Finals - Medicine + Surgery

Question 1

What is used to manage acute flares of RA when on maintenance DMARD treatment?

Answer 1

oral steroids or IM steroids such as methylpred or tramcinolone

Question 2

What is the initial management of RA?

Answer 2

conventional DMARD monotherapy (usually methotrexate), often with short-term bridging corticosteroid. Methotrexate is given weekly.

Question 3

What may TNF-alpha inhibitors reactivate? What should be checked first?

Answer 3

TB, CXR should be checked first for presence of Ghon focus (Latent TB)

Question 4

Electrolyte abnormalities seen with thiazide like diuretics

Answer 4

hypercalcaemia, as well as hyponatraemia, hypokalaemia and hypomagnesaemia.

Question 5

1st line treatment for trigeminal neuralgia

Answer 5

carbamazepine is the first-line treatment for trigeminal neuralgia. The starting dose is typically 100mg twice daily, gradually titrated up to an effective dose or maximum tolerated dose

Other anticonvulsants such as oxcarbazepine or lamotrigine may be used as second-line treatments.

Question 6

What monitoring is required in HSP? Why?

Answer 6

lood pressure and urinanalysis should be monitored to detect progressive renal involvement

Question 7

What is HSP a type of?

Answer 7

IgA vasculitis

Question 8

Preceding influenza predisposes to what type of pneumonia

Answer 8

Staph Aureus

Question 9

1st line treatment for chronic plaque psoriasis

Answer 9

Topical potent corticosteroid + vitamin D analogue

Calcipotriol can be increased to twice daily before referral to secondary care

Question 10

1st line treatment for scalp psoriasis

Answer 10

topical potent corticosteroids

Question 11

Postpartum contraception

Answer 11

POP is the only method of contraception that can be initiated at any time postpartum.

Although this patient is not breastfeeding, the COCP should not be initiated in the first 21 days after delivery due to the increased venous thromboembolism risk.

The IUD and the IUS can only be inserted within 48 hours of childbirth or after 4 weeks.

Question 12

How long after pregnancy can a woman get pregnant?

Answer 12

21 days

Question 13

Benzo OD medication

Answer 13

Flumazenil - GABA antagonist

Question 14

Difference between histamine drugs

Answer 14

Histamine-1 Antihistamines (e.g. loratadine)
Histamine-2 Antacids (e.g. ranitidine)

Question 15

1st line treatment for allergic bronchopulmonary aspergillosis

Answer 15

Pred

Question 16

Definitive management of vestibular neuronitis

Answer 16

Vestibular rehabilitation

Question 17

Is hearing affected in vestibular neuronitis?

Answer 17

No

Question 18

How to differ between BPPV and vestibular neuritis in terms of spinnign?

Answer 18

In BPPV, spinning is triggered by head movement. In vestibular neuronitis, spinning is worsened by head movements.

Question 19

Acute management of vestibular neuritis

Answer 19

Prochlorperazine is recommended to alleviate vertigo, nausea and vomiting associated with vestibular neuronitis - used acutely, not definitive

Question 20

How do viral layrinthitis and vestibular neuritis differ in terms of presentation?

Answer 20

The presentation of viral labyrinthitis is similar to that of vestibular neuronitis; however, hearing loss and tinnitus are more likely to be present in viral labyrinthitis. In vestibular neuronitis only the vestibular nerve is involved; thus hearing is spared.

Question 21

Formula for alcohol units

Answer 21

Alcohol units = volume (ml) * ABV / 1,000

Question 22

When should a beta blocker be stopped in acute HF?

Answer 22

if the patient has heart rate < 50/min, second or third degree AV block, or shock

Question 23

Treatment for acute pulmonary oedema

Answer 23

IV loop diuretic e.g. furosemide

Question 24

Acute HF not responding to treatment…

Answer 24

CPAP

Question 25

When may nitrates be useful in patients with acute HF?

Answer 25

nitrates may be useful if the patient has concomitant myocardial ischaemia or severe hypertension

Question 26

When does infantile colic typically resovle by?

Answer 26

normally improves around 3-4 months of age and resolves around 6 months of age

Question 27

Treatment for vaginal vault prolapse

Answer 27

sacrocolpoplexy

Question 28

Treatment for cystocele

Answer 28

anterior colporrhaphyu

Question 29

Treatment for rectocele

Answer 29

Posterior colporrhaphy

Question 30

Investigations for acromegaly

Answer 30

1st line - serum IGF-1 In the investigation of acromegaly, if a patient is shown to have raised IGF-1 levels, an oral glucose tolerance test (OGTT) with serial GH measurements is suggested to confirm the diagnosis

Question 31

What may be expected following a start of an ACEi? What are acceptable changes? When to consider swapping to an alternative hypertensive?

Answer 31

a rise in the creatinine and potassium may be expected after starting ACE inhibitors acceptable changes are an increase in serum creatinine, up to 30% from baseline and an increase in potassium up to 5.5 mmol/l. A potassium above 6mmol/L should prompt cessation of ACE inhibitors in a patient with CKD (once other agents that promote hyperkalemia have been stopped)

Question 32

What is amaurosis fugax? Which artery does it affect? What does this arise from?

Answer 32

Amaurosis fugax is a form of stroke that affects the retinal/ophthalmic artery, arises from internal carotid ipsilaterally

Question 33

What does an anterior cerebral artery stroke cause?

Answer 33

leg weakness but not face weakness or speech impairment

Question 34

What does a posterior cerebral artery stroke cause?

Answer 34

Contralateral homonymous hemianopia with macular sparing and visual agnosia

Question 35

What does an MCA stroke cause>

Answer 35

Contralateral hemiparesis and sensory loss with the upper extremity being more affected than the lower, contralateral homonymous hemianopia and aphasia

Question 36

What does a basilar artery stroke cause?

Answer 36

Locked in syndrome

Question 37

What is weber's syndrome?

Answer 37

form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis (branches of the posterior cerebral artery that supply the midbrain)

Question 38

What does an anterior inferior cerebellar artery stroke cause?

Answer 38

Ipsilateral: facial paralysis and deafness Contralateral: limb/torso pain and temperature loss Ataxia, nystagmus AKA Lateral Pontine Syndrome

Question 39

What does a pontine haemorrhage present with?

Answer 39

reduced GCS, paralysis and bilateral pin point pupils

Question 40

most common cause of amaurosis fugax

Answer 40

Atherosclerosis of the internal carotid

Question 41

How does wallenberg syndrome (posterior inferior cerebellar artery) present?

Answer 41

Ipsilateral: facial pain and temperature loss Contralateral: limb/torso pain and temperature loss Ataxia, nystagmus

Question 42

how to differentiate between PICA and AICA stroke

Answer 42

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) Ipsilateral: facial pain and temperature loss Contralateral: limb/torso pain and temperature loss Ataxia, nystagmus Anterior inferior cerebellar artery (lateral pontine syndrome) Symptoms are similar to Wallenberg's (see above), but: Ipsilateral: facial paralysis and deafness

Question 43

Risk of phototherapy as a treatment for psoriasis

Answer 43

SCC

Question 44

Power equation

Answer 44

Power = 1 - the probability of a type II error Can be increased by increasing the sample size

Question 45

What tests are used to assess statistical correlation?

Answer 45

Correlation parametric (normally distributed): Pearson's coefficient non-parametric: Spearman's coefficient

Question 46

Types of parametric tests

Answer 46

Student's t-test - paired or unpaired* Pearson's product-moment coefficient - correlation *paired data refers to data obtained from a single group of patients, e.g. Measurement before and after an intervention. Unpaired data comes from two different groups of patients, e.g. Comparing response to different interventions in two groups

Question 47

Types of non-parametric tests

Answer 47

Mann-Whitney U test compares ordinal, interval, or ratio scales of unpaired data Wilcoxon signed-rank test compares two sets of observations on a single sample, e.g. a 'before' and 'after' test on the same population following an intervention chi-squared test used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions Spearman, Kendall rank - correlation

Question 48

How are accoustic neuromas best visualsied?

Answer 48

MRI of the cerebellopontine angle

Question 49

Gold standard for diagnosing contact dermatitis

Answer 49

Skin patch testG

Question 50

Gold standard for diagnosing immediate hypersensitivity reactions

Answer 50

Skin prick testing

Question 51

Who can be considered for a non-urgent referral with in women witha breast lump?

Answer 51

A woman < 30 years of age presenting with an unexplained breast lump with or without pain does not meet 2WW criteria but can be considered for a non-urgent referral INAPPROPRIATE TO DIAGNOSE FIBROADENOMA ON CLINICAL EXAM ALONE

Question 52

What is mondor's disease of the breast?

Answer 52

localised thrombophlebitis of a breast vein.

Question 53

What type of breast inflam is common in smokers? How is it treated?

Answer 53

Periductal mastitis is common in smokers and may present with recurrent infections. Treatment is with co-amoxiclav.

Question 54

Types of mastitis

Answer 54

Non-lactational - periductal - common in smokers and treated with co-amox Lactational - common postpartum and treated with fluclox

Question 55

STEMI management if patient is having PCI (within 120 minutes of episode occuring)

Answer 55

Patients undergoing a PCI are given dual antiplatelet therapy prior to the PCI itself which involves aspirin and prasugrel (if the patient does not take an oral anticoagulant) or clopidogrel (if they do take an oral anticoagulant).

Question 56

Preferred stent type for primary PCI

Answer 56

Drug eluting stents

Question 57

What type of arterial access preferred for primary PCI?

Answer 57

Radial

Question 58

If PCI cannot be delivered within 120 minutes of STEMI, what should be offered? What does this consist of?

Answer 58

Fibrinolysis Need to give an antithrombin - fondaparinux Ticagrelor is given following procedure

Question 59

What ABG findings present with cushing's syndrome

Answer 59

hypokalaemic metabolic alkalosis

Question 60

loss of left heart border on CXR

Answer 60

left lingula consolidation

Question 61

What can LMWH cause on electrolytes? Why?

Answer 61

Hyperkalaemia Can suppress aldosterone

Question 62

Triad for cardiac tamponade

Answer 62

muffled heart sounds, paradoxical pulse and jugular vein distension.

Question 63

Following referral to ENT, patients with sudden onset sensorineural hearing loss are treated with what?

Answer 63

High dose oral corticosteroids

Question 64

What do ground glass hepatocytes on light microscopy point towards in hepatitsis B?

Answer 64

Chronic infection

Question 65

When should an MSU be sent for women with a suspected UTI?

Answer 65

If ASx with visible or non-visible haematuria

Question 66

What drug class may be useful in patients with an overactive bladder (both voiding and storage symptoms)

Answer 66

antimuscarinic drugs - tolterodine

Question 67

What can beta blockers exacerbate?

Answer 67

plaque psoriasis

Question 68

What type of antihypertensive is asx with tiredness?

Answer 68

Beta blocker

Question 69

Migraine management

Answer 69

acute: triptan + NSAID or triptan + paracetamol prophylaxis: topiramate or propranolol

Question 70

Transfusion threshold for patients with ACS

Answer 70

The transfusion threshold for patients with ACS is 80 g/L

Question 71

What type of renal mass is seen in tuberous sclerosis?

Answer 71

angiomyolipoma - typically seen bilaterally - it is benign

Question 72

What is seen in acute interstital nephritis?

Answer 72

an 'allergic' type picture consisting usually of raised urinary WCC and eosinophils, alongside impaired renal function

Question 73

What is sampling bias?

Answer 73

When subjects are not representative of the population

Question 74

What is drusen pathognomonic for?

Answer 74

Drusen = Dry macular degeneration - Presence of drusen on fundoscopy (referred to as 'amber material under the retinal pigment epithelium in both eyes')

Question 75

What is a useful test in those with macular degeneration? Why?

Answer 75

Amsler grid testing (to check for distortion of line perception) may be useful in testing patients with suspected age related macular degeneration

Question 76

What is wet macular degeneration characterised by?

Answer 76

Choroidal neovascularisation

Question 77

What is a risk factor for macular degeneration

Answer 77

Smoking

Question 78

How do macular degeneration and open-angle glaucoma differ in terms of vision loss?

Answer 78

Macular degeneration is associated with central field loss Primary open-angle glaucoma is associated with peripheral field loss

Question 79

What should decreasing vision over months with metamorphopsia (distorted vision) and central scotoma (dark spot) should cause high suspicion of?

Answer 79

wet age-related macular degeneration

Question 80

Definitive treatment of wet AMD

Answer 80

anti-VEGF (Bevacizumab)

Question 81

Medical treatment of dry AMD

Answer 81

There is no curative medical treatment for dry AMD. High dose of beta-carotene, vitamins C and E, and zinc can be given to slow deterioration of visual loss

Question 82

What should patients with long saphenous vein superficial thrombophlebitis have?

Answer 82

an US scan to exclude DVT

Question 83

Recommended management for supergicial thrombophlebitis

Answer 83

Compression stockings

Question 84

1st line treatment for acute gout

Answer 84

NSAIDS Colchicine should be used to treat acute gout if NSAIDs are contraindicated for example a peptic ulcer.

Question 85

Should allopurinol be continued during an acute attack of gout?

Answer 85

only in pattients presenting with an acute flare of gout who are already established on treatment

Question 86

What should be prescribing adjunct to allopurinol initiation?

Answer 86

NSAID or colchicine 'cover'

Question 87

Who should allopurinol be offered to?

Answer 87

All patients after their first attack of gout

Question 88

Mackler triad for boerhaave syndromw

Answer 88

vomiting, thoracic pain, subcutaneous emphysema.

Question 89

Inferior MI and AR murmur should raise suspicion of?

Answer 89

ascending (proximal) aorta dissection

Question 90

What type of organism can cause immune mediated neurological diseases following a LRTI?

Answer 90

Mycoplasma

Question 91

Is weight bearing reccomended following hip fracture?

Answer 91

Yes, immediately

Question 92

How does the leg present following hip fracture? How does this differ in dislocation?

Answer 92

Shortened and externally rotated Dislocation is internally rotated

Question 93

General rule for management of intracapasular fractures

Answer 93

Intracapsular femoral fracture - hemiarthroplasty extracapsular femoral fracture - dynamic hip screw

Question 94

Patients with a GRACE score of >3% should undergo coronary angiography when?

Answer 94

within 72 hoyurs of admission

Question 95

fundoscopy findings of anterior ischaemic optic neuropathy

Answer 95

swollen pale disc and blurred margins

Question 96

What is polymyalgia rheumatica associated with?

Answer 96

GCA - can lead to anterior ischaemic optic neuropathy if left untreated

Question 97

What can local anaethetic toxicity be treated with?

Answer 97

IV 20% lipid emulsion

Question 98

Formula for number needed to treat

Answer 98

NNT = 1 / Absolute Risk Reduction

Question 99

how can loop diuretics affect hearing?

Answer 99

May cause ototoxicity

Question 100

When should FIT testing be offered?

Answer 100

FIT testing should be offered first-line to help exclude colorectal cancer for patients aged ≥ 50 years with any of the following: rectal bleeding abdominal pain weight loss

Question 101

What can occur following an inferior MI?

Answer 101

AV block

Question 102

what is the most likely diagnosis in an uncircumcised man, who has developed a tight white ring around the tip of the foreskin and phimosis

Answer 102

lichen sclerosis

Question 103

What type of referral should be made if querying parkinson's disease?

Answer 103

Urgent referral to neurology

Question 104

How may bell's palsy affect the tongue?

Answer 104

With a Bell's palsy loss of taste of the anterior two-thirds of the tongue (on the same side as the facial weakness) may occur

Question 105

When should referral to ENT be made in bells palsy?

Answer 105

For a patient with a Bell's palsy, if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT

Question 106

What to do if CT or MRI shows limited infarct core in an acute ischaemic stroke?

Answer 106

Thrombectomy Can be done between 6-24 hourss

Question 107

What should be done prior to thrombolysis in an acute ischaemic stroke?

Answer 107

Treatment of hypertension (>185/110)

Question 108

1st line secondary prevention of stroke, if not tolerated give what?

Answer 108

If clopidogrel is contraindicated or not tolerated, give aspirin for secondary prevention following stroke

Question 109

What to do if large artery acute ischaemic stroke?

Answer 109

Consider mechanical clot retrieval

Question 110

Globus, hoarseness and no red flags

Answer 110

?laryngopharyngeal reflux

Question 111

first line radiological investigation for suspected stroke

Answer 111

Non-contrast CT head scan

Question 112

Cushing's triad for raised ICP

Answer 112

hypertension, bradycardia, and irregular breathing

Question 113

What movement is classically impaired in adhesive capsulitis

Answer 113

External rotation (on both active and passive movement) is classically impaired in adhesive capsulitis

Question 114

Definitive diagnostic investigation for small bowel obstruction

Answer 114

CT abdomen

Question 115

1st line investigation for small bowel obstruction

Answer 115

abdominal X-ray

Question 116

Management of small bowel obstruction

Answer 116

initial steps: NBM IV fluids nasogastric tube with free drainage

Question 117

How can nerve root pain be distinguished from other pain in the leg?

Answer 117

by the dermatomal distribution and an associated neurological deficit

Question 118

What's seen on polarised light microscopy in pseudogout?

Answer 118

weakly positively birefringent rhomboid-shaped crystals

Question 119

How to distinguish pseudogout from gout?

Answer 119

Chondrocalcinosis helps to distinguish pseudogout from gout - Linear calcification of the articular cartilage

Question 120

Acute epididymo-orchitis in sexually active younger adults is most commonly caused by?

Answer 120

Chlamydia

Question 121

Epididymo-orchitis in individuals with a low STI risk (e.g. married male in 50s, wife only partner) is likely due to?

Answer 121

enteric organisms (e.g. E. coli)

Question 122

Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg's positive?

Answer 122

Subacute combined degeneration of the spinal cord

Question 123

Whipple's triad of insulinoma

Answer 123

Symptoms and signs of hypoglycemia Plasma glucose < 2.5 mmol/L Reversibility of symptoms on the administration of glucose Importantly C-peptide levels do not fall on the administration of insulin if the patient has an insulinoma as endogenous levels are not reduced.

Question 124

If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given?

Answer 124

either oral azathioprine or oral mercaptopurine to maintain remission

Question 125

If a mild-moderate flare of distal ulcerative colitis doesn't respond to topical (rectal) aminosalicylates then what should be added?

Answer 125

oral aminosalicylates should be added - both topical and oral mesalazine

Question 126

f a severe flare of UC has not responded to IV steroids after 72 hours, consider adding?

Answer 126

IV ciclosporin or surgery

Question 127

Ethylene glycol toxicity management

Answer 127

fomepizole

Question 128

Ethanol toxicity management

Answer 128

Haemodialysis

Question 129

Ongoing loin pain, haematuria, pyrexia of unknown origin?

Answer 129

?Renal cell carcinoma

Question 130

Metabolic alkalosis + hypokalaemia ?

Answer 130

?prolonged vomiting

Question 131

What is the only test recommended for H. pylori post-eradication therapy?

Answer 131

Urea breath tes

Question 132

Klumpke's paralysis

Answer 132

Involving brachial trunks C8-T1. Classically there is weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner's syndrome.

Question 133

arm is hanging loose on the side. It is pronated and medially rotated.

Answer 133

Erb's palsy - Brachial trunks C5-6

Question 134

Investigating suspected PE: if the CTPA is negative then consider?

Answer 134

a proximal leg vein ultrasound scan if DVT is suspected

Question 135

widespread rash with fluid-filled blisters, fever, and recent initiation of phenytoin strongly suggests?

Answer 135

Toxic epidermal necrolysis

Question 136

Peptic ulceration, galactorrhoea, hypercalcaemia?

Answer 136

MEN type 1

Question 137

What should be considered for Afro-Caribbean patients with heart failure who are not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy

Answer 137

Hydrazine and nitrate

Question 138

What should patients with reduced LVEF should be given as first-line treatment

Answer 138

a beta blocker and an ACE inhibitor

Question 139

When starting ACE-inhibitors and beta-blockers for heart failure with reduced ejection fraction, how should you start the drugs?

Answer 139

One drug at a time

Question 140

Can prostate cancer be seen with a normal PSA?

Answer 140

Yes

Question 141

key investigation in diagnosing early CKD

Answer 141

urinary albumin:creatinine ratio (ACR)

Question 142

When should you stop a statin?

Answer 142

When patient is on a macrolide - erythro/clarithromycin

Question 143

What can be used to avoid transfusion associated graft versus host disease?

Answer 143

Irradiation of blood products

Question 144

What is oesophagael adenocarcinoma associated with?

Answer 144

GORD or Barrett's

Question 145

How does synringomyelia present?

Answer 145

with cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine

Question 146

What is syringomyelia? What does it have a strong association with?

Answer 146

collection of cerebrospinal fluid within the spinal cord. Causes include: a Chiari malformation: strong association

Question 147

areflexia, ataxia, ophthalmoplegia

Answer 147

Miller Fisher syndrome (subtype of GBS)

Question 148

Exudative causes of pleural effusion

Answer 148

HIGH PROTEIN infection pneumonia (most common exudate cause), connective tissue disease rheumatoid arthritis systemic lupus erythematosus neoplasia lung cancer mesothelioma metastases pancreatitis pulmonary embolism Dressler's syndrome

Question 149

Transudative causes of pleural effusion

Answer 149

LOW PROTEIN heart failure (most common transudate cause) hypoalbuminaemia liver disease nephrotic syndrome malabsorption hypothyroidism Meigs' syndrome

Question 150

Sudden deterioration with ventilation suggests?

Answer 150

Tension pneumothorax

Question 151

Bleeding on dabigatran? What to reverse?

Answer 151

Idarucizumab

Question 152

Persistent unexplained hoarseness in a patient aged >45 years old, consider what?

Answer 152

urgent referral to ENT and CXR to exclude apical lung lesion

Question 153

Damage to which CN causes a RAPD

Answer 153

optic nerve - CN II

Question 154

Useful for managing tremor in drug-induced parkinsonism

Answer 154

Procyclidine

Question 155

Which anti-parkinson drug has been ASx with lung fibrosis?

Answer 155

Cabergoline

Question 156

Which anti-parkinsonian drug has a reduced effectiveness over time?

Answer 156

Levodopa

Question 157

tumour marker in breast cancer

Answer 157

CA15-3

Question 158

mixed aortic valve disease, what examination finding?

Answer 158

Bisferiens pulse

Question 159

Massive PE + hypotension, do what?

Answer 159

Thrombolyse with alteplase

Question 160

holosystolic murmur, high-pitched and 'blowing' in character

Answer 160

mitral regurg

Question 161

Horner's syndrome features

Answer 161

miosis, ptosis, enophthalmos and anhidrosis

Question 162

How to differ between horner's and third nerve palsy

Answer 162

Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner's

Question 163

What determines site of lesion in horner's syndrome?

Answer 163

anhydrosis determines site of lesion: head, arm, trunk = central lesion: stroke, syringomyelia just face = pre-ganglionic lesion: Pancoast's, cervical rib absent = post-ganglionic lesion: carotid artery

Question 164

Arterial/venous thrombosis, miscarriage, livedo reticularis

Answer 164

anticardiolipin antibody +ve

Question 165

Uncontrollable splenic bleeding in trauma patients is an indication for what?

Answer 165

Splenectomy

Question 166

Indications for splenectomy

Answer 166

Uncontrollable splenic bleeding Hilar vascular injuries Devascularised spleen

Question 167

Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus

Answer 167

?adenomyosis

Question 168

J waves on ECG

Answer 168

Hypothermia

Question 169

what is given before endoscopy in patients with suspected variceal haemorrhage

Answer 169

Both terlipressin and antibiotics

Question 170

What is used if uncontrolled variceal haemorrhage

Answer 170

Sengstaken-Blakemore tube

Question 171

What is used as a last resort treatment following sengstaken blakemore tube in variceal haemorrhage? What can it cause?

Answer 171

Transjugular Intrahepatic Portosystemic Shunt (TIPSS) - connects the hepatic vein to the portal vein exacerbation of hepatic encephalopathy is a common complication

Question 172

What is the pattern of pyrexia in still's disease?

Answer 172

Pyrexia in Still's disease has a characteristic pattern. It typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash

Question 173

What is contraindicated in V tach?

Answer 173

Verapamil

Question 174

What lung pathology can methotrexate cause?

Answer 174

pneumonitis - typically presents with cough, dyspnoea and fever

Question 175

What are the most common triggers of autonomic dysreflexia

Answer 175

Faecal impaction / urinary retention

Question 176

presentation of hypertension, bradycardia and physical symptoms of sympathetic overdrive in a patient with a spinal cord injury above the level of T6 is typical of?

Answer 176

Autonomic dysreflexia

Question 177

A man presents with central, pleuritic chest pain and fever 4 weeks following a myocardial infarction. The ESR is elevated

Answer 177

Dressler syndrome

Question 178

widespread systolic murmur, hypotension, pulmonary oedema following MI

Answer 178

Rupture of the papillary muscle due to a myocardial infarction → acute mitral regurgitation

Question 179

A patient is noted to have persistent ST elevation 4 weeks after sustaining a myocardial infarction. Examination reveals bibasal crackles and the presence of a third and fourth heart sound

Answer 179

left ventricular aneurysm

Question 180

Bilateral, mid-to-lower zone patchy consolidation in an older patient

Answer 180

? Legionella

Question 181

Chest drain swinging

Answer 181

Rises in inspiration, falls in expiration

Question 182

Mx of minimal change disease

Answer 182

prednisolone

Question 183

How to differ between syncopal episodes and seizures?

Answer 183

Syncopal episodes are associated with a rapid recovery and short post-ictal period. Seizures are associated with a far greater post-ictal period

Question 184

What must be assessed in a patient with potential bilateral urinary tract obstruction?

Answer 184

Renal function

Question 185

A history of Intravenous drug use coupled with a descending paralysis, diplopia and bulbar palsy is characteristic of

Answer 185

infection with Clostridium botulinum

Question 186

When can you diagnose stage 1/2 CKD?

Answer 186

CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR

Question 187

What is used in the management of Von Willebrand's disease?

Answer 187

Desmopression

Question 188

Electrolyte abnormality in T1DM

Answer 188

Metabolic acidosis with increased anion gap

Question 189

most common site of metatarsal stress fractures is?

Answer 189

2nd metatarsal shaft

Question 190

When may nerve blocks be considered in a rib fracture?

Answer 190

Nerve blocks may be considered if a rib fracture is not controlled by normal analgesia

Question 191

Stages of shock

Answer 191

Class I shock would be completely compensated for. Class II shock would cause tachycardia. Class III shock causes tachycardia and hypotension as well as confusion. Class IV shock causes loss of consciousness as well as severe hypotension.

Question 192

Parkinsonism with associated autonomic disturbance (atonic bladder, postural hypotension) points towards

Answer 192

Multiple system atrophy

Question 193

Which testicular tumours present with raised markers? What are they?

Answer 193

Yolk sac tumour - AFP Teratoma - HCG, presents 20-30 Seminoma - normal, presents in 30+

Question 194

What is hyperacute transplant rejection caused by?

Answer 194

pre-existing antibodies against ABO or HLA antigens Usually occurs within 24-48 hours post-transplant

Question 195

Severe life-threatening complication of C.Diff

Answer 195

Pseudomembranous colitis

Question 196

Rosacea features

Answer 196

nose, cheeks and forehead flushing, erythema, telangiectasia → papules and pustules

Question 197

Soft, non-tender swelling on one side of the scrotum that transilluminates

Answer 197

Hydrocele

Question 198

For type 2 diabetics requiring treatment, metformin is contraindicated in those with?

Answer 198

eGFR < 30

Question 199

Early ultrasound imaging in acute pancreatitis is important to determine the aetiology as this may affect management (e.g. patients with gallstones/biliary obstruction). What would this be?

Answer 199

US abdo

Question 200

Phaeo triad

Answer 200

triad of sweating, headaches, and palpitations in association with severe hypertension

Question 201

Vision worse going down stairs? Think what

Answer 201

4th nerve palsy

Question 202

when looking straight ahead, the affected eye appears to deviate upwards and is rotated outwards. What palsy?

Answer 202

4th nerve

Question 203

triad for hepatorenal syndrome. Mx?

Answer 203

ascites, low urine output, and a significant increase in serum creatinine. Terlipressin is 1st line

Question 204

What murmur seen in anaemia? How does it present?

Answer 204

Aortic flow murmur, soft ESM which doesn't radiate

Question 205

IgA nephropathy classically presents as?

Answer 205

visible haematuria following a recent URTI, 1-2 days after. A=Acute

Question 206

Infant with bilious vomiting & obstruction?

Answer 206

?Intestinal malrotation

Question 207

no association between P waves (atrial activity) and QRS complexes (ventricular activity)>

Answer 207

Complete heart block Treated with transvenous pacing if ASx with brady

Question 208

What is the most suitable management option for epistaxis where the bleed site is difficult to localise

Answer 208

Anterior packing

Question 209

Measles is characterised by

Answer 209

prodromal symptoms, Koplik spots (white spots on buccal mucosa). maculopapular rash starting behind the ears and conjunctivitis

Question 210

long-term prophylaxis of cluster headaches?

