetes ?

A

Autoimmune disease such as coeliac and thyroid

236
Q

Carcinoma associated with GORD?

A

Adeno

237
Q

Causes of cellulitis?

A

Streptococcus and staph

238
Q

Progressive dysphagia is characteristic of ?

A

esophageal carcinoma

239
Q

Achalasia increased risk of?

A

Oesophageal carcinoma

240
Q

Splenic flexure most often associated with what?

A

Ischaemic Colitis

241
Q

CVD raised lactate and soft tender abdo

A

Mesenteric ischaemia

242
Q

The only recommended test for H. pylori post-eradication therapy?

A

Urea breath test

243
Q

When should urea breath test not be performed?

A

Within 4 weeks of antibacterial or 2 weeks of ppi

244
Q

Suspected GI bleed when to endoscope?

A

All patients with suspected upper GI bleed require an endoscopy within 24 hours of admission

245
Q

Gastric ulcer risks what to do?

A

Biopsy and rescope as risk of cancer.

246
Q

Electrolyte imbalance in refeeding?

A

Hypophosphataemia

247
Q

Most strongly associated condition with h.pylori?

A

Duodenal ulcer

248
Q

Raised ACE?

A

Sarcoid

249
Q

Chronic mesenteric ischaemia triad?

A

Colicky pain, Bruit and weight loss

250
Q

Addison’s pigmentation and blood tests?

A

Gums and palms, Hyperkalaemia and Hyponatraemia

Hypoglycaemia

251
Q

Treatment of C-diff

A

Mild-moderate metro TDS oral 10-14 days severe vanc

252
Q

Best investigation for ischaemic colitis?

A

CT

253
Q

Conn’s syndrome blood gas?

A

Metabolic alkalosis, hypokalaemic

Hypernatraemia

254
Q

NAFLD blood test?

A

Enhanced liver fibrosis (ELF) blood test

255
Q

Initial UC treatment? if no improvement after 4/52?

A

Aminosalicylates, add pred if no improvement

256
Q

Crohns first treatment?

A

Steroids also stop smoking

257
Q

When to consider MRCP?

A

If USS shows no stones but bileduct is dilated and or LFTs deranged

258
Q

How soon to do cholecystectomy if has acute cholecystitis?

A

Within 1 week

259
Q

Managing common bile duct stones?

A

Offer bile duct clearance and laparoscopic cholecystectomy to people with symptomatic or asymptomatic common bile duct stones.

260
Q

Leuokocytes and blood no nitrates in urine with pain think what?

A

Renal stones

261
Q

Iron test if unwell?

A

Transferrin as less likely to be raised due to inflammation

262
Q

Wilsons bloods?

A

Reduced copper and reduced caeruloplasmin

263
Q

Possible treatments for hepatorenal syndrome?

A

Terlipressin

264
Q

Bloods in diabetes insipidus?

A

high plasma osmolality, low urine osmolality

265
Q

a urine osmolality of >700 mOsm/kg excludes

A

DI

266
Q

Vitiligo more common which condition?

A

Thyroid/autoimmune

267
Q

Tests to determine whether a pre-renal uraemia or tubular necrosis?

A

Urine sodium high >30mmol for acute tubular necrosis

268
Q

Does acute tubular necrosis respond to fluid challenges?

A

No

269
Q

Erythropoetin side effects?

A

HTN, flu like, bone pain, encephalopathy, red cellm aplasia

270
Q

Failure of Erythropoietin?

A

iron deficient, inadequate dose, hyperparathyroid, infection,

271
Q

Haemolytic uraemic syndrome cause most likely?

A

E-coli 0157

272
Q

CKD haemodialysis cause of death?

A

IHD

273
Q

Symptoms of goodpastures?

A

pulmonary haemorrhage
followed by rapidly progressive glomerulonephritis

Can have fever arthralgia etc too

274
Q 
nose, stuffiness, sinus infections and nosebleeds.
Coughing, sometimes with bloody phlegm.
Shortness of breath or wheezing.
Fever.
Fatigue.

?antibody

A

Granulomatosis with polyangitis (wegeners)

C-ANCA

275
Q

Antibody in goodpastures?

A

anti-glomerular basement membrane (GBM)

All the G’s

276
Q

Renal biopsy in goodpastures shows?

A

linear IgG deposits along basement membrane

G’s good patures

277
Q

Goodpastures treatment?

A

Plasma exchange, steroids cyclophosphamide

278
Q

Acute rejection of kidney transplant time frame?

A

<6 months

279
Q

Commonest extra-renal polycystic complication?

