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FINALS > FINALS > Flashcards

FINALS Flashcards

1
Q

AF and CCB or flecainide

A

Contraindicated if structural heart disease

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2
Q

Metallic click on auscultation

A

Metallic valve replacement, should be on warfarin with INR 3-4

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3
Q

Bleeding on dabigatran

A

Only DOAC with reversal agent, idarucizumab

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4
Q

1st line investigation for AF

A

ECG- irregularly irregular, absent P waves

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5
Q

Unstable patient with AF

A

Urgent DC cardioversion

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6
Q

First line for AF presenting within 48 hours without a precipitating cause

A

Rate control with beta blocker

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7
Q

All patients with AF should be assessed with

A

CHADsVASc and HASBLED

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8
Q

What is first line treatment for heart failure which improves mortality

A

Bisoprolol and Ramipril

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9
Q

Symptomatic relief in heart failure and given even when ejection fraction is preserved

A

Furosemide

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10
Q

Why bumetanide over furosemide

A

Better oral bioavailability

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11
Q

Why cant you give ACEi and Valsartan (entresto)

A

Risk of angioedema

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12
Q

1st line investigation in heart failure

A

BNP

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13
Q

How do you make a heart failure diagnosis

A

Specialist does based on echo

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14
Q

First line treatment for all heart failure with reduced ejection fraction

A

Bisoprolol and Ramipril (even if has COPD)

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15
Q

Monitoring for ACE-i and Spironolactone

A

Renal function checked 2 weeks after starting or changing dose

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16
Q

ACS, cold peripheries and poor urine output

A

cardiogenic shock

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17
Q

PCI with stents ongoing treatment

A

DAPT for atleast 12 months

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18
Q

ACS, bradycardia and AV node block

A

Inferior MI

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19
Q

First line investigation for ACS

A

ECG and troponin

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20
Q

Initial treatment of ACS

A

Morphine, Metaclopromide, Oxygen (if sats <94), Nitrates (GTN infusion), Aspirin (300mg)

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21
Q

Risk score for NSTEMI/ Unstable Angina

A

GRACE

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22
Q

Headache, sweating and palpitations with severe hypertension

A

Phaeochromocytoma

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23
Q

Pedal oedema resistant to diuretics

A

CCB side effect

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24
Q

AV nipping on fundoscopy

A

Hypertensive retinopathy

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25
Q

1st line investigation for hypertension

A

Ambulatory blood pressure monitoring or Home blood pressure monitoring

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26
Q

Threshold for HTN in normal people in clinic and home

A

140/90 in clinic, 135/85 at home

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27
Q

Target BP in diabetics

A

130/80

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28
Q

Target BP in over 80s

A

150/90

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29
Q

Which HTN patients need same day assessment

A

Severe (>180/120) or symptomatic

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30
Q

What does increased compliance of lung indicate

A

Emphysema

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31
Q

FEV1/FVC >0.7

A

Obstructive lung pathology

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32
Q

T2 respiratory failure with raised bicarbonate

A

Chronic T2RF, aim for sats 88-92

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33
Q

First line investigation for pneumothorax

A

Chest XR

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34
Q

What to do if Pneumothorax and underlying lung condition so is secondary pneumothorax

