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Finals - Things to Go Over > Finals - Medicine + Surgery > Flashcards

Finals - Medicine + Surgery Flashcards

1
Q

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

A

oral steroids or IM steroids such as methylpred or tramcinolone

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2
Q

What is the initial management of RA?

A

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

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3
Q

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

A

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

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4
Q

Electrolyte abnormalities seen with thiazide like diuretics

A

hypercalcaemia, as well as hyponatraemia, hypokalaemia and hypomagnesaemia.

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5
Q

1st line treatment for trigeminal neuralgia

A

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.

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6
Q

What monitoring is required in HSP? Why?

A

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

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7
Q

What is HSP a type of?

A

IgA vasculitis

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8
Q

Preceding influenza predisposes to what type of pneumonia

A

Staph Aureus

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9
Q

1st line treatment for chronic plaque psoriasis

A

Topical potent corticosteroid + vitamin D analogue

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

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10
Q

1st line treatment for scalp psoriasis

A

topical potent corticosteroids

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11
Q

Postpartum contraception

A

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.

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12
Q

How long after pregnancy can a woman get pregnant?

A

21 days

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13
Q

Benzo OD medication

A

Flumazenil - GABA antagonist

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14
Q

Difference between histamine drugs

A

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

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15
Q

1st line treatment for allergic bronchopulmonary aspergillosis

A

Pred

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16
Q

Definitive management of vestibular neuronitis

A

Vestibular rehabilitation

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17
Q

Is hearing affected in vestibular neuronitis?

A

No

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18
Q

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

A

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

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19
Q

Acute management of vestibular neuritis

A

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

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20
Q

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

A

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.

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21
Q

Formula for alcohol units

A

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

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22
Q

When should a beta blocker be stopped in acute HF?

A

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

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23
Q

Treatment for acute pulmonary oedema

A

IV loop diuretic e.g. furosemide

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24
Q

Acute HF not responding to treatment…

A

CPAP

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25
Q

When may nitrates be useful in patients with acute HF?

A

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

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26
Q

When does infantile colic typically resovle by?

A

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

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27
Q

Treatment for vaginal vault prolapse

A

sacrocolpoplexy

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28
Q

Treatment for cystocele

A

anterior colporrhaphyu

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29
Q

Treatment for rectocele

A

Posterior colporrhaphy

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30
Q

Investigations for acromegaly

A

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

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31
Q

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

A

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)

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32
Q

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

A

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

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33
Q

What does an anterior cerebral artery stroke cause?

A

leg weakness but not face weakness or speech impairment

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34
Q

What does a posterior cerebral artery stroke cause?

A

Contralateral homonymous hemianopia with macular sparing and visual agnosia

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35
Q

What does an MCA stroke cause>

A

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

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36
Q

What does a basilar artery stroke cause?

A

Locked in syndrome

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37
Q

What is weber’s syndrome?

A

form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

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38
Q

What does an anterior inferior cerebellar artery stroke cause?

A

Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness

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39
Q

What does a pontine haemorrhage present with?

A

reduced GCS, paralysis and bilateral pin point pupils

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40
Q

most common cause of amaurosis fugax

A

Atherosclerosis of the internal carotid

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41
Q

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

A

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

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42
Q

how to differentiate between PICA and AICA stroke

A

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

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43
Q

Risk of phototherapy as a treatment for psoriasis

A

SCC

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44
Q

Power equation

A

Power = 1 - the probability of a type II error

Can be increased by increasing the sample size

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45
Q

What tests are used to assess statistical correlation?

A

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

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46
Q

Types of parametric tests

A

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

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47
Q

Types of non-parametric tests

A

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

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48
Q

How are accoustic neuromas best visualsied?

A

MRI of the cerebellopontine angle

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49
Q

Gold standard for diagnosing contact dermatitis

A

Skin patch testG

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50
Q

Gold standard for diagnosing immediate hypersensitivity reactions

A

Skin prick testing

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51
Q

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

A

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

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52
Q

What is mondor’s disease of the breast?

A

localised thrombophlebitis of a breast vein.

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53
Q

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

A

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

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54
Q

Types of mastitis

A

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

Lactational - common postpartum and treated with fluclox

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55
Q

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

A

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).