A

Liver cysts

280
Q

Urine shows what in intrinsic AKI?

A

Protein- specific

281
Q

Kidney disease and contrast if needed?

A

Offer IV fluids

282
Q

Gold standard for bladder cancer diagnosis?

A

Cystoscopy

283
Q

Painless frank haematuria, do what?

A

Cystoscopy

284
Q

K+ greater then 6 do what ? Greater than 6.5 do what?

A

ECG and if >6.5 treat regardless

285
Q

Addisons ABG?

A

metabolic acidosis with a normal anion gap

286
Q

Aspirin, lactic acidosis, DKA all cause?

A

Metabolic acidosis with raised anion gap

287
Q

Interstitial nephritis vs tubular necrosis?

A

Nephritis inflammatory so +++white cells

288
Q

> 45 unexplained frank haematuria?

A

2 week referral to urology

289
Q

Calculate anion gap how what normal?

A

(sodium + potassium) - (bicarbonate + chloride) normal 8-14

290
Q

Osmalality in DI?

A

Raised plasma and low urine

Often raised serum sodium

291
Q

Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness

A

HUS

292
Q

Penicillin can cause which renal disorder?

A

acute interstitial nephritis

eosinophillic casts seen

293
Q

fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension?

A

Acute interstitial nephritis

294
Q

CAnca association with disease and renal biopsy?

A

Wegeners, crescenteric glomerulonephritis

295
Q

AKI unknown cause?

A

USS

296
Q

Glucose IV needs per day ?

A

50-100g regardless of weight

297
Q

Vit D type supplement in CKD?

A

alfacalcidol no activation needed

298
Q

Detriment of high phosphate in CKD?

A

Pulls calcium from bones

299
Q

Severe hypokalaemia?

How managed?

A

<2.5 should have IV replacement in high care area with ECG monitoring

300
Q

Purely nephrotic syndrome cause in adult?

A

Focal segmental

301
Q

Differentiate between IGA and post strep?

A

IgA haematuria soon after, Young male

post strep primarily proteinuria 1-2 weeks after

302
Q

Nephrogenic DI treatment?

A

Can use thiazide

303
Q

solid organ transplant recipients virus?

A

CMV

304
Q

Bilateral renal stones what blood test to do?

A

U&Es

305
Q

Urea a lot higher than creatinine AKI cause?

A

Dehydration

306
Q

Nephrotic syndrome direct risk of what?

A

VTE give LMWH

307
Q

Chronic diabetic nephropathy USS?

A

Bilateral large kidneys

308
Q

CKD kidneys on USS?

A

Bilateral small

309
Q

Sepsis ABG?

A

↑lactate This gives them a metabolic acidosis with a raised anion gap.

310
Q

Acidosis, peristent K↑ Uraemic encephalopathy and pericarditis are indications for?

A

Dialysis

311
Q

Organism in peritoneal infections due to dialysis?

A

Staph epidermis

312
Q

Minimal change management?

A

Steroids! 80% respond

313
Q

Warfarin use in breast feeding?

A

YES

314
Q

Squamous cell lung cancer paraneoplastic features? This type common in who?

A

Secrete TSH, hyperthyroid
Secrete PTH ↑ Ca2+
Most common in smokers

315
Q

Wells score for PE likely /unlikely?

A

4 or less is unlikely 5 or more is likely

316
Q

Wells score for DVT likely/unlikely?

A

2 or more likely 1 or less unlikely

317
Q

Wells score of 1 for DVT do what?

A

Order d-dimer if +ve do USS

318
Q

Wells score of 5 for PE do what?

A

CTPA

319
Q

Wells score of 4 for PE do what?

A

D-dimer and if +ve CTPA

320
Q

First radiological Investigation when symptoms of PE?

A

CXR to rule other cause out

321
Q

Treatment of DVT?

A

Rivaroxaban

322
Q

Fasting glucose normal value? Impaired?

A

<5.5

5.5-6.9 impaired

323
Q

Value after 2 hrs for non diabetic OGTT?

A

<7.8

324
Q

7.9-11 after OGTT?

A

Impaired

325
Q

Hba1c normal impaired and diabetes?

A

Normal <42
Impaired 42-47
Diabetes >48

326
Q

COPD initial management?

A

SABA or SAMA

327
Q

COPD SABA and SAMA but still exacerbating- No asthmatic?

A

Offer LABA or LAMA

328
Q

COPD SABA and SAMA still exacerbating but asthmatic features?

A

Consider LABA+ICS

329
Q

COPD has LABA +ICS but still troubled?