Answer 210

Verapamil

Question 211

Cluster headache - acute treatment

Answer 211

subcutaneous sumatriptan + 100% O2

Question 212

Symptom control in non-CF bronchiectasis

Answer 212

inspiratory muscle training + postural drainage

Question 213

Bronchiectasis: most common organism

Answer 213

Haemophilus influenzae

Question 214

Pneumonia in an alcoholic

Answer 214

Klebsiella

Question 215

In those diagnosed with anal fistula, best Ix?

Answer 215

MRI is the best investigation to characterise the fistula course

Question 216

For patients with rosacea with predominant flushing but limited telangiectasia, consider?

Answer 216

Bromonidine gel

Question 217

What can SAH cause on ECG?

Answer 217

Torsades de pointes

Question 218

All patients with severe hyperkalaemia (≥ 6.5 mmol/L) or with ECG changes:

Answer 218

IV calcium gluconate insulin/dextrose infusion

Question 219

pain on palpation of the tragus, itching, discharge and hearing loss

Answer 219

otitis externa

Question 220

Firm and well-circumscribed mass that transilluminates on the dorsal aspect of the wrist ?

Answer 220

Ganglion cyst

Question 221

most common cause of osteomyelitis?

Answer 221

staph aureus

Question 222

Cause of raised serum NP besides HF

Answer 222

Renal dysfunction (eGFR < 60) can cause a raised serum natriuretic peptides

Question 223

first-line medication for primary biliary cholangitis

Answer 223

Ursodeoxycholic acid

Question 224

common features of meniscal lesions

Answer 224

Knee locking and giving-way

Question 225

Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of

Answer 225

acanthamoebic keratitis

Question 226

first-line treatment for regular broad complex tachycardias without adverse features

Answer 226

IV amiodarone

Question 227

What is key in determining the severity of C. difficile infection

Answer 227

white cell count

Question 228

Patients with orbital cellulitis require?

Answer 228

admission to hospital for IV antibiotics due to the risk of cavernous sinus thrombosis and intracranial spread

Question 229

DIlated pupil, females, absent leg reflexes

Answer 229

Holmes adie syndrome

Question 230

first line for lower back pain

Answer 230

NSAIDs

Question 231

Abdominal pain, constipation, neuropsychiatric features, basophilic stippling?

Answer 231

Lead poisoning

Question 232

Fever, loin pain, nausea and vomiting ?

Answer 232

Acute pyelonephritis

Question 233

standard for the diagnosis and screening of HIV?

Answer 233

Combination tests (HIV p24 antigen and HIV antibody)

Question 234

After an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test when?

Answer 234

12 weeks

Question 235

Bile-acid malabsorption may be treated with? often occurs after?

Answer 235

cholestyramine, after cholecystectomy

Question 236

empirical antibiotic of choice for neutropenic sepsis?

Answer 236

Piperacillin with tazobactam (Tazocin)

Question 237

Gas gangrene is caused by?

Answer 237

Clostridium Pefringens

Question 238

Is digoxin monitored?

Answer 238

No, unless suspected toxicity

Question 239

Recommend Adult Life Support (ALS) adrenaline doses

Answer 239

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

Question 240

The first line investigation for children aged 5 to 16 with suspected asthma is?

Answer 240

fractional nitric oxide

Question 241

1st line treatment for CO poisoning

Answer 241

100% high flow o2

Question 242

potential complication of panretinal photocoagulation

Answer 242

Decrease in night vision

Question 243

Spinal cord transection after trauma can present with? How to manage?

Answer 243

neurogenic shock, manage with vasopressors

Question 244

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

Answer 244

Central retinal vein occlusion

Question 245

Neuromuscular disorders result in what pattern on pulmonary function tests?

Answer 245

Restrictive

Question 246

Pioglitazone - contraindicated by:

Answer 246

HF Bladder cancer

Question 247

Screening for an abdominal aortic aneurysm consists of

Answer 247

single abdominal ultrasound for males aged 65

Question 248

Critical limb ischaemia presents as?

Answer 248

pain at rest for greater than 2 weeks, often at night, not helped by analgesia

Question 249

What are generally used to induce remission of Crohn's disease?

Answer 249

Pred

Question 250

What is used first-line to maintain remission in patients with Crohn's

Answer 250

Azathioprine or mercaptopurine

Question 251

first line test for diagnosis of small bowel overgrowth syndrome

Answer 251

Hydrogen breath testing

Question 252

What is the most likely SSRI to lead to QT prolongation and Torsades de pointes

Answer 252

Citalopram

Question 253

Burning thigh pain? Dx? What nerve affected?

Answer 253

? meralgia paraesthetica - lateral cutaneous nerve of thigh compression

Question 254

What is the most common cause of peritonitis secondary to peritoneal dialysis

Answer 254

Coagulase-negative Staphylococcus e.g. Epidermis

Question 255

What nephropathy is frequently associated with malignancy

Answer 255

Membranous nephropathy

Question 256

Patients who have had an episode of SBP require antibiotic prophylaxis with what?

Answer 256

Cipro

Question 257

Unilateral glue ear in an adult needs evaluation for what?

Answer 257

Posterior nasal space tumour

Question 258

What medication may be used in patients with raised ICP?

Answer 258

IV mannitol is an osmotic diuretic that may be used in patients with raised ICP

Question 259

Peptic ulceration, galactorrhoea, hypercalcaemia

Answer 259

multiple endocrine neoplasia type I

Question 260

In the treatment of anaphylaxis, adrenaline may be given every 5 minutes by the following doses

Answer 260

0-6 years old: 150micrograms (0.15ml 1 in 1,000). 6-12 years old: 300micrograms (0.3ml 1 in 1,000). 13+ years old: 500micrograms (0.5ml 1 in 1,000).

Question 261

What Rate control medication can interfere with MG?

Answer 261

Beta blockers

Question 262

Sjogren's syndrome mX

Answer 262

pilocarpine - helps to stimulate saliva production

Question 263

CXR finding on ank spond

Answer 263

Apical fibrosis

Question 264

What nerve supplies the extensor muscle group of forearms?

Answer 264

Radial

Question 265

What nerve supplies the interosseous muscles of hand (involved in adduction)?

Answer 265

Ulnar

Question 266

Disseminated gonococcal infection triad

Answer 266

tenosynovitis, migratory polyarthritis, dermatitis

Question 267

What blood test can rise in small bowel obstruction?

Answer 267

Serum amylase

Question 268

Dermatophyte nail infection, mx?

Answer 268

oral terbinafine

Question 269

Treatment of choice for essential tremor

Answer 269

Propanolol

Question 270

What can essential tremor affect besides the hands?

Answer 270

While an essential tremor is classically associated with a tremor present with sustained muscle tone (i.e. postural tremor) in the hands, it can also affect the vocal cords

Question 271

What is the most sensitive scan to diagnose diffuse axonal injury

Answer 271

MRI

Question 272

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

Answer 272

?Dengue

Question 273

Patients with polymyalgia rheumatica typically respond dramatically to steroids, failure to do so should?

Answer 273

Prompt consideration of an alternative diagnosis

Question 274

Proximal aortic dissections are generally managed with?

Answer 274

Surgical aortic root replacement

Question 275

Strong suspicion of PE but a delay in the scan:

Answer 275

Start on treatment dose anticoag meanwhile

Question 276

Medial epicondylitis is aggravated by?

Answer 276

wrist flexion and pronation

Question 277

What should be done if needle aspiration of a pneumothorax is unsuccessful?

Answer 277

Insertion of a chest drain

Question 278

Mx of acute bronchitis? When is this different?

Answer 278

NICE guidance does not recommend antibiotics for acute bronchitis in people who are not at high risk of complications and who are not systemically very unwell. However, if a patient is very unwell or at risk of complications, antibiotics should be offered.

Question 279

Desmopression MOA

Answer 279

Vasopressin V2 receptor agonist

Question 280

Mx of lung abscess

Answer 280

IV ABx If no improvement, consider CT-guided percutaneous drainage

Question 281

Subacute productive cough, foul-smelling sputum, night sweats

Answer 281

Lung abscess

Question 282

If a hernia cannot be reduced it is referred to as?

Answer 282

an incarcerated hernia - these are typically painless

Question 283

Most effective antipsychotic for negative Sx of schizo

Answer 283

Clozapine

Question 284

What is a recognised respiratory complication of pancreatitis

Answer 284

ARDS

Question 285

Are patients with pancreatitis given Abx?

Answer 285

Not routinely, fluids and analgesia are mainstay

Question 286

Should patients with acute pancreatitis be kept NBM?

Answer 286

Patients with acute pancreatitis should not routinely be made 'nil-by-mouth' Enteral nutrition should be offered to anyone with moderately severe or severe acute pancreatitis

Question 287

Which antihypertensive can cause peripheral oedema?

Answer 287

CCBs e.g. amlodipine

Question 288

What happens to iodine uptate in subacute thyroiditis?

Answer 288

Decreased iodine uptake

Question 289

Mx of BPH

Answer 289

First tamsulosin - alpha 1 antagonist then Finasteride - 5alpha reductase inhibitors

Question 290

What can be used in refractory pain for shingles?

Answer 290

Corticosteroids can be used in refractory pain in shingles if simple analgesia and neuropathic analgesia do not help, but only for acute shingles

Question 291

If combination of storage and voiding Sx that persist following tamsulosin, trial what Mx?

Answer 291

antimuscaric (anticholinergic drug) e.g. tolterodine or darifenacin

Question 292

Best anaesthetic agent in trauma? Why?

Answer 292

Ketamine. no drop in BP

Question 293

How are patient's diabetic medication managed during operations?

Answer 293

most patients taking only oral antidiabetic drugs may be managed by manipulating medication on the day of surgery, depending on the particular drug

Question 294

How do episcleritis and scleritis differ?

Answer 294

In episcleritis, the injected vessels are mobile when gentle pressure is applied on the sclera. In scleritis, vessels are deeper, hence do not move. Scleritis is PAINFUL

Question 295

Gold standard for diagnosing CSF, if not can use?

Answer 295

Beta-2-transferring, use glucose if not (would be positive)

Question 296

chronic history of lower limb weakness characterised by a pyramidal distribution, where flexors are more affected than extensors in the lower limbs. This is accompanied by hyperreflexia and an upgoing plantar response, which are indicative of an upper motor neuron lesion.

Answer 296

MS

Question 297

Mx of anal fissures that don't respond to conservative management

Answer 297

sphincterectomy

Question 298

Acute anal fissue (<1 week) Mx

Answer 298

soften stool, dietary fibre, analgesia and topical anaesthetic cream (e.g. lidocaine) if necessary

Question 299

Lateral anal fissure?

Answer 299

LOOK FOR OTHER CAUSES

Question 300

Chronic anal fissure Mx

Answer 300

topical GTN

Question 301

Mx of simple rib fractures

Answer 301

Conservative

Question 302

Most common cause of sudden onset sensorineural hearing loss

Answer 302

Idiopathic

Question 303

What Mx is used to prevent vasospasm in aneurysmal SAH

Answer 303

Nimodipine

Question 304

How much should once daily insulin dose be on day before and day of surgery?

Answer 304

reduced by 20%

Question 305

Open and closed comedones, pustules and nodules

Answer 305

acne vulgaris

Question 306

Liver failure following cardiac arrest think

Answer 306

Ischaemic hepatitis

Question 307

Presbycusis presents qwith?

Answer 307

bilateral high-frequency hearing loss

Question 308

Mx of diverticulitis flare

Answer 308

oral antibiotics at home. If they do not improve within 72 hours, admission to hospital for IV ceftriaxone + metronidazole is indicated

Question 309

1st line treatment for pyoderma gangrenosum

Answer 309

Oral steroids

Question 310

Hodgkin's lymphoma - most common type

Answer 310

Nodular sclerosing

Question 311

Which CCB most likely to precipitate HF

Answer 311

Verapamil (CONTRAINDICATED)

Question 312

What medication to consider in all housebound patients?

Answer 312

Daily vitamin D supplements

Question 313

Neonatal hypotonia: associated with

Answer 313

Prader Willi

Question 314

What is Hutchinson's Sign?

Answer 314

Hutchinson's sign: vesicles extending to the tip of the nose. This is strongly associated with ocular involvement in shingles. NB: Anterior Uveitis is the ocular involvement

Question 315

patients with unilateral deafness or tinnitus, worry about?

Answer 315

Accoustic neuroma

Question 316

Loss of corneal reflex with unilateral hearing loss

Answer 316

Accoustic neuroma

Question 317

What CNs are affected by vestibular schwannoma?

Answer 317

CN V, VII, VIII

Question 318

What is rhinitis medicamentosa?

Answer 318

a condition of rebound nasal congestion brought on by extended use of topical decongestants

Question 319

How are most intracranial aneurysms now treated?

Answer 319

Coiling by an interventional neuroradiologist

Question 320

What can raised platelets be an indicator of?

Answer 320

Lung cancer

Question 321

Timeline for determining cause of postoperative fever

Answer 321

Day 1-2: 'Wind' - Pneumonia, aspiration, pulmonary embolism Day 3-5: 'Water' - Urinary tract infection (especially if the patient was catheterised) Day 5-7: 'Wound' - Infection at the surgical site or abscess formation Day 5+: 'Walking' - Deep vein thrombosis or pulmonary embolism Any time: Drugs, transfusion reactions, sepsis, line contamination.

Question 322

What blood test result can heparin cause? What does this lead to?

Answer 322

Thrombocytopenia, prothrombotic state

Question 323

management for subluxation of the radial head

Answer 323

Passive supination of the elbow joint whilst flexed to 90 degrees

Question 324

(paradoxically) prolonged APTT + low platelets

Answer 324

Antiphospholipid syndrome

Question 325

Pancreatic pseudocyst Mx?

Answer 325

Manage conservatively initially, then consider radiological fine-needle aspiration

Question 326

When should a thoracic surgical opinion be sough when draining a pneumothorax?

Answer 326

f after 3-5 days there is persistent air leak (e.g. bubbling chest drain) or failure of the lung to re-expand

Question 327

Discoid lupus erythematous Mx

Answer 327

topical steroids → oral hydroxychloroquine

Question 328

raised, erythematous rash, most commonly seen on the face and scalp in young women.

Answer 328

Discoid lupus

Question 329

Mx of HUS

Answer 329

supportive

Question 330

What does metastatic bone pain respond to?

Answer 330

analgesia, bisphosphonates or radiotherapy Trial these in order

Question 331

Diverticulitis symptoms + pneumaturia or faecaluria?

Answer 331

?colovesical fistula

Question 332

Common blood test results in alcoholic liver disease

Answer 332

Macrocytic anaemia and thrombocytopenia

Question 333

the commonest extra-colonic malignancy of HNPCC?

Answer 333

Endometrial

Question 334

first line investigations for patients with a suspected diagnosis of vestibular schwannoma are

Answer 334

audiogram and gadolinium-enhanced MRI head scan

Question 335

What are the opioids of choice for pain relief in palliative care patients with severe renal impairment? Why?

Answer 335

Buprenorphine or fentanyl are the opioids of choice for pain relief in palliative care patients with severe renal impairment, as they are not renally excreted and therefore are less likely to cause toxicity than morphine

Question 336

Mx of heparin induced thrombocytopenai

Answer 336

anticoagulation can be provided by direct thrombin inhibitor e.g. argatroban

Question 337

Perioral dermatitis should be treated with?

Answer 337

topical or oral ABx

Question 338

Leriche syndrome triad

Answer 338

Classically, it is described in male patients as a triad of symptoms: 1. Claudication of the buttocks and thighs 2. Atrophy of the musculature of the legs 3. Impotence (due to paralysis of the L1 nerve)

Question 339

Local complication of gonorrhoea in males

Answer 339

urethral stricture

Question 340

visual hallucinations associated with eye disease.

Answer 340

Charles bonnet syndrome

Question 341

What type of urinary incontinence is the most associated with amitriptyline?

Answer 341

Overflow

Question 342

What may patients develop following catheterisation for acute urinary retention?

Answer 342

post-obstructive diuresis

Question 343

incubation period of Ebola virus

Answer 343

2 - 21 days

Question 344

'pigment-laden macrophages within the mucosa on PAS staining'.

Answer 344

Melanosis coli - caused by prolonged laxative use

Question 345

Syphyllis test results

Answer 345

Positive non-treponemal test + positive treponemal test consistent with active syphilis infection Positive non-treponemal test + negative treponemal test consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above) Negative non-treponemal test + positive treponemal test : consistent with successfully treated syphilis

Question 346

investigation of choice for a suspected pharyngeal pouch

Answer 346

Barium swallow combined with dynamic video fluoroscopy

Question 347

IO access is attained at the?

Answer 347

Proximal tibia

Question 348

What can be used to assess the presence of fluid in the abdomen and thorax

Answer 348

FAST scan

Question 349

What exercises can be performed by the patient at home to treat BPPV

Answer 349

Brandt-Daroff

Question 350

most common cause of occupational asthma

Answer 350

Isocyanates

Question 351

Sildenafil MOA

Answer 351

phosphodiesterase type V inhibitor

Question 352

What type of chest pain can arise secondary to malignancy?

Answer 352

Pericarditis

Question 353

Immunocompromised patients with poor dentition can develop what?

Answer 353

airway compromise from cellulitis at the floor of the mouth known as Ludwig's angina.

Question 354

emergency medical management of acute angle-closure glaucoma

Answer 354

Alongside eye drops, IV acetazolamide

Question 355

Ix for acute angle closure glaucoma

Answer 355

Both tonometry and gonioscopy

Question 356

Sudden weight loss is associated with what liver conditiion?

Answer 356

NAFLDF

Question 357

CCB SEs

Answer 357

headache, flushing, ankle oedema

Question 358

In patients with non-alcoholic fatty liver disease, what is recommended to aid diagnosis of liver fibrosis?

Answer 358

enhanced liver fibrosis (ELF) testing

Question 359

Primary open-angle glaucoma: What is first-line if the IOP is ≥ 24 mmHg

Answer 359

360° selective laser trabeculoplasty (SLT)

Question 360

Fracture of the proximal ulna, with an associated dislocation of the proximal radioulnar joint.

Answer 360

A Monteggia fracture

Question 361

a distal radial fracture with an associated dislocation of the distal radioulnar joint.

Answer 361

Galeazzi fracture

Question 362

How to differ between galeazzi fracture and monteggia fracture

Answer 362

Galeazzi fracture: a distal radial fracture with an associated dislocation of the distal radioulnar joint. A Monteggia fracture (1) is a fracture of the proximal ulna, with an associated dislocation of the proximal radioulnar joint. A method to remember the difference between the two of these is by combining the name of the fracture with the bone that is broken: Monteggia ulna (Manchester United), Galeazzi radius (Galaxy rangers)

Question 363

distal radius fracture with dorsal displacement

Answer 363

Colles

Question 364

distal radius fracture with volar displacement

Answer 364

Smiths

Question 365

fracture of the neck of the fourth or fifth metacarpal with volar displacement of the metacarpal head.

Answer 365

Boxers

Question 366

What may be considered if a rib fracture is not controlled by normal analgesia

Answer 366

Nerve block

Question 367

Nausea and vomiting associated with chemotherapy or radiotherapy often respond to?

Answer 367

5-HT3-receptor antagonist (ondansetron) in combination with dexamethasone

Question 368

What are chiari malformations often associated with? Why?

Answer 368

syringomyelia due to disturbed cerebrospinal fluid flow at the foramen magnum

Question 369

Headache caused by raised intracranial pressure due to brain cancer (or metastases) can be palliated with?

Answer 369

Dex

Question 370

What pneumonia is associated with cold sores?

Answer 370

Strep pneumoniae

Question 371

Ix of lipoma

Answer 371

Clinical diagnosis, unless >5cm then do an US to check for liposarcoma

Question 372

lump characteristics: smooth mobile painless Dx?

Answer 372

Lipoma

Question 373

HIV + proctitis ?

Answer 373

? Lymphogranuloma venereum

Question 374

A woman suddenly falls to the ground then lays motionless

Answer 374

Atonic seizure

Question 375

An MRI of the brain and spinal cord reveals multiple white matter lesions, some of which are periventricular

Answer 375

MS

Question 376

chronic, painful, inflammatory skin disorder is characterized by nodules, pustules, sinus tracts, and scars in intertriginous areas

Answer 376

Hidradenitis suppurativa

Question 377

Mx of shingles

Answer 377

The majority of patients with suspected shingles should be treated with antivirals within 72 hours of onset

Question 378

What can loop diuretics do to bone health?

Answer 378

Worsen due to hypocalcaemia

Question 379

What is preferred to morphine in palliative patients with mild-moderate renal impairment

Answer 379

Oxycodone

Question 380

How can Primary and secondary aldosteronism can be differentiated?

Answer 380

by looking at the renin levels. If renin is high then a secondary cause is more likely, i.e renal artery stenosis.

Question 381

first line anti-emetic for intracranial causes of nausea and vomiting

Answer 381

Cyclizine

Question 382

What blood test is useful for late presentations of acute pancreatitis (>24 hours)?

Answer 382

lipase

Question 383

What are inflammatory markers in biliary colic?

Answer 383

Normal

Question 384

SIADH MX

Answer 384

fluid restrict

Question 385

Flashes and floaters?

Answer 385

vitreous/retinal detachment

Question 386

Prolonged diarrhoea may result in what blood gas result?

Answer 386

metabolic acidosis associated with hypokalaemia

Question 387

SVC obstruction can cause visual disturbances such as ?

Answer 387

blurred vision

Question 388

bulging of the veins on the forehead (back pressure due to compression), the papilloedema which is a sign of raised intracranial pressure and Pemberton sign.

Answer 388

SVC obstruction

Question 389

When is surgical excision given in fibroadenoma?

Answer 389

Breast fibroadenoma: surgical excision is usual if >3cm

Question 390

shortened and internally rotated leg

Answer 390

Posterior hip dislocation

Question 391

Normal pressure hydrocephalus neuroimaging findings:

Answer 391

ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement

Question 392

What can doxasosin cause?

Answer 392

postural hypotension

Question 393

What blood test should be considered in women with recurrent vaginal candidiasis

Answer 393

HbA1c

Question 394

Total anterior circulation infarcts - all 3 of the following:

Answer 394

unilateral hemiparesis and/or hemisensory loss of the face, arm & leg homonymous hemianopia higher cognitive dysfunction e.g. dysphasia

Question 395

Haemodialysis can give a falsely low?

Answer 395

HbA1C

Question 396

management of acute relapse of MS

Answer 396

High dose steroids

Question 397

Should you use ABx in pressure ulcer treatment?

Answer 397

Do not routinely use antibiotics in pressure ulcer treatment, only if there are signs of infection

Question 398

Treatment for herpes simplex keratitis

Answer 398

topical aciclovir

Question 399

painful red eye with photophobia and epiphora. abnormal fluorescein staining, typical appearance is a linear branching corneal ulcer

Answer 399

Herpes simplex keratitis

Question 400

Uncal herniation affects what cranial nerve?

Answer 400

3 Dilated pupil due to compression of the third cranial nerve

Question 401

Chronic urinary retention is classed as high pressure urinary retention if

Answer 401

renal function is impaired or if there is hydronephrosis

Question 402

What type of CXR is used to identify bowel perf

Answer 402

erect - shows pneumoperitoneum

Question 403

Excessive use of breakthrough analgesia should raise suspicion for?

Answer 403

Compartment syndrome

Question 404

Hartmann's procedure

Answer 404

sigmoid colectomy and formation of end stoma

Question 405

In patients with severe colitis, what should be used for Ix?

Answer 405

colonoscopy should be avoided due to the risk of perforation - a flexible sigmoidoscopy is preferred

Question 406

Pulsus paradoxus, think?

Answer 406

Cardiac tamponade

Question 407

30-40 year old with basal emphysema and abnormal LFTs

Answer 407

?A1AT

Question 408

What can reactive arthritis cause in the hands?

Answer 408

Dactylitis

Question 409

Common SEs of adenosine

Answer 409

Flushing and chest pain

Question 410

When prescribing maintenance fluids, how much of water per day is typically requried?

Answer 410

25-30 ml/kg/day

Question 411

Acronym for causes of upper zone fibrosis:

Answer 411

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

Question 412

Lower zone fibrosis acronym:

Answer 412

ACID A - asbestos. C - connective tissue diseases. I - idiopathic pulmonary fibrosis. D - drugs e.g. methotrexate, nitrofurantoin.

Question 413

malignant tumour that occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure, Codman triangle with a sunburst appearance

Answer 413

osteosarcoma

Question 414

fixed dilated pupil with conjunctival injection

Answer 414

Acute closed-angle glaucoma

Question 415

Neutrophil predominant leucocytosis with periumbilical pain?

Answer 415

think acute appendicitis

Question 416

When is surgery indicated in patients with repeated endoscopic treatment?

Answer 416

Surgery is indicated in patients with ongoing acute bleeding despite repeated endoscopic therapy

Question 417

What is the oral antibiotic of choice to treat erythrasma

Answer 417

Erythromycin

Question 418

first-line treatment in opioid detoxification

Answer 418

Methadone or buprenorphine

Question 419

Pneumothorax: persistent air leak or recurrent episodes . plan?

Answer 419

consider referral for VATS to allow for mechanical/chemical pleurodesis +/- bullectomy

Question 420

What pain meds to avoid in Myeloma?

Answer 420

NSAIDs, can precipitate renal failure

Question 421

What types of shock cause warm peripheries? What cause cold?

Answer 421

Neurogenic, septic, and anaphylactic shock (together are all distributive shock) will cause warm peripheries, with the others causing cool peripheries (cardiogenic and hypovolaemic)

Question 422

Unilateral spastic paresis and loss of proprioception/vibration sensation with loss of pain and temperature sensation on the opposite side

Answer 422

Brown-Sequard syndrome

Question 423

What does NAC commonly cause on administration?

Answer 423

an anaphylactoid reaction (non-IgE mediated mast cell release)

Question 424

A non-healing painless ulcer associated with a chronic scar is indicative of

Answer 424

squamous cell carcinoma (SCC)

Question 425

Mx of actinic keratosis

Answer 425

Fluorouracil crea,

Question 426

C peptide levels in T1DM

Answer 426

Low

Question 427

severe hypertension and bilateral retinal hemorrhages and exudates, think?

Answer 427

Malignant hypertension

Question 428

What artery is at risk with duodenal arteries?

Answer 428

Gastroduodenal

Question 429

itchy, violaceous papules on the flexor aspects of her wrists

Answer 429

Lichen planus - polygonal rash on flexor surgaces

Question 430

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

Answer 430

Central retinal vein occlusion

Question 431

What may indicate referred lumbar spine pain as a cause of hip pain

Answer 431

positive femoral nerve stretch test

Question 432

Most common type of melanoma that has the typical diagnostic features of a changing mole

Answer 432

Superficial spreading melanoma

Question 433

What can essential tremor also affect?

Answer 433

The vocal cords

Question 434

Malignancy + raised CK?

Answer 434

Polymyositis

Question 435

Salter Harris Classification

Answer 435

The classification can be easily remembered using the acronym 'SALTR': I: Slipped (either side of the growth plate slipping past each other) - Physis only II: Above growth plate (physis) - Physis and metaphysis III: Lower than growth plate (physis) - Physis and Epiphysis IV: Through (fracture through both above and below the growth plate) - Physis, Metaphysis and Epiphysis V: Rammed (a crush injury)

Question 436

1st line Ix for avascular necrosis of hip. Gold standard

Answer 436

X-ray, MRI

Question 437

first-line for chronic plaque psoriasis

Answer 437

Topical potent corticosteroid + vitamin D analogue

Question 438

Acute onset of atrial fibrillation: if ≥ 48 hours or uncertain (e.g. patient not sure when symptoms started). Mx

Answer 438

Rate control - Beta blockers, if asthmatic - verapamil

Question 439

intervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma

Answer 439

Biliary stenting

Question 440

The Parkland formula for fluid resuscitation in burns is:

Answer 440

Volume of fluid = total body surface area of the burn % x weight (Kg) x 4ml

Question 441

1st line Iv for CO poisoning

Answer 441

ABG

Question 442

first-line investigation for a suspected osteoporotic vertebral fracture

Answer 442

X-ray spine

Question 443

If subarachnoid haemorrhage is suspected but a CT head done within 6 hours of symptom onset is normal, plan?

Answer 443

do not do an LP, consider an alternative diagnosis instead

Question 444

For patients with acute heart failure, what may be useful if the patient has concomitant myocardial ischaemia or severe hypertension

Answer 444

Nitrates

Question 445

common cause of chronic wound infections

Answer 445

Pseudomonas, especially in diabetics

Question 446

lemon tinge to the skin is associated with

Answer 446

Pernicious anaemia

Question 447

pedunculated heterogeneous mass on echocardiogram

Answer 447

Atrial myxoma

Question 448

pharmacological options for treatment of orthostatic hypotension

Answer 448

Fludrocortisone and midodrine

Question 449

differential for chronic hepatitis B patients with acute flare up

Answer 449

Hep D superinfection

Question 450

What is used as a vitamin D supplement in end-stage renal disease because it does not require activation in the kidneys

Answer 450

Alfacalcidol

Question 451

What should be considered if a bradycardia doesn't respond to drugs or transcutaneous pacing

Answer 451

Transvenous pacing

Question 452

What important differential can present similarly to renal colic>

Answer 452

Symptoms of a ruptured AAA can present similarly to renal colic with loin to groin pain. However, it is a very important differential diagnosis, particularly in men aged above 50 years.