A

Always admit

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35
Q

How do you treat tension pneumothorax

A

Wide bore cannula into 2nd intercostal space mid clavicular line

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36
Q

FEV1/FVC more than 0.8 with reduced FVC

A

Restrictive lung disease

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37
Q

COPD exacerbation, pH <7.3 despite nebulisers

A

BiPAP

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38
Q

Nausea, refractory hypokalaemia and patient on theophylline

A

Theophylline toxicity

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39
Q

Cor Pulmonale first line investigation

A

Clinical diagnosis, echo to confirm

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40
Q

Symptoms of cor pulmonale

A

Peripheral oedema, raised JVP, loud P2

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41
Q

Big requirement for LTOT

A

Stop smoking

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42
Q

Pulmonary hypertension criteria

A

pulmonary artery pressure over 20

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43
Q

Recurrent miscarriages, prolonged APTT and thrombocytopenia

A

Antiphospholipid syndrome

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44
Q

ECG- ST depression, T wave inversion V1-4, 1,2 and aVF

A

Right ventricular strain

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45
Q

skin necrosis after warfarin

A

Protein C deficiency

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46
Q

1st line investigation in PE

A

CXR

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47
Q

Unprovoked PE and symptoms of possible malignancy

A

CT TAP

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48
Q

Most common ECG finding in PE

A

Sinus tachycardia

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49
Q

How long should a cancer patient be on a DOAC after PE

A

6 months

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50
Q

SCLC, Muscle strength improving on repetitive movement

A

Lambert eaton

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51
Q

Breast cancer or SCLC with progressive muscle stiffness

A

Stiff man syndrome, antiamphiphysin

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52
Q

SCLC, cerebellar symptoms and sensory neuropathy

A

Anti hu

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53
Q

1st line investigation for lung cancer

A

Chest XR

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54
Q

Consequences of SCLC

A

SIADH, Cushings, Lambert Eaton Syndrome

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55
Q

Why do Squamous cell cancers get hypercalcaemia

A

Parathyroid hormone related protein release

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56
Q

Chronic diarrhoea, bloating and scleroderma

A

Small bowel bacterial overgrowth

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57
Q

Bile acid malabsoprtion

A

SeHCAT test

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58
Q

Middle aged female, bloating, CA125

A

Ovarian Cancer

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59
Q

Barley Wheat and Rye

A

Coeliacs should avoid

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60
Q

1st line investigation for Coeliac

A

Serum IgA antiTTG and IgA levels

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61
Q

Definitive diagnosis of coeliac

A

Endoscopy and duodenal biopsy

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62
Q

Which HLA is coeliac

A

DQ2/8

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63
Q

Ulcerating legion on lower limb and PMH IBD

A

Pyoderma gangrenosum

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64
Q

Acute red eye, hypopyon, intense photophobia

A

Acute uveititis

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65
Q

IBD history, assymetrical joint swelling and HLA B27

A

Enteropathic arthritis

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66
Q

1st line investigation for IBD

A

Faecal calprotectin

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67
Q

First line investigation for bloody diarrhoea

A

Colonoscopy

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68
Q

How do you manage acute severe UC flares

A

In hospital with IV hydrocortisone

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69
Q

How do you treat mild-moderate UC

A

Topical mesalazine then oral if no response in 4 weeks

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70
Q

What do you have to do before you prescribe infliximab

A

Interferon gamma test and CXR (exclude TB)

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71
Q

middle aged female with very serious itching and anti mitochondrial antibody positive

A

Primary biliary cholangitis

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72
Q

pan acinar emphysema, early onset liver disease, PiZZ phenotype

A

Alpha 1 antitrypsin deficiency

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73
Q

Raised transferrin saturations, tanned, diabetes

A

Hereditary haemochromatosis

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74
Q

First lines investigation for decompensated liver disease

A

LFTs, U and Es, albumin, INR

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75
Q

Features of decompensated liver disease

A

Ascites, encephalopathy and coagulopathy

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76
Q

How to improve mortality in severe ALD

A

IV steroids

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77
Q

Most common causes of cirrhosis

A

Alcohol, NAFLD, Hep B and Hep C

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78
Q

AST/ ALT raised on LFT

A

Hepatitis picture

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79
Q

Bilirubin/ ALP raised on LFT

A

Cholestatic picture

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80
Q

AST more than double ALT

A

Alcohol related (shots, shots, shots)

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81
Q

Hep C, purpuric rash, deteriorating renal function

A

Type 2 cryoglobulinaemia

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82
Q

Needle stick injury from hep B patient and no previous vaccination

A

Accelerated Hep B vaccination

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83
Q

Raised BMI, raised ALT and AST

A

Non alcoholic fatty liver disease

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84
Q

1st line investigation for hepatitis

A

Liver screen including hepatitis A B and C serology

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85
Q

What must be present in the serology for it to be an active hepatitis B (both acute and chronic)

A

HBsAg

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86
Q

Which hepatitis is most likely to progress to chronic liver disease

A

Hepatitis C

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87
Q

First line treatment for Hep B

A

Interferon alpha

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88
Q

First line treatment for Hep C

A

Direct acting anti virals

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89
Q

Painless palpable gallbladder and jaundice

A

Pancreatic cancer

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90
Q

Small bowel obstruction after cholecystitis

A

Gallstone ileus

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91
Q

Beads on a string on ERCP

A

Primary sclerosing cholangitis

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92
Q

1st line investigation for gallstones

A

Ultrasound abdomen

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93
Q

What requires an urgent laparoscopic cholecystectomy

A

Pancreatitis, Cholecystitis, choledocholithiasis

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94
Q

What is the definitive treatment for any gallstone related disease

A

Laparoscopic Cholecystectomy

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95
Q

No CBD stone but deranged LFTs or bile duct dilatation on ultrasound

A

MRCP needed to clarify pathology and anatomy

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96
Q

Which operation leads to an ileostomy

A

Right hemicolectomy

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97
Q

What staging for colon cancer

A

TNM

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98
Q

Thousands of colonic polyps and autosomal dominant APC gene mutation

A

FAP

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99
Q

Mutation in the mismatch repair gene (MMR)

A

HNPCC (lynch syndrome)

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100
Q

Small bowel polyps, melanotic macules in lipds or genitals and STK11 gene mutation

A

Peutz Jueger Syndrome

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101
Q

1st line investigation for colorectal cancer

A

Coloscopy

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102
Q

Who gets FIT or FOB testing

A

Everyone 60-74

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103
Q

How is colorectal cancer diagnosis made

A

Colonoscopy

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104
Q

Closed loop obstruction

A

High risk of bowel ischaemia

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105
Q

Right iliac fossa pain after appendectomy

A

Meckels diverticulum

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106
Q

Unexplained acute LBO

A

Ogilvies syndrome

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107
Q

1st line investigation for acute abdomen (no indications for CAT 1 lap i.e. unstable patient)

A

CT abdomen and pelvis

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108
Q

How will SBO present

A

Colicky abdominal pain, vomiting and absolute constipation

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109
Q

What to do with patients in refractory shock i.e. shock even after fluids w/ acute abdomen

A

category 1 emergency laparotomy

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110
Q

What is the most common cause of SBO and how do you treat if no ischaemia or necrosis