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56
Q

Preferred stent type for primary PCI

A

Drug eluting stents

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57
Q

What type of arterial access preferred for primary PCI?

A

Radial

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58
Q

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

A

Fibrinolysis

Need to give an antithrombin - fondaparinux

Ticagrelor is given following procedure

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59
Q

What ABG findings present with cushing’s syndrome

A

hypokalaemic metabolic alkalosis

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60
Q

loss of left heart border on CXR

A

left lingula consolidation

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61
Q

What can LMWH cause on electrolytes? Why?

A

Hyperkalaemia

Can suppress aldosterone

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62
Q

Triad for cardiac tamponade

A

muffled heart sounds, paradoxical pulse and jugular vein distension.

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63
Q

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

A

High dose oral corticosteroids

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64
Q

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

A

Chronic infection

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65
Q

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

A

If ASx with visible or non-visible haematuria

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66
Q

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

A

antimuscarinic drugs - tolterodine

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67
Q

What can beta blockers exacerbate?

A

plaque psoriasis

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68
Q

What type of antihypertensive is asx with tiredness?

A

Beta blocker

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69
Q

Migraine management

A

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

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70
Q

Transfusion threshold for patients with ACS

A

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

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71
Q

What type of renal mass is seen in tuberous sclerosis?

A

angiomyolipoma - typically seen bilaterally - it is benign

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72
Q

What is seen in acute interstital nephritis?

A

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

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73
Q

What is sampling bias?

A

When subjects are not representative of the population

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74
Q

What is drusen pathognomonic for?

A

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

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75
Q

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

A

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

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76
Q

What is wet macular degeneration characterised by?

A

Choroidal neovascularisation

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77
Q

What is a risk factor for macular degeneration

A

Smoking

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78
Q

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

A

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

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79
Q

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

A

wet age-related macular degeneration

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80
Q

Definitive treatment of wet AMD

A

anti-VEGF (Bevacizumab)

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81
Q

Medical treatment of dry AMD

A

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

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82
Q

What should patients with long saphenous vein superficial thrombophlebitis have?

A

an US scan to exclude DVT

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83
Q

Recommended management for supergicial thrombophlebitis

A

Compression stockings

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84
Q

1st line treatment for acute gout

A

NSAIDS

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

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85
Q

Should allopurinol be continued during an acute attack of gout?

A

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

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86
Q

What should be prescribing adjunct to allopurinol initiation?

A

NSAID or colchicine ‘cover’

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87
Q

Who should allopurinol be offered to?

A

All patients after their first attack of gout

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88
Q

Mackler triad for boerhaave syndromw

A

vomiting, thoracic pain, subcutaneous emphysema.

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89
Q

Inferior MI and AR murmur should raise suspicion of?

A

ascending (proximal) aorta dissection

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90
Q

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

A

Mycoplasma

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91
Q

Is weight bearing reccomended following hip fracture?

A

Yes, immediately

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92
Q

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

A

Shortened and externally rotated

Dislocation is internally rotated

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93
Q

General rule for management of intracapasular fractures

A

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

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94
Q

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

A

within 72 hoyurs of admission

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95
Q

fundoscopy findings of anterior ischaemic optic neuropathy

A

swollen pale disc and blurred margins

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96
Q

What is polymyalgia rheumatica associated with?

A

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

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97
Q

What can local anaethetic toxicity be treated with?

A

IV 20% lipid emulsion

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98
Q

Formula for number needed to treat

A

NNT = 1 / Absolute Risk Reduction

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99
Q

how can loop diuretics affect hearing?

A

May cause ototoxicity

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100
Q

When should FIT testing be offered?

A

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

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101
Q

What can occur following an inferior MI?

A

AV block

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102
Q

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

A

lichen sclerosis

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103
Q

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

A

Urgent referral to neurology

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104
Q

How may bell’s palsy affect the tongue?

A

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

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105
Q

When should referral to ENT be made in bells palsy?

A

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

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106
Q

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

A

Thrombectomy

Can be done between 6-24 hourss

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107
Q

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

A

Treatment of hypertension (>185/110)

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108
Q

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

A

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

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109
Q

What to do if large artery acute ischaemic stroke?