Question 453

Adult patients with a hydrocele require what?

Answer 453

an ultrasound to exclude underlying causes such as a tumour

Question 454

What is a common complication of Colles' fracture? What may it result in?

Answer 454

Median nerve injury is a common complication of Colles' fracture - may result in weakness or loss of thumb or index finger flexion

Question 455

Most common causes of massive splenomegaly in UK

Answer 455

CML/myelofibrosis

Question 456

After the first VTE, patients with antiphospholipid syndrome should be on?

Answer 456

Lifelong warfarin

Question 457

Patients with anti-phospholipid syndrome who haven't had a thrombosis previously are generally on?

Answer 457

low dose aspirin

Question 458

Low serum calcium, raised serum phosphate, raised ALP and raised PTH

Answer 458

chronic kidney disease leading to secondary hyperparathyroidism NOTE: This is different to osteomalacia where you would get low phosphate

Question 459

An important adverse effect of aminoglycosides is

Answer 459

Ototoxicity

Question 460

Aortic stenosis - most common cause:

Answer 460

younger patients < 65 years: bicuspid aortic valve older patients > 65 years: calcification

Question 461

What can be used to distinguish vestibular neuronitis from posterior circulation stroke? How does it work?

Answer 461

The HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke During the HiNTs examination for peripheral vertigo, the head impulse test will show a corrective saccade (positive result) if the vestibulo-ocular reflex is disrupted. This occurs when the head is turned toward the affected side, causing the eyes to make a saccade to re-fixate on the target. If the reflex is intact (in a healthy individual or on the unaffected side), the eyes will stay fixed on the target when the head turns toward the normal side. In the early stages of vestibular neuronitis, horizontal nystagmus may also be present, unlike the direction-changing nystagmus seen in central vertigo cases. The test of skew usually yields normal results in peripheral vertigo. When a patient focuses on their nose while their eyes are alternately covered, vertical misalignment may occur in central vertigo, leading to corrective movements. This finding is absent in peripheral causes

Question 462

What does meformin increase the risk of?

Answer 462

lactic acidosis - suspend during intercurrent illness eg. diarrhoea and vomiting

Question 463

Herpes zoster ophthalmicus requires?

Answer 463

urgent ophthalmological review and 7-10 days of oral antivirals

Question 464

Mx of asymptomatic mitral stenossi

Answer 464

Mitral stenosis patients who are asymptomatic are generally monitored and given medical therapy rather than having percutaneous/surgical intervention

Question 465

treatment of choice for Bowen's disease

Answer 465

Topical 5-fluorouracil

Question 466

Red, scaly patches that grow on sun-exposed sites in older patients should raise suspicion of

Answer 466

Bowen's disease, which is a precursor to squamous cell carcinoma (SCC)

Question 467

most commonly affected site in ischaemic colitis

Answer 467

Splenic flexure

Question 468

Moderate/severe psoriatic arthropathy mx

Answer 468

methotrexate

Question 469

plain abdominal film classically shows small bowel obstruction and air in the biliary tree

Answer 469

Gallstone ileus

Question 470

Key SE of ciprofloxacin

Answer 470

Achilles tendon rupture

Question 471

imaging of choice in suspected renal colic

Answer 471

Non-contrast KUB

Question 472

A third heart sound is one of the possible features of

Answer 472

left sided HF

Question 473

Most common form of prostate cancer

Answer 473

Adenocarcinoma

Question 474

What is a useful test of exocrine function in chronic pancreatits

Answer 474

Faecal elastase

Question 475

Status epilepticus: rule out what before thinking of other causes?

Answer 475

Hypoxia and hypoglycaemia

Question 476

Pulmonary oedema is an indication for what in a patient with acute kidney injury

Answer 476

Haemodialysis

Question 477

Thyrotoxicosis with tender goitre =

Answer 477

subacute (De Quervain's) thyroiditis

Question 478

Visual changes secondary to drugs

Answer 478

blue vision: Viagra ('the blue pill') yellow-green vision: digoxin

Question 479

What is a key investigation in patients with suspected encephalitis

Answer 479

PCR of cerebrospinal fluid for viruses

Question 480

Joint aspirate in rheumatoid arthritis shows a

Answer 480

high WBC count, predominantly PMNs. Appearance is typically yellow and cloudy with absence of crystals

Question 481

key differential for abdominal pain and fever in patients with cirrhosis and portal hypertension

Answer 481

Spontaneous bacterial peritonitis

Question 482

WHat should be prescribed adjunct to methotrexate in RA?

Answer 482

Folate to prevent myelosuppression

Question 483

dyspnoea, chest pain, cough, hypoxia and new pulmonary infiltrates seen on chest x-ray in a patient with a background of sickle cell

Answer 483

acute chest syndrome

Question 484

Mx of acute chest syndrome

Answer 484

Analgesia, respiratory support and Abx, ?transfusion

Question 485

Early Sx of MS

Answer 485

Lethargy

Question 486

What movements are typically spared in MND

Answer 486

eye movements

Question 487

What is Verapamil contraindicated in?

Answer 487

V tach and HF

Question 488

Immediate Mx of suspected temporal arteritis

Answer 488

oral pred

Question 489

refractory hypertension and reduced eGFR after starting ACE inhibitor

Answer 489

Renal artery stenosis

Question 490

AF cardioversion drugs

Answer 490

amiodarone + flecainide

Question 491

Recurrent otitis externa following numerous antibiotic treatment should raise suspicion of?

Answer 491

Candida

Question 492

acute progression of visual loss, metamorphopsia (wavy distortion of straight lines), and retinal haemorrhages

Answer 492

Wet AMD

Question 493

What is required in the investigation of all patients presenting with an AKI of unknown aetiology

Answer 493

an US

Question 494

Crypt abscesses on histology?

Answer 494

UC

Question 495

What should be corrected first before giving bisphosphonates?

Answer 495

Hypocalcemia/vitamin D deficiency should be corrected before giving bisphosphonates

Question 496

investigation of choice for varicose veins/chronic venous disease? What does it show/

Answer 496

Venous duplex ultrasound is the investigation of choice for varicose veins/chronic venous disease - it will show retrograde venous flow

Question 497

Unilateral, purulaent discharge from eye

Answer 497

bacterial conjunctivitis

Question 498

Transferrin in IDA

Answer 498

Transferrin will be high BUT transferring saturation will be low

Question 499

CT head findings on alzheimers

Answer 499

widespread cerebral atrophy mainly involving the cortex and hippocampus

Question 500

Quinsy Mx

Answer 500

IV antibiotics and surgical drainage, and a tonsillectomy should be considered in 6 weeks

Question 501

Toxic multinodular goitre Mx

Answer 501

radioactive iodine is the treatment of choice

Question 502

Gold standard Ix for MS

Answer 502

MRI head

Question 503

What Mx slows bone healing

Answer 503

NSAIDs

Question 504

Bladder still palpable after urination, think?

Answer 504

Retention with urinary overflow

Question 505

How to differentiate between femoral and iliac artery claudication

Answer 505

Claudication affecting the femoral vessels is likely to present with calf pain rather than iliac claudication which causes buttock pain

Question 506

What hormonal therapy is reccomended in turners

Answer 506

Growth

Question 507

Woman with bone mets, most likely to originate from?

Answer 507

Breast

Question 508

Example of nephrotoxic medications that should be stopped in AKI

Answer 508

NSAIDs, diuretics, ACE inhibitors, and metformin

Question 509

In cardiac tamponade, there will be an abnormally large drop in BP during inspiration, known as?

Answer 509

Pulsus Paradoxus

Question 510

bilateral, conductive pattern hearing loss, sometimes with associated tinnitus

Answer 510

Otosclerosis

Question 511

Difference between presbycusis and otosclerosis

Answer 511

Presbyacusis gives a sensorineural, high frequency hearing loss picture. Otosclerosis - progressive conductive deafness, which typically presents in middle age. Tinnitus and vertigo may also be present, but are less common.

Question 512

Which thyroid cancer has best prognosi

Answer 512

Papillary

Question 513

most common reason total hip replacements need to be revised

Answer 513

Aseptic loosening of implant

Question 514

1st line Mx for glaucoma

Answer 514

Latanoprost - prostaglandin analogue

Question 515

SE of phenytoin

Answer 515

Peripheral neuropathy

Question 516

Mx of diabetic gastroparesis

Answer 516

Metoclopramide

Question 517

What is a common complication from intraventricular haemorrhages

Answer 517

Hydrocephalus

Question 518

Following nebulised SABA, what should all patients with asthma be given?

Answer 518

Oral pred (40-50mg)

Question 519

Pigmentation of nail bed affecting proximal nail fold suggests?

Answer 519

Acral lentiginous melanoma: Pigmentation of nail bed affecting proximal nail fold suggests melanoma (Hutchinson's sign)

Question 520

When should NIV be considered in COPD exacerbation?

Answer 520

NIV should be considered in all patients with an acute exacerbation of COPD in whom a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment

Question 521

What type of melanoma can arise in areas not associated with sun exposure e.g. soles of feet and palms

Answer 521

acral lentiginous

Question 522

Gold standard investigation for mesothelioma

Answer 522

Thoracoscopic biopsy

Question 523

Most likely cause of AKI if poor response to fluid challenge

Answer 523

ATN

Question 524

CKD on haemodialysis - most likely cause of death is?

Answer 524

IHD

Question 525

What electrolyte abnormality predisposes patients to digoxin toxicity

Answer 525

hypokalaemia

Question 526

treatment of choice for all patients with a displaced hip fracture

Answer 526

Hemiarthroplasty or total hip replacement

Question 527

General rule for hip fractures

Answer 527

Intracapsular femoral fracture - hemiarthroplasty extracapsular femoral fracture - dynamic hip screw

Question 528

Firm and well-circumscribed mass that transilluminates on the dorsal aspect of the wrist ?

Answer 528

Ganglion cyst

Question 529

What is used to treat cerebral oedema in patients with brain tumours

Answer 529

Dex

Question 530

How does myoglobulinuria cause renal failure?

Answer 530

By tubular cell necrosis

Question 531

diagnostic investigation of choice is the investigation of choice for suspected Non-Hodgkin's lymphoma?

Answer 531

Excisional node biopsy

Question 532

low T3/T4 and normal TSH with acute illness

Answer 532

Sick euthyroid syndrome

Question 533

Gold standard Ix for MS causing optic neuritis

Answer 533

MRI of the brain and orbits with gadolinium contrast is the investigation of choice

Question 534

Isoniazid, an anti-TB medication, may induce?

Answer 534

Pellagra Four D's of pellagra (vitamin B3 deficiency): Diarrhoea Dermatitis Dementia Death

Question 535

known cause of neutropenia and a temperature of > 38 degrees?

Answer 535

Think neutropenic sepsis

Question 536

What type of medications cause a raised INR?

Answer 536

Inhibitors of cP450 Inducers cause a decreased INR - think D in induce for decrease

Question 537

Creatinine level in tumour lysis syndrome

Answer 537

Raised

Question 538

What is the acceptable upper limit of residual urine in patients < 65 years old?

Answer 538

<50ml

Question 539

Small cell lung cancer with progressive confusion and lethargy

Answer 539

Think SIADH, hyponatraemia causing cerebral oedema

Question 540

What artery affected in epistaxis

Answer 540

Sphenopallatine

Question 541

pain on the radial side of the wrist tenderness over the radial styloid process abduction of the thumb against resistance is painful

Answer 541

De Quervain's tenosynocitis

Question 542

Carotid artery stenosis Ix

Answer 542

Carotid artery stenosis is diagnosed (and degree of stenosis assessed) via duplex ultrasound

Question 543

Abdominal distension, absence of passing flatus or stool, late onset/no vomiting?

Answer 543

Large bowel obstruction

Question 544

What medication doesn't worsen AKI but should be stopped due to an increased risk of toxicity?

Answer 544

Metformin

Question 545

Hypotension + melaena?

Answer 545

Bleeding peptic ulcer

Question 546

keratoderma blennorrhagicum on the soles of his feet - a waxy yellow rash. Pathognomic for?

Answer 546

Reactive arthritis

Question 547

SEs of GTN

Answer 547

Hypotension, tachycardia and headache

Question 548

tender goitre, hyperthyroidism and raised ESR. The globally reduced uptake on technetium thyroid scan is also typical

Answer 548

Subacute thyroiditis

Question 549

What type of anaemia can phenytoin cause?

Answer 549

Macrocytic anaemia

Question 550

5 day history painful left sided neck swelling below the angle of the jaw. She also complains of a foul taste in her mout

Answer 550

Sialadenitis

Question 551

intermittent dysphagia (difficulty swallowing), halitosis (bad breath), and nocturnal coughing are characteristic of

Answer 551

Pharyngeal pouch (Zenker's diverticulum)

Question 552

What anaesthetic drug can cause adrenal suppression

Answer 552

Etomidate

Question 553

Common cause of bilateral carpal tunnell syndrome

Answer 553

RA

Question 554

Hypotension, dyspnoea, wheezing, angioedema during a blood transfusion

Answer 554

Anaphylaxis

Question 555

All men with a suspected UTI should have what sent before starting antibiotics?

Answer 555

Mid stream urine culture

Question 556

What accounts for the majority of ocular complications in temporal arteritis

Answer 556

Anterior ischaemic optic neuropathy

Question 557

'Rheumatoid'-like joint problems but nail changes

Answer 557

Psoriatic arthritis

Question 558

What should be used in palliative care for nausea and vomiting that is due to gastric dysmotility and stasis

Answer 558

Metoclopramide

Question 559

What common drug used for IBD can cause drug induced pancreatitis?

Answer 559

Mesalazine

Question 560

The most common malignancy associated with acanthosis nigricans is

Answer 560

GI adenocarcinoma

Question 561

What medication are beneficial in proteinuric CKD, regardless of diabetic status

Answer 561

SGLT-2 inhibitors

Question 562

Deep ulcer on toe/heel

Answer 562

?Arterial ulcer

Question 563

small (1-2cm) calcified nodule is visible in the lateral area of the right mid zone

Answer 563

Ghon complex - latent TB

Question 564

Complication of discitis that can cause worsenining features

Answer 564

Epidural abscess

Question 565

Indications for thoracotomy in haemothorax include

Answer 565

>1.5L blood initially or losses of >200ml per hour for >2 hours

Question 566

First line treatment for most patients with a pituitary tumour causing acromegaly

Answer 566

Transphenoidal surgery Then octredotide (somatostatin anaologue) and bromocriptine (dopamine agonist)

Question 567

Most common cause of chronic pancreatitis

Answer 567

Alcohol excess

Question 568

How to differentiate acute cholecystitis and biliary colic

Answer 568

people with cholecystitis typically are systemically unwell

Question 569

pain on hip extension in an IVDU

Answer 569

Psoas abscess

Question 570

Failure to correct childhood squints may lead to what?

Answer 570

Ambylopia

Question 571

Widened mediastinum on CXR

Answer 571

Think aortic dissection

Question 572

Ix for Aortic dissection

Answer 572

CT angiography of CAP, if unstable doe transoesophagaeal echocardiography

Question 573

Classification and Mx of aortic dissection

Answer 573

type A - ascending aorta, 2/3 of cases - surgery and control BP in meantime type B - descending aorta, distal to left subclavian origin, 1/3 of cases - conservative mx with BP management (IV labetalol)

Question 574

What is a key Sx adjunt to dyspepsia that warrants an urgent referral

Answer 574

Weight loss

Question 575

Ethylene glycol toxicity management

Answer 575

fomepizole. Also ethanol / haemodialysis

Question 576

respiratory secretions & bowel colic may be treated by

Answer 576

hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide

Question 577

What nerve is at risk in a shaft fracture of the humerus

Answer 577

Radial

Question 578

Severe vomiting → haematemesis

Answer 578

Mallory weiss syndrome

Question 579

What joint condition can cause pyoderma gangrenosum

Answer 579

RA

Question 580

HIV, neuro symptoms, multiple brain lesions with ring enhancement

Answer 580

Toxoplasmosi

Question 581

HIV, neuro symptoms, single brain lesions with homogenous enhancement

Answer 581

CNS lymphoma

Question 582

Most appropriate anti emetic in parkinsons

Answer 582

Domperidone

Question 583

Tamoxifen increases the risk of what?

Answer 583

VTE and endometrial cancer

Question 584

1st line Mx of hyperhidrosis

Answer 584

Topical aluminium chloride

Question 585

Rough guidance on which conditions are AD and AR inheritance

Answer 585

Autosomal recessive conditions are 'metabolic' - exceptions: inherited ataxias Autosomal dominant conditions are 'structural' - exceptions: Gilbert's, hyperlipidaemia type II

Question 586

Sickle cell patients should be started on long term WHAT to reduce the incidence of complications and acute crises

Answer 586

Hydroxycarbamide

Question 587

How may HOCM present

Answer 587

Exertional dyspnoea

Question 588

tingling/numbness of the 4th and 5th finger. Dx?

Answer 588

Cubital tunnel syndrome is caused by compression of the ulnar nerve

Question 589

What Dx should be considered in patients with portal hypertension and lower gastrointestinal bleeding

Answer 589

Rectal varices

Question 590

posterior circulation symptoms, such as dizziness and vertigo, during exertion of an arm

Answer 590

Subclavian steal syndrome

Question 591

flu like illness → brief remission→ followed by jaundice and haematemesis

Answer 591

Yellow fever

Question 592

gold standard for diagnosis of OSA

Answer 592

Nocturnal polysomnography

Question 593

GRACE score higher than 3% in an NSTEMI?

Answer 593

PCI within 72 hours

Question 594

Right upper quadrant tenderness and bilious fluid in the intra-abdominal drain would suggest a WHAT following cholecystectomy

Answer 594

Bile leak

Question 595

weak pulses and aortic regurgitation in an aortic dissection

Answer 595

Think type A, IV labetalol and surgery

Question 596

Types of respiratory failure

Answer 596

Type 1 respiratory failure: Low pO2, no CO2 retention Type 2 respiratory failure: Low pO2, high pCO2

Question 597

What skin condition can cold sores trigger?

Answer 597

Erythema multifiorme

Question 598

Urine osmolality levels in ATN

Answer 598

<350`

Question 599

methotrexate toxicity Mx

Answer 599

Folinic acid

Question 600

non-falciparum malaria Mx

Answer 600

Primaquine is used in non-falciparum malaria to destroy liver hypnozoites and prevent relapse

Question 601

. Primary herpes simplex infection, caused by the Herpes Simplex Virus (HSV), can lead to a dermatological condition known as

Answer 601

Erythema multiforme

Question 602

Why is nephrotic syndrome prothrombotic

Answer 602

Loss of antithrombin 3

Question 603

slow-growing, flesh-coloured or pink lesions with a pearly appearance. The rolled edges, central depression and presence of telangiectasia (dilated blood vessels) are classic features of?

Answer 603

Basal cell carcinoma

Question 604

When should a thrombolytic drug be considered in CPr?

Answer 604

If a PE is suspected

Question 605

Prerenal disease is suggested by what blood test result

Answer 605

Urine sodium <20

Question 606

What electrolyte abnormality can SAH cause? How?

Answer 606

Hyponatraemia, SIADH

Question 607

At what FRAX score should a DEXA scan be arranged?

Answer 607

As a guide, a QFracture score ≥ 10% means a DEXA scan should be arranged

Question 608

What Abx can cause IPF

Answer 608

Nitrofurantoin

Question 609

red and watery right eye with mild photophobia, not painful but discomfort

Answer 609

Episcleritis

Question 610

preferred way to support nutrition in patents with motor neuron disease

Answer 610

PEG tube

Question 611

Difference between BPPV and vestibular neuronitis

Answer 611

in bppv vertigo is triggered by head movements, in vestibular neuronitis - its worsened

Question 612

skin hypopigmentation and loss of sensation

Answer 612

Leprosy

Question 613

classic features of irritable bowel syndrome

Answer 613

Abdominal pain, Bloating and Change in bowel habit

Question 614

If a pleural effusion fluid protein/serum protein ratio is >0.5, the effusion is an?

Answer 614

Exudate

Question 615

Mx of wilson's disease

Answer 615

Penicillamine

Question 616

What Ix should all adults with suspected asthma have?

Answer 616

a bronchodilator reversibility (BDR) test

Question 617

recurrent painless haematuria, poor renal function and a sensorineural deafness

Answer 617

Alport syndrome

Question 618

recommended treatment for post-thrombotic syndrome

Answer 618

Compression stockings

Question 619

What murmur often occurs secondary to pulmonary htn

Answer 619

Functional tricuspid regurgitation often occurs secondary to pulmonary hypertension

Question 620

Critical limb ischaemia presents as?

Answer 620

pain at rest for greater than 2 weeks, often at night, not helped by analgesia

Question 621

STEMI management, what anticoagulants to give>

Answer 621

STEMI management: if patient is having PCI then prasugrel is given in addition to aspirin. If patient is on an anticoagulant then clopidogrel used instead

Question 622

What type of nystagmus seen in BPPV?

Answer 622

Rotatory nystagmus is indicative of a positive Dix-Hallpike manoeuvre

Question 623

benign, lateral, unilateral neck mass. acellular fluid with cholesterol crystals on aspiration

Answer 623

Branchial cyst

Question 624

Mx of acetazolamide

Answer 624

Acetazolamide is a carbonic anhydrase inhibitor that is used to treat idiopathic intracranial hypertension

Question 625

How can TB affect the joints?

Answer 625

Can cause a polyarthritis

Question 626

Hyaline casts may be seen in the urine of patients taking?

Answer 626

Loop diuretics

Question 627

Brain abscess Mx:

Answer 627

IV 3rd-generation cephalosporin + metronidazole

Question 628

first-line test for HIV screening of asymptomatic individuals or patients with signs and symptoms of chronic infection

Answer 628

Combined HIV antibody/antigen tests

Question 629

purplish, lace-patterned discolouration of the skin

Answer 629

Livedo reticularis

Question 630

investigation of choice in genital herpes

Answer 630

NAAT

Question 631

What is used to treat cerebral oedema in patients with brain tumours

Answer 631

Dexamethasone

Question 632

Abdominal wound dehiscence should initially be managed with

Answer 632

coverage of the wound with saline impregnated gauze + IV broad-spectrum antibiotics

Question 633

Sudden onset headache, visual field defects + evidence of pitutary insufficiency (e.g. hypotension)

Answer 633

Pituitary apoplexy

Question 634

first step in mx of patient with pleural effusion

Answer 634

Pleural aspirate

Question 635

preferred method of access for haemodialysis

Answer 635

AV fistula

Question 636

right iliac fossa, spouted and has a liquid output

Answer 636

Loop ileostomy

Question 637

Where may gallstones present following cholecystectomy?

Answer 637

Gallstones may be present in the CBD causing ongoing jaundice and pain after cholecystectomy

Question 638

Mx of renal stones >20mm

Answer 638

Percutaneous nephrolithotoym

Question 639

pulmonary, hepatic, cerebral and spinal AVMs

Answer 639

Hereditary haemorrhagic telengiectasia

Question 640

Features of still's disease

Answer 640

Pyrexia in Still's disease has a characteristic pattern. It typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash

Question 641

ntervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma

Answer 641

Biliary stenting

Question 642

Adrenaline induced ischaemia mx

Answer 642

Phentolamine

Question 643

triad of sudden onset abdominal pain, ascites, and tender hepatomegaly

Answer 643

Budd-chiari syndrome

Question 644

Whatshould be used as the first-line treatment in opioid detoxification

Answer 644

Methaodone or buprenorphine Naloxone is used in emergency management

Question 645

Low cortisol on 9am cortisol test implies

Answer 645

Addison's, need to synchacth

Question 646

Grades of hepatic encephalopathy

Answer 646

Grade I: Irritability Grade II: Confusion, inappropriate behaviour Grade III: Incoherent, restless Grade IV: Coma

Question 647

secondary prophylaxis of hepatic encephalopathy

Answer 647

Rifamixin and lactulose

Question 648

ocular pain and pain on eye movements associated with redness and swelling around the eye suggests

Answer 648

Orbital cellulitis

Question 649

net-like pattern of reddish-blue skin discolouration that is non-blanching affecting her legs

Answer 649

Livedo reticularits

Question 650

Management of myasthenic crisis

Answer 650

intravenous immunoglobulin, plasmapheresis

Question 651

definitive management for theophylline toxicity

Answer 651

Haemodialysis

Question 652

Obesity with abnormal LFTs

Answer 652

?NAFLD

Question 653

unilateral tremor that improves with voluntary movement

Answer 653

Parkinson's disease

Question 654

Acute sensorineural hearing loss is an emergency and requires

Answer 654

urgent referral to ENT for audiology assessment and brain MRI

Question 655

Chronic fatigue syndrome, how long before diagnosis can be made?

Answer 655

3 months

Question 656

first-line investigation for a suspected osteoporotic vertebral fracture

Answer 656

X ray spine

Question 657

treatment of choice for Bowen's disease

Answer 657

Topical 5-fluorouracil

Question 658

What type of ABx can lower the seizure threshold

Answer 658

Ciprofloxacin

Question 659

Mx of subacute thyroiditis

Answer 659

NSAIDs - simple analgesia and conservative management

Question 660

initial hyperthyroidism, painful goitre and globally reduced uptake of iodine-131

Answer 660

Subacute thyroiditis

Question 661

hyperdense, crescentic collection around the left parietal lobe.

Answer 661

Acute subdural haematoma If hypodense - chronic

Question 662

Migraine Mx

Answer 662

acute: triptan + NSAID or triptan + paracetamol prophylaxis: topiramate or propranolol Topiramate not preferred in a woman of childbearing age

Question 663

What Mx can cause osteonecrosis of the jaw

Answer 663

Bisphosphonate use

Question 664

In patients with both vitamin B12 and folate deficiencies, what must be treated first

Answer 664

In patients with both vitamin B12 and folate deficiencies, the vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of spinal cord

Question 665

Mx of mild varicoceles

Answer 665

Reassure and observe

Question 666

most likely operation to be done for symptomatic chronic subdural bleeds

Answer 666

burr hole evac

Question 667

Increased, homogenous uptake on a radioactive iodine uptake test suggests

Answer 667

graaves disease

Question 668

Raised ALP in the presence of normal LFT's should raise suspicion of

Answer 668

malignancy. Particularly bone cancer/ metastases

Question 669

Mx of hyperacute transplant rejection

Answer 669

Removal of graft

Question 670

anorectal pain and a tender lump on the anal margin

Answer 670

Thrombosed haemorrhoids

Question 671

What medication provides symptomatic relief for MG

Answer 671

Pyridostigmine long-acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction, temporarily improving symptoms of myasthenia gravis

Question 672

asthma + aspirin sensitivity + nasal polyposis

Answer 672

Samter's triad AVOID ASPIRIN AND NSAIDS IN ASTHMA

Question 673

2.5mm coved ST elevation in leads V1 and V2 followed by an inverted T wave. Exaggerated when fleicanide is given. Dx? Mx?

Answer 673

Brugada syndrome. Definitive management for Brugada syndrome is implantable cardioverter-defibrillator

Question 674

Is strangulated hernia an open or laparoscopic procedure?

Answer 674

Open

Question 675

Mx of gonorrhoea if patient refuses injection

Answer 675

For patients with gonorrhoea, a combination of oral cefixime + oral azithromycin is used if the patient refuses IM ceftriaxone

Question 676

BP med that can cause gingival hyperplasia

Answer 676

Amlodipine

Question 677

What can Over rapid aspiration/drainage of pneumothorax ersult in?

Answer 677

Re-expansion in pulmonary oedema

Question 678

Left lower quadrant pain, low-grade fever in elderly patient

Answer 678

Diverticulitis

Question 679

Corneal abrasion Mx

Answer 679

topical antibiotics should be given to prevent secondary bacterial infection

Question 680

Difference in abg between diarrhoea and vomiting

Answer 680

Diarrhoea - metabolic acidosis (normal anion gap) Vomiting - metabolic alkalosis

Question 681

Can Abx be used as monotherapy in acne?

Answer 681

No, typically used adjunt to benzoyl peroxide

Question 682

How should severe cellulits be treated

Answer 682

co-amoxiclav, cefuroxime, clindamycin or ceftriaxone

Question 683

fasciculations

Answer 683

THink MND - typically spares ocular muscles

Question 684

Rate of insulin infusion for DKA in adults

Answer 684

Diabetic ketoacidosis: the IV insulin infusion should be started at 0.1 unit/kg/hour

Question 685

Most common organism found in central line infections

Answer 685

Staph epidermidis

Question 686

Scrotal swelling you can't get above:

Answer 686

Inguinal hernia

Question 687

crypt abscesses

Answer 687

UC

Question 688

All cases of pneumonia should have a repeat WHAT at 6 weeks after clinical resolution

Answer 688

CXR

Question 689

Otalgia, fever, protruding ear and post-auricular tenderness

Answer 689

?mastoiditis, admit and IV ABx

Question 690

How to differentiate between NMS and SS

Answer 690

NMS is typically seen in younger patients within hours-days after starting an antipsychotic and is associated with decreased reflexes and normal pupils Seretonin syndrome - hyperreflexia and dilated pupils

Question 691

diagnostic investigation of choice is the investigation of choice for suspected Non-Hodgkin's lymphoma

Answer 691

Excisional node biopsy

Question 692

Subdural haemorrhage results from bleeding of damaged?

Answer 692

bridging veins between the cortex and venous sinuses

Question 693

Timolol MOA in gluacoma

Answer 693

Reduces aqueous secretion by ciliary body - reduces aqueous production

Question 694

What supplementation is required prior to surgery for patients taking prednisolone

Answer 694

Hydrocortisone

Question 695

most likely cause of an irregular broad complex tachycardia in a stable patient

Answer 695

AF with BBB

Question 696

Urinary incontinence + gait abnormality + dementia

Answer 696

Normal pressure hydrocephalus

Question 697

What anti hypetensive can cause reflex tachy

Answer 697

Nifedipine causes peripheral vasodilation which may result in reflex tachycardia

Question 698

What should be corrected before giving bisphosphonates

Answer 698

Hypocalcaemia, vit D deficiency

Question 699

How to differentiate between spider naevi and telengiectasia

Answer 699

Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge

Question 700

What electrolyte abnormality can precipitate digoxin toxicity

Answer 700

Hypokalaemia

Question 701

All patients with suspected upper GI bleed require?

Answer 701

An endoscopy within 24 hours of admission

Question 702

red eye, photophobia and gritty sensation

Answer 702

Keratitis

Question 703

A raised SAAG (>11g/L) indicates that it is?

Answer 703

Portal HTN that has caused the ascites

Question 704

What has been shown to reduce the rate of CKD progression in ADPKD (and is approved by NICE)

Answer 704

Tolvaptan

Question 705

For a patient with a Bell's palsy, if the paralysis shows no sign of improvement after 3 weeks, mx?

Answer 705

Urgent referral to ENT

Question 706

presentation of dysentery after a long incubation period

Answer 706

Amoebiasis Managed with oral metro

Question 707

What anaesthetic agent is useful in patients with a high risk of post operative vomiting

Answer 707

Propofol

Question 708

`Necrotising fasciitis: most commonly affected site is

Answer 708

Perineum

Question 709

Complete heart block following a MI?

Answer 709

RCA lesion

Question 710

Dx of BPPV

Answer 710

Dix-hallpike

Question 711

Following weight loss, whatis the first-line treatment for moderate/severe obstructive sleep apnoea

Answer 711

CPAP

Question 712

Negative non-treponemal test + positive treponemal test is consistent with

Answer 712

successfully treated syphilis

Question 713

Positive non-treponemal test + negative treponemal test

Answer 713

consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)

Question 714

Positive non-treponemal test + positive treponemal test

Answer 714

consistent with active syphilis infection

Question 715

What can uncal herniation secondary to subdural cause?

Answer 715

third nerve palsy - down and out eye

Question 716

A man suddenly stares into space and is non-responsive. He then repeatedly smacks his lip and appears to be chewing. This lasts for around 1 minute

Answer 716

Focal impaired awareness seizure

Question 717

Abdominal distension, absence of passing flatus or stool, late onset/no vomiting

Answer 717

?LBO - ?malignancy

Question 718

low T3/T4 and normal TSH with acute illness

Answer 718

Sick euthyroid syndrome

Question 719

most common cause of secondary hypertension

Answer 719

Primary hy-peraldosteronism

Question 720

most common cause of puritus vulvae is

Answer 720

contact dermatitis

Question 721

Migraine triggers mneomonic

Answer 721

CHOCOLATE: chocolate, hangovers, orgasms, cheese/caffeine, oral contraceptives, lie-ins, alcohol, travel, exercise

Question 722

If there is clubbing with hyperthyroidism, think?

Answer 722

Graves

Question 723

1st line drug in the management of ocular myasthenia gravis

Answer 723

Pyridostigmine

Question 724

What is a potential, and serious, cause of new onset atrial fibrillation following gastrointestinal surgery. What is the Mx?

Answer 724

Anastomotic leak An anastomotic leak is a surgical emergency and patients must be taken back to theatre as soon as possible

Question 725

What cancer marker is elevated in breast?

Answer 725

CA-15-3

Question 726

Mx of venous ulceration

Answer 726

Compression bandaging

Question 727

'Popeye' deformity in the middle of the upper arm

Answer 727

Biceps rupture

Question 728

What skin condition may carbamezapine cause?

Answer 728

Steven Johnsons syndrome

Question 729

Surgery/metformin on day of surgery

Answer 729

OD or BD: take as normal TDS: miss lunchtime dose assumes only one meal will be missed during surgery, eGFR > 60 and no contrast during procedure

Question 730

Diagnostic criteria for AKI

Answer 730

↑ creatinine > 26µmol/L in 48 hours ↑ creatinine > 50% in 7 days ↓ urine output < 0.5ml/kg/hr for more than 6 hours

Question 731

What type of surgery is done in type A aortic dissection

Answer 731

Aortic root replacement, IV labetalol adjunt

Question 732

What type of head injury can present several weeks after the accident?

Answer 732

Subdural haematoma

Question 733

Mx of non-falciparum malaria

Answer 733

Primaquine is used in non-falciparum malaria to destroy liver hypnozoites and prevent relapse

Question 734

Ix of accoustic neuroma

Answer 734

MRI of cerebellopontine angle

Question 735

Mouth manifestation of EBV. What is indicative of

Answer 735

Hairy leukoplakia is an EBV-associated lesion on the side of the tongue, and is considered indicative of HIV

Question 736

Medical causes of gingival hyperplasia

Answer 736

phenytoin, ciclosporin, calcium channel blockers and AML

Question 737

1st line treatment for seborrhoeic dermatitis

Answer 737

Topical ketoconzole

Question 738

rythematous, scaly patches in sebum-rich areas such as the face (particularly nasolabial folds, eyebrows) and upper chest

Answer 738

Seborrhoeic dermatitis - Malassezia Furfur

Question 739

PDE 5 inhibitors (e.g. sildenafil) - contraindicated by?

Answer 739

Nitrates and nicorandil

Question 740

Kussmaul's sign? Feature of?

Answer 740

The JVP increasing with inspiration is known as Kussmaul's sign and can be a feature of constrictive pericarditis.

Question 741

What are used to detect occupational asthma

Answer 741

Serial peak flow measurements at work and at home

Question 742

Common electrolyte abnormality in SAH

Answer 742

Hyponatraemia

Question 743

What type of repair is done for symptomatic AAA

Answer 743

undergo endovascular repair (EVAR)

Question 744

Solitary firm papule/nodule that dimples on pinching

Answer 744

Dermatofibroma

Question 745

How to differentiate between TACO and TRALI

Answer 745

Transfusion Associated Circularory Overload: Hypertension, raised jugular venous pulse, afebrile, S3 present. Transfusion Related Acute Lung Injury: Hypotension, pyrexia, normal/unchanged JVP

Question 746

What type of surgeries can lead to B12 deficiency

Answer 746

Gastrectomy, ileocaecal ersection

Question 747

What deficiency seen in coeliac?

Answer 747

Coeliac disease is associated with iron, folate and vitamin B12 deficiency

Question 748

Mouth side effect of tetracyclines

Answer 748

Black hairy tongue

Question 749

Ix for all patients with suspected acute pericarditis

Answer 749

Transthoracic echo

Question 750

How to differentiate between bullous pemphigoid and pemphigus vulgaris

Answer 750

Blisters/bullae no mucosal involvement (in exams at least*): bullous pemphigoid mucosal involvement: pemphigus vulgaris

Question 751

How does ATN respond to fluid challenges?

Answer 751

Poorly

Question 752

hip/groin pain and a snapping sensation

Answer 752

Acetabular labral tears

Question 753

Postural headache but normal imaging ->

Answer 753

IIH

Question 754

How to differentiate between tetanus and botulism

Answer 754

Fever, facial spasms, dysphagia in an intravenous drug user → ?tetanus (botulism would cause a flacid paralysis)

Question 755

Adrenaline induced ischaemia mx

Answer 755

Phentolamine

Question 756

Disseminated gonococcal infection triad

Answer 756

tenosynovitis, migratory polyarthritis, dermatitis

Question 757

What medication can make perioral dermatitis worse?

Answer 757

Steroids

Question 758

Order of Mx for symptomatic bradycardia

Answer 758

IV atropine 500mcg Transcutaneous pacing Transvenous pacing

Question 759

First line management of acute pericarditis involves combination of

Answer 759

NSAID and colchicine

Question 760

Criteria for oxygen support in ACS

Answer 760

<94 percent

Question 761

Medical Mx of ER +ve breast cancers

Answer 761

Pre-menopausal - tamoxifen Post-menopausal (including POF) - aromatose inhibitors - ozole

Question 762

Diarrhoea, fatigue, osteomalacia →

Answer 762

Coeliacl?

Question 763

Visual loss, relative afferent pupillary defect, 'red spot' on the retina →

Answer 763

Central retinal artery occlusion

Question 764

Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness

Answer 764

HUS

Question 765

Ix of choice for optic neuritis

Answer 765

Suspected optic neuritis: MRI of the brain and orbits with gadolinium contrast is the investigation of choice

Question 766

Best Ix for HIV

Answer 766

Combined antibody/antigen test

Question 767

Bubbly urine and nephritc picture

Answer 767

Enterovesical fistula?

Question 768

Most specific finding on ECG for acute pericarditis

Answer 768

PR depression

Question 769

Deterioration in patient with hepatitis B

Answer 769

?hepatocellular carcinoma

Question 770

Ix for diabetes insipidus

Answer 770

Water deprivation test

Question 771

Mx of painful mouth that may occur at the end of life

Answer 771

Benzydamine hydrochloride mouthwash or spray may be useful in reducing the discomfort associated with a painful mouth that may occur at the end of life

Question 772

Mx of vestibular neuronitis

Answer 772

Acute: Prochloprazine Chronic: Vestibular rehabilitation

Question 773

Hodgkin's lymphoma - best prognosis + worst prognosis

Answer 773

Best prognosis - Lymphocyte predominant Worst prognosis - lymphocyte depleted

Question 774

Aims of treatment in glaucoma

Answer 774

Reducing aqueous secretion and inducing pupillary constriction

Question 775

What should be managed in the setting of acute ischaemic stroke prior to thrombolysis

Answer 775

Hypertension (>185/110 mmHg) in the setting of acute ischaemic stroke should be treated prior to thrombolysis - use labetalol

Question 776

What type of infection is indicated in contact lens wearers?

Answer 776

Acanthamoebic keratitis Typically seen in those who swim/act as a lifeguard with contact lenses in

Question 777

foreign body sensation, conjunctival injection, and hypopyon on slit-lamp examination

Answer 777

Contact lens associated keratitis - if no water based RFs, think pseudoonas

Question 778

What prophylaxis is needed for patients with nephrotic syndrome

Answer 778

LMWH prophylaxis

Question 779

Dysphagia, aspiration pneumonia, halitosis →

Answer 779

?pharyngeal pouch

Question 780

Finkelstein's test

Answer 780

the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

Question 781

Post splenectomy blood film features:

Answer 781

Howell- Jolly bodies Pappenheimer bodies Target cells Irregular contracted erythrocytes

Question 782

Mechanical valves - target INR

Answer 782

Mechanical valves - target INR: aortic: 3.0 mitral: 3.5

Question 783

Mx of nec fas

Answer 783

immediate surgical debridement nd IV antibiotics

Question 784

Best antibody for pernicious anaemia

Answer 784

IF antibody, can use gastric parietal cell if not

Question 785

Bilateral grittiness - think?

Answer 785

Blepharitis. Mx with hot compress and lid hygiene

Question 786

Mx of myasthenic crisis

Answer 786

IVIG, plasmapharesis

Question 787

What associated condition causes hallucinations with age related macular degeneration

Answer 787

Charles bonnet syndrome

Question 788

Mx of proximal pole scaphoid fractures

Answer 788

Urgent surgical screw fixation

Question 789

growing keratotic nodule in an immunosuppressed patient on a sun-exposed site points strongly to a diagnosis of

Answer 789

SCC - managed with excision and biopsy

Question 790

What medication co-prescribed with SSRIs is a common cause of seretonin syndrome

Answer 790

Tramadol

Question 791

abnormally large drop in BP during inspiration, known as? Seen in?

Answer 791

In cardiac tamponade, there will be an abnormally large drop in BP during inspiration, known as pulsus paradoxus

Question 792

Key side effects of prostaglandin analogues include

Answer 792

increased eyelash length, iris pigmentation and periocular pigmentation

Question 793

Transcutaneous pacing AKA

Answer 793

External pacing

Question 794

Generalised tonic clonic seizure Mx

Answer 794

Generalised tonic-clonic seizures males: sodium valproate females: lamotrigine or levetiracetam

Question 795

Focal seizure Mx

Answer 795

first line: lamotrigine or levetiracetam second line: carbamazepine, oxcarbazepine or zonisamide

Question 796

Absence seizures Mx

Answer 796

Absence seizures (Petit mal) first line: ethosuximide second line: male: sodium valproate female: lamotrigine or levetiracetam carbamazepine may exacerbate absence seizures

Question 797

Myoclonic seizures Mx

Answer 797

Myoclonic seizures males: sodium valproate females: levetiracetam

Question 798

Tonic or atonic seizure Mx

Answer 798

Tonic or atonic seizures males: sodium valproate females: lamotrigine

Question 799

treatment of choice for SLE

Answer 799

Hydroxychloroquine

Question 800

Difference in cauess of oral and genital herpes

Answer 800

Oral - HSV 1 Genital - HSV 2

Question 801

Long term management of diverticular didsease

Answer 801

Increased dietary fibre intake

Question 802

Breakthrough dose

Answer 802

1/6th dose of morphine

Question 803

codeine to morphine

Answer 803

divide by 10

Question 804

morphine to subcut morphine

Answer 804

divide by 6

Question 805

Increase morphine doses by how much if pain not controlled

Answer 805

30-50%

Question 806

Recurrent episodes of natal cleft pain with discharge

Answer 806

?Pilonidal disease

Question 807

Important differential between viral labyrinthitis and vestibular neuronitis

Answer 807

VIRAL LABYRINTHITIS HAS HEARING LOSS

Question 808

Mx of otitis media with perf

Answer 808

ABx and review in 6-8 weeks (5 day course of amox)

Question 809

A description of the contents for amoebic liver abscesses is described as 'anchovy sauce'

Answer 809

E. histolytica is known to digest hepatic tissue

Question 810

As well as xanthochromia, CSF findings consistent with subarachnoid haemorrhage include

Answer 810

Normal or raised opening pressure

Question 811

Myeloma aspirate

Answer 811

Plasma cells

Question 812

EBV: associated malignancies:

Answer 812

Burkitt's lymphoma Hodgkin's lymphoma nasopharyngeal carcinoma

Question 813

Hypoglycaemia with impaired GCS: give

Answer 813

IV glucose if there is access

Question 814

Aim for a break of how long in between courses of topical corticosteroids in patients with psoriasis

Answer 814

4 week

Question 815

speech fluent, comprehension abnormal, repetition impaired

Answer 815

Wernicke's (receptive) dysphasia Due to a lesion of the superior temporal gyrus. It is typically supplied by the inferior division of the left MCA

Question 816

Speech is non-fluent, laboured, and halting. Repetition is impaired Comprehension is normal

Answer 816

Broca's (expressive) aphasia Due to a lesion of the inferior frontal gyrus. It is typically supplied by the superior division of the left MCA

Question 817

Speech is fluent but repetition is poor. Aware of the errors they are making Comprehension is normal

Answer 817

Conduction aphasia Arcuate fasciculus affected in stroke

Question 818

Following weight loss, WHAT is the first-line treatment for moderate/severe obstructive sleep apnoea

Answer 818

CPAP

Question 819

Adverse skin reaction that carbamezapine can cause

Answer 819

Steven Johnson's syndrome

Question 820

Contralateral homonymous hemianopia with macular sparing and visual agnosia

Answer 820

posterior cerebral artery

Question 821

Stevens-Johnson syndrome exhibits Nikolsky sign in erythematous areas. What is this?

Answer 821

blisters and erosions appear when the skin is rubbed gently

Question 822

What nerve lesion can cause weakness of foot dorsiflexion and foot eversion

Answer 822

Common peroneal nerve

Question 823

treatment of choice for essential tremor

Answer 823

Propanolol

Question 824

undoscopy typically shows a swollen pale disc and blurred margins

Answer 824

Anterior ischaemic optic neuropathy

Question 825

What anti hypertensive can ause increased HR?

Answer 825

Nifedipine - peripheral vasodilation - reflex tachycardia

Question 826

What is used for long-term prophylaxis of cluster headaches

Answer 826

Verapamil

Question 827

Greek boy develops pallor and jaundice after having a lower respiratory tract infection. He has a history of neonatal jaundice. The blood film shows Heinz bodies

Answer 827

G6Pd

Question 828

first line investigation for stable chest pain of suspected coronary artery disease aetiology

Answer 828

Contrast-enhanced CT coronary angiogram

Question 829

What is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease

Answer 829

Thrombocytopenia

Question 830

Addison's disease/adrenal insufficiency can cause what acid base disturbance

Answer 830

Hyperkalaemic metabolic acidosis

Question 831

Target saturations in COPD are WHAT if CO2 is normal on ABG

Answer 831

94-98%

Question 832

Nicorandil SE

Answer 832

ulceration of GI tract

Question 833

The most common site of metatarsal stress fractures is the?

Answer 833

2nd metatarsal shaft

Question 834

diagnostic investigation of choice for pancreatic cancer

Answer 834

High resolution CT scan

Question 835

Isolated lateral hip/thigh pain with tenderness over the greater trochanter

Answer 835

Trochanteric bursitis

Question 836

How may uraemia present in AKI? What is it an indication for?

Answer 836

Encephalopatny or pericarditis, indication for dialysis

Question 837

COPD - LTOT if 2 measurements of pO2

Answer 837

<7.3kPa

Question 838

Patients who are allergic to aspirin may also react to what drug?

Answer 838

Sulfasalazin e

Question 839

Localised headache, neck pain, and neurological signs (e.g. Horner's) are indicative of

Answer 839

Carotid artery dissection

Question 840

empirical treatment of choice in native valve endocarditis

Answer 840

IV amox

Question 841

Diabetic ketoacidosis: the IV insulin infusion should be started at

Answer 841

0.1 unit/kg/hour

Question 842

What are curlings ulcers

Answer 842

acute gastric ulcers that develop in response to severe physiological stress, such as burns

Question 843

thrombophlebitis of the internal jugular vein following an anaerobic oropharngeal infection.

Answer 843

Lemierre's syndrome

Question 844

Pagets Mx

Answer 844

IV bisphosphonates

Question 845

Genital wart treatment

Answer 845

multiple, non-keratinised warts: topical podophyllum solitary, keratinised warts: cryotherapy

Question 846

Autonomic dysreflexia can only occur if the spinal cord injury occurs above the level of?

Answer 846

T6

Question 847

Which duct can be blocked by gallstones without causing jaundice?

Answer 847

Cystic

Question 848

Facial rash plus lymphadenopathy think?

Answer 848

Sarcoidosis

Question 849

Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of

Answer 849

shaken baby syndrome

Question 850

How to differentiate between anterior and posterior shoulder dislocation

Answer 850

Anterior shoulder dislocation is associated with FOOSH; while posterior shoulder dislocation is more likely associated with seizures and electric shock

Question 851

What medication can make clopidogrel less effective?

Answer 851

Omeprazole

Question 852

Infective exacerbation of COPD: first-line antibiotics are

Answer 852

Amox, clarithro, or foxy

Question 853

When to use cryoprecipitate in bleeding

Answer 853

Low fibrinogen

Question 854

Dysplasia on biopsy in Barrett's oesophagus requires

Answer 854

Endoscopic mucosal therapy

Question 855

What medications are useful in patients with T2DM who are obsese?

Answer 855

Sitagliptin

Question 856

Severe diarrhoea, particularly in elderly patients may results in what blood gas

Answer 856

renal impairment, hypokalaemia and hyponatraemia - metabolic acidosis

Question 857

What may lower lobe pneumonia present with?

Answer 857

Upper quadrant abdo pain

Question 858

Mx for post LP headache

Answer 858

Caffeine and fluids

Question 859

Marker for carcinoid tumours

Answer 859

Urinary 5-HIA

Question 860

Haptoglobin level in haemolysis

Answer 860

Low - Haptoglobin binds to free haemoglobin

Question 861

What contraceptive method can cause drug induced cholestasis

Answer 861

COCP

Question 862

first-line investigation in suspected prostate cancer

Answer 862

Multiparametric MRI

Question 863

first-line for spasticity in multiple sclerosis

Answer 863

Baclofen and Gabapentin

Question 864

inferior myocardial infarction and AR murmur should raise suspicions of

Answer 864

Ascending aorta dissection

Question 865

False positive VDRL/RPR:

Answer 865

'SomeTimes Mistakes Happen' (SLE, TB, malaria, HIV)

Question 866

As well as Horner's syndrome, Pancoast tumours may also present with

Answer 866

shoulder pain and upper limb neurological signs due to local extension of the tumour

Question 867

Dermatitis, diarrhoea, dementia/delusions, leading to death

Answer 867

Pellagra

Question 868

The presence of an elevated prolactin level along with secondary hypothyroidism and hypogonadism is indicative o

Answer 868

stalk compression is consistent with a non-functioning pituitary adenoma

Question 869

Prostatitsi Mx

Answer 869

quinolone for 14 days e.g. cipro

Question 870

Systemic lupus erythematosus with proteinuria on urinalysis

Answer 870

Lupus nephritis

Question 871

What type of tumours can secrete pituitary hormones

Answer 871

Carcinoid tumours

Question 872

What is INO? Why does it occur? WHat does it result in?

Answer 872

Internuclear ophthalmoplegia (INO) occurs due to a lesion of the medial longitudinal fasciculus (MLF), a tract that allows conjugate eye movement. This results in impairment of adduction of the ipsilateral eye. The contralateral eye abducts, however with nystagmus.

Question 873

abdominal pain, diarrhoea and flushing which are the classical features

Answer 873

Carcinoid syndrome

Question 874

'Global' T wave inversion (not fitting a coronary artery territory) -

Answer 874

think non-cardiac cause of abnormal ECG

Question 875

Best ABx for MRSA

Answer 875

Vanco

Question 876

A double pulse felt in systole is called a

Answer 876

bisferiens pulse or pulsus bisferiens Caused by mixed aortic valve disease

Question 877

Mx to prevent relapse in MS

Answer 877

Natalizumab

Question 878

Ix for Takayasu's

Answer 878

Vascular imaging is required to make a diagnosis of Takayasu's arteritis - either magnetic resonance angiography (MRA) or CT angiography (CTA)

Question 879

What strain HPV RF for oropharyngeal cancer

Answer 879

16/18

Question 880

f shown a skull x-ray in an exam, think what condition?

Answer 880

Paget's

Question 881

Most important causes of VT clinically

Answer 881

Hypokalaemia, then hypomagnesaemia

Question 882

Mx of small cell lung cancer

Answer 882

Surgery plays little role in the management of small cell lung cancer, with chemotherapy being the mainstay of treatment. Adjuvant radiotherapy is also now given in patients with limited disease.

Question 883

n a child with sickle cell disease presenting with fever (temperature >38°C), do what

Answer 883

urgent hospital admission

Question 884

DKA resolution is defined as

Answer 884

pH >7.3 and blood ketones < 0.6 mmol/L and bicarbonate > 15.0mmol/L

Question 885

GCS - motor response

Answer 885

6. Obeys commands 5. Localises to pain 4. Withdraws from pain 3. Abnormal flexion to pain (decorticate posture) 2. Extending to pain 1. None To be counted as localising, the arm must be brought above the clavicle, else it should be scored as 'flexing'

Question 886

GCS - Verbal

Answer 886

5. Orientated 4. Confused 3. Words 2. Sounds 1. None

Question 887

GCS - Eye

Answer 887

4. Spontaneous 3. To speech 2. To pain 1. None

Question 888

A transaminitis (elevated ALT and AST) in the 10,000s is most commonly caused by

Answer 888

Paracetemol OD

Question 889

Pigmented gallstones are associated with

Answer 889

Sickle cell anaemia

Question 890

Mx of autonomic dysreflexia

Answer 890

emoval/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia e.g. removal of faecal matter

Question 891

Schistosomiasis Mx

Answer 891

Praziquantel

Question 892

What side of the heart can carcinoid syndrome affect? what does it cause

Answer 892

Carcinoid syndrome can affect the right side of the heart. The valvular effects are tricuspid insufficiency and pulmonary stenosis

Question 893

LP findings for GBS

Answer 893

Protein risen, normal WCC

Question 894

firm, smooth, tender and pulsatile liver edge

Answer 894

RHF

Question 895

Mx of botulism

Answer 895

Botulism antitoxin

Question 896

What metaboli distrubance can cholera present with

Answer 896

Hypoglycaemia

Question 897

Parkland formula

Answer 897

4ml * % body surface area * weight (kg) = ml of Hartmann's to be given in first 24 hours The Parkland formula is used to calculate the amount of fluid to give in the first 24 hours after burns, with half being given in the first 8 hours

Question 898

Dermatitis in acral, peri-orificial and perianal distribution

Answer 898

?Zinc deficiency

Question 899

initial management of acute limb ischaemia

Answer 899

analgesia, IV heparin and vascular review

Question 900

Mx of acute bronchitisi

Answer 900

The management is usually supportive, but if available it can be guided by the CPR levels. If the patient has a CRP of 20-100mg/L they should be offered a delayed prescription or if they have a CRP >100mg/L you should offer antibiotics immediately. The antibiotic of choice is usually doxycycline.

Question 901

Intermittent limb claudication, absent or weak peripheral pulses in a young woman,

Answer 901

Takayasu's arteritis

Question 902

eGFR variables

Answer 902

CAGE - Creatinine, Age, Gender, Ethnicity

Question 903

What Ix may be useful for diagnosing and monitoring the severity of liver cirrhosis

Answer 903

Transient elastography

Question 904

Laughter → fall/collapse

Answer 904

?cataplexy

Question 905

Recognised complication of NG feeding

Answer 905

Diarrhoea

Question 906

Widened Qrs

Answer 906

>100ms

Question 907

first line test for diagnosis of small bowel overgrowth syndrome

Answer 907

Hydrogen breath testing

Question 908

Facial rash plus lymphadenopathy think

Answer 908

Sarcoidosis

Question 909

Features and Mx of anterior dislocation of shoulder

Answer 909

most common type of dislocation may follow a fall on arm or shoulder always check pulses and nerves (particularly AXILLARY - as commonly injured) Always do a radiograph Treatment: reduction (many methods), analgesia and sling

Question 910

Features and Mx of posterior shoulder dislocation

Answer 910

rare, caused by seizure or electrocution 'lightbulb sign' on x-ray refer to orthopaedic surgeons

Question 911

Multiple sclerosis patient with bladder dysfunction. What Ix?

Answer 911

get an ultrasound KUB first to assess bladder emptying

Question 912

Knee osteo pain ladder

Answer 912

Topical NSAIDs Oral NSAID + PPi

Question 913

Mx of MRSA

Answer 913

Vanco 1st Linezolid 2nd

Question 914

In children the most common site where osteomyelitis occurs in a long bone is the

Answer 914

Metaphysis

Question 915

What urinary Ix done for phaeo

Answer 915

Metanephrines NOT catecholamines

Question 916

What are common complications of seborrhoeic dermatitis

Answer 916

Otitis externa and blepharitis

Question 917

The universal donor of fresh frozen plasma is

Answer 917

AB RhD negative blood

Question 918

New onset AF is considered for electrical cardioversion if

Answer 918

it presents within 48 hours of presentation

Question 919

Definition of upper GI bleed

Answer 919

haemorrhage with an origin proximal to the ligament of Treitz

Question 920

Cellulitis (near the eyes or nose) Mx

Answer 920

Co-amox

Question 921

Mechanism of controlled ventilation in raised ICP

Answer 921

hyperventilation --> reduce pCO2 → vasoconstriction of the cerebral arteries → reduced ICP

Question 922

persistent sensation of having a 'lump in the throat', when there is none.

Answer 922

Globus

Question 923

What endocrine abnormality can cause a euvolaemic hyponatraemia

Answer 923

Hypothyroidism

Question 924

widespread cerebral atrophy mainly involving the cortex and hippocampus

Answer 924

Alzheimer's

Question 925

What should be used for standard-release ISMN to prevent nitrate tolerance

Answer 925

Asymmetric dosing regimes

Question 926

What type of pill is best in women with acne

Answer 926

COCP, swap from POP if on this

Question 927

Moderate-severe aortic stenosis is a contraindication to which anti hypertensice

Answer 927

Ace inhibitors

Question 928

Pulmonary embolism and renal impairment. What Ix

Answer 928

V/Q scan is the investigation of choice

Question 929

Renal colic. Mx of pain if NSAIDs contraindicated

Answer 929

Renal colic: if NSAIDs are contraindicated or not giving sufficiency pain relief NICE recommend IV paracetamol

Question 930

first-line imaging of choice when investigating thyroid nodules

Answer 930

Ultrasonography

Question 931

most common and important viral infection in solid organ transplant recipients

Answer 931

CMV

Question 932

White cells present on urine dip and AKI

Answer 932

think AIN

Question 933

Defunctioning the bowel indicates what type of stoma

Answer 933

Loop ileostomy

Question 934

triad of encephalopathy, jaundice and coagulopathy

Answer 934

Liver failure

Question 935

Mx of euvolemic and hypervolemic hyponatraemic patients who don't have severe symptoms

Answer 935

Fluid restrict

Question 936

How does airway management differ in spinal cord injury?

Answer 936

n adults where there is no concern for a cervical spine injury, a head-tilt chin-lift manoeuvre is appropriate but in the setting of major trauma like this patient where cervical spine injuries are unknown, a jaw-thrust is more appropriate

Question 937

What Ix must be done regularly post op

Answer 937

Electrolyte panel to check for post operative ileus

Question 938

Young adult with sore throat, fever, lethargy, cervical lymphadenopathy persisting > 1 week

Answer 938

Infectious mononucleosis

Question 939

What is the most common cause of hypernatraemia in the elderly

Answer 939

Dehydration, either due to decreased intake or increased GI loss (eg. diarrhoea or vomiting)

Question 940

Compartment syndrome is most commonly associated with what fractures?

Answer 940

Supracondylar and tibial shaft

Question 941

What therapy is avoided if there is thyroid eye disease

Answer 941

Radioactive Iodine

Question 942

Important SEs of penicillins

Answer 942

Toxic epidermal necrolysis

Question 943

Urinary prioblems in a man with a history of gonorrhoea may be due to

Answer 943

Urethral stricture

Question 944

What is the commonest cause of viral encephalitis in the adult population

Answer 944

Herpes simplex Enteroviruses are most common cause of viral meningitis

Question 945

Metabolic ketoacidosis with normal or low glucose:

Answer 945

Think alcohol

Question 946

If a pituitary incidentaloma is found within the sellar, what must be done?

Answer 946

Lab investigation must be done to determine if it is functional or non functional

Question 947

Best anaesthetic agent for haemodynamically unstable patients

Answer 947

Ketamine

Question 948

Mx of salicyclate OD

Answer 948

IV sodium bicarb

Question 949

What Sx are a red flag for patients with chronic rhinosinusitis

Answer 949

Unilateral

Question 950

red eye and reduced vision following intraocular surgery.

Answer 950

Endophthalmitis

Question 951

How many days before surgery is warfarin stopped

Answer 951

5

Question 952

Ongoing diarrhoea in Crohn's patient post-resection with normal CRP. Mx?

Answer 952

cholestyramine

Question 953

Patients with type I diabetes and a BMI > 25 should be considered for WHAT in addition to insulin

Answer 953

metformin

Question 954

Target-shaped lesion in the right upper lobe with air crescent sign present

Answer 954

Aspergilloma

Question 955

reatment of choice for small bowel bacterial overgrowth syndrome

Answer 955

Rifamixin

Question 956

hypochromic microcytic anaemia high ferritin iron & transferrin saturation - basophilic stippling of red blood cells

Answer 956

Sideroblastic anaemia

Question 957

Ix for mycoplasm

Answer 957

Serology

Question 958

Cardiac deformity associated with ADPKD

Answer 958

Mitral valve prolapse

Question 959

Women with breast cancer and no palpable axillary lymphadenopathy at presentation should have a WHAT before their primary surgery

Answer 959

Pre operative axillary US

Question 960

What can CLL transform to? What is this known as?

Answer 960

CLL can transform to high-grade lymphoma (Richter's transformation) making patients suddenly unwell

Question 961

SE of vincristine

Answer 961

Periphereal neuropathy

Question 962

Strongest association of H.pylori

Answer 962

Duodenal ulcer

Question 963

SE of ciclosporin

Answer 963

Hepatotoxicity + nephrotoxicity

Question 964

An itchy rash affecting the face and scalp distribution is commonly caused by

Answer 964

Seborrhoeic dermatitis

Question 965

Restless leg syndrome - management includes

Answer 965

opamine agonists such as ropinirole

Question 966

The patient's symptoms of 'antsy' legs, a creeping sensation, and relief with movement are suggestive of

Answer 966

restless legs syndrome (RLS), also known as Willis-Ekbom disease

Question 967

What condition should metformin be stopped in?

Answer 967

MI, risk of lactic acidosis

Question 968

What should be used to treat AF if there is coexistent heart failure, first onset AF or an obvious reversible cause

Answer 968

Rhythm e.g. amiodorone

Question 969

Grave's disease, orange peel shin lesions

Answer 969

Pretibial myxoedema

Question 970

Thin, intracystic eggshell calcification throughout the bladder.

Answer 970

Schistosomiasis --> think SCC of bladder

Question 971

How to start fluid resus in children

Answer 971

Start IV fluid resuscitation in children or young people with a bolus of 10 ml/kg over less than 10 minutes

Question 972

What pulse is HOCM associated with

Answer 972

Bisfieriens - double pulse

Question 973

If a patient with AF has a stroke or TIA, the anticoagulant of choice should be

Answer 973

warfarin or a direct thrombin or factor Xa inhibitor If not, clopi

Question 974

Type of melanoma that invades aggressively and metastasies early

Answer 974

Nodular

Question 975

electrolyte abnormality that PPis can cause

Answer 975

Hyponatraemia

Question 976

Difference in menorrhagia with thyroid issues

Answer 976

Hyperthyroidism is associated with oligomennorhoea, or amennorhoea, whereas hypothyroidism is associated with menorrhagia

Question 977

Mx of toxoplasmosi

Answer 977

Immunocompetent patients with toxoplasmosis don't usually require treatment Pyrimethamine and sulphadiazine are management options for immunocompromised patients.

Question 978

Ank spond Xray findings

Answer 978

subchondral erosions, sclerosis and squaring of lumbar vertebrae

Question 979

Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker suggests

Answer 979

Leptospirosis

Question 980

aynaud's phenomenon with extremity ischaemia

Answer 980

Buerger's disease - Thromboangiitis obliterans

Question 981

What is a RAPD

Answer 981

when the affected and normal eye appears to dilate when light is shone on the affected eye

Question 982

Management of SCC in cosmetically important sites

Answer 982

MOHS

Question 983

Management of SCC of skin

Answer 983

Surgical excision with 4mm margins if lesion <20mm in diameter. If tumour >20mm then margins should be 6mm

Question 984

In aortic dissection, a pulse deficit may be seen: What may this include?

Answer 984

weak or absent carotid, brachial, or femoral pulse variation in arm BP

Question 985

Septic arthritis ABx therapy duration

Answer 985

4-6 weeks

Question 986

Most important prognostic factor in melanoma

Answer 986

Invasion depth of the tumour

Question 987

Asthma Mx pathway for >12

Answer 987

Low dose ICS/formoterol Low dose MART Moderate dose MART Check Feno and eosinophils (if raised) --> refer to respiratory specificaly If not raised --> Add LTRA or LAMDA

Question 988

What can alcohol bingeing lead to in terms of endocrinological picture?

Answer 988

Alcohol bingeing can lead to ADH suppression in the posterior pituitary gland subsequently leading to polyuria

Question 989

branching linear lesion with terminal bulbs seen on fluorescein staining is characteristic of

Answer 989

Herpes simplex keratitis Treat with topical aciclovir

Question 990

What should patients be screened for before starting rituximab treatment

Answer 990

Hep B

Question 991

Constipation - if symptoms don't respond to a bulk-forming laxative such as isphagula husk, try an

Answer 991

Osmotioc laxativev such as a macrogol

Question 992

Which opioid is licensed for neuropathic pain

Answer 992

Tramadol

Question 993

Patients who have varicose veins and an active or healed venous leg ulcer should be referred to

Answer 993

Secondary care for treatment

Question 994

What should be considered in patients with ches wall trauma who have elevated JVP, persistent hypotension and tachycardia despite fluid resuscitation

Answer 994

Cardiac tamponade - pericardiocentesis

Question 995

Patients with ascites (and protein concentration <= 15 g/L) should be given WHAT as SBP prophylaxis

Answer 995

oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis

Question 996

Red eye - glaucoma or uveitis?

Answer 996

glaucoma: severe pain, haloes, 'semi-dilated' pupil uveitis: small, fixed oval pupil, ciliary flush

Question 997

What is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds

Answer 997

Whole breast radiotherapy

Question 998

Adults with asthma who are poorly controlled on SABA prn + regularly ICS

Answer 998

regular low-dose regular ICS/formoterol combination inhaler (MART therapy)

Question 999

ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness

Answer 999

Myocarditis

Question 1000

For children aged 5 to 16, if the FeNO level is not raised, or if FeNO testing is not available then measure

Answer 1000

bronchodilator reversibility (BDR) with spirometry

Question 1001

What may topical steroids cause in patients with darker skin

Answer 1001

Patchy depigmentation

Question 1002

What ytpe of lung cancer is most likely to cause cavitating lesions

Answer 1002

Squamous cell

Question 1003

Achilles tendonitis Mx

Answer 1003

rest, NSAIDs, and physio if symptoms persist beyond 7 days

Question 1004

Ix of choice for gastric cacner

Answer 1004

Oesophago-gastro-duodenoscopy with biopsy

Question 1005

Prosthetic heart valves - antithrombotic therapy:

Answer 1005

bioprosthetic: aspirin mechanical: warfarin + aspirin

Question 1006

Mirror image nuclei

Answer 1006

Hodgkin's lymphoma

Question 1007

Red or black lump, oozes or bleeds, sun-exposed skin

Answer 1007

Nodular melanoma

Question 1008

blood in the eye anterior chamber known as

Answer 1008

Hyphema --> urgent referral to on call opthal

Question 1009

Most common organism causing cholangitis

Answer 1009

E.coli

Question 1010

Infective endocarditis causing congestive cardiac failure is an indication for WHAT

Answer 1010

Emergency valve replacement surgery

Question 1011

Most common primary site of brain mets

Answer 1011

Lung

Question 1012

What clotting time does warfarin prolong

Answer 1012

PT

Question 1013

Most likely SSRI to lead to QT prolongation and torsades

Answer 1013

Citalopram

Question 1014

What is Simmond's triad? What is it used for?

Answer 1014

Use Simmonds triad (palpation, examining the angle of declination at rest and the calf squeeze test) to assess for evidence of Achilles tendon rupture

Question 1015

what type of oesophagael cancer does achalasia increase risk of

Answer 1015

SCC

Question 1016

Progressively worsening headache with higher cognitive function impaired. What is required

Answer 1016

Urgent imaging

Question 1017

Ix of choice for suspected psoas

Answer 1017

CT abdo

Question 1018

Definitive Mx of sickle cell crisis

Answer 1018

Exchange transfusion

Question 1019

Mx of HAP

Answer 1019

Co-amox

Question 1020

Mx of polycythaemia Vera

Answer 1020

aspirin reduces the risk of thrombotic events venesection first-line treatment to keep the haemoglobin in the normal range chemotherapy hydroxyurea - slight increased risk of secondary leukaemia phosphorus-32 therapy

Question 1021

Dx that can result in both corneal opacities and optic neuritis

Answer 1021

Amiodarone

Question 1022

When to treat subclinical hypothyroidism

Answer 1022

if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart

Question 1023

Mx of amiodarone induced hypothyroidism

Answer 1023

Keep amiodarone and add levo

Question 1024

Returning traveller with fever/flu-like symptoms, anaemia/jaundice/renal impairment

Answer 1024

Falciparum malaria

Question 1025

When dealing with heart failure not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy, a widened QRS complex favours what Mx

Answer 1025

Cardiac resynchronisation therapy

Question 1026

Pancytopaenia 5 years post-chemotherapy/radiotherapy →

Answer 1026

Myelodysplastic syndrome

Question 1027

In patients with breast cancer undergoing breast conserving surgery with adjuvant radiotherapy if, at sentinel node biopsy, more 3 or more involved nodes are found then WHAT is indicated

Answer 1027

axillary node clearance

Question 1028

If a diagnosis of acute cholecystitis remains uncertain after ultrasonography, what Ix may be done

Answer 1028

technetium-labelled HIDA scan may be done

Question 1029

abdominal X-ray shows multiple dilated loops of bowel with air-fluid levels and prominent haustra.

Answer 1029

LBO

Question 1030

Hiccups in palliative care

Answer 1030

chlorpromazine or haloperidol

Question 1031

Quinine can cause what

Answer 1031

Hypoglycaemia

Question 1032

What type of CP450 medications increase warfarin

Answer 1032

INhibitors INcrease warfarin

Question 1033

How does NMS typically present on blood tests

Answer 1033

Raised CK and WCC

Question 1034

What is the key parameter to monitor in patients with hyperosmolar hyperglycaemic state

Answer 1034

Serum osmolality

Question 1035

Anisocoria worse in bright light implies a problem with which pupil

Answer 1035

the dilated pupil

Question 1036

Cardiac catheterisation results - jump in oxygen saturation from right atrium to right ventricle

Answer 1036

VSD?

Question 1037

treatment option for patients with metastatic HCC

Answer 1037

Sorafenib

Question 1038

SE of sulfasalazine in men

Answer 1038

Low sperm count

Question 1039

Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis

Answer 1039

Lymphogranuloma Venereum

Question 1040

Classical presentaiton of cauda equina? Late signs include?

Answer 1040

Cauda equina syndrome classically presents with lower back pain, sciatica, reduced perianal sensation. Late signs include urinary incontinence

Question 1041

Mx of refractory anaphylaxis

Answer 1041

IV adrenaline + IV fluids

Question 1042

Avoid what anti emetic in bowel obstruction

Answer 1042

metoclop

Question 1043

Isolated rise in GGT in the context of a macrocytic anaemia suggests

Answer 1043

Alcohol XS

Question 1044

combination of HIV + chest symptoms + unremarkable auscultatory findings in an exam are highly suggestive

Answer 1044

Pneumocystitis jiroveci

Question 1045

Ciclosporin side-effects

Answer 1045

everything is increased - fluid, BP, K+, hair, gums, glucose

Question 1046

screening test for APKD

Answer 1046

US

Question 1047

oral ulcers, genital ulcers and uveitis

Answer 1047

Behcets

Question 1048

proportion of patients with the condition who have a positive test result

Answer 1048

Sensitivity

Question 1049

Proportion of patients without the condition who have a negative test result

Answer 1049

Specificity

Question 1050

Acute heart failure with hypotension Mx

Answer 1050

inotropes be considered for patients with severe left ventricular dysfunction who have potentially reversible cardiogenic shock

Question 1051

In beta-thalassaemia, what is given adjunt to repeat transfusions? Why?

Answer 1051

In beta-thalassaemia major, iron chelation therapy (e.g. desferrioxamine) is important to prevent the complications of iron overload due to repeat transfusions

Question 1052

Mx of Paracetemol OD if presentation >8 hours

Answer 1052

Paracetamol overdose: if presentation 8-24 hours after ingestion of an overdose of more than 150 mg/kg start acetylcysteine even if the plasma-paracetamol concentration is not yet available

Question 1053

Mx of paracetemol OD if presentation >24 hours

Answer 1053

if presentation > 24 hours after an overdose start acetylcysteine if the patient is jaundiced, has hepatic tenderness or an elevated ALT

Question 1054

What should patients on SGLT-2 inhibitors be monitored for?

Answer 1054

Closely monitor legs and feet of patients taking canagliflozin for ulcers or infection - possible increased risk of amputation

Question 1055

A wide-based gait with loss of heel to toe walking is called an

Answer 1055

Ataxic gait

Question 1056

Mx of servere AI hepatitis

Answer 1056

Steroids

Question 1057

How long of a break to take between topical steroid uses in psoriasis?

Answer 1057

4 weeks

Question 1058

How to differ between radial tunnel syndrome and lateral epidondylitis

Answer 1058

Radial tunnel syndrome presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation

Question 1059

muscle relaxant of choice for rapid sequence induction for intubation

Answer 1059

Suxamethonium

Question 1060

Risk of 0.9% NaCL in large columes

Answer 1060

Hyperchloraemic metabolic acidosis

Question 1061

Spontaneous bacterial peritonitis: most common organism found on ascitic fluid culture is

Answer 1061

E.Coli

Question 1062

Mx of prolactinoma

Answer 1062

Dopamine agonist Then surgery if indicated

Question 1063

exquisitely tender red-eye in a patient with SLE

Answer 1063

Scleritis

Question 1064

Biggest risk of hyphema

Answer 1064

Glaucoma

Question 1065

Which nerve damaged in wrist drop?

Answer 1065

Radial, often caused by fracture of shaft of humerus

Question 1066

Slow growing, painless, mobile lump in the parotid gland of older female →

Answer 1066

?Pleomorphic adenoma

Question 1067

Alcoholic ketoacidosis is managed with

Answer 1067

Saline infusion and thiamine

Question 1068

Should morphine always be given in patients with ACS?

Answer 1068

No, only to patients with severe pain - otehrwise paracetemol may be given

Question 1069

What antihypertensive can worse glucose tolerance

Answer 1069

Thiazides

Question 1070

A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination

Answer 1070

VSD

Question 1071

Flashers and floaters in vision without vision loss

Answer 1071

Posterior vitreous detachment If with vision loss, retinal detachment

Question 1072

What may a raised CRP in SLE indicate

Answer 1072

Underlying infection

Question 1073

Latent tuberculosis treatment options:

Answer 1073

3 months of isoniazid (with pyridoxine) and rifampicin, or 6 months of isoniazid (with pyridoxine)

Question 1074

What Mx should all patients with PAD takeq

Answer 1074

Clopi and statin

Question 1075

High uric acid + renal impairment following chemotherapy. Dx? Mx?

Answer 1075

Tumour lysis syndrome. Mx is rasburicase

Question 1076

lump in the midline between umbilicus and the xiphisternum

Answer 1076

Epigastric hernia

Question 1077

Mx of suspected neutropenic sepsis

Answer 1077

If neutropenic sepsis is suspected (i.e. recent chemo + fever) IV antibiotics must be started immediately - do not wait for WBC

Question 1078

What airway management is preferred if concerned about cervical spine injury?

Answer 1078

Jaw thrust

Question 1079

Complication of Klebsiella

Answer 1079

Empyema

Question 1080

Ix of choice for avascular necrosis of the hi[

Answer 1080

MRI

Question 1081

Alternative to spirinolactone if gynaecomastia troublesome in HF

Answer 1081

Eplerenone

Question 1082

Recommend Adult Life Support (ALS) adrenaline doses

Answer 1082

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

Question 1083

Correcting sodium levels rapidly is dangerous: What can it lead to

Answer 1083

Hyponatraemia correction - osmotic demyelination syndrome Hypernatreamia correction - cerebral oedema

Question 1084

Types of AKI

Answer 1084

Pre-renal: Caused by inadequate renal perfusion e.g. dehydration, haemorrhage, heart failure, sepsis Kidneys act to concentrate urine and retain sodium - urine osmolality high, urine sodium low Renal: Most common = acute tubular necrosis Damage to tubular cells due to prolonged ischaemia or toxins Kidneys can no longer concentrate urine or retain sodium - urine osmolality low, urine sodium high Rarer causes = acute glomerulonephritis, acute interstitial nephritis Post-renal: Obstruction of urinary tract Usually identified with hydronephrosis on renal ultrasound

Question 1085

1st line treatment for compacted ear wax

Answer 1085

Olive oil drops

Question 1086

1st line treatment for digoxin toxicity

Answer 1086

Digibind

Question 1087

What antibodies in drug induced lupus

Answer 1087

anti-histone

Question 1088

Renal tubular acidosis leads to what ABG picture

Answer 1088

hyperchloraemic, normal anion gap metabolic acidosis

Question 1089

t SCC is associated with what infection

Answer 1089

HPV

Question 1090

What Mx for prevention of calcium stones

Answer 1090

Potassium citrate

Question 1091

HerpesVirus FAmily

Answer 1091

Herpes simplex type I (HSV-1). Herpes simplex type II (HSV-2). Varicella-zoster virus (VZV/HHV-3). Epstein-Barr virus (EBV/HHV-4). Cytomegalovirus (CMV/HHV-5). Herpesvirus type 6 (HBLV/HHV-6) - Roseola Infantum Herpesvirus type 7 (HHV-7) - Roseola Infantum Kaposi's sarcoma herpesvirus (KSHV/HHV-8).

Question 1092

Persistent mouth ulcer

Answer 1092

?SCC

Question 1093

Alterntative to atropine in symtpomatic brady

Answer 1093

Adrenaline

Question 1094

Earliest and most common Sx of spinal cord compression

Answer 1094

Back pain

Question 1095

Medical Mx of raynauyd

Answer 1095

Nifedipine

Question 1096

Renal transplant + Infection?

Answer 1096

CMV

Question 1097

What is diclofenac contraindicated in?

Answer 1097

IHD

Question 1098

In type 1 diabetics, blood glucose targets:

Answer 1098

5-7 mmol/l on waking and 4-7 mmol/l before meals at other times of the day

Question 1099

continuous dribbling incontinence after prolonged labour

Answer 1099

Vesicovaginal fistula

Question 1100

most common complication of thyroid eye disease

Answer 1100

Exposure keratopathy

Question 1101

Isolated fever in well patient in first 24 hours following surgery?

Answer 1101

Physiological reaction to surgery

Question 1102

treatment for acute clot retention

Answer 1102

Continuous bladder irrigation via a 3 way urethral catheter

Question 1103

Unruptured sigmoid volvulus is primarily managed by

Answer 1103

Flatus tube insertion

Question 1104

HOCM Auscultation

Answer 1104

HOCM may present with ejection systolic murmur, louder on performing Valsalva and quieter on squatting

Question 1105

Criteria for LTOT

Answer 1105

Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following: secondary polycythaemia peripheral oedema pulmonary hypertension

Question 1106

Alternative to amiodorane in ALS

Answer 1106

Lidocaine

Question 1107

For patients with rosacea with predominant flushing but limited telangiectasia, consider prescribing

Answer 1107

Bromonidine gel

Question 1108

referred and most effective mode of treatment for achalasia in a young patient without multiple comorbidities

Answer 1108

Pneumatic dilatation

Question 1109

What is the technique to stop variceal bleeding if it is oesophageal

Answer 1109

Endoscopic band ligation

Question 1110

What % reduction aimed for in HDL cholesterol

Answer 1110

40%

Question 1111

ASymmetrical spreading lymphadenopathy

Answer 1111

Hodkin's

Question 1112

Widespread convulsions without conscious impairment is likely to represent a

Answer 1112

Pseudoseizure

Question 1113

Lymph node pain when drinking alcohol is very specific

Answer 1113

Hodgkin's lymphoma

Question 1114

Plucking of clothes is typically seen in WHAT lobe seizures

Answer 1114

Temporal

Question 1115

Triad for insulinoma

Answer 1115

Whipple's triad of symptoms of 1) hypoglycaemia with fasting or exercise, 2) reversal of symptoms with glucose, and 3) recorded low BMs at the time of symptoms is hallmark for an insulinoma

Question 1116

Combination of alcohol + what ABx can lead to a strange hangover like reaction

Answer 1116

Metro

Question 1117

What is the ulnar paradox

Answer 1117

proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions When the ulnar nerve is damaged at the wrist, the medial two lumbrical muscles are affected (the lateral two being supplied by the median nerve). Denervation of the lumbricals, which flex the metacarpal phalangeal joints (MCPJ) and extend the interphalangeal joints (IPJ), causes unopposed extension of the MCPJ by extensor digitorum longus and flexion of the IPJ by flexor digitorum profundus and superficialis. This gives the hand a claw like appearance. When the ulnar nerve is damaged at the elbow, the ulnar half of flexor digitorum profundus is also affected resulting in a less marked clawing due to reduced unopposed flexion at the IPJ.

Question 1118

Sudden heart failure, raised JVP, pulsus parodoxus, recent MI

Answer 1118

left ventricular free wall rupture

Question 1119

What are cotton wool spots in diabetic retinopathy

Answer 1119

Areas of infarction

Question 1120

NSTEMI (managed with PCI) antiplatelet choice:

Answer 1120

if the patient is not taking an oral anticoagulant: prasugrel or ticagrelor if taking an oral anticoagulant: clopidogrel

Question 1121

The main components for managing sickle cell crisis should be

Answer 1121

analgesia, oxygen, and IV fluids. You can also consider antibiotics if you suspect an infection, and transfusion if the Hb is low

Question 1122

most common cause of hypopituitarism

Answer 1122

non secreting pituitary macroadenomas

Question 1123

HIV, diarrhoea, Ziehl-Neelsen stain showing protozoa

Answer 1123

Cryptosporidium parvum

Question 1124

'empty delta sign' seen on venography

Answer 1124

Saggital sinus thrombosis

Question 1125

treatment of choice for facial hirsutism

Answer 1125

Topical eflornithine

Question 1126

The transfusion threshold for patients without ACS

Answer 1126

70g/L

Question 1127

Motion sickness Mx

Answer 1127

hyoscine > cyclizine > promethazine

Question 1128

What is a high stepping gait? Why does it develop? Unilateral and bilateral causes?

Answer 1128

A high-stepping gait develops to compensate for foot drop. If found unilaterally then a common peroneal nerve lesion should be suspected. Bilateral foot drop is more likely to be due to peripheral neuropathy.

Question 1129

The causes of massive splenomegaly are as follows:

Answer 1129

myelofibrosis chronic myeloid leukaemia visceral leishmaniasis (kala-azar) malaria Gaucher's syndrome

Question 1130

Pulse pressure in AS vs AR

Answer 1130

AS - narrow AR - widefned

Question 1131

Mx of perforated eardrum

Answer 1131

no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time

Question 1132

What is a positive straight leg raise suggest?

Answer 1132

A positive straight leg raise is performed by raising the leg whilst it is straight if this causes pain in the distribution of the sciatic nerve then the test is positive.

Question 1133

Squints may be classified as to where the eye deviates toward

Answer 1133

the nose: esotropia temporally: exotropia superiorly: hypertropia inferiorly: hypotropia

Question 1134

night blindness + tunnel vision

Answer 1134

Retinitis pigmentosa

Question 1135

Mx of allopurinol if recurrent episodes of gout

Answer 1135

Continue Howvever, should not start allopurinol in first episode of gout - need NSAID cover

Question 1136

How to remember skewed distributions

Answer 1136

alphabetical order: mean - median - mode '>' for positive, '<' for negative

Question 1137

CN6 palsy manifesting as diplopia could be the first sign of

Answer 1137

Brain mets

Question 1138

nvestigation of choice for suspected Boerhaave's syndrome

Answer 1138

CT contrast swallow

Question 1139

Rotator Cuff muscles

Answer 1139

Subscapularis - positioned anteriorly on your chest, helps with internal rotation of shoulder Supraspinatus - positioned on top of your shoulder and runs parallel to your deltoid. Needed for the first 20° of shoulder abduction, then the rest of abduction is done by the deltoid Infraspinatus - positioned posteriorly on the superior aspect of your back, helps with external rotation of shoulder Teres minor - positioned posteriorly on the superior aspect of your back, helps with external rotation of shoulder

Question 1140

In hypothermia, what can rapid rewarming lead to?

Answer 1140

Peripheral vasodilation and shock

Question 1141

CT abdomen is arranged, which demonstrates simultaneous dilatation of the common bile duct and pancreatic ducts.

Answer 1141

Double duct sign - pancreatic cancer

Question 1142

Avoid what antiemetic in bowel obstruction

Answer 1142

Metaclopramide

Question 1143

Mx of renal stones

Answer 1143

watchful waiting if < 5mm and asymptomatic 5-10mm shockwave lithotripsy 10-20 mm shockwave lithotripsy OR ureteroscopy (pregnant) > 20 mm percutaneous nephrolithotomy

Question 1144

Mx of uretic stoens

Answer 1144

shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers 10-20 mm ureteroscopy

Question 1145

Gold standard Ix for cerebral venous sinus thrombosis

Answer 1145

MR venogram

Question 1146

What medication presdisposes to vitreous haemorrhage

Answer 1146

Blood thinning agents

Question 1147

What is the main neurovascular structure that is compromised in a scaphoid fracture

Answer 1147

Dorsal carpal branch of the radial artery

Question 1148

subtype of eczema characterised by an intensely pruritic rash on the palms and soles

Answer 1148

Pompholyx eczema

Question 1149

After 5 shocks, what dose of amiodarone should be given in ALS

Answer 1149

150

Question 1150

How to diagnose orthostatic hypotension/

Answer 1150

when there is a drop in SBP of at least 20 mmHg and/or a drop in DBP of at least 10 mmHg after 3 minutes of standing

Question 1151

'unrecordable' blood sugar measurement with confusion and abdominal pain

Answer 1151

DKA

Question 1152

What can be used to shrink nasal polyps

Answer 1152

Topical corticosteroids

Question 1153

how to differentiate between PAD and spinal stenosis

Answer 1153

eatures in the history that point more towards to spinal stenosis over peripheral arterial include Pain improving on sitting down or crouches down Weakness of the leg Lack of smoking history Lack of cardiovascular history

Question 1154

Risk factors for thrombosis, headache, reduced consciousness, vomiting →

Answer 1154

?intracranial venous thrombosis

Question 1155

Acute onset of tear-drop scaly papules on trunk and limbs

Answer 1155

Guttate psoriasis

Question 1156

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller

Answer 1156

Dengue

Question 1157

Initial Mx of open fractures

Answer 1157

Administration of intravenous antibiotics, photography of wound and application of a sterile soaked gauze and impermeable film

Question 1158

most effective treatment for prominent telangiectasia in rosacea

Answer 1158

Laser therapy

Question 1159

Ix for budd chiari

Answer 1159

US doppler flow

Question 1160

Pagets Mx

Answer 1160

Bisphosphonates

Question 1161

Normal/raised total gas transfer with raised transfer coefficient:

Answer 1161

Asthma

Question 1162

Consider WHAT in young female patients who develop AKI after the initiation of an ACE inhibitor Important for m

Answer 1162

fibromuscular dysplasia

Question 1163

Blood stained discharge from nipple is likely to be associated with

Answer 1163

Intraductal papilloma

Question 1164

What nerve is at risk during total hip replacement

Answer 1164

Sciatic nerve

Question 1165

What value of schobers test is suggestive of AS

Answer 1165

Schober's test <5cm is suggestive of ankylosing spondylitis. This is an indication of reduced lumbar flexion.

Question 1166

Renal impairment, respiratory symptoms, joint pain, systemic features

Answer 1166

ANCA associated vasculitis

Question 1167

Mx of ramsay hunt

Answer 1167

oral aciclovir and steroids

Question 1168

Hypokalaemia, osteomalacia

Answer 1168

T2 RTA

Question 1169

Samter's triad

Answer 1169

aspirin sensitivity, asthma and nasal polyps

Question 1170

What endocrine abnormality can haemochromatosis cause?

Answer 1170

Cranial DI

Question 1171

How does lithium cause nephrogenic DI

Answer 1171

lithium desensitizes the kidney's ability to respond to ADH in the collecting ducts

Question 1172

What type of ABx lowers seziure threshold

Answer 1172

Quinolones

Question 1173

Ix of choice for bladder cancer

Answer 1173

Flexi cysto

Question 1174

Options for pharmacological cardioversion in AF

Answer 1174

'f pharmacological cardioversion has been agreed on clinical and resource grounds for new-onset atrial fibrillation, offer: flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease or amiodarone if there is evidence of structural heart disease.'

Question 1175

Clinical features of psoas abscessses

Answer 1175

Psoas irritation is evidenced when the position of comfort is the patient lying on their back with slightly flexed knees. Inability to weight bear or pain when moving the hip is usually evident.

Question 1176

Visual defect in craniopharyngioma compared to pituitary adenoma

Answer 1176

Craniopharyngioma - Inferior bitemporal hemianopia Pituitary adenoma - Superior bitemporal hemianopia

Question 1177

First line Mx of suspected laryngopharyngeal reflux

Answer 1177

A trial of PPi

Question 1178

abdominal, neurological and psychiatric symptoms. Think?

Answer 1178

Acute intermittent prophyria

Question 1179

What ovarian tumour can cause endometrial hyperplasia?

Answer 1179

Granulosa cell tumours

Question 1180

Urethritis in a male, negative for Gonorrhoea and Chlamydia

Answer 1180

Mycoplasma genitalium

Question 1181

What does cryoprecipitate contain

Answer 1181

factor VIII, fibrinogen, von Willebrand factor and factor XIII

Question 1182

Where is the lesion for Wernicke's aphasia? Broca's?

Answer 1182

Superior temporal gyrus, inferior

Question 1183

HIV, neuro symptoms, single brain lesions with homogenous enhancement

Answer 1183

CNS Lymphoma

Question 1184

Anterior uveitis is most likely to be treated with a

Answer 1184

steroid eye drops (such as prednisolone acetate) and mydriatic eye drops (such as cyclopentolate). The steroid treats the underlying infection and the mydriatic eye drop dilates the pupil and reduces the pain.

Question 1185

Elderly patient dizzy on extending neck

Answer 1185

Vertebrobasilar ischaemia

Question 1186

Ankylosing spondylitis - x-ray findings

Answer 1186

subchondral erosions, sclerosis and squaring of lumbar vertebrae

Question 1187

Refeeding syndrome metabolic picture

Answer 1187

hypophosphataemia this is the hallmark symptom of refeeding syndrome may result in significant muscle weakness, including myocardial muscle (→ cardiac failure) and the diaphragm (→ respiratory failure) hypokalaemia hypomagnesaemia: may predispose to torsades de pointes abnormal fluid balance

Question 1188

bilateral leg pain on walking that is relieved by forward flexion (such as leaning on a shopping trolley), improved symptoms when cycling (as this involves spinal flexion), and worsening with extension (such as walking downhill). Dx?

Answer 1188

Lumbar canal stenosis - pathophysiology involves narrowing of the spinal canal, typically due to age-related degenerative changes, causing compression of the cauda equina nerve roots particularly when standing erect or extending the spine.

Question 1189

Most common cause of wound infection post op

Answer 1189

Staph Aureus

Question 1190

presence of a cardiac tamponade is suggested by Becks Triad

Answer 1190

Hypotension Muffled heart sounds Raised JVP

Question 1191

Medical Mx of NMS

Answer 1191

Bromocriptine

Question 1192

What electrolyte abnormalities suggest dehydration

Answer 1192

Urea raised disproportionately compared to creatine

Question 1193

The absence of a carotid pulse in the presence of sinus tachycardia indicates

Answer 1193

Non shockable rhythm

Question 1194

Man returns from trip abroad with maculopapular rash and flu-like illness

Answer 1194

HIV seroconversion

Question 1195

Carotid artery stenosis is diagnosed (and degree of stenosis assessed) via

Answer 1195

Duplex US

Question 1196

Blood test results for wilson's

Answer 1196

reduced serum caeruloplasmin reduced total serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin) free (non-ceruloplasmin-bound) serum copper is increased increased 24hr urinary copper excretion

Question 1197

What may exacerbate orthostatic hypotension

Answer 1197

y venous pooling during exercise (exercise-induced), after meals (postprandial hypotension) and after prolonged bed rest (deconditioning)

Question 1198

Reynold's pentad

Answer 1198

Charcot's triad (RUQ pain, jaundice, fever) plus hypotension and confusion

Question 1199

Erysipelas is localised skin infection caused b

Answer 1199

Strep Pyogenes

Question 1200

Abdominal pain, constipation, neuropsychiatric features, basophilic stippling

Answer 1200

Lead poisoning

Question 1201

Treatment of choice for scavies

Answer 1201

Permethrin

Question 1202

inverted P wave in lead I, right axis deviation, and loss of R wave progression

Answer 1202

Dextrocardia

Question 1203

Mx of achalasia

Answer 1203

pneumatic (balloon) dilation is increasingly the preferred first-line option less invasive and quicker recovery time than surgery patients should be a low surgical risk as surgery may be required if complications occur surgical intervention with a Heller cardiomyotomy should be considered if recurrent or persistent symptoms

Question 1204

HIV, neuro symptoms, widespread demyelination

Answer 1204

PMFL

Question 1205

What type of CVD can present with neurological complaints

Answer 1205

Aortic dissection

Question 1206

AS management

Answer 1206

AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg

Question 1207

Recurrent chest infections + subfertility

Answer 1207

think primary ciliary dyskinesia syndrome (Kartagener's syndrome)

Question 1208

Multiple rib fractures with > or = 2 rib fractures in more than 2 ribs is diagnosed as a

Answer 1208

Flail chest

Question 1209

Difference in emphysema distribution in COPD and A1AT

Answer 1209

Emphysema is most prominent in the lower lobes in A1AT deficiency and the upper lobes in COPD

Question 1210

Most common complication following meningitis

Answer 1210

Sensorineural hearing loss

Question 1211

Avoid cyclizine in what chronic heart condition

Answer 1211

Heart failure - can cause a drop in CO

Question 1212

Medical causes of AIN

Answer 1212

drugs: the most common cause, particularly antibiotics penicillin rifampicin NSAIDs allopurinol furosemide

Question 1213

Thyrotoxic storm is treated with

Answer 1213

beta blockers, propylthiouracil and hydrocortisone

Question 1214

Axillary freckles are indicative of

Answer 1214

NF type 1

Question 1215

ECG finding of deeply inverted or biphasic waves in V2-3 in a person with the previous history of angina is characteristic of

Answer 1215

Wellen's syndrome. This is highly specific for a critical stenosis of the left anterior descending artery

Question 1216

Pneumonia, peripheral blood smear showing red blood cell agglutination

Answer 1216

Mycoplasma

Question 1217

Hypocalcaemia: prolonged QT interval is an indication for

Answer 1217

urgent IV calcium gluconate

Question 1218

What should be performed in patients with suspected acute limb ischaemia

Answer 1218

Handheld arterial doppler examination

Question 1219

Headache linked to Valsalva manoeuvres. What is this until proven otherwise?

Answer 1219

raised ICP until proven otherwise so LP is contraindicated

Question 1220

What is prescribed adjunt to methotrexate in RA

Answer 1220

Folate to prevent myelosuppression

Question 1221

Clinical findings in ankylosing spondylitis include

Answer 1221

reduced chest expansion, reduced lateral flexion and reduced forward flexion (Schober's test)

Question 1222

What organ toxicity is common in trastuzumab? What investigation is done prior to commencing treatment?

Answer 1222

Cardiac toxicity, echo

Question 1223

When to offer spironolactone in HF

Answer 1223

Offer a mineralcorticoid receptor antagonist, in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure

Question 1224

first-line for spasticity in multiple sclerosis

Answer 1224

Baclofen and gabapentin

Question 1225

triad of vomiting, pain and failed attempts to pass an NG tube

Answer 1225

Gastric volvulus

Question 1226

Blurring of optic disc margin on fundoscopy

Answer 1226

Papilloedema

Question 1227

Reversible Causes of cardiac arrest

Answer 1227

The 'Hs' Hypoxia Hypovolaemia Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders Hypothermia The 'Ts' Thrombosis (coronary or pulmonary) Tension pneumothorax Tamponade - cardiac Toxins

Question 1228

combination of a high reticulocyte count and severe anaemia indicates

Answer 1228

SCA

Question 1229

GI complication of radiotherapy for prostate cancer

Answer 1229

Proctitis

Question 1230

1st line for lower back pain

Answer 1230

NSAIDs

Question 1231

Psoas abscess Mx

Answer 1231

Percutaneous drainage and IV ABx

Question 1232

What diabetic medication is associated with UTI

Answer 1232

SGLT-2

Question 1233

Diastolic murmur + AF. Dx?

Answer 1233

Mitral Stenosis

Question 1234

Persistent productive cough +/- haemoptysis in a young person with a history of respiratory problems

Answer 1234

?Bronchiectasis

Question 1235

Prior to discharge, following an acute asthma attack, PEF should be

Answer 1235

>75% of best or predicted

Question 1236

triad of CVD, high lactate and soft but tender abdomen

Answer 1236

Mesenteric ischaemia

Question 1237

Mx of mild to moderate Sx in carpal tunnel syndrome

Answer 1237

Carpal tunnel syndrome: a trial of conservative treatment (wrist splint +/- steroid injection) should be tried initially for patients with mild-moderate symptoms

Question 1238

How to differentiate between macular degeneration and primary open angle glaucoma in terms of vision loss?

Answer 1238

Common eye disorders affecting vision: Macular degeneration is associated with central field loss Primary open-angle glaucoma is associated with peripheral field loss

Question 1239

Empyema Mx

Answer 1239

Prompt drainage alongside ABx therapy

Question 1240

Children and young people with unexplained bone swelling or pain: consider very urgent

Answer 1240

direct access X-ray to assess for bone sarcoma

Question 1241

Fetor hepaticus, sweet and fecal breath, is a sign of

Answer 1241

Liver failure

Question 1242

Mx of suspected myxoedema coma

Answer 1242

IV thyroid replacement and IV hydrocortisone

Question 1243

What is required in the investigation of all patients presenting with an AKI of unknown aetiology

Answer 1243

An USS

Question 1244

Fever/back pain with pain on extension of the hip

Answer 1244

Iliopsoas abscess

Question 1245

Post-tonsillectomy haemorrhage Mx

Answer 1245

Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre. Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics.

Question 1246

Sterile pyuria and white cell casts in the setting of rash and fever should raise the suspicion of

Answer 1246

AIN, commonly caused by ABs

Question 1247

initial period of recovery followed by a sudden worsening of symptoms. What condiiton is associated with this?

Answer 1247

Bacterial sinusitis - double sickening

Question 1248

Alcoholic ketoacidosis is Mx with

Answer 1248

IV fluids and thiamine

Question 1249

Osteomalacia Mx

Answer 1249

Vit D supplements

Question 1250

Mx of Crohn's

Answer 1250

Inducing remission - glucocorticoids, 2nd line - mesalazine Maintaining remisdsion - azathioprine or mercaptopurine

Question 1251

Is insluin used in HHS?

Answer 1251

No, Insulin is only used in hyperosmolar hyperglycaemic state if the glucose stops falling while giving IV fluids - otherwise risk of central pontine myelinolysis

Question 1252

Brown sequard syndrome cause? Features?

Answer 1252

caused by lateral hemisection of the spinal cord Features ipsilateral weakness below lesion ipsilateral loss of proprioception and vibration sensation contralateral loss of pain and temperature sensation

Question 1253

Dx of SBP

Answer 1253

paracentesis. Confirmed by neutrophil count >250 cells/ul

Question 1254

muscle wasting of the hands, numbness and tingling and possibly autonomic symptoms

Answer 1254

Neurogenic thoracic outlet syndrome

Question 1255

What can be inserted to reduce the risk of sudden cardiac death in HOCM

Answer 1255

implantable cardioverter-defibrillator

Question 1256

Binocular vision post-facial trauma is suggestive of

Answer 1256

Depressed fracture of the zygoma

Question 1257

pepperspot appearnce on skull X ray

Answer 1257

Primary hyperparathyroidism

Question 1258

Axillary node clearance is associated with

Answer 1258

arm lymphedema and functional arm impairment

Question 1259

n acute asthma, the BTS guidelines only recommend ABGs for

Answer 1259

Patients with o2 sats <92

Question 1260

ECG finding in cardiac tamponade

Answer 1260

Electrical alternans

Question 1261

How to differentiate causes of bitemporal hemianopia

Answer 1261

lesion of optic chiasm upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

Question 1262

Mobitz II is an indication for what long term management

Answer 1262

Pacemaker

Question 1263

If a perforated tympanic membrane doesn't heal, mx?

Answer 1263

Myringoplasty

Question 1264

Empyema aspirate features

Answer 1264

Turbid effusion with pH<7.2, Low glucose, High LDH

Question 1265

Non-resolving unilateral discharge suggests

Answer 1265

Cholesteatoma

Question 1266

Triad of Sx for Fat embolism

Answer 1266

Triad of symptoms: Respiratory Neurological Petechial rash (tends to occur after the first 2 symptoms)

Question 1267

What type of retinopathy is treated with panretinal laser photocoagulation

Answer 1267

Proliferative retinopathy

Question 1268

potential complication of total hip replacement, presenting acutely with a 'clunk', leg shortening and internal rotation

Answer 1268

Posterior hip dislocation

Question 1269

Persistent PUO and lymphadenopathy with high WCC?

Answer 1269

Look for lymphoma

Question 1270

thickening and distortion in the region of the fovea, Hx of diabetes

Answer 1270

Diabetes maculopathy

Question 1271

Decrease in pO2/FiO2 in poorly patient with non-cardiorespiratory presentation

Answer 1271

ARDS

Question 1272

first-line treatment for magnesium sulphate induced respiratory depression

Answer 1272

Calcium gluconate

Question 1273

Lactational amenorrhoea is a reliable method of contraception as long as

Answer 1273

amenorrhoeic, baby <6 months, and breastfeeding exclusively

Question 1274

painful arc of shoulder abduction

Answer 1274

Subacromial impingement

Question 1275

What may periureteric fat stranding indicate?

Answer 1275

recent stone passage, if a ureteric calculus is not present.

Question 1276

central scotoma and there are well-demarcated red patches on the retina on fundoscopy.

Answer 1276

Wet AMD

Question 1277

Mx of acromegaly

Answer 1277

if patients are not suitable for trans-sphenoidal surgery, or have residual symptoms, then octreotide may be used

Question 1278

Medication overuse headache Mx

Answer 1278

simple analgesia + triptans: stop abruptly opioid analgesia: withdraw gradually

Question 1279

Diagnostic criteria for ARDS;

Answer 1279

Clinical + CXR + pO2/fiO2 < 40kPa (300 mmHg)

Question 1280

First line management of acute pericarditis involves combination of

Answer 1280

NSAID and colchicine

Question 1281

Electrolyte abnormality seen in chronic alcoholism

Answer 1281

hypomagnasaemia

Question 1282

Eczema herpeticum is a primary infection of the skin caused by

Answer 1282

HSV and uncommonly coxsackie

Question 1283

Signs of systemic sepsis with changing lower limb neurology

Answer 1283

Possible epidural abscess

Question 1284

Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes

Answer 1284

Silicosis

Question 1285

Myoedema coma typically presents with?

Answer 1285

Confusion and hypothermia

Question 1286

What type of NSAID is contraindicated in CVD

Answer 1286

Diclofenac

Question 1287

What is the most useful initial diagnostic test in haemolytic uraemic syndrome

Answer 1287

Blood film

Question 1288

What Ix is required in all patients with unknown AKI aetiology

Answer 1288

US

Question 1289

How to differentiate between aplastic and sequestration crisis in SCA

Answer 1289

Aplastic crisis has reduced reticulocytes, whereas sequestration crisis has increased reticulocytes

Question 1290

Intestinal angina (or chronic mesenteric ischaemia) is classically characterised by a triad of

Answer 1290

severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit - by far the most common cause is atherosclerotic disease in arteries supplying the GI tract

Question 1291

What to give before beta blockade in phaeo

Answer 1291

PHaeochromocytoma - give PHenoxybenzamine before beta-blockers

Question 1292

What to do if patient undergoing major bleeding when on warfarin

Answer 1292

It should be remembered that irrespective of the patient's INR levels, all patients on warfarin who have major bleeding are advised to stop warfarin and are administered intravenous vitamin K 5mg and PCC.

Question 1293

What can be seen on fundoscopy in a fat embolism

Answer 1293

Retinal haemorrhages and intra-arterial fat globules on fundoscopy can be assoicated with fat embolsim

Question 1294

Most common cause of SVCO

Answer 1294

Lung cancer - specifically small cell

Question 1294

Useful marker for re-infarction in MI

Answer 1294

Creatine kinase (CK-MB) remains elevated for 3 to 4 days following infarction. Troponin remains elevated for 10 days. This makes CK-MB useful for detecting re-infarction in the window of 4 to 10 days after the initial insult

Question 1295

Prodrome symptoms of sweating, pallor and nausea/vomiting before a transient loss of consciousness are suggestive of

Answer 1295

reflex (neurally mediated) syncope. This is further supported by quick recovery after the syncope.

Question 1296

antisynthetase syndrome

Answer 1296

Subtype of dermatomyositis, characterised by a combination of myositis and interstitial lung disease. This syndrome is caused by antibodies against anti-Jo1, also known as tRNA synthetase.

Question 1297

Which malignancy's can progress to AML.

Answer 1297

Myelodysplasia and polycythaemia vera

Question 1298

crescent sign on hip X ray

Answer 1298

Avascular necrosis of hip - caused by csteroids

Question 1299

A chest X-ray shows bilateral bronchial dilatation with a tram-line appearance.

Answer 1299

Bronchiectasis

Question 1300

When is ABG warranted in acute asthma

Answer 1300

in patients with o2 sats <92%

Question 1301

what joint involvement is characteristic of hand osteoarthritis

Answer 1301

Carpometacarpal and distal interphalangeal joint involvement is characteristic of hand osteoarthritis

Question 1302

What is the most appropriate investigation for patients with increased urinary cortisol and low plasma ACTH levels

Answer 1302

CT adrenal glands

Question 1303

Best Mx for renal colic

Answer 1303

IM diclofenac if no GI bleeed

Question 1304

DIlated pupil, females, absent leg reflexes

Answer 1304

Holmes ADIe

Question 1305

What is the most common underlying cause of a vitreous haemorrhage

Answer 1305

Proliferative diabetic retinopathy

Question 1306

Mx of severe urticaria

Answer 1306

A short course of an oral corticosteroid may required in addition to a non-sedating antihistamine

Question 1307

Medical Mx of IBS

Answer 1307

First-line pharmacological treatment - according to predominant symptom pain: antispasmodic agents constipation: laxatives but avoid lactulose diarrhoea: loperamide is first-line 2nd line: Amitriptylline

Question 1308

Enzyme deficiency in gilbert's

Answer 1308

UDP glucoronyl transferase

Question 1309

Medical Mx of pyelonephritis in pregnancy

Answer 1309

Cefalexin

Question 1310

Irregular pattern on fluoroscein staining of eye

Answer 1310

Dendritic ulcer - Herpes simplex - topical aciclovir and urgent opthal assessment

Question 1311

Cancers associated with SIADH

Answer 1311

Lung, prostate, thymus, lymphoma

Question 1312

How to differentiate between aplastic and sequestration crisis in SCD?

Answer 1312

Aplastic crisis has reduced reticulocytes, whereas sequestration crisis has increased reticulocytes

Question 1313

How to identify cause of visual field defects based on presentation?

Answer 1313

left homonymous hemianopia means visual field defect to the left, i.e. lesion of right optic tract homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior) incongruous defects = optic tract lesion; congruous defects= optic radiation lesion or occipital cortex

Question 1314

A patient develops acute heart failure 10 days following a myocardial infarction. On examination he has a raised JVP, pulsus paradoxus and diminished heart sound. Dx?

Answer 1314

Left ventricular free wall rupture

Question 1315

empirical antibiotic of choice for neutropenic sepsis

Answer 1315

Piperacillin with tazobactam (Tazocin)

Question 1316

muscle wasting of the hands, numbness and tingling and possibly autonomic symptoms

Answer 1316

Neurogenic thoracic outlet syndrome

Question 1317

Does campylobacter always require treatment?

Answer 1317

NO, can be managed supportively unless severe - then mcrolide

Question 1318

Symptomatic aortic stenosis Mx

Answer 1318

surgical AVR for low/medium operative risk patients transcatheter AVR for high operative risk patients

Question 1319

Middle-aged, personality changes, involuntary movements

Answer 1319

Hungtington's disease

Question 1320

Fever, loin pain, nausea and vomiting

Answer 1320

acute pyelonephritis

Question 1321

Ix for gout

Answer 1321

Measure uric acid levels in suspected gout (i.e. in the acute setting) a uric acid level ≥ 360 umol/L is seen as supporting a diagnosis if uric acid level < 360 umol/L during a flare repeat the uric acid level measurement at least 2 weeks after the flare has settled

Question 1322

Which cancer has high risk of tumour lysis syndrome? How does it present? How to Mx?

Answer 1322

Burkitt's lymphoma Rasburicase (a recombinant version of urate oxidase, an enzyme which catalyses the conversion of uric acid to allantoin*) is often given before the chemotherapy to reduce the risk of this occurring. Complications of tumour lysis syndrome include: hyperkalaemia hyperphosphataemia hypocalcaemia hyperuricaemia acute renal failure

Question 1323

Sudden deterioration with ventilation suggests

Answer 1323

Tension pneumothorax

Question 1324

What ECG finding can SAH cause

Answer 1324

Torsades du Pointes

Question 1325

Ix for cardiac tamponade

Answer 1325

Echo

Question 1326

Secondary amenorrhoea: low-level gonadotrophins indicate

Answer 1326

a hypothalamic cause e.g. excess exercise

Question 1327

Causes of optic neuritis

Answer 1327

MS, diabetes, syphillis

Question 1328

Eye complication of sarcoid

Answer 1328

Anterior uveitis

Question 1329

If both menorrhagie and dysmenorrhoea present, what should be prescribed?

Answer 1329

NSAIds should be prescribed in preference to transexamic acid

Question 1330

What should all patients who have had an acute MI be treated with?

Answer 1330

ACEi, beta blocker, DAPT, statin

Question 1331

Medications to avoid in HF

Answer 1331

Verapamil, Flecainide, Thizaolidinediones, NSAIDs, glucocorticoids

Question 1332

What Mx can cause discolouration to vision? What colour

Answer 1332

Sildenafil - blue Digoxin - yellow/green

Question 1333

What mx can cause cataracts

Answer 1333

Steroids

Question 1334

What mx can cause corneal opacities

Answer 1334

Amiodarone, indomenhacin

Question 1335

What Mx can cause optic neuritis

Answer 1335

Amiodarone, metro, ethambutol

Question 1336

Mnemonic for cP450 enzyme inhibitors

Answer 1336

Inhibitors INcrease INR The mnemonic SICKFACES.COM can be used to easily remember common CYP450 inhibitors. Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol & Grapefruit juice Chloramphenicol Erythromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole

Question 1337

Mnemonic for cP450 enzyme inducers

Answer 1337

The mnemonic CRAP GPs can be used to easily remember common CYP450 inducers. Carbemazepines Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbitone Sulphonylureas

Question 1338

What Mx can sildenafil not be given adjunct

Answer 1338

Nitrates and nicorandil

Question 1339

What is Lhermitte's sign?

Answer 1339

shock like sensation radiating down the spine induced by neck flexion

Question 1340

What is Uhthoff's phenomenon

Answer 1340

Worsening multiple sclerosis symptoms during rising body temperature

Question 1341

Difference between swan neck and boutonniere deformity

Answer 1341

In swan neck deformity, the PIP joint is hyperextended and the distal interphalangeal (DIP) joint is bent. In boutonnière deformity, the PIP joint can't be straightened.

Question 1342

PSP triad

Answer 1342

early dysphagia, recurrent falls, gaze palsy

Question 1343

Organisms causing post splenectomy sepsis

Answer 1343

Think NHS: Neisseria Haemophilus Streptococcus

Question 1344

Difference in optic disc between CRVO and vitreous haemorrhage

Answer 1344

CRVO has optic disc swelling, VH doesn't

Question 1345

What is used to treat cerebral oedema in patients with brain tumours

Answer 1345

Dexamethasone

Question 1346

What combination of eye drops used in the management of acute angle closure glaucoma?

Answer 1346

Direct parasympathomimetic eyedrops, such as pilocarpine, cause pupillary constriction thus widening the iridocorneal angle and allowing for humour to drain. Beta-blocker eye drops, such as timolol, reduce aqueous humour production. These two actions in combination work to reduce intraocular pressure.

Question 1347

Worsening FVC in a patient with MG, what medication may have predisposed to this?

Answer 1347

Beta blocker

Question 1348

Mx of euvolemic and hypervolemic hyponatraemic patients who don't have severe symptoms

Answer 1348

Fluid restrict

Question 1349

Prior to discharge, following an acute asthma attack, PEF should be what?

Answer 1349

>75% of best or predicted

Question 1350

What is required to diagnose dementia?

Answer 1350

Neuroimaging

Question 1351

What does COPD standby medication consist of?

Answer 1351

Short course of oral corticosteroids and oral ABx to keep at home

Question 1352

What makes lateral epicondylitis worse?

Answer 1352

resisted wrist extension/suppination whilst elbow extended

Question 1353

Supraspinatus tendonitis. How does it present?

Answer 1353

Rotator cuff injury Painful arc of abduction between 60 and 120 degrees Tenderness over anterior acromion

Question 1354

Sudden hypoxia and increased ventilation pressure following intubation and ventilation, Dx?

Answer 1354

Tension pneumothorax

Question 1355

Long term mechanical ventilation in trauma patients can result in what? What does this result in?

Answer 1355

Tracheo-oesophageal fistula (TOF) formation, which increases the risk of ventilator-associated pneumonias and aspiration pneumonias - the latter caused by aspirated stomach contents

Question 1356

Perforated tympanic membrane Mx

Answer 1356

If done by barotrauma, reassure and advise will likely resolve in 6-8 weeks If done by otitis media, give amox

Question 1357

What do T and Z score mean?

Answer 1357

The T score is your bone density compared to a healthy 30-year-old. The Z score compares your bone density to someone your age and body size. The Z score is adjusted for age, gender and ethnic factors.

Question 1358

DIC typical blood picture

Answer 1358

↓ platelets ↓ fibrinogen ↑ PT & APTT ↑ fibrinogen degradation products

Question 1359

Important to check what blood test result in post operative ileus?

Answer 1359

U+E

Question 1360

Useful anaesthetic agent in trauma

Answer 1360

Ketamine, doesn't count a drop in BP

Question 1361

Hyoscine hydrobromide or hyoscine butylbromide MOA

Answer 1361

muscarinic antagonist

Question 1362

How long before surgery to stop HRT?

Answer 1362

4 weeks

Question 1363

first line anti-emetic for intracranial causes of nausea and vomiting

Answer 1363

Cyclizine

Question 1364

Best test for ACL injury

Answer 1364

Lachman's test (knee at 20-30 degrees) is superior to the anterior draw test

Question 1365

What transfusion can be used to help in acute chest crises in SCD

Answer 1365

Exchange transfusions are a way of reducing the number of sickle red cells and increasing the number of normal red cells, in order to improve oxygenation

Question 1366

Mx of SCFE

Answer 1366

Internal fixation

Question 1367

Risk of tamoxifen

Answer 1367

pre and perimenopausal (VTE)

Question 1368

Risk of anastrazole

Answer 1368

Osteoporosis

Question 1369

Mx of pseudomonas in CF

Answer 1369

Oral cipro

Question 1370

Rivaroxaban and apixaban can be reversed by

Answer 1370

Andexanet alpha

Question 1371

Warfarin can be reversed by

Answer 1371

Vitamin K

Question 1372

Heparin can be reversed by

Answer 1372

Protamine sulphate

Question 1373

Dabigatran can be reversed by

Answer 1373

Idaricizumab

Question 1374

painless haematuria and HTN ina young patient

Answer 1374

APKD

Question 1375

What test can be used to confirm Gilbert's?

Answer 1375

bilirubin rises post IV nicotinic acid

Question 1376

DIfference between chalazion and stye

Answer 1376

Chalzion - cyst - painless Stye - abscess - painful BOTH USUALLY CAUSED BY STAPH AUREUS Treated with hot compresses, and only topical ABx if associated conjunctivitis

Question 1377

Brown-squard syndrome

Answer 1377

paralysis and loss of proprioception ipsilaterally, loss of temperature and pain contralaterally Lesion at mid-thoracic level

Question 1378

Hoow to differentiate between blepharitis and conjunctivitis

Answer 1378

Blepharitis - bilateral grittiness, asx with seborrhoeic dermatitis, NO discharge Conjunctivitis - discharge

Question 1379

Ix for AAA

Answer 1379

Ultrasound is the usual initial investigation for establishing the diagnosis. CT angiogram gives a more detailed picture of the aneurysm and helps guide elective surgery to repair the aneurysm.

Question 1380

What is hypermetropia a risk factor for?

Answer 1380

acute angle glaucoma

Question 1381

What is myopia a risk factor for?

Answer 1381

Retinal detachment, open angle glaucoma

Question 1382

Initial emergency Mx for acute angle closure glaucoma

Answer 1382

IV acetazolamide

Question 1383

What glaucoma medication can cause change in colour of the eye or increase eyelash length?

Answer 1383

Prostaglandin analogues - latanoprost Adverse effects include brown pigmentation of the iris, increased eyelash length

Question 1384

Pharamcology summary of glaucoma

Answer 1384

Question 1385

How to differentiate between episcleritis and scleritis clinically

Answer 1385

phenylephrine drops may be used to differentiate between episcleritis and scleritis phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels if the eye redness improves after phenylephrine a diagnosis of episcleritis can be made

Question 1386

wber syndrome affects ther

Answer 1386

midbrain

Question 1387

Lateral medullary syndrome affects the

Answer 1387

medulla

Question 1388

What can untreated neck goitre lead to?

Answer 1388

Tracheomalacia, sudden onset shortness of breath

Question 1389

amber material under the retinal pigment epithelium in both eyes

Answer 1389

Drusen, between Bruchen's membrane and retinal pigment epithelium

Question 1390

What nerve affected in collesf racture

Answer 1390

Media

Question 1391

How long to continue iron tablets for once it has been correectewd?

Answer 1391

3months after correction

Question 1392

gallstones in the gallbladder

Answer 1392

cholecyystolithiasis

Question 1393

Gallstones in the CBD

Answer 1393

choledocholithiasis

Question 1394

Jaundice, pruritus, dark urine and pale stool suggest

Answer 1394

bile duct obstruction

Question 1395

Differentiating bronchitis and pneumonia

Answer 1395

History: Sputum, wheeze, breathlessness may be absent in acute bronchitis whereas at least one tends to be present in pneumonia. Examination: No other focal chest signs (dullness to percussion, crepitations, bronchial breathing) in acute bronchitis other than wheeze. Moreover, systemic features (malaise, myalgia, and fever) may be absent in acute bronchitis, whereas they tend to be present in pneumonia.

Question 1396

What can be used to guide decision making process regarding ABx therapy in bronchitis?

Answer 1396

CRP

Question 1397

What Mx can be used for persistent dry cough in palliative care

Answer 1397

humidified air, codeine, morphine, oral corticosteroids

Question 1398

Meckels diverticulum can be a risk factor for what?

Answer 1398

Intusussception

Question 1399

Criteria to admit in new onset A fib

Answer 1399

Tachycardic (>150), hypotensive

Question 1400

Relative bradycardia compared to temperature

Answer 1400

Faget's sign Think Typhoid

Question 1401

Hypertrophic pulmonary osteoarthropathy triad

Answer 1401

Periostitis, clubbing and painful arthropathy of large joints Asx with lung cancers

Question 1402

Recurrent otitis media resistant to ABx, deep retration pocket in tympanic membrane noted o/e

Answer 1402

Cholesteatoma

Question 1403

Mx that can be used in Meniere's prevention

Answer 1403

Betahistine

Question 1404

When should pred be considered in bell's palsy

Answer 1404

If presentaiton within 72 hours

Question 1405

Which anti-epileptics cause thrombocytopenia

Answer 1405

Carbamezapine and sodium valproate

Question 1406

When to double dose of levonorgestrel?

Answer 1406

Obese or on anti epileptic medications - becomes 3mg instead of 1.5

Question 1407

What should be given prior to colonoscopy?

Answer 1407

Magnesium citrate prep

Question 1408

What arrythmias can cause canon A waves? what are they?

Answer 1408

V tach, complete heart block, junctional tach Cannon A waves are large jugular vein pulsations that occur when the right atrium contracts against a closed tricuspid valve.

Question 1409

Extra-renal manifestations of ADPKD

Answer 1409

Liver cysts ovarian cysts Berry aneurysm - SAH Mitral valve prolapse Diverticular disease

Question 1410

Recurrent steatorrhoea, weight loss and gallstones. Hx of diabetes. O/E - jaundice

Answer 1410

Somatostatinoma

Question 1411

Mx of postpartum thyroiditis

Answer 1411

Propanolol

Question 1412

Damage to hypoglossal nervse causes tongue to deviate which way?

Answer 1412

Towards lesion e.g. ipsilaterally. Right hypoglossal nerve lesion, tongue deviates towards the right.

Question 1413

Garden spade deformity

Answer 1413

Smith's fracture

Question 1414

Humeral shaft fracture causes damage to which nerve

Answer 1414

Radial

Question 1415

What Mx can be used acutely for Mx of nausea in meniere

Answer 1415

Cyclizine, good for ENT causes of N&V

Question 1416

Positive valgus stess test

Answer 1416

MCL

Question 1417

Positive varus stress test

Answer 1417

LCL

Question 1418

Difference in location radial fractures between adult and children

Answer 1418

Children - radial neck Adult - radial head

Question 1419

What is Nelson's syndrome?

Answer 1419

an enlargement of an adrenocorticotropic hormone-producing tumour in the pituitary gland, following surgical removal of both adrenal glands in a patient with Cushing’s disease.

Question 1420

Bilateral sciatica?

Answer 1420

?Cauda equina

Question 1421

IVC obstruction triad. Caused by?

Answer 1421

oedema below level of obstruction, lower limb oedema, tachycardia. Caused by renal cancer

Question 1422

Leriche syndrome triad

Answer 1422

claudication, impotence and decreased pulses due to aortoiliac occlusion

Question 1423

What Ix if suspecting abscess secondary to PID?

Answer 1423

USS

Question 1424

second line to chloramphenicol for bacterial conjunctivitis

Answer 1424

Fusidic acid

Question 1425

At what Hb threshold can you operate?

Answer 1425

>100, if <100 postpone operation and investigation, if <80 needs transfusion

Question 1426

Mx of entamoeba

Answer 1426

Metro

Question 1427

Mx of campylobacter

Answer 1427

Macrolide, if not - cipro

Question 1428

Mx of salmonella

Answer 1428

Cipro

Question 1429

Mx of shigella

Answer 1429

Cipro

Question 1430

Oral candidiasis Mx

Answer 1430

Localised: Oral miconazole Extensive: Oral Fluconazole

Question 1431

DIC blood results

Answer 1431

A typical blood picture includes: ↓ platelets ↓ fibrinogen ↑ PT & APTT ↑ fibrinogen degradation products schistocytes due to microangiopathic haemolytic anaemia

Question 1432

Antihistamine creasm

Answer 1432

Calamine lotion, topical menthol 1%

Question 1433

Winging of scapula. What nerve affected?

Answer 1433

Long thoracic

Question 1434

What electrolyte abnormality can trimethoprim cause?

Answer 1434

Folate

Question 1435

What can predispose to ovarian torsion?

Answer 1435

Malignancy

Question 1436

What Ix for suspected SVCO

Answer 1436

Contrast CT

Question 1437

Most common cause of UTI in immunosuppresssed

Answer 1437

Pseudomonas

Question 1438

Initial Mx of cardiac tamponade

Answer 1438

CHECK BP IF UNSTABLE, oxygen and fluids THEN pericardiocentesis

Question 1439

Pregnant patient with stones with renal stones. Ix?

Answer 1439

USS

Question 1440

First line Mx for restless leg syndrome

Answer 1440

Dopamine agonist e.g. pramipexole or ropinirole

Question 1441

Difference between bulbar and pseudobulbar palsy

Answer 1441

A bulbar palsy is a lower motor neuron lesion of cranial nerves IX, X and XII. A pseudobulbar palsy is an upper motor neuron lesion of cranial nerves IX, X and XII.

Question 1442

Pt with phaeo triad. Initialy Ix in GP?

Answer 1442

Refer to see specialist on same day

Question 1443

Pt with malignant HTN but no signs of end organ damage. Mx?

Answer 1443

Review and remeasure BP in 1 week

Question 1444

If pt high risk of bleeding, alternative to fondaparinux for NSTEMI Mx?

Answer 1444

Unfractionated heparin

Question 1445

STEMI Mx

Answer 1445

Question 1446

NSTEMI Mx

Answer 1446

Question 1447

Bone pain/swelling in children. Potential Dx?

Answer 1447

Bone sarcoma, urgent X ray within 48 huours

Question 1448

Lump that is increasing in size children and adults. Potential Dx?

Answer 1448

Soft tissue sarcoma. Consider USS within 48 hours and 2 weeks respectively.

Question 1449

Samter's triad

Answer 1449

Asthma, aspirin sensitivit and nasal polyps. Polyps typically present with obstruction, rhinorrhoea and anosmia

Question 1450

Mx of sigmoid volvlulus

Answer 1450

Flexible sigmoidoscopy

Question 1451

Which of measles or rubella has conjunctivitis

Answer 1451

Measles

Question 1452

What CTD can cause menorrhagia

Answer 1452

Ehler Danlos

Question 1453

For patients with strong family Hx of colorectal cancer (<50), Mx?

Answer 1453

Offer colonoscopy as likely a strong genetic basis

Question 1454

Bounding pulse

Answer 1454

Acute CO2 retention

Question 1455

How to treat metabolic causes of hypercalcaemia in end of life?

Answer 1455

Haloperidol

Question 1456

Best antiemetic in parkinsons

Answer 1456

DomperidoneBe

Question 1457

Best class of medication in parkinsons to treat tremor

Answer 1457

Antimuscarinics

Question 1458

What cancer can cause thrombocytosis?

Answer 1458

Lung cancer

Question 1459

Options for rhythm control in AF

Answer 1459

<48 hours of presentaiton Fleicanide or amiodarone if no evidence of structural heart disease

Question 1460

How to differentiate biliary colic and acute cholecystitis?

Answer 1460

Acute cholecystitis has raised inflammatory markers, biliary colic has normal

Question 1461

Diagnostic feature of empyema

Answer 1461

Loculated pleural effusion on ultrasound

Question 1462

MEN 1 is associated with

Answer 1462

parathyroid, pancreatic, pancreatic, islet cell, and pituitary tumours.

Question 1463

MEN 2a is characterised by

Answer 1463

thyroid medullary carcinoma, pheochromocytoma, and parathyroid tumours

Question 1464

MEN 2b is associated with

Answer 1464

thyroid medullary carcinoma, pheochromocytoma, and mucocutaneous ganglioneuromas.

Question 1465

Mx of post-herpetic neuralgia

Answer 1465

TCA

Question 1466

ipsilateral weakness below lesion ipsilateral loss of proprioception and vibration sensation contralateral loss of pain and temperature sensation

Answer 1466

Brown-sequard syndrome

Question 1467

best Ix for mesenteric ischaemia

Answer 1467

Abdo CT

Question 1468

CHADSVASC score

Answer 1468

The CHA2DS2-VASc was designed to assess stroke risk in patients with atrial fibrillation. Clinicians should consider anti-coagulating males with a CHA2DS2-VASC score greater than 0 and females with a score greater than 1. Anti-coagulation is recommended in anyone with a score greater than 2: C - Congestive cardiac failure (1) H - Hypertension >140/90, or on anti-hypertensives (1) A2 - Age >75 years (2) D - Diabetes mellitus (1) S2 - Stroke, TIA or thromboembolism in the past (2) V – Vascular disease (1) A –Age 65–74 years (1) Sc – Sex – female (1).

Question 1469

Diagnostic Ix for achalasia

Answer 1469

Oesophagael manometry

Question 1470

Stroke in a young person with recent Hx of immobility think?

Answer 1470

PFO, do an echo

Question 1471

Mx of gastrinoma

Answer 1471

Somatostatin analogue - Octreotide

Question 1472

Weber classification of fractures

Answer 1472

The most common classification used, especially within the Emergency Department, is the Weber classification, which classifies lateral malleolus fractures: Type A = below the syndesmosis Type B = at the level of the syndesmosis Type C = above the level of the syndesmosis

Question 1473

dilated pupil, which shows a delayed and incomplete constriction to light

Answer 1473

Holmes-adle pupil.

Question 1474

Ix for holmes-adle pupil

Answer 1474

To confirm the diagnosis, testing with low-dose pilocarpine can be carried out. There is usually no response to a dilute pilocarpine solution in a normal pupil. In a Holmes–Adie pupil, there is hypersensitivity to the solution due to degeneration of post-ganglionic neurones (denervation hypersensitivity).

Question 1475

What type of disorders can manifest with bleeding problems?

Answer 1475

CTD

Question 1476

Where does a direct inguinal hernia protrude? How does it present? WHat is it associated with?

Answer 1476

protrudes through a weak point in the inguinal canal's posterior wall, typically in Hesselbach's triangle and medial to the inferior epigastric vessels. It presents as a groin lump and can extend into the scrotum if untreated. ASsociated with heavy lifting

Question 1477

What anti parkinson medication can cause compulsive behabiours

Answer 1477

Dopamine agonists e.g. ropinirole

Question 1478

What artery likely affected in bleeding duodenal ulcer

Answer 1478

Gastroduodenal

Question 1479

Small, numerous opacities in upper lung zones with hilar lymphadenopathy

Answer 1479

Silicosis

Question 1480

presence of probable pancreatitis (raised amylase, epigastric pain, vomiting), alongside the radiographic findings of bilateral pulmonary infiltrates, is suggestive of

Answer 1480

ARDS

Question 1481

Mx of hyperkalaemia

Answer 1481

immediate treatment with 30 ml of 10% calcium gluconate by slow intravenous injection to protect the cardiac myocytes from excess potassium. Following this, you should give ten units of Actrapid® in 100 ml of 20% glucose; this helps to draw potassium intracellularly. Salbutamol nebulisers can also help. Finally, calcium resonium 15 g orally or 30 g rectally is used to mop up excess potassium in the gastrointestinal tract.

Question 1482

Post-bone marrow transplant, the clinical features of respiratory disease and obstructive spirometry suggest

Answer 1482

Bronchiolitis obliterans

Question 1483

What excess vitamins can cause kidney stones?

Answer 1483

C/D

Question 1484

What artery affected in temporal arteritis?

Answer 1484

Superficial temporal artery

Question 1485

What artery affected in peptic (gastric) ulcer?

Answer 1485

Left gastric

Question 1486

Normocytic anaemia. What Ix?

Answer 1486

EPO

Question 1487

An acoustic neuroma is associated with an over-proliferation of which type of cell?

Answer 1487

Over-proliferation of Schwann cells forms the pathological basis of an acoustic neuroma.

Question 1488

Malignant cartilaginous tumour which most often arises from long bones and typically gives the appearance of ‘popcorn’ or ‘cotton wool’ calcification

Answer 1488

Chondrosarcoma

Question 1489

What to do if major bleeding on warfarin?

Answer 1489

Major bleeding: stop warfarin sodium give phytomenadione (vitamin K1) by slow intravenous injection give dried prothrombin complex (factors II, VII, IX, and X); if dried prothrombin complex is unavailable (fresh-frozen plasma can be given but is less effective) recombinant factor VIIa is not recommended for emergency anticoagulation reversal.

Question 1490

What to if minor bleeding on warfarin?

Answer 1490

INR > 8.0, minor bleeding: stop warfarin sodium give phytomenadione (vitamin K1) by slow intravenous injection repeat the dose of phytomenadione if INR is still too high after 24 h; restart warfarin sodium when INR < 5.0. INR 5.0–8.0, minor bleeding: stop warfarin sodium give phytomenadione (vitamin K1) by slow intravenous injection restart warfarin sodium when INR < 5.0.

Question 1491

What to do if no bleeding on warfarin?

Answer 1491

INR > 8.0, no bleeding: stop warfarin sodium give phytomenadione (vitamin K1) by mouth using the intravenous preparation orally [unlicensed use] repeat the dose of phytomenadione if INR is still too high after 24 h; restart warfarin when INR < 5.0. INR 5.0–8.0, no bleeding: withhold 1 or 2 doses of warfarin sodium and reduce subsequent maintenance dose.

Question 1492

An unwell child with an unhealed burn must be treated for WHAT until proven otherwise

Answer 1492

toxic shock syndrome

Question 1493

What nerve is associated with tear formation?

Answer 1493

Intermediate nerve, branch of facial nerve

Question 1494

Mx of cataract

Answer 1494

phacoemulsification

Question 1495

definitive treatment in PSC

Answer 1495

Liver transplanatation

Question 1496

Mx of scleritis

Answer 1496

oral NSAIDs

Question 1497

What drug can be trialled in chronic plaque psoriasis if no response to other medications?

Answer 1497

Methotrexate

Question 1498

hypertension in young women with a ‘string of beads’ appearance of the renal artery on CT. Dx? Mx?

Answer 1498

Fibromuscular dysplasia, managed with antihypertensives and renal artery balloon angioplasty

Question 1499

Echo findings on HOCM

Answer 1499

Characteristic 'banana-shaped' left ventricular cavity. This shape results from septal hypertrophy, which reduces the size of the left ventricular cavity. HOCM is commonly associated with left ventricular diastolic dysfunction, which impairs the heart's ability to relax and fill properly during the resting phase. Over time, this can enlarge the left atrium as it accommodates the increased blood volume and works harder to maintain normal cardiac function.

Question 1500

What electrolyte abnormality can cause peptic ulcer disease?

Answer 1500

Hypercalcaemia

Question 1501

What sided varicocele is worrying? Why?

Answer 1501

A varicocele is a dilatation of the pampiniform plexus of the spermatic cord; this network of veins is dependent on the spermatic vein. A left-sided varicocele is associated with a left renal malignancy in a small proportion of patients. The anatomy of the testicular (gonadal) veins is asymmetrical. The right drains directly into the inferior vena cava. The left drains into the left renal vein. A large left renal tumour may compress/invade into the left renal vein, causing an obstruction to venous return, which results in a varicocele. Assessment with an ultrasound of the kidneys is recommended.

Question 1502

presence of alopecia with abnormal scalp skin must raise the possibility of

Answer 1502

tinea capitis

Question 1503

What can be given after a fluid challenge to improve urine output?

Answer 1503

Vasopressor, e.g. noradrenalien

Question 1504

What antihypertensive can cause angioedema?

Answer 1504

Ramipril

Question 1505

Best Ix for sialadenitis

Answer 1505

US guided fine needle aspiration

Question 1506

What is suspected in post-bone marrow transplant patients presenting with obstructive spirometry after 100 day

Answer 1506

bronchiolitis obliterans

Question 1507

history of hereditary haemorrhagic telangiectasia and his presentation of exertional dyspnoea

Answer 1507

pulmonary AV malformation

Question 1508

Mx of sepsis in ascending cholangitis

Answer 1508

urgent decompression of the common bile duct with ERCP is the preferred and least risky approach for source control in this critically ill individual.

Question 1509

In major trauma, best support for hypotension?

Answer 1509

Packed red blood cells (through a fluid warmer)

Question 1510

Mx of toxic shock syndrome

Answer 1510

IV clindamycin and vancomycin

Question 1511

What bone affected in otosclerosis?

Answer 1511

Stapes

Question 1512

triad of pain, tingling, and numbness radiating from the buttocks to the calf and foot. Dx? Mx?

Answer 1512

likely diagnosis is sciatica caused by a herniated disc, spondylolisthesis, or spinal stenosis. Diagnosis is confirmed with a positive straight leg raise test. Treatment involves analgesia, physiotherapy referral, and specialist consideration if symptoms persist beyond 6-8 weeks.

Question 1513

Sx of carpal tunnel syndrome following FOOSH?

Answer 1513

Lunate bone dislocation NOTE: Scaphoid most common fracture, lunate most common dislocation

Question 1514

What location of gallstone is an ERCP appropriate?

Answer 1514

CBD

Question 1515

A mnemonic to learn the degrees of burns could be

Answer 1515

"S.P.F" which stands for Superficial (first degree), Partial thickness (second degree), and Full thickness (third degree)

Question 1516

patient with an unimpressive focus of infection (e.g. a small patch of infection) who is in multiorgan failure

Answer 1516

toxic shock syndrome

Question 1517

What should be prescribed adjunt to retinoids in women?

Answer 1517

Contraception

Question 1518

What murmur in proximal aortic dissection

Answer 1518

Aortic regurgitation is heard as an early diastolic murmur, loudest at the right second intercostal space.

Question 1519

primary anticoagulation recommended in acute limb ischaemia

Answer 1519

IV unfractionated heparin

Question 1520

If something is methicillin sensitive, what ABx do u give?

Answer 1520

Fluclox

Question 1521

Normal QT interval

Answer 1521

<420 seconds

Question 1522

What dermatological emergency can psoriasis lead to? MX?

Answer 1522

Erythroderma, urgent treatment as a dermatological emergency - urgent admission to the hospital is necessary. There is a significant risk of infection and dehydration, requiring intravenous fluids and ample use of topical emollients and steroids.

Question 1523

keratin pearls on biopsy

Answer 1523

SCC

Question 1524

1st line Mx for AIH

Answer 1524

Azathioprine and prednisolone

Question 1525

What can large fibroids cause?

Answer 1525

Urinary retention - think if there is suprapubic tenderness

Question 1526

Initial Mx of hypocalcaemia

Answer 1526

Observe, if symptomatic or <1.95 then give calcium gluconate

Question 1527

Gold standard Ix for salivary gland stoens

Answer 1527

Sialography

Question 1528

Bat wing pattern on CXR, history of immunodeficiency

Answer 1528

PCP

Question 1529

first like Ix for suspected hypocalcaemia

Answer 1529

ECG - prolonged QT

Question 1530

Mx of acute cholecystitis

Answer 1530

Analgesia, IV fluids, IV abx, abdo USS

Question 1531

Above what spinal level are metastatic lesions more common for back pain than osteoporosis?

Answer 1531

T4

Question 1532

Mx of diabetic retinopathy with maculopathy

Answer 1532

Anti-VEGF injection

Question 1533

exudates forming a ring around a dot haemorrhage near the fovea

Answer 1533

Diabetic retinopathy with maculopathy

Question 1538

Mx of proliferative diabetic retinopathy

Answer 1538

Panretinal photocoagulation

Question 1538

Suddent onset breathless in CF?

Answer 1538

Pneumothoraces, PE not common

Question 1539

Acutely painful visual loss, proptosis, conjunctival injection and a firm, tender and pulsatile eyeball

Answer 1539

carotid cavernous fistula It results from abnormal communication between the cavernous sinus's carotid artery and the venous system. Management is with endovascular surgery to obliterate the fistula.

Question 1540

multiple petechiae and ecchymoses, IDA whilst on blood thinner. Ix?

Answer 1540

GI endoscopy - look for causes of bleeding

Question 1541

1st line Ix for carotid artery stenosis

Answer 1541

US carotid

Question 1542

Constipation secondary to opiate use? Mx?

Answer 1542

Senna - stimulant

Question 1543

anaemic, with tachycardia and a gallop rhythm

Answer 1543

HF due to anaemia

Question 1544

Ix for giardiasis

Answer 1544

SMall bowel biopsy

Question 1545

Most common composition of gallstones

Answer 1545

Cholesterol

Question 1546

all patients with confirmed PE who are haemodynamically unstable should be started on a continuous infusion of

Answer 1546

unfractionated heparin, and thrombolysis should be considered

Question 1547

Causes of toxic shock syndrome

Answer 1547

Retained tampon, packing in epistaxis

Question 1548

What management in PAD when an ulcer has developed?

Answer 1548

Angioplastyu

Question 1549

Grading of diabetic retinopathy

Answer 1549

Diabetic retinopathy is graded based on the findings on fundus examination: Background – microaneurysms, retinal haemorrhages, hard exudates and cotton wool spots Pre-proliferative – venous beading, multiple blot haemorrhages and intraretinal microvascular abnormality (IMRA) Proliferative – neovascularisation and vitreous haemorrhage Diabetic maculopathy also exists separately and involves: Exudates within the macula Macular oedema NOTE: MACULA MAY BE DESCRIBED AS NEAR THE FOVEA TOM TIP: The main distinction is between non-proliferative (which includes background and pre-proliferative) and proliferative diabetic retinopathy. The key feature of proliferative diabetic retinopathy is the development of new blood vessels (neovascularisation).

Question 1550

Mx of diabetic retinopathy

Answer 1550

Non-proliferative diabetic retinopathy requires close monitoring and careful diabetic control. Treatment options for proliferative diabetic retinopathy are: Pan-retinal photocoagulation (PRP) – extensive laser treatment across the retina to suppress new vessels Anti-VEGF medications by intravitreal injection Surgery (e.g., vitrectomy) may be required in severe disease An intravitreal implant containing dexamethasone is an option for macular oedema. TOM TIP: Look up pictures of a retina treated with pan-retinal photocoagulation so you can spot it in exams.

Question 1551

Abrupt drop in urine output in a catheter is caused by? Opposed to a gradual drop? Mx?

Answer 1551

abrupt - urinary clot, flush Gradual - dehydration and hypovolaemia, fluid bolus

Question 1552

Supracondylar fracture of the humerus most likely to cause damage to which nerve?

Answer 1552

Median

Question 1553

First Ix for retinoblastoma

Answer 1553

US of affected eye

Question 1554

What antibodies are in HDN

Answer 1554

IgG

Question 1555

Men with recurrent bacteriuria, consider what Dx?

Answer 1555

Chronic bacterial prostatitis

Question 1556

first line Ix in someone with delayed puberty

Answer 1556

Skeletal X ray - make sure their bone age is same as chronological age

Question 1557

Isolated gross motor delay in a child with otherwise normal development must raise the question of

Answer 1557

muscular dystrophy

Question 1558

typical signs of a patient with an anastomotic leak

Answer 1558

atrial fibrillation, increasing confusion and signs of sepsis

Question 1559

Mx of portal hypertension

Answer 1559

Propanolol

Question 1560

Long term treatment of choice for oesophogael varices

Answer 1560

Band ligation of large varices

Question 1561

ECG features of right ventricular strain, what may this indicate?

Answer 1561

Pulmonary hypertension

Question 1562

What can sinusitis predispose to?

Answer 1562

Cerebral abscess

Question 1563

aortic dissection, spontaneous pneumothorax and upward lens dislocation

Answer 1563

Marfans

Question 1564

cough that is worse at night. Dx?

Answer 1564

Acute bronchitis

Question 1565

Cavitating lesions. What vasculitis?

Answer 1565

cANCA - Wegners

Question 1566

tender, pea-sized nodule in the upper pole of the testis over 24 hours is characteristic of

Answer 1566

testicular appendage

Question 1567

first line Mx for aspiration pneumonia

Answer 1567

Co-amox

Question 1568

facial nerve palsy and a lump at the angle of the jaw is highly suggestive of

Answer 1568

Parotid gland adenocarcinoma

Question 1569

Best drug for MND

Answer 1569

Riluzole

Question 1570

What vitamin deficiency can tuberculosis medication cause?

Answer 1570

Vit D

Question 1571

revious and recent history of a viral upper respiratory tract infection, in combination with enlarged neck nodes and high temperature, should point to a diagnosis of

Answer 1571

mesenteric adenitis in children presenting with right iliac fossa pain. Appendicitis tends to present with a low grade fever

Question 1572

1st line Ix in someone with amenorrhoea

Answer 1572

Pregnancy test

Question 1573

What must be ruled out before Dx of hyperprolactinaemia?

Answer 1573

Hypothyroidism Chronic renal failure Pregnancy

Question 1574

When is surgical drainage needed in orbital cellulitis? What is medical management otherwise?

Answer 1574

If invading ethmoidal sinus, medical management is cef and mtro

Question 1575

Peripheral, spiculated lung mass

Answer 1575

Adenocarcinoma (also most common lung cancer)

Question 1576

Mx of sliding hiatus hernia

Answer 1576

Initial lifestyle management and PPI Then fundoplication Paraoesophagael surgery done for paraoesophagael hernia

Question 1577

Toxin cause of hypomagnasaemia

Answer 1577

Alcohol

Question 1578

dry cough, low-grade fever, headache, general malaise and interstitial infiltrates on chest X-ray is consistent with

Answer 1578

Mycoplasma

Question 1579

How to differentiate between TEN, staphylococcal scaled skin syndrome

Answer 1579

Stevens–Johnson syndrome (SJS) is characterised by a severe mucocutaneous reaction, typically involving less than 10% of the total body surface area, with significant mucosal involvement. Although this patient has extensive mucosal involvement seen in SJS, the total body surface area affected (greater than 30%) indicates that TEN is a more likely diagnosis. and SJS SSSS usually has minimal to no mucosal involvement

Question 1580

First line Ix for salivary gland stones

Answer 1580

US neck

Question 1581

alpha synuclein

Answer 1581

Parkinson's/Lewy body

Question 1582

Neurofibrillary tangles

Answer 1582

Alzheimers

Question 1583

Spongioform complexes

Answer 1583

CJD

Question 1584

Which dopamine agonist best for prolactinoma

Answer 1584

Cabergoline

Question 1585

Abx options for COPD infective exacerbations

Answer 1585

Amox, clarithro and doxy - give if sputum is colored, or clinical signs of pneumonia

Question 1586

Abx threshold in tonsilitis

Answer 1586

CENTOR score >3 CENTOR: Cough Absent Exudate present Nodes (Cervical) palpable Temperature

Question 1587

Common causes of drug induced lupus? Antibody?

Answer 1587

isoniazid (used for TB), procainamide, hydralazine, minocycline and phenytoin Anti-histone antibody

Question 1588

sensorineural deafness and a desquamating rash in a newborn. Dx? Prevention?

Answer 1588

Congenital syphillis, use ben pen

Question 1589

If appendicitis self resolves, but an appendix mass seen on USS. WHen should appendicectomy be carried out?

Answer 1589

6-8 weeks

Question 1590

Abx for pseudo aeruginosa

Answer 1590

Cipro

Question 1591

Alternative pain medication to IM diclofenac in patients with PUD

Answer 1591

IV paracetamol

Question 1592

SE of doxorubicin

Answer 1592

Dilated cardiomyopathy

Question 1593

SE of cyclophosphomide

Answer 1593

Haemorrhagic cystitis

Question 1594

Pericarditis Sx or signs on ECG with raised creatinine. Mx?

Answer 1594

Haemodialyse, this is an AKI that is leading to uraemia

Question 1595

white patch on the side of his tongue that he is not able to rub off in a patient with HIV. Dx? Mx?

Answer 1595

?oral hairy leukoplakia, reger to secondary care

Question 1596

Mx of ascending cholangitis

Answer 1596

if septic, ERCP for biliary drainage and IV ABx

Question 1597

Risk factors for Idiopathic intracranial HTN. What condition often associated with it?

Answer 1597

Obesity, tetracyclines Acne often associated with it as tetracyclines used for that

Question 1598

What dose of dex in metastatic spinal cord comrpession

Answer 1598

16mg

Question 1599

Indications for acute dialysis include

Answer 1599

refractory hyperkalaemia, fluid overload, toxin ingestion, and uraemia. Suspect in anyone with high creatinine, think AKI being the cause first

Question 1600

Ix for IIH

Answer 1600

CT head, if normal do LP - shows raised opening pressur

Question 1601

What sign means that mastitis requires ABx

Answer 1601

nipple fissure - give fluclox

Question 1602

What UTI medication can cause a fasely low GFR

Answer 1602

Trimethoprim inhibits tubular creatinine secretion, leading to an increase in serum creatinine independent of the true glomerular filtration rate (GFR).

Question 1603

What are antibodies in bullous pemphigoid directed against

Answer 1603

antibodies (IgG and C3) against hemidesmosome proteins in the epithelial basement membrane

Question 1604

euglycaemic metabolic acidosis with high anion gap in a patient with T2DM. Think?

Answer 1604

SGLT-2 causing DKA. Check meds

Question 1605

Medication for steroid induced diabetes

Answer 1605

Sulphonylurea e.g. gliclazide

Question 1606

Management of persistent hyperglycaemia in someone who has just started enteral feeding

Answer 1606

Insulin

Question 1607

Mx of someone on a mab who presents with fever

Answer 1607

Admit for further investigations

Question 1608

Mnemonic to remember KCC for liver transplanatation

Answer 1608

"PHLaSH": P: pH < 7.3 H: Hepatic encephalopathy (Grade III or IV) L: Lactate > 3.5 mmol/L (early) or > 3.0 mmol/L (after resuscitation) S: Serum creatinine > 300 µmol/L H: Prothrombin Time (PT) > 100 seconds

Question 1609

Best Ix to do prior to initiation for acetylcholinesterase inhibitors

Answer 1609

ECG, for QT

Question 1610

What is useful in patients for whom the diagnosis of prosthetic valve endocarditis remains uncertain following echocardiography

Answer 1610

PET CT

Question 1611

Best anticoagulant for cavernous sinus thrombosis

Answer 1611

LMWH

Question 1612

immediate management of ACAG

Answer 1612

Pilocarpine eye drops, carbonic anhidrase inhibitors

Question 1613

When are carbonic anhidrase inhibitors contraindicated

Answer 1613

SCD

Question 1614

Anti epileptic that can cause pancreaitits

Answer 1614

VAlproate

Question 1615

Mx of MRSA infectivite endocarditis

Answer 1615

Vanco and rifamp

Question 1616

erythematous rash, hot to touch and associated scaling. Dx?

Answer 1616

Erythroderma, think background of eczema or psoriasis

Question 1617

Delayed presentation of viral thyroiditis

Answer 1617

Euthyroid

Question 1618

Best initial Ix for cushings

Answer 1618

Overnight dexamethasone suppressiont est

Question 1619

Mastits in a patient that has swapped from breast to bottle feeding over the last few weeks. Dx? Mx?

Answer 1619

Non-lactational mastitis, give co-amox and review in 48 hours

Question 1620

Mx of colicky pain due to peristalsis in malignant obstruction

Answer 1620

Hycosine butylbromide

Question 1621

hyponatraemia and hyperkalaemia in a neonate. Dx?

Answer 1621

CAH, may have a fused labia and urogenital sinus

Question 1622

scaphoid abdomen and a barrel chest.in a neonate. Dx?

Answer 1622

Congenital diaphragmatic hernia

Question 1623

Yawning in a neonate. Potential Dx?

Answer 1623

Opioid withdrawal due to maternal drug use

Question 1624

fever and foul smelling discharge following invasive testing for antenatal conditions

Answer 1624

Chorioamnionites

Question 1625

What is haemotympanum a sign of? Ix?

Answer 1625

Basal sjull fracture, urgent CT head within an hour

Question 1626

In the case of confirmed malignancy, what Ix is advised to check for metastatic spread and help stage disease

Answer 1626

CT CAP

Question 1627

What should be screened for prior to initiation of infliximab?

Answer 1627

TB - can either do CXR to check for ghon focus, or IGRA to test for latnet TB

Question 1628

Mx of overflow diarrhoea due to constipation in an adult

Answer 1628

Phosphate enema

Question 1629

What drugs to avoid in alzheiemrs

Answer 1629

Anticholinergiics - e.g. oxybutynin

Question 1630

Best blood test for rheumatic

Answer 1630

Anti-streptolysin O test

Question 1631

Common SE of nebulised salbutamol

Answer 1631

Tachycardia

Question 1632

What reflex may be absent on someone with a vitreous haemorrahge

Answer 1632

red reflex

Question 1633

Best marker for re-infarction

Answer 1633

CK-MB

Question 1634

Best Ix for infective endocarditis

Answer 1634

TOE

Question 1635

Surgical management of cauda equina syndrome

Answer 1635

Surgical decompression and laminectomy

Question 1636

Mx of non-epileptic seizures

Answer 1636

Refer for psychotherapy

Question 1637

Ix for mesenteric ischaemia

Answer 1637

CT angiography, do lactate too

Question 1638

What medication can be used for aspirin overdose?

Answer 1638

Sodium bicarbonate

Question 1639

Oesophogael candidias. Do what testing?

Answer 1639

HIV

Question 1640

Most important management of acute chest crises

Answer 1640

Pain management

Question 1641

What blood marker may be low in haemolysis?

Answer 1641

Haptoglobin RBC is broken down into LDH and Hb Hb is carried in the blood by haptoglobin Low levels of haptoglobin imply it's saturated by Hb

Question 1642

What Ix before trastuzumab?

Answer 1642

Echo

Question 1643

What can recurrent episodes of otitis media lead to?

Answer 1643

Tympanosclerosis - characterised by chalky white patches on tympanic membrane and conductive hearing loss

Question 1644

Most common cause of intracerebral haemorrhage

Answer 1644

Hypertensive vasculopathy

Question 1645

inguinal lymphadenopathy following painless penile ulcer, think?

Answer 1645

Lymphogranuloma venerum - give doxy

Question 1646

anticoag not working with DOAC, swap to?

Answer 1646

Warfarin

Question 1647

Four day history of sore throat, fever and inability to swallow her own saliva., tender swelling over the lateral aspect of her neck and targetted ultrasound reveals a thrombus in her jugular vein.

Answer 1647

Lemierre syndrome - infective thrombophlebeiutis, can lead to septic emboli and stroke

Question 1648

history of chronic pancreatitis presents with post-prandial vomiting and abdominal pain

Answer 1648

Pseudocyst Pseudocysts can be asymptomatic or present with signs of biliary obstruction (abdominal pain, jaundice) or gastric outlet obstruction (post-prandial vomiting) due to mass effect of an enlarging pseudocyst on adjacent structures If become infected, can become an abscess and cause fevers etc

Question 1649

If IgA deficient, test for coeliac?

Answer 1649

IgG TTG, then duodenal biopsy

Question 1650

Medical management of acute limb ischaemia is with

Answer 1650

High flow o2 and unfractionated heparin infusion

Question 1651

Mx of acute breathlessness post thyroidectomy

Answer 1651

urgent return to theatre to open the stitches and evacuate the haematoma Neck haematoma is a life-threatening complication of thyroid surgery and can present with signs of airway obstruction (e.g. stridor, respiratory distress), dysphagia, hoarseness and a painful neck mass.

Question 1652

Significant AKI with Hx of intraabdominal malignancy, what ix?

Answer 1652

US renal tract

Question 1653

How to differ between medical and surgical third nerve palsys?

Answer 1653

Medical third nerve palsies spare the pupil, just causibng ptosis and double vision. An example would be diabetes causing vasculopathic iscahemia to the optic nerve

Question 1654

Thyroid eye disease with visual disturbance. Mx?

Answer 1654

Surgical decompression of the optic nerve

Question 1655

Ix for leprosy? Mx? AKA?

Answer 1655

Skin swab, rifampicin (monthly) and dapsone (daily), AKA hansen's disease

Question 1656

Fluid management for insulinoma

Answer 1656

Dextrose and potassium supplement

Question 1657

Metabolic acidosis ina patient with CKD

Answer 1657

Could be progression to end stage CKD, causes low bicarboante and increased resp rate and hypocarbia to compensate partially

Question 1658

Worsening renal function with dark brown urine should raise suspicion of

Answer 1658

ATN

Question 1659

Peripheral nuropeathies in different locations across the body randomly with background of ischaemia, inflammatory or infection. Dx? Mx?

Answer 1659

Mononeuritis multiplex. Check for cause

Question 1660

Low grade Barrets Mx? High grade Mx?

Answer 1660

Low grade - high dose PPi and surveillance High grande - endomucosal resection

Question 1661

Most important spirometry measure for restrictive conditions e.g. GBS and MG

Answer 1661

FVC

Question 1662

Little to no improvement when started on co-benyldopa in PD. Think?

Answer 1662

Parkinson plus syndrome - do lying and standing BP for MSA, do vertical gaze test for PSP

Question 1663

What should be given after dexamethasone in metastatic spinal cord compression?

Answer 1663

Radiotherapy given within 24 hours to prevenet premanent neurological damage

Question 1664

What CN's are within the cavernous sinus?

Answer 1664

3,4,5,6

Question 1665

Cranial nerves and brainstem

Answer 1665

Midbrain - 3,4 Pons - 5,6,7,8 Medulla - 9-12

Question 1666

history of reduced sensation to the left side of her face, double vision and is struggling with pain in her left eye. Extensive left sided periorbital oedema and proptosis. Dx?

Answer 1666

Caervnous sinus syndrome, likely due to a thrombus secodnary to cavernous sinus infection

Question 1667

Best first Ix for ?diabetes insipidus

Answer 1667

Serum and urine osmolality

Question 1668

no clinical features suggestive or urge or stress incontinence, recent Hx of radiotherapy to the pelvis. Constant urinary leakage. Dx?

Answer 1668

Vesicovaginal fistula

Question 1669

Best marker of prognostic function of liver damage

Answer 1669

PT or INR, APTT usually spared

Question 1670

Dorsal column

Answer 1670

Fine touch, vibration and proprioception

Question 1671

Spinothalamic

Answer 1671

Pain and temperature

Question 1672

What to give in UTI if trimethoprim or nitrofurantoin contraindicated?

Answer 1672

Pivmecillinam

Question 1673

Diagnostic test for strep pneumoniae

Answer 1673

urinary antigen

Question 1674

1st line treatment for allergic conjunctivitis

Answer 1674

topical mast cell stabilizer (sodium cromoglycate) and topical antihistamine (antazoline).

Question 1675

Best malaria prophtylaxis

Answer 1675

atovaquone-proguanil

Question 1676

What HTN cut off is required before giving BP control instead of aleteplase?

Answer 1676

185/110

Question 1677

1st line Mx for otitis externa

Answer 1677

Topical cirpo and hydrocortisone

Question 1678

100 mg of oral morphine per 24 hours is approximately equivalent to WHAT dose of transdermal fentanyl

Answer 1678

25 μg/hour of transdermal fentanyl

Question 1679

What tests required for brain death diagnosis

Answer 1679

Clinical neuro examination and apnoea test

Question 1680

Gene affected in FAP

Answer 1680

APC

Question 1681

Gene affected in lynch syndrome

Answer 1681

MLH2

Question 1682

Gene affected in Li-fraumeni

Answer 1682

TP53

Question 1683

1st line test for Tb Gold standard

Answer 1683

1st line - sputum acid fast b acilli smear Gold standard - sputum culture

Question 1684

Symptomatic Mx of large fibroids

Answer 1684

First line - transexamic acid/mefenamic acid Then GnRH

Question 1685

Alternative to HRT for patients with vasomotor Sx

Answer 1685

Clonidine or SSRI

Question 1686

1st line Mx for uncomplicated malaria

Answer 1686

ACT - artemisin combination therapy

Question 1687

Features of mild NPDR

Answer 1687

Microaneurysms onlyF

Question 1688

Features of moderate NPDR

Answer 1688

microaneurysms, intraretinal haemorrhages and hard exudates.

Question 1689

Features of severe NPDR

Answer 1689

microaneurysms, intraretinal haemorrhages, hard exudates and the ‘4–2–1 rule’: severe intraretinal haemorrhages in four quadrants, venous beading in at least two quadrants and intraretinal microvascular abnormalities (IRMAs) in at least one quadrant.

Question 1690

Features of proliferative diabetic retinopathy

Answer 1690

neovscularisation - panretinal photocoagulation

Question 1691

Diffuse bilateral interstitial infiltrates following immunosuppression. Think?

Answer 1691

PCP

Question 1692

What anatomical feature increaes risk of primary acute angle closure gaucom

Answer 1692

Narrow anterior chamber angle

Question 1693

etinal whitening in a sector of the retina, scattered flame-shaped haemorrhages and venous dilatation and tortuosity in the affected area are consistent with

Answer 1693

Branch retinal vein occlusion

Question 1694

painless, firm plaque on the dorsal side of the penis and penile curvature during erections are characteristic of

Answer 1694

Peyronie's disease

Question 1695

new neurological deficits and increased intracranial pressure in post operative period for neurosurgery

Answer 1695

Think cerebral oedeam

Question 1696

Best short term feeding approach if patient struggling with dysphagia

Answer 1696

NG tube feedin

Question 1697

initial management for this patient with complex maxillofacial fractures involving the maxilla and zygomatic bones

Answer 1697

Open reduction and initial fixation

Question 1698

Initial Mx for ASD

Answer 1698

applied behaviour analysis therapty

Question 1699

Best graft for cosmetic results

Answer 1699

Full thickeness skin graft

Question 1700

Mx of arteriovenous malformation

Answer 1700

Emobolisation of the malformation, eliminationg the abnormal connection between artery and vein

Question 1701

Ideal medication for a depressed patient who wants to stop smoking

Answer 1701

Buproprion, it is an atypical antidepressant

Question 1702

Gold standard for bariatric surgery

Answer 1702

Roux en Y gastric bypass

Question 1703

Mx of obesity

Answer 1703

>35 BMI with no co-morbidities and motivation to lose wight - orlistat and dietary/exercise advice >35 with comorbiditis or >40 - gastric bypass

Question 1704

Urinary Sx with PMHx of STIs

Answer 1704

Urethral stricture

Question 1705

Who should be referred for consideration of an Aortic valve replacement

Answer 1705

Aortic stenosis with LVEF or <55

Question 1706

dry cough, increasing shortness of breath on exertion, hypoxia, finger clubbing and bibasal crepitations. Hx of smoking. Dx?

Answer 1706

IPF

Question 1707

lower back pain, pain in the left leg, and tingling in the left big toe. What dermatome? What sign also seen,

Answer 1707

L5 dermatome, foot drop also seen

Question 1708

most likely causative organism for diarrhoea in an HIV positive patient with protozoa seen on microscopy

Answer 1708

Cryptosporidium Parvum

Question 1709

Damage to the hypoglossal nerve on one side will cause the tongue to deviate towards which side?

Answer 1709

Towards the lesion, e.g. if tongue deciates to right, right hypoglossal affected

Question 1710

zig-zagging and flashing lights, headache, nausea, and vomiting are typical features of

Answer 1710

Migraine with aura

Question 1711

Mx of severe, acute urticaria

Answer 1711

Oral Corticosteroids e.g prednisolone, NOT TOPICAL

Question 1712

Signs of optic neuritis with no optic disc swelling on fundoscopy. Cause?

Answer 1712

Retrobulbar cause

Question 1713

Initial Mx of nephrotic syndrome

Answer 1713

Loop diuretic, then consider pred

Question 1714

Mx of postpartum thyroiditis

Answer 1714

Thyroid phase - propanolol Hypothyroid phase - levo

Question 1715

Anti diabetic drug that needs stopping before CT scan with contrast

Answer 1715

Mettformin, nephrotoxic

Question 1716

Inital Mx of post operative low urine output, tachycardia and hypotension

Answer 1716

Fluid challenge - likely due to hypovolaemia

Question 1717

presence of bilateral pleural effusions and upper lobe blood vessel diversion on chest X-ray suggests WHAT is causing breathlessness

Answer 1717

Cardiac cause

Question 1718

sudden onset of visual loss, the presence of an afferent pupillary defect, and red spot (the cherry red spot) on fundoscopy are all consistent with

Answer 1718

Central retinal artery occlusion

Question 1719

symptoms of a painful red eye without discharge and a diffuse area of redness on the sclera are suggestive of ? Mx

Answer 1719

Scleritis, urgent assessment by opthalmologist

Question 1720

When to use amitriptyline over duloxetine for neuropathic pain

Answer 1720

Renal impairment (<30)

Question 1721

e symptoms of tiredness, bloating and weight loss along with flattened villi and increased lymphocytes in the lamina propria and surface epithelium on duodenal biopsy suggest

Answer 1721

Coeliac

Question 1722

copious sputum production, and the history of childhood pneumonia and recurrent chest infections. Dx>

Answer 1722

Bronchiectasis due to CF

Question 1723

What Sx can bronchiectasis cause in an exacerbation

Answer 1723

Haemoptysis

Question 1724

severe left-sided abdominal pain, blood mixed in with her stools, and tenderness on palpation in the left lower quadrant, the most likely cause of her symptoms is?

Answer 1724

Diverticulitis

Question 1725

broad complex ectopic beats suggest what as the origin?

Answer 1725

Ventricular ectopics

Question 1726

Long history yet small size of the lesion, together with the description of a raised, pale border. Most likely Dx?

Answer 1726

BCC

Question 1727

What indicates the need to start Abx in a patient with a long term catheter?

Answer 1727

Systematic unwellness e.g. fever and mild confusion - suggestive of UTi

Question 1728

bilateral renal masses, reduced renal function and haematuria.

Answer 1728

PCKD. Do an US

Question 1729

Worrying feature of a migraine

Answer 1729

Abrupt onset

Question 1730

elevated blood pressure, radiofemoral delay, and chest X-ray findings of notching of the ribs in the midclavicular line are suggestive of

Answer 1730

Aortic coarctation

Question 1731

e history of sinusitis, oral ulceration and haemoptysis and the bilateral pulmonary nodules on chest X-ray

Answer 1731

Granulomatosis with polyangiitis

Question 1732

sore throat, malaise, intermittent fever, swollen tonsils, yellow-tinged sclerae, and tender lymph nodes

Answer 1732

Infectious mononucleosis

Question 1733

How to reduce risk of oral candidiasis with beclometasone

Answer 1733

Use a large volume spacer

Question 1734

Mx of empyema

Answer 1734

Chest drain insertion

Question 1735

Gold standard treatment for OSA

Answer 1735

CPAP

Question 1736

Histological examination of testicular mass shows areas of mature cartilage and columnar epithelium.

Answer 1736

Teratoma

Question 1737

low testosterone and low LH and FSH levels, the most likely cause of hypogonadotrophic hypogonadism

Answer 1737

Pituitary adenoma

Question 1738

Acute HF after recent MI, likely due to?

Answer 1738

Papillary muscle rupture

Question 1739

upper temporal defect in both visual fields.

Answer 1739

Optic chiasm compression from an inferior approach

Question 1740

Most common cause of non-bullous impetigo

Answer 1740

Staph auresu

Question 1741

presence of a rash with folliculitis on the chest. What immunosuppressive disease can cause this?

Answer 1741

HIV serovoncersion - late stage

Question 1742

Gram-positive cocci arranged in pairs

Answer 1742

Strep pneumoniae

Question 1743

What part of memory is affected most in alzheimers'

Answer 1743

Short term

Question 1744

Mx of neuropathic bladder due to multiple sclerosis

Answer 1744

Intermittent self catheterisation

Question 1745

What feature of C diff makes it hard to destroyq

Answer 1745

Spore formation

Question 1746

multiple tender ulcers on the preputial skin following recent sexual intercourse is suggestive of

Answer 1746

HSV infection

Question 1747

crampy abdominal pain, poor appetite, sore throat, fever, cervical lymphadenopathy, and tenderness in the right iliac fossa, suggest

Answer 1747

Mesenteric adenitis

Question 1748

exaggerated lumbar lordosis and the palpable depression above L5 can be clinical findings of

Answer 1748

Spondylololisthesis, where one vertebra slips out of line with the one above it. Usually occurs in lumbar spine. Neurological examination usually noraml

Question 1749

h large for gestation uterus and severe early onset pre-eclampsia

Answer 1749

Molar pregnancy

Question 1750

Most likely route of spread of lung cancer

Answer 1750

Haematogenosu

Question 1751

facial swelling, fullness, and prominent chest veins are consistent with s

Answer 1751

SVCO

Question 1752

lymphocytosis with normal Hb, neutrophil count and near normal platelet count and the film appearances (small mature lymphocytes and smear cells are common) are also consistent with what

Answer 1752

CLL

Question 1753

Persistent painless lymphadenopathy. Think?

Answer 1753

CLL or Non-hodgkin's. Non-hodgkin's will not have a significant lymphocytosis

Question 1754

1st line treatment for children and adolescents with anorexia

Answer 1754

Family therapy

Question 1755

Standard treatment for hepatic encephalopathy. How does it work

Answer 1755

Latulose, works by reducing the ammount of ammonia in the blood

Question 1756

Best method of IOL if bishop's score low?

Answer 1756

vaginal prostaglandin gel

Question 1757

What can be used for slowly progressing labour

Answer 1757

Membrane sweep, NOT USED FOR INDUCTION

Question 1758

history of chronic sinusitis and unresolving headaches. When he bends forward, purulent fluid pours from his nose. Dx? What anatomical structure is most likely the source of this fluid?

Answer 1758

Chronic maxillary sinusitis, maxillary sinus most commonly involved

Question 1759

symptoms of pain worsened by movement and difficulty sleeping, along with a normal X-ray and pain on shoulder abduction between 80° and 120° are consistent with

Answer 1759

Subacromial bursitis

Question 1760

What virus is associated with squamous cell carcinoma of the oropharynx, which includes the tonsils (typically palatine tonsils and lingual tonsils)

Answer 1760

HPV

Question 1761

What can be used to reduce breathlessness in end stage heart failure with metastases?

Answer 1761

Morphine

Question 1762

1st line Mx of hodgkin's

Answer 1762

Chemo

Question 1763

Most appropriate strategy to prevent colon cancer in someone with GAP

Answer 1763

Panproctocolectomy

Question 1764

fear of public speaking, avoidance behaviour, and recognition that his fears are irrational are consistent with a diagnosis of

Answer 1764

Social phobia

Question 1765

weak grip, cough and shallow breathing following laryngoscopy and vocal chord biopsy which was carried out under general anaesthetic. What does this suggest? Reversal agent?

Answer 1765

suggest residual effects of neuromuscular blockade, use neostigmine to reverse

Question 1766

What procedure can provide palliation of dysphagia in patients with oesophagael cancer?

Answer 1766

Placement of an oesophagael stent Particularly useful in those with advanced or metastatic disease who aren't candidates for curative treatment

Question 1767

back pain, fatigue, normocytic anaemia, thrombocytopenia and renal failure. Dx?

Answer 1767

Myeloma

Question 1768

What can be given in septic shock to maintain blood pressure

Answer 1768

Noradrenaline/epinephrine infusion, increases SVR and maintains blood pressure

Question 1769

duct-like structures lined by regular, low columnar cells separated by loose fibrous tissue, with well-defined margins is consistent with what breast lump

Answer 1769

FIbroadenoma

Question 1770

Pulling the pinna, or pressure on the tragus often exacerbates the pain of what condition

Answer 1770

Otitis externA

Question 1771

Only reccomended treatment for asystole

Answer 1771

Adrenaline/epinephrine

Question 1772

Best airway device to protect lungs from regurgitated stomach contents

Answer 1772

Tracheal tube

Question 1773

Most common pathogen in leg cellulitis

Answer 1773

Strep pyogenes

Question 1774

Breast condition that characteristically causes pain associated with the menstrual cycle

Answer 1774

Fibrocystic disease

Question 1775

Test for what if recurrent candidiasis

Answer 1775

Diabetes

Question 1776

In chronic lithium use, what test shouold be done prior to water deprivation if complaints of polyuria/polydipsia

Answer 1776

Serum calcium, rule out hypercalcaemia as a cause due to hyperparathyroidism

Question 1777

What can be given prior to a contrast scan in a patient with existing CKD?

Answer 1777

IV saline

Question 1778

Best Ix for cervical spine fracture

Answer 1778

CT scan of the neck

Question 1779

Benign arrhtyhmia seen in women aged 20-30 years, asx with s feeling as if the heart stops for a second followed by a pounding sensation

Answer 1779

Supraventricular premature beats

Question 1780

Most common cause of prosthetic joint infections

Answer 1780

Staph aureus

Question 1781

Mx of paralytic ileus post op

Answer 1781

Drip and suck - NG tube and IV fluids

Question 1782

Proctitis and lymphadenopathy in MSM

Answer 1782

Lymphogranuloma vnereum

Question 1783

increased ratio of LH:FSH along with oligomenorrhoea and BMI in the overweight range indicates

Answer 1783

PCOS

Question 1784

Best treatment option for metastatic spinal cord compression to preserve neurological function

Answer 1784

External beam radiotherapy

Question 1785

Difference between inflammatory and mechanical back pain

Answer 1785

Inflammatory back pain (IBP) is typically improved with activity and not relieved by rest, as opposed to mechanical pain which is worse with activity and is relieved by rest.

Question 1786

Septic shock, still hypotensive with IV fluids, give?

Answer 1786

Vasopressors - adrenaline

Question 1787

pain on abduction of the right shoulder that is worse with the arm in internal rotation and when abduction is resisted. Dx?

Answer 1787

Supraspinatus tendiopathy, can be diagnosed clincially - NSAIDs and physio is Mx

Question 1788

Terminal restlessness should be managed with

Answer 1788

Midazolam

Question 1789

Drug causes of IPF

Answer 1789

Nitrio, Bleomycin, Methotrexate, amiodarone

Question 1790

What arrythmia can safely be excluded if patient is conscious?

Answer 1790

VF

Question 1791

Post ictal weakness following a focal seizure

Answer 1791

Todd's paresis, seen in focal frontal lobe seizures

Question 1792

Painful shin rash + cough

Answer 1792

?sarcoid

Question 1793

Mx of TEN

Answer 1793

Supportive, move to ICU

Question 1794

Mxx of hyperthyroidism in pregnancy

Answer 1794

1st trimester: Propyl 2nd trimester: Carbimazole