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

(branches of the posterior cerebral artery that supply the midbrain)

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38
Q

What does an anterior inferior cerebellar artery stroke cause?

A

Ipsilateral: facial paralysis and deafness

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

AKA Lateral Pontine Syndrome

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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

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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

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114
Q

Definitive diagnostic investigation for small bowel obstruction

A

CT abdomen

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115
Q

1st line investigation for small bowel obstruction

A

abdominal X-ray

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116
Q

Management of small bowel obstruction

A

initial steps:
NBM
IV fluids
nasogastric tube with free drainage

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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

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118
Q

What’s seen on polarised light microscopy in pseudogout?

A

weakly positively birefringent rhomboid-shaped crystals

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119
Q

How to distinguish pseudogout from gout?

A

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

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120
Q

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

A

Chlamydia

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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)

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122
Q

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

A

Subacute combined degeneration of the spinal cord

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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.

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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

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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

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126
Q

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

A

IV ciclosporin or surgery

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127
Q

Ethylene glycol toxicity management

A

fomepizole

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128
Q

Ethanol toxicity management

A

Haemodialysis

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129
Q

Ongoing loin pain, haematuria, pyrexia of unknown origin?

A

?Renal cell carcinoma

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130
Q

Metabolic alkalosis + hypokalaemia ?

A

?prolonged vomiting

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131
Q

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

A

Urea breath tes

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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.

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133
Q

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

A

Erb’s palsy - Brachial trunks C5-6

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134
Q

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

A

a proximal leg vein ultrasound scan if DVT is suspected

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135
Q

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

A

Toxic epidermal necrolysis

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136
Q

Peptic ulceration, galactorrhoea, hypercalcaemia?

A

MEN type 1

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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

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138
Q

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

A

a beta blocker and an ACE inhibitor

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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

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140
Q

Can prostate cancer be seen with a normal PSA?

A

Yes

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141
Q

key investigation in diagnosing early CKD

A

urinary albumin:creatinine ratio (ACR)

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142
Q

When should you stop a statin?

A

When patient is on a macrolide - erythro/clarithromycin

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143
Q

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

A

Irradiation of blood products

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144
Q

What is oesophagael adenocarcinoma associated with?

A

GORD or Barrett’s

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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

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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

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147
Q

areflexia, ataxia, ophthalmoplegia

A

Miller Fisher syndrome (subtype of GBS)

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148
Q

Exudative causes of pleural effusion

A

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

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149
Q

Transudative causes of pleural effusion

A

LOW PROTEIN

heart failure (most common transudate cause)

hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption

hypothyroidism

Meigs’ syndrome

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150
Q

Sudden deterioration with ventilation suggests?

A

Tension pneumothorax

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151
Q

Bleeding on dabigatran? What to reverse?

A

Idarucizumab

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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

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153
Q

Damage to which CN causes a RAPD

A

optic nerve - CN II

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154
Q

Useful for managing tremor in drug-induced parkinsonism

A

Procyclidine

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155
Q

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

A

Cabergoline

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156
Q

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

A

Levodopa

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157
Q

tumour marker in breast cancer

A

CA15-3

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158
Q

mixed aortic valve disease, what examination finding?

A

Bisferiens pulse

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159
Q

Massive PE + hypotension, do what?

A

Thrombolyse with alteplase

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160
Q

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

A

mitral regurg

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161
Q

Horner’s syndrome features

A

miosis, ptosis, enophthalmos and anhidrosis

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162
Q

How to differ between horner’s and third nerve palsy

A

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

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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

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164
Q

Arterial/venous thrombosis, miscarriage, livedo reticularis

A

anticardiolipin antibody +ve

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165
Q

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

A

Splenectomy

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166
Q

Indications for splenectomy

A

Uncontrollable splenic bleeding
Hilar vascular injuries
Devascularised spleen

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167
Q

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

A

?adenomyosis

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168
Q

J waves on ECG

A

Hypothermia

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169
Q

what is given before endoscopy in patients with suspected variceal haemorrhage

A

Both terlipressin and antibiotics

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170
Q

What is used if uncontrolled variceal haemorrhage

A

Sengstaken-Blakemore tube

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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

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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

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173
Q

What is contraindicated in V tach?

A

Verapamil

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174
Q

What lung pathology can methotrexate cause?

A

pneumonitis - typically presents with cough, dyspnoea and fever

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175
Q

What are the most common triggers of autonomic dysreflexia

A

Faecal impaction / urinary retention

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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

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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

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178
Q

widespread systolic murmur, hypotension, pulmonary oedema following MI

A

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

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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

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180
Q

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

A

? Legionella

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181
Q

Chest drain swinging

A

Rises in inspiration, falls in expiration

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182
Q

Mx of minimal change disease

A

prednisolone

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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

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184
Q

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

A

Renal function

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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

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186
Q

When can you diagnose stage 1/2 CKD?

A

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

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187
Q

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

A

Desmopression

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188
Q

Electrolyte abnormality in T1DM

A

Metabolic acidosis with increased anion gap

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189
Q

most common site of metatarsal stress fractures is?

A

2nd metatarsal shaft

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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

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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.