A

Consider mechanical clot retrieval

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110
Q

Globus, hoarseness and no red flags

A

?laryngopharyngeal reflux

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111
Q

first line radiological investigation for suspected stroke

A

Non-contrast CT head scan

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112
Q

Cushing’s triad for raised ICP

A

hypertension, bradycardia, and irregular breathing

113
Q

What movement is classically impaired in adhesive capsulitis

A

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

114
Q

Definitive diagnostic investigation for small bowel obstruction

A

CT abdomen

115
Q

1st line investigation for small bowel obstruction

A

abdominal X-ray

116
Q

Management of small bowel obstruction

A

initial steps:
NBM
IV fluids
nasogastric tube with free drainage

117
Q

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

A

by the dermatomal distribution and an associated neurological deficit

118
Q

What’s seen on polarised light microscopy in pseudogout?

A

weakly positively birefringent rhomboid-shaped crystals

119
Q

How to distinguish pseudogout from gout?

A

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

120
Q

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

A

Chlamydia

121
Q

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

A

enteric organisms (e.g. E. coli)

122
Q

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

A

Subacute combined degeneration of the spinal cord

123
Q

Whipple’s triad of insulinoma

A

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.

124
Q

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

A

either oral azathioprine or oral mercaptopurine to maintain remission

125
Q

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

A

oral aminosalicylates should be added - both topical and oral mesalazine

126
Q

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

A

IV ciclosporin or surgery

127
Q

Ethylene glycol toxicity management

A

fomepizole

128
Q

Ethanol toxicity management

A

Haemodialysis

129
Q

Ongoing loin pain, haematuria, pyrexia of unknown origin?

A

?Renal cell carcinoma

130
Q

Metabolic alkalosis + hypokalaemia ?

A

?prolonged vomiting

131
Q

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

A

Urea breath tes

132
Q

Klumpke’s paralysis

A

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

133
Q

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

A

Erb’s palsy - Brachial trunks C5-6

134
Q

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

A

a proximal leg vein ultrasound scan if DVT is suspected

135
Q

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

A

Toxic epidermal necrolysis

136
Q

Peptic ulceration, galactorrhoea, hypercalcaemia?

A

MEN type 1

137
Q

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

A

Hydrazine and nitrate

138
Q

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

A

a beta blocker and an ACE inhibitor

139
Q

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

A

One drug at a time

140
Q

Can prostate cancer be seen with a normal PSA?

A

Yes

141
Q

key investigation in diagnosing early CKD

A

urinary albumin:creatinine ratio (ACR)

142
Q

When should you stop a statin?

A

When patient is on a macrolide - erythro/clarithromycin

143
Q

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

A

Irradiation of blood products

144
Q

What is oesophagael adenocarcinoma associated with?

A

GORD or Barrett’s

145
Q

How does synringomyelia present?

A

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

146
Q

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

A

collection of cerebrospinal fluid within the spinal cord.

Causes include:
a Chiari malformation: strong association

147
Q

areflexia, ataxia, ophthalmoplegia

A

Miller Fisher syndrome (subtype of GBS)

148
Q

Exudative causes of pleural effusion

A

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

149
Q

Transudative causes of pleural effusion

A

heart failure (most common transudate cause)

hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption

hypothyroidism

Meigs’ syndrome

150
Q

Sudden deterioration with ventilation suggests?

A

Tension pneumothorax

151
Q

Bleeding on dabigatran? What to reverse?

A

Idarucizumab

152
Q

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

A

urgent referral to ENT and CXR to exclude apical lung lesion

153
Q

Damage to which CN causes a RAPD

A

optic nerve - CN II

154
Q

Useful for managing tremor in drug-induced parkinsonism

A

Procyclidine

155
Q

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

A

Cabergoline

156
Q

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

A

Levodopa

157
Q

tumour marker in breast cancer

A

CA15-3

158
Q

mixed aortic valve disease, what examination finding?

A

Bisferiens pulse

159
Q

Massive PE + hypotension, do what?

A

Thrombolyse with alteplase

160
Q

holosystolic murmur, high-pitched and ‘blowing’ in character

A

mitral regurg

161
Q

Horner’s syndrome features

A

miosis, ptosis, enophthalmos and anhidrosis

162
Q

How to differ between horner’s and third nerve palsy

A

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

163
Q

What determines site of lesion in horner’s syndrome?