A

Consider LABA + ICS+LAMA

330
Q

Features of Life threatening asthma?

A 
Hypotension, 
Peak flow <33%
spo2 <92%
Arrhythmias,
silent chest or cyanosis
Normal Co2
Pa02 <8
331
Q

Features of acute severe asthma?

A

PEFR 33-50%
RR>25
HR>110
No complete sentences

332
Q

Increasing symptoms, peak flow 50-74%

No other features

A

Moderate asthma

333
Q

H pylori treatment?

A

PPI BD
Amox plus clarithro or metro for 7 days
If pen allergic Clarithro plus metro

334
Q

Optic neuritis features?

A

Eye movement painful, RAPD, Red desaturation

335
Q

Peri ureteric fat stranding?

A

Passage of stone recently or if round kidney pyelonephritis

336
Q

Usual target BP in diabetics no organ damage vs normal person target?

A

140/80

vs 140/90

337
Q

> 80 years BP target?

A

150/90

338
Q

BP target diabetics organ damage?

A

130/80

339
Q

Adverse signs warranting cardioversion?

A

shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating,
cold, clammy extremities, confusion or impaired consciousness

syncope

myocardial ischaemia

heart failure

340
Q

Trachea pulled to side of white out 2 differentials?

A

Collapse or pneumonectomy

341
Q

Trachea deviated away from white out?

A

Pleural effusion

342
Q

How many scales on the MRC dyspnoea ?

A

5

343
Q

Adenosine contraindicated in who?

A

Asthmatics

344
Q

Most common pathogen for meningitis in adults?

A

Strep pneumoniae, HIB Meningitidis

345
Q

Infants and young children meningitis cause?

A

HIB

346
Q

Most useful test in determining cause of hypocalcaemia?

A

PTH

347
Q

Signs of CCF CXR?

A 
Alveolar oedema (bat’s wings) 
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
348
Q

Gout changes on Xray?

A

Soft tissue swelling, erosions at joint particularly 1st MTP- overhanging edges

349
Q

Osteomyelitis vs gout?

A

Likely high WCC more insidious onset

350
Q

Ace inhibitor can cause a falsely low result for what blood test?

A

BNP

351
Q

Initial therapy for rheumatoid?

A

DMARD + Short steroid course

352
Q

Transjugular shunt joins what?

A

Hepatic vein and portal vein

353
Q

benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space

A

Mortons neuroma

May feel “pebble in shoe”

354
Q

Osteopaenia vs osteoporosis?

A

Osteopaenia

355
Q

Bakers cyst signs?

A

arthritis or gout and following a minor trauma to the knee lump becomes tense on extension of knee

356
Q

Bicarb normal values?

A

22-26mmol

357
Q

Where does paget’s usually affect?

A

skull, spine/pelvis, and long bones

Imaginary line down centre of body of person

358
Q

Gout worsened by?

A

Thiazide

359
Q

First line imaging for angina?

A

CT coronary angiography

360
Q

First line investigation angina?

A

ECG

361
Q

Is amylase or lipase included in glasgow pancreas score?

A

No LDH and AST are enzymes included

362
Q

Lupus pernio what looks like associations?

A

Purple on nose and nostrils, Sarcoid

363
Q

Postural HYPOtension no change in HR?

A

Diabetes

364
Q

Oesophagitis proven?

A

ppi full dose 1 months assess response if good use low dose if not double dose

365
Q

FEV1 and FVC increased reduced restrictive?

A

FEV1 and FVC both reduced and ration normal or increased

366
Q

Obstructive causes of lung disease?

A

Asthma
COPD
Bronchiectasis

367
Q

Restrictive causes of lung disease

A

Fibrosis, sarcoidosis bone deformity, neuromuscular

368
Q

Upper resp infections when to give abx?

A

children younger than 2 years with bilateral acute otitis media
children with otorrhoea who have acute otitis media
patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present

369
Q

INR 5-8 no bleeding?

A

Withhold 1-2 doses then reduce maintenance

370
Q

INR > 8.0

No bleeding

A

vitamin K orally

371
Q

High INR major bleeding?

A

IV vit K stop warfarin and giv prothrombin

372
Q

Joint effect in rheumatoid?

A

Symmetrical

373
Q

Toxic megacolon size where?

A

> 6cm and transverse mainly

374
Q

K less than what to add spiro for BP control?

A

<4.5mmol

375
Q

Antibodies myasthenia and lambert eaton ?

A

Myasthenia Ach lambert eaton voltage gated

376
Q

Peri ureteric fat stranding?

A

Passage of stone recently or if round kindey pyelonephritis

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