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192
Q

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

A

Multiple system atrophy

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193
Q

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

A

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

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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

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195
Q

Severe life-threatening complication of C.Diff

A

Pseudomembranous colitis

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196
Q

Rosacea features

A

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

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197
Q

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

A

Hydrocele

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198
Q

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

A

eGFR < 30

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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

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200
Q

Phaeo triad

A

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

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201
Q

Vision worse going down stairs? Think what

A

4th nerve palsy

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202
Q

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

A

4th nerve

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203
Q

triad for hepatorenal syndrome. Mx?

A

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

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204
Q

What murmur seen in anaemia? How does it present?

A

Aortic flow murmur, soft ESM which doesn’t radiate

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205
Q

IgA nephropathy classically presents as?

A

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

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206
Q

Infant with bilious vomiting & obstruction?

A

?Intestinal malrotation

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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

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208
Q

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

A

Anterior packing

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209
Q

Measles is characterised by

A

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

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210
Q

long-term prophylaxis of cluster headaches?

A

Verapamil

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211
Q

Cluster headache - acute treatment

A

subcutaneous sumatriptan + 100% O2

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212
Q

Symptom control in non-CF bronchiectasis

A

inspiratory muscle training + postural drainage

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213
Q

Bronchiectasis: most common organism

A

Haemophilus influenzae

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214
Q

Pneumonia in an alcoholic

A

Klebsiella

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215
Q

In those diagnosed with anal fistula, best Ix?

A

MRI is the best investigation to characterise the fistula course

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216
Q

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

A

Bromonidine gel

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217
Q

What can SAH cause on ECG?

A

Torsades de pointes

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218
Q

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

A

IV calcium gluconate
insulin/dextrose infusion

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219
Q

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

A

otitis externa

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220
Q

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

A

Ganglion cyst

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221
Q

most common cause of osteomyelitis?

A

staph aureus

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222
Q

Cause of raised serum NP besides HF

A

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

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223
Q

first-line medication for primary biliary cholangitis

A

Ursodeoxycholic acid

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224
Q

common features of meniscal lesions

A

Knee locking and giving-way

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225
Q

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

A

acanthamoebic keratitis

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226
Q

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

A

IV amiodarone

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227
Q

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

A

white cell count

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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

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229
Q

DIlated pupil, females, absent leg reflexes

A

Holmes adie syndrome

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230
Q

first line for lower back pain

A

NSAIDs

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231
Q

Abdominal pain, constipation, neuropsychiatric features, basophilic stippling?

A

Lead poisoning

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232
Q

Fever, loin pain, nausea and vomiting ?

A

Acute pyelonephritis

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233
Q

standard for the diagnosis and screening of HIV?

A

Combination tests (HIV p24 antigen and HIV antibody)

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234
Q

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

A

12 weeks

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235
Q

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

A

cholestyramine, after cholecystectomy

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236
Q

empirical antibiotic of choice for neutropenic sepsis?

A

Piperacillin with tazobactam (Tazocin)

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237
Q

Gas gangrene is caused by?

A

Clostridium Pefringens

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238
Q

Is digoxin monitored?

A

No, unless suspected toxicity

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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

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240
Q

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

A

fractional nitric oxide

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241
Q

1st line treatment for CO poisoning

A

100% high flow o2

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242
Q

potential complication of panretinal photocoagulation

A

Decrease in night vision

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243
Q

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

A

neurogenic shock, manage with vasopressors

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244
Q

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

A

Central retinal vein occlusion

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245
Q

Neuromuscular disorders result in what pattern on pulmonary function tests?

A

Restrictive

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246
Q

Pioglitazone - contraindicated by:

A

HF
Bladder cancer

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247
Q

Screening for an abdominal aortic aneurysm consists of

A

single abdominal ultrasound for males aged 65

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248
Q

Critical limb ischaemia presents as?

A

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

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249
Q

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

A

Pred

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250
Q

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

A

Azathioprine or mercaptopurine

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251
Q

first line test for diagnosis of small bowel overgrowth syndrome

A

Hydrogen breath testing

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252
Q

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

A

Citalopram

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253
Q

Burning thigh pain? Dx? What nerve affected?

A

? meralgia paraesthetica - lateral cutaneous nerve of thigh compression

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254
Q

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

A

Coagulase-negative Staphylococcus e.g. Epidermis

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255
Q

What nephropathy is frequently associated with malignancy

A

Membranous nephropathy

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256
Q

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

A

Cipro

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257
Q

Unilateral glue ear in an adult needs evaluation for what?

A

Posterior nasal space tumour

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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

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259
Q

Peptic ulceration, galactorrhoea, hypercalcaemia

A

multiple endocrine neoplasia type I

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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).

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261
Q

What Rate control medication can interfere with MG?

A

Beta blockers

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262
Q

Sjogren’s syndrome mX

A

pilocarpine - helps to stimulate saliva production

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263
Q

CXR finding on ank spond

A

Apical fibrosis

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264
Q

What nerve supplies the extensor muscle group of forearms?

A

Radial

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265
Q

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

A

Ulnar

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266
Q

Disseminated gonococcal infection triad

A

tenosynovitis, migratory polyarthritis, dermatitis

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267