A

Adhesions and conservative, IVI and NG tube

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111
Q

Screening for AAA

A

Every man over 65 gets a one off ultrasound

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112
Q

IVC collapse or halo sign on CT

A

Hypovolaemic shock

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113
Q

Anurysmal sac enlarging after AAA repair

A

Endoleak

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114
Q

Chest pain and connective tissue disorder like marfans

A

Aortic dissection

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115
Q

1st line investigation for stable AAA patient with suspicion of rupture

A

CT angiography

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116
Q

AAA screening

A

One off ultrasound to every male at 65

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117
Q

Which AAA require intervention

A

> 5.5cm or symptomatic

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118
Q

Microcytic anaemia and disproportionately low MCV

A

Thalassaemia

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119
Q

Normocytic anaemia and reduced renal function

A

CKD related anaemia

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120
Q

Macrocytic anaemia and mixed upper/lower neuro signs

A

B12 deficiency causing subactue degeneration of the cord

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121
Q

First line investigation if IDA and over 60

A

2WW colonoscopy

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122
Q

Dyspepsia and IDA investigation

A

2WW UGI-endoscopy

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123
Q

Asthma, eosinophila and pANCA

A

Churgg Strauss Syndrome

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124
Q

Obesity, Type 2 respiratory failure and obstructive sleep apnoea

A

Obesity hypoventilation syndrome

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125
Q

Asthmatic and pCO2 of 6.5

A

Near fatal asthma attack

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126
Q

Asthma diagnostic investigation

A

Clinical diagnosis, can use spirometry to confirm

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127
Q

Initial management of asthma

A

SABA (and ICS if symptoms)

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128
Q

How long before you know if LTRA isnt helping

A

8 weeks

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129
Q

Define life threatening asthma

A

PaCO2 above 6

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130
Q

Ankle swelling, erythema, loss of foot sensation and T2DM

A

Charcot arthopathy

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131
Q

Metformin and CKD

A

Stop metformin in eGFR under 30

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132
Q

Insulin and driving

A

DVLA must be informed and patient must record blood sugar every 2 hours

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133
Q

1st line investigation for diabetes

A

HbA1c or fasting blood sugar

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134
Q

When to intensify diabetes medication regime

A

HbA1c remains over 58

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135
Q

When to consider insulin in T2DM

A

When 3 oral medications are still not helping

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136
Q

How to treat hyperosmolar hyperglycaemic state

A

IV fluids and sometimes FRII

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137
Q

thunderclap occipital headache and reduced GCS

A

Subarachnoid haemorrhage

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138
Q

Temporal headache, jaw claudication, raised ESR

A

Giant cell arteritis

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139
Q

LP in last 24 hours, headache worst when upright

A

Low pressure headache

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140
Q

1st line investigation for migraine

A

Clinical diagnosis. Neuroimaging if red flags

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141
Q

1st line treatment for migraine

A

Sumatriptan and Ibuprofen

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142
Q

First line prophylaxis for migraine

A

Propanolol

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143
Q

Topiramate CI

A

Pregnancy. Make sure on reliable contraception

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144
Q

Multiple flat light brown plaques, waxy surface along the scalp or back

A

Sebhorreic keratosis

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145
Q

Multiple scaly thick plaques on sun exposed areas

A

Acitinic/ solar keratosis

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146
Q

A hard raised grown with an ulcerated centre that began as a boil

A

Keratoacanthoma

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147
Q

1st line investigation for skin cancer

A

Excision biopsy and breslow thickness

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148
Q

What to do with melanoma lesions

A

Excise and send for histology to guide staging

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149
Q

What stage is a melanoma with nodal involvement

A

3

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150
Q

What stage is a melanoma with metastases

A

4

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151
Q

How to treat basal or squamous cell carcinomas

A

Excision or topical chemotherapy

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152
Q

Visual hallucinations and macular degeneration

A

Charles Bonnet Syndrome

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153
Q

Parkinsonism, visual hallucinations and memory impairment

A

Lewy body dementia

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154
Q

Deranged LFTs, asterixis and confusion

A

Hepatic encephalopathy

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155
Q

Delirium first investigation

A

Clinical diagnosis but look for cuases

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156
Q

What to do if patient lacks capacity

A

Treat them in their best interests under the mental capacity act

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157
Q

Bisphosphonate use, jaw pain and swelling

A

Osteonecrosis of jaw

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158
Q

Fall onto outstretched hand and dinner fork deformity

A

Colles Fracture

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159
Q

Normal serum calcium and phosphate with elevated alk phos

A

Pagets disease of the bone

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160
Q

1st line investigation for osteoporosis

A

DEXA scan

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161
Q

Who gets osteoporosis commonly

A

Long term steroids and post menopausal

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162
Q

How do you calculate risk of osteoporosis

A

FRAX

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163
Q

What supplements might you need if have osteoporosis

A

Calcium and vitamin D

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164
Q

Involuntary upward eye movements

A

Oculogyric crisis

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165
Q

Alternating deep then shallow breathing with recurrent apnoea

A

Cheyne Stokes breathing

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166
Q

Prolonged QT interval and twisting of QRS complexes

A

Torsades de Pointes

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167
Q

First line investigation for end of life

A

Clinical assessment but need to rule out reversible causes

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168
Q

What needs to be considered in palliative care

A

Psychological, social and spiritual factors

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169
Q

What to do if frequently using as needed medications

A

Replace with syringe driver

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170
Q

Dendritic pattern on fluorescin stained cornea

A

Herpes simplex virus

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171
Q

Young female, very high BMI, on the pill with headaches

A

Check for papilloedema, idiopathic intracranial HTN (therapeutic LP)

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172
Q

White fluid level visible in the anterior chamber of the eye

A

Hypopyon

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173
Q

First line investigation for diabetic retinopathy

A

Fundoscopy

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174
Q

When does diabetic retinopathy become symptomatic

A

When it becomes proliferative

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175
Q

What is treatment of diabetic retinopathy

A

Radical control of Diabetes, Blood Pressure and Lipids

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176
Q

Is diabetic retinopathy reversible

A

No

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177
Q

Pigment in the anterior vitreous on fundoscopy

A

Schaffer sign of retinal detachment

178
Q

Pale retina without cherry red spot on fundoscopy

A

Ophthalmic artery occlusion

179
Q

Pale retina with cherry red spot on fundoscopy

A

Central retinal artery occlusion

180
Q

Visual blurring made worse with heat

A

Optic neuritis (Uhthoffs Phenomenon)

181
Q

Acute, painless loss of vision unilaterally

A

Vascular in origin

182
Q

Bilateral acute visual field loss

A

TIA/Stroke/Optic chiasm i.e. not optic

183
Q

Amaurosis Fugax

A

Associated with carotid artery stenosis and predicts future stroke

184
Q

Chinese, facial pain, double vision and lymphadenopathy

A

Nasopharyngeal carcinoma

185
Q

Young child with recurrent epistaxis and purpuric lesions on fingertips and tongue

A

Hereditary haemorrhagic telangiectasia

186
Q

Evolving sunburn like erythema and confusion 48 hours after nasal packing

A

Toxic shock syndrome

187
Q

Nose bleed first line investigation

A

Nasal speculum examination

188
Q

Where do most nosebleeds come from

A

Anterior= first aid, then silver nitrate cautery then rapid rhino unilateral anterior packing

189
Q

What to do if posterior bleed (profuse, bilateral, cant see bleeding point)

A

Posterior packing and antibiotics

190
Q

Diabetic with persistent otalgia despite antibiotics

A

Malignant otitis externa

191
Q

Progressive hearing loss and aural fullness with a persistent foul smell

A

Cholesteatoma

192
Q

Vertigo, tinnitus, aural fullness, facial weakness +- neurofibromatomosis type 2

A

acoustic neuroma

193
Q

First line investigation for vertigo

A

Thorough history and examination

194
Q

First line investigation for menieres disease

A

Audiometry

195
Q

Which direction is the dizziness in tru vertigo

A

Rotational

196
Q

What is peripheral vertigo (ears)

A

Reproducible, fatiguable, horizontal nystagmus and no neuro signs

197
Q

What is central vertigo (brain)

A

Doesn’t fatigue and cant be reproduced, multidirectional nystagmus, other neuro signs

198
Q

Drooling, stridor and tripod sitting in a toxic looking child

A

Epiglottitis

199
Q

Bilateral cervical lymphadenopathy, fever, myalgia and testicular swelling

A

Mumps

200
Q

Acrid/bitter teast in mouth while eating, pain in parotid/ submandibular region

A

Salivary duct stones

201
Q

First line investigation in tonsilitis

A

Oropharyngeal examination

202
Q

FeverPAIN

A 
Fever
Pus on tonsils
Attended in 3 days
severely Inflamed tonsils
No cough or coryza
203
Q

FeverPAIN 2-3=

A

back up prescription(Phenoxymethylpenicillin) , self care advice

204
Q

FeverPAIN 4+=

A

Phenoxymethylpenicillin

205
Q

FeverPAIN 0-1=

A

Self care advice

206
Q

Acute retention, acute glaucoma and tachycardia

A

Anticholinergic effects

207
Q

LUTS with nocturnal enuresis

A

high pressure chronic urinary retention

208
Q

Prolonged large urine production after catheter

A

Post obstructive diuresis

209
Q

Acute retention first line investigation

A

Bladder scan if in doubt

210
Q

Chronic retention first line investigation

A

Ultrasound KUB

211
Q

Urgent first line treatment in acute retention

A

Catheterise first ask questions later !

212
Q

What does failed TWOC suggest in acute retention

A

Chronic urinary retention

213
Q

How to diagnose most causes of acute retention

A

Drug chart review, urine dip and bloods

214
Q

Post URTI with flank pain

A

IgA nephropathy

215
Q

Dry cough, dry/red eyes, sinusitis, joint pain and nephritis syndrome

A

Granulomatosis with polyangitis

216
Q

Pulmonary haemorrhage, rapidly progressive GN and anti GBM antibodies

A

Goodpastures syndrome

217
Q

1st line investigation in glomerulonephritis

A

Urine dip for protein and blood

218
Q

3 signs of nephritis syndrome

A

Oedema, hypertension and haematuria

219
Q

3 signs of nephrotic syndrome

A

Oedema, hypoalbuminaemia and proteinuria

220
Q

Whats the main treatments for GN

A

Steroids and immunosuppressants

221
Q

Painless testicular lump in male over 60

A

Benign seminoma

222
Q

Painless testicular lump in a young male with positive bHCG

A

Non seminoma

223
Q

Prolonged (longer than 1 day) pain and swollen testicle

A

Epididymoorchitis

224
Q

What two things cause epididymoorchitis

A

STI and E Coli

225
Q

1st line investigation for severe testicular pain

A

Surgery if torsion suspected !

226
Q

What surgery is done for torsion

A

Bilateral orchidopexy

227
Q

What is the ischaemic time for a testicle

A

4-8hours

228
Q

Young patient treated for DKA with reduced GCS, severe acidosis and relative bradycardia

A

Cerebral oedema

229
Q

Metformin use, impaired kidney and acidosis

A

Metformin induced lactic acidosis

230
Q

Elderly patient, T2DM, hyperglycaemia and hypernatraemia

A

Hyperosmolar hyperglycaemic state

231
Q

First line investigation for DKA

A

Venous blood gas and serum ketones

232
Q

First line treatment in DKA

A

0.9% sodium chloride fluid bolus

233
Q

How to avoid complications in DKA

A

Monitor glucose and potassium

234
Q

When does a DKA require critical care input

A

If not resolved in 24hours

235
Q

Sudden decline in GCS after correcting hyponatraemia

A

Osmotic demyelination syndrome

236
Q

Polydipsia, normal glucose and high end of normal sodium

A

Diabetes insipidus

237
Q

Large hands and jaw and bilateral hemianopia

A

Pituitary tumour with acromegaly

238
Q

First line investigation for hyponatraemia

A

Paired osmolalities (serum and urinary)

239
Q

First line treatment if hyponatraemic with symptoms

A

3% hypertonic saline in higher level care

240
Q

If hyponatraemic but no symptoms or chronic then

A

Assess fluid status and do urinary sodium

241
Q

How do you treat SIADH

A

Fluid restrict and look for cause

242
Q

Whats diagnostic for SIADH

A

High urinary sodium in euvolaemic patient

243
Q

Young female with resistant hypertension and hypokalaemia

A

Conns syndrome

244
Q

Headache, sweating, tachycardia and hypertension

A

Phaeochromocytoma

245
Q

Unduppressed cortisol levels following high dose dexamethasone suppression test

A

Cushings disease (pituitary adenoma). High dose= high up cause i.e. in brain i.e. pituitary adenoma

246
Q

First line investigation for cushings syndrome

A

Urinary cortisol collection, low dose dexamethasone suppression test or salivary cortisol collection

247
Q

What can happen if you suddenly stop long term steroids

A

Addisonian crisis

248
Q

Hoarse voice post thyroidectomy

A

Recurrent laryngeal nerve injury

249
Q

Low calcium, high phosphate, high PTH, short fingers

A

Pseudohypoparathyroidism

250
Q

Facial twitching after tapping anterior to tragus

A

Chvosteks sign, hypocalcaemia

251
Q

First line investigation in hypercalcaemia

A

Bone profile and parathyroid hormone

252
Q

Normal treatment for primary hyperparathyroidism

A

Parathyroidectomy

253
Q

Normal treatment for secondary hyperparathyroidism

A

Treat CKD and give phosphate binders for high phosphate

254
Q

Normal treatment for tertiary hyperparathyroidism

A

Self limiting. Normally post kidney transplant when body readjusting.

255
Q

primary parathyroid adenomas are associated with which gene

A

MEN

256
Q

Philadelphia chromosome

A

Chronic Myeloid Leukaemia

257
Q

Auer Rods

A

Acute Myeloid Leukaemia

258
Q

DIC and t(15;17)

A

Acute promyelocytic leukaemia

259
Q

1st line investigation in leukaemia

A

Peripheral Blood film

260
Q

2nd line investigation in leukaemia

A

Bone marrow biopsy

261
Q

First line treatment for CML

A

Imantinib

262
Q

Treatment of CML when imantinib fails

A

stem cell transplant

263
Q

Menorrhagia and prolonged bleeding time

A

Von Willebrands disease

264
Q

Low platelets and low fibrinogen

A

DIC

265
Q

Raised INR, low platelets and deranged LFTs

A

Liver cirrhosis

266
Q

1st line investigation for haemophillia

A

Factor 8 and 9 assay levels

267
Q

How do you treat life threatening bleeding in haemophilia A

A

Factor 8 concentrate

268
Q

What is the most common presentation of haemophillia A

A

Bleeding into joints

269
Q

Whats the difference between haemophillia and von willebrands

A

Von Willebrands has a prolonged bleeding time

270
Q

Red scaly lesions on finger joints

A

Gottrons papules (dermatomyositis)

271
Q

Episodes of white cold digits

A

Raynauds phenomenon

272
Q

Telescopic digits

A

Arthitis mutilans

273
Q

1st line investigation for polyarthritis

A

Bloods: RF, AntiCCP, ESR/CRP and XR affected joints

274
Q

How do you treat acute flares of inflammatory arthritis

A

Bridging steroids and DMARDs

275
Q

Urethritis, conjuncitivitis, arthritis

A

Reactive arthritis

276
Q

Assymetric polyarthralgia, tenosynovitis and skin lesions

A

Gonococcal arthritis

277
Q

HLA B27 POSITIVE

A

Seronegative spondyloarthropatheis

278
Q

First line investigation of a hot swollen joint

A

Needle aspiration

279
Q

First line investigation of a hot swollen joint

A

Needle aspiration

280
Q

Hot swollen joint

A

Assume septic until proven otherwise

281
Q

Should you give antibiotics straight away in septic arthritis

A

Aspirate first !!

282
Q

Lateral tibial plateaux fracture

A

ACL rupture

283
Q

Strong lateral blow to the knee

A

ACL, MCL and medial meniscus tears

284
Q

Anterior drawer test for the ankle

A

Tests talofibular ligament

285
Q

Light bulb sign on shoulder XRay

A

Posterior dislocation of the shoulder

286
Q

Pain on palpation of the anatomical snuff box

A

Scaphoid fracture (AVN risk)

287
Q

Paradoxical breathing after trauma to the chest

A

Flail segment

288
Q

First line investigation for ankle fracture

A

AP, lateral and oblique XR of the ankle

289
Q

What is the ottawa rule

A

A number of rules where you cant rule out ankle fracture if its yes to any

290
Q

Ottawa rules

A
  1. Inability to weight bear immediately after injury and in A and E
  2. Pain on palpation of lateral malleolus
  3. Pain on palpation of medial malleolus
291
Q

What happens if its yes to an ottawa rule

A

Lateral and AP XRs

292
Q

What happens if a fracture is unstable

A

More likely to need surgery

293
Q

If it is a closed fracture dislocation what should be done

A

Closed reduction in A and E

294
Q

Heavy smoker and recurrent digit ischaemia

A

Thromboangitis obliterans

295
Q

Haemoptysis, haematuria and antiGMI

A

Goodpastures syndrome

296
Q

New agitation and hallucinations on prednisolone

A

Steroid induced psychosis

297
Q

Fever >5 days, conjunctivitis and strawberry tongue

A

Kawasakis disease

298
Q

Transmural inflammation and beads on a string angiography

A

Polyarteritis nodosa

299
Q

Recurrent mouth and genital ulcers not due to infection

A

Behcet syndrome

300
Q

First line investigation for vasculitis

A

Rheumatological antibody screen

301
Q

Vasculitis plus renal, lung or skin involvement then what is needed for diagnosis

A

Biopsy

302
Q

First line treatment for all small vessel vasculitis

A

Cyclophosphamide and corticosteroids

303
Q

Ongoing treatment for small vessel vasculitis

A

Low dose steroid and Methotrexate or mycophenolate or azathioprine

304
Q

LP= oligoclonal bands and high protein

A

Multiple sclerosis

305
Q

Campylobacter, ascending polyneuropathy and antiGM1

A

Guillain Barre syndrome

306
Q

Spinal cord lesion, normal MRI and anti-aquaporin4 positive

A

Nueromyelitis optica

307
Q

First line investigation for MS

A

MRI head and spine

308
Q

What is required for MS diagnosis

A

MRI/ clinical findings disseminated in both time and space

309
Q

First line treatment for spasticity in MS

A

Baclofen or gapapentin

310
Q

MS acute exacerbation medication

A

methylprednisolone

311
Q

DMARD for MS

A

Interferon beta

312
Q

Coarse tremor, confusion, hallucinations with history of alcohol excess

A

Delerium tremens = chlordiazepoxide

313
Q

Alcoholic excess, metabolic acidosis and ketosis

A

Alcoholic ketoacidosis

314
Q

Disulfiram

A

Promotes alcohol abstinence, inhibits acetaldehyde dehydrogenase

315
Q

1st line investigation for wernickes encephalopathy

A

clinical diagnosis

316
Q

What is wernickes encephalopathy

A

thiamine deficiency causes acute neurological symptoms: nystagmus, ataxia, confusion

317
Q

What is korsakoffs

A

Chronic memory problem (retrograde and antegrade amnesia with confabulation) caused by thiamine defiency

318
Q

What should you be aware of in wernickes encephalopathy

A

Hypoglycaemia

319
Q

Cape like distribution of pain/ temperature loss

A

Syringomelia

320
Q

Sensory level L1-2, up going plantars, absent knee reflexes

A

Conus medullaris lesion

321
Q

VDLR positive, loss of vibration/proprioception

A

Tabes dorsalis (tertiary syphilis)

322
Q

First line investigation for traumatic spine injury

A

CT spine

323
Q

First line investigation for non traumatic spine injury

A

MRI spine

324
Q

If spinal cord injury is secondary to trauma what should you do first

A

spinal immobilisation

325
Q

RF for anterior spinal artery syndrome

A

Atherosclerosis, aortic aneurysm and dissection

326
Q

Where should spinal cord injuries be managed

A

Tertiary neurosurgical centres

327
Q

Hypertension, bradycardia and kussmaul breathing

A

Cushings triad of raised ICP

328
Q

Fall in elderly patient on warfarin

A

Possible subdural, consider prothrombin complex if INR raised

329
Q

High suspicion of SAH but normal CT

A

Lumbar puncture at 12 hours for Xanthochromia

330
Q

First line investigation for intra cranial haemorrhage

A

CT Head

331
Q

3 categories of traumatic subdural haematoma

A

Acute (1-2days, hyperdense)
Subacute (3-14 days, isodense)
Chronic (15 days, hypodense)

332
Q

What to do if signs of raised ICP

A

Urgent referral to specialist neurosurgical centre

333
Q

What to do in stroke prior to treatment

A

CT Head because might be secondary to haemorrhage

334
Q

Type 1 hypersensitivity reaction

A

IgE mediated mast cell degranulation and histamine release (anaphylaxis)

335
Q

Anaphylaxis to penicillin

A

3rd gen cephalosporins in 3%

336
Q

Fever, rash, lymphadenopathy, deranged LFTs and eosinophilia

A

Drug reaction with eosinophilia and systemic symptoms

337
Q

1st line investigation to confirm anaphylaxis

A

Mast cell tryptase

338
Q

Initial treatment in anaphylaxis

A

0.5mg (0.5ml) 1:1000 Adrenaline

339
Q

What should you try and do early on when treating anaphylaxis

A

Remove the source

340
Q

How long should you monitor for after an anaphylactic reaction

A

6 hours in case theres a biphasic reaction

341
Q

Treatment to a contact of a patient with meningococcal meningitis

A

Ciprofloxacin 500mg STAT

Ceftriaxone in preg

342
Q

Gram negative diplococci on CSF gram stain

A

Neisseria meningitides

343
Q

Encapsulated yeast on india ink staining of CSF

A

Cryptococcal meningitides (as seen in HIV)

344
Q

First line investigation for meningitis

A

Lumbar puncture

345
Q

First line investigation for sepsis

A

Lactate, cultures and urine output

346
Q

How quickly do you have to do sepsis 6

A

Everything including Abx administration within 1hr

347
Q

What to do if septic patient not responding to initial treatment

A

Consider ICU

348
Q

Which antibiotic in neutropenic sepsis

A

Piperacillin Tazobactam

349
Q

Flushed, dry, tachycardia and dilated pupils

A

Anticholinergic syndrome

350
Q

Reduced GCS, pupillary changes and cardiorespiratory depression

A

Sedative syndrome- opioids, benzos, baclofen, barbituates

351
Q

Confusion, autonomic instability and neuromuscular hyperactivity

A

Serotonin syndrome

352
Q

First line investigation for overdose

A

Blood gas and ECG

353
Q

First line treatment for TCA overdose

A

Sodium bicarbonate 8.4% and supportive measures

354
Q

How to treat paracetamol overdose

A

N acetylcysteine according to nonogram

355
Q

What do you have to be careful of when giving naloxone

A

Opioids have a longer half life than naloxone so might have to give as infusion

356
Q

Facial nerve palsy following head injury

A

Basal skull fracture

357
Q

What is mannitol

A

Hypertonic saline used to lower ICP

358
Q

Unilateral ptosis and down and out eye and fixed dilated pupol

A

Surgical/ Traumatic 3rd nerve palsy

359
Q

Inability to abduct eye after head injury

A

6th nerve palsy in raised ICP

360
Q

1st line investigation in head injury

A

CT head

361
Q

What to do if reduced GCS more than 2 hours since head injury

A

CT head within the hour

362
Q

Where should you also assess if someone is coming in with a head injury

A

Cervical spine

363
Q

Head injury + GCS 15 + no concerning clinical or imaging features

A

Discharged without supervision

364
Q

When does an alcohol withdrawal seizure last

A

12-48 hours after last drink

365
Q

Focal weakness after seizures

A

Todds Paralysis

366
Q

Acute paralysis and dysarthria following treatment for hyponatraemia

A

Osmotic demyelination syndrome

367
Q

Status epilepticus first line investigation

A

Clinical diagnosis (Elevated lactate, prolactin and creatine kinase can help distinguish true seizures)

368
Q

What is a common and reversible cause of seizure

A

Hypoglycaemia

369
Q

First line treatment for status epilepticus

A

IV lorazepam, Buccal Midazolam or Rectal Diazepam and repeat if needed

370
Q

How long can you not drive for with a seizure of any type

A

6 months

371
Q

Flexed internally rotated and ADducted hip

A

Posterior hip dislocation

372
Q

Hypoxia, neurological signs and petechial rash after long bone fracture

A

Fat embolus syndrome

373
Q

Pain out of proportion to the trauma

A

Compartment syndrome

374
Q

First line investigation for hip fracture

A

AP pelvis XR and lateral XR of affected hip

375
Q

Preoperative preparation for hip fracture surgery

A

Analgesia, fluid restriction, stop blood thinning medication, early surgery

376
Q

How to treat intracapsular displaced fractures

A

Femoral head replacement, consider prior mobility

377
Q

Postoperative preparation for hip fracture surgery

A

Thromboprophylaxis, early mobilisation

378
Q

Hyperkalaemia ECG

A

Absent P waves, tall T waves, broad QRS

379
Q

Sharp chest pain relieved by leaning forwards, saddle shaped ST segments

A

Pericarditis

380
Q

Polyarthropathy, fractures and calcific skin lesions with CKD

A

Osteodystrophy

381
Q

First line investigation for acute renal failure

A

U and Es

382
Q

What determines the severity of AKI

A

Rise in basline creatinine

383
Q

What are indications for renal replacement therapy in AKI

A

Refractory to treatment and

Hyperkalaemic, acidotic, encephalopathic or fluid overloaded

384
Q

Post operative hypotension

A

Common side effect of epidural and spinal anaethesia

385
Q

Pain associated with renal colic

A

Responds well to PR diclofenac

386
Q

Trigeminal neuralgia first line medication

A

Carbamazepine

387
Q

Diabetic painful neuropathy first line medication

A

Duloxetine

388
Q

Why might you use several analgesics at once

A

Reduces total dose of each so less chance of side effects

389
Q

When to avoid NSAIDs

A

Elderly, pregnancy, asthmatics and renal impairment

390
Q

How to treat neuropathic pain

A

Non opioid analgesics

391
Q

Which diabetes medication causes weight gain and fluid retention

A

Pioglitazone

392
Q

Which diabetes medications cause weight gain and hypoglycaemic events

A

Sulphonylureas and IV insulin

393
Q

How to manage insulin when diabetic patient started on NG feeding or TPN

A

Variable rate insulin infusion

394
Q

What drugs to give after surgical resection of phaeochromocytoma

A

Alpha blockage then beta blockade

395
Q

First line investigation for diabetes

A

Capillary blood glucose and HbA1c

396
Q

How should you plan diabetics elective surgery

A

Delay until glucose control optimised (<69)

397
Q

What should you do with basal insulin during surgery

A

Continue it all the way through at a low dose

398
Q

How do you take someone off VRII

A

continue it 30 mins after first SC insulin

399
Q

Acute worsening of infection after starting ART in HIV patient

A

IRIS- immune reconstitution inflammatory syndrome

400
Q

Reduced visual acuity and perivascular infiltrates in HIV patient

A

CMV retinitis

401
Q

Odonophagia and white mucosal plaques at endoscopy in HIV patient

A

Oesophageal candidiasis

402
Q

HIV patient and desaturation on exertion

A

Pneumocystis jirovecii pneumonia

403
Q

HIV patient and brain MRI demonstrating ring enhancing lesions

A

Toxoplasmosis encephalitis

404
Q

HIV patient and violet plaques and human herpes virus 8

A

Kaposis sarcoma

405
Q

First line investigation for HIV

A

Combined HIV antibodies and p24 antigen

406
Q

What to do if positive HIV test

A

Repeat to confirm

407
Q

What to do if negative HIV test

A

Repeat in 12 weeks

408
Q

How to limit spread of HIV

A

Appropriate use of condoms, safe needle use and post exposure prophylaxis

409
Q

Gential ulcer, acute fever, headache and myalgia just after starting treatment for syphilis

A

Jarisch Herxheimer reaction

410
Q

Genital ulcer, painful unilateral inguinal lymphadenopathy and proctocolitis

A

Lymphogranuloma Venereum

411
Q

Painful ulcer and lymphadenopathy

A

Chancroid

412
Q

What should you always test for in a patient with STI

A

HIV

413
Q

CSF with low glucose, high protein and lymphocytes

A

TB meningitis

414
Q

Orange stained body fluids

A

Rifampicin therapy

415
Q

Red green colour vision disturbance

A

Ethambutol induced optic neuritis

416
Q

First line investigation for active TB

A

CXR and sputum

417
Q

First line investigation for latent TB

A

Mantoux test or interferon gamma assay

418
Q

How long treatment does active TB need

A

6-12 months

419
Q

How long treatment does latent TB need

A

3-6 months

420
Q

What should you test for if a patient has latent TB

A

HIV

421
Q

Polyarthralgia, conjuncitivits and mouth ulcers

A

Reactive arthritis

422
Q

Chronic abdominal pain, altered bowel habit with no identifiable cause

A

Post infectious IBS

423
Q

Campylobacter, ascending bilateral limb weakness and loss of reflexes

A

Guillain Barre Syndrome

424
Q

First line investigation for infectious diarrhoea

A

Stool sample

425
Q

Whats the treatment for travellers diarrhoea

A

Supportive measures

426
Q

General malaise, relative bradycardia and rose spots

A

Salmonella typhi

427
Q

Fever, headache, retro orbital pain, myalgia and rash

A

Dengue

428
Q

Bulls eye rash

A

Lyme disease

429
Q

Fist line treatment for malaria

A

Prompt Artemisinin combination therapy

430
Q

Why do travellers get more severe malaria

A

Low immunity

431
Q

Things to consider in returning traveller

A

Could be something normal or malaria, influenza, hepatiis, HIV

432
Q

Rheumatoid factor

A

Rheumatoid arthritis

Sjogrens

433
Q

Anti cyclic citrullinated peptide

A

Rheumatoid arthritis

434
Q

ANA positive

A 
SLE
SS
Sjogrens
Poly/Dermato-myositis
AI Hepatitis
435
Q

Anti dsDNA and Anti Smith

A

SLE

436
Q

Anti centromere

A

Limited systemic sclerosis

437
Q

Anti mitochondrial

A

Primary biliary cirrhosis

438
Q

Anti-Scl-70 (anti topoisomerase)

A

Diffuse systemic sclerosis

439
Q

Anti Ro and Anti La

A

Sjogrens

440
Q

Anti Jo (synthetase) and AntiMi2

A

Poly/Dermatomyositis

441
Q

Anti histone

A

Drug induced lupus

442
Q

ANCA

A

Vasculitis

FINALS (8 decks)

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