A

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

164
Q

Arterial/venous thrombosis, miscarriage, livedo reticularis

A

anticardiolipin antibody +ve

165
Q

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

A

Splenectomy

166
Q

Indications for splenectomy

A

Uncontrollable splenic bleeding
Hilar vascular injuries
Devascularised spleen

167
Q

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

A

?adenomyosis

168
Q

J waves on ECG

A

Hypothermia

169
Q

what is given before endoscopy in patients with suspected variceal haemorrhage

A

Both terlipressin and antibiotics

170
Q

What is used if uncontrolled variceal haemorrhage

A

Sengstaken-Blakemore tube

171
Q

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

A

Transjugular Intrahepatic Portosystemic Shunt (TIPSS) - connects the hepatic vein to the portal vein

exacerbation of hepatic encephalopathy is a common complication

172
Q

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

A

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

173
Q

What is contraindicated in V tach?

A

Verapamil

174
Q

What lung pathology can methotrexate cause?

A

pneumonitis - typically presents with cough, dyspnoea and fever

175
Q

What are the most common triggers of autonomic dysreflexia

A

Faecal impaction / urinary retention

176
Q

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?

A

Autonomic dysreflexia

177
Q

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

A

Dressler syndrome

178
Q

widespread systolic murmur, hypotension, pulmonary oedema following MI

A

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

179
Q

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

A

left ventricular aneurysm

180
Q

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

A

? Legionella

181
Q

Chest drain swinging

A

Rises in inspiration, falls in expiration

182
Q

Mx of minimal change disease

A

prednisolone

183
Q

How to differ between syncopal episodes and seizures?

A

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

184
Q

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

A

Renal function

185
Q

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

A

infection with Clostridium botulinum

186
Q

When can you diagnose stage 1/2 CKD?

A

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

187
Q

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

A

Desmopression

188
Q

Electrolyte abnormality in T1DM

A

Metabolic acidosis with increased anion gap

189
Q

most common site of metatarsal stress fractures is?

A

2nd metatarsal shaft

190
Q

When may nerve blocks be considered in a rib fracture?

A

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

191
Q

Stages of shock

A

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.

192
Q

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

A

Multiple system atrophy

193
Q

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

A

yolk sac tumour - AFP
Teratoma - HCG
Seminoma - normal

194
Q

What is hyperacute transplant rejection caused by?

A

pre-existing antibodies against ABO or HLA antigens

Usually occurs within 24-48 hours post-transplant

195
Q

Severe life-threatening complication of C.Diff

A

Pseudomembranous colitis

196
Q

Rosacea features

A

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

197
Q

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

A

Hydrocele

198
Q

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

A

eGFR < 30

199
Q

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?

A

US abdo

200
Q

Phaeo triad

A

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

201
Q

Vision worse going down stairs? Think what

A

4th nerve palsy

202
Q

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

A

4th nerve

203
Q

triad for hepatorenal syndrome. Mx?

A

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

204
Q

What murmur seen in anaemia? How does it present?

A

Aortic flow murmur, soft ESM which doesn’t radiate

205
Q

IgA nephropathy classically presents as?

A

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

206
Q

Infant with bilious vomiting & obstruction?

A

?Intestinal malrotation

207
Q

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

A

Complete heart block

Treated with transvenous pacing if ASx with brady

208
Q

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

A

Anterior packing

209
Q

Measles is characterised by

A

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

210
Q

long-term prophylaxis of cluster headaches?

A

Verapamil

211
Q

Cluster headache - acute treatment

A

subcutaneous sumatriptan + 100% O2

212
Q

Symptom control in non-CF bronchiectasis

A

inspiratory muscle training + postural drainage

213
Q

Bronchiectasis: most common organism

A

Haemophilus influenzae

214
Q

Pneumonia in an alcoholic

A

Klebsiella

215
Q

In those diagnosed with anal fistula, best Ix?

A

MRI is the best investigation to characterise the fistula course

216
Q

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

A

Bromonidine gel

217
Q

What can SAH cause on ECG?

A

Torsades de pointes

218
Q

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

A

IV calcium gluconate
insulin/dextrose infusion

219
Q

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

A

otitis externa

220
Q

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

A

Ganglion cyst

221
Q

most common cause of osteomyelitis?

A

staph aureus

222
Q

Cause of raised serum NP besides HF

A

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

223
Q

first-line medication for primary biliary cholangitis

A

Ursodeoxycholic acid

224
Q

common features of meniscal lesions

A

Knee locking and giving-way

225
Q

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

A

acanthamoebic keratitis

226
Q

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

A

IV amiodarone

227
Q

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

A

white cell count

228
Q

Patients with orbital cellulitis require?

A

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

229
Q

DIlated pupil, females, absent leg reflexes

A

Holmes adie syndrome

230
Q

first line for lower back pain

A

NSAIDs

231
Q

Abdominal pain, constipation, neuropsychiatric features, basophilic stippling?

A

Lead poisoning

232
Q

Fever, loin pain, nausea and vomiting ?

A

Acute pyelonephritis

233
Q

standard for the diagnosis and screening of HIV?

A

Combination tests (HIV p24 antigen and HIV antibody)

234
Q

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

A

12 weeks

235
Q

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

A

cholestyramine, after cholecystectomy

236
Q

empirical antibiotic of choice for neutropenic sepsis?

A

Piperacillin with tazobactam (Tazocin)

237
Q

Gas gangrene is caused by?

A

Clostridium Pefringens

238
Q

Is digoxin monitored?

A

No, unless suspected toxicity

239
Q

Recommend Adult Life Support (ALS) adrenaline doses

A

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

240
Q

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

A

fractional nitric oxide

241
Q

1st line treatment for CO poisoning

A

100% high flow o2

242
Q

potential complication of panretinal photocoagulation

A

Decrease in night vision

243
Q

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

A

neurogenic shock, manage with vasopressors

244
Q

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

A

Central retinal vein occlusion

245
Q

Neuromuscular disorders result in what pattern on pulmonary function tests?

A

Restrictive

246
Q

Pioglitazone - contraindicated by:

A

HF
Bladder cancer

247
Q

Screening for an abdominal aortic aneurysm consists of

A

single abdominal ultrasound for males aged 65

248
Q

Critical limb ischaemia presents as?

A

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

249
Q

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

A

Pred

250
Q

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

A

Azathioprine or mercaptopurine

251
Q

first line test for diagnosis of small bowel overgrowth syndrome

A

Hydrogen breath testing

252
Q

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

A

Citalopram

253
Q

Burning thigh pain? Dx? What nerve affected?

A

? meralgia paraesthetica - lateral cutaneous nerve of thigh compression

254
Q

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

A

Coagulase-negative Staphylococcus e.g. Epidermis

255
Q

What nephropathy is frequently associated with malignancy

A

Membranous nephropathy

256
Q

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

A

Cipro

257
Q

Unilateral glue ear in an adult needs evaluation for what?

A

Posterior nasal space tumour

258
Q

What medication may be used in patients with raised ICP?

A

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

259
Q

Peptic ulceration, galactorrhoea, hypercalcaemia

A

multiple endocrine neoplasia type I

260
Q

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

A

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).

261
Q

What Rate control medication can interfere with MG?

A

Beta blockers

262
Q

Sjogren’s syndrome mX

A

pilocarpine - helps to stimulate saliva production

263
Q

CXR finding on ank spond

A

Apical fibrosis

264
Q

What nerve supplies the extensor muscle group of forearms?

A

Radial

265
Q

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

A

Ulnar

266
Q

Disseminated gonococcal infection triad

A

tenosynovitis, migratory polyarthritis, dermatitis

267
Q

What blood test can rise in small bowel obstruction?

A

Serum amylase

268
Q

Dermatophyte nail infection, mx?

A

oral terbinafine

269
Q

Treatment of choice for essential tremor

A

Propanolol

270
Q

What can essential tremor affect besides the hands?

A

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

271
Q

What is the most sensitive scan to diagnose diffuse axonal injury

A

MRI

272
Q

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

A

?Dengue

273
Q

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

A

Prompt consideration of an alternative diagnosis

274
Q

Proximal aortic dissections are generally managed with?

A

Surgical aortic root replacement

275
Q

Strong suspicion of PE but a delay in the scan:

A

Start on treatment dose anticoag meanwhile

276
Q

Medial epicondylitis is aggravated by?

A

wrist flexion and pronation

277
Q

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

A

Insertion of a chest drain

278
Q
A

Finals - Things to Go Over (6 decks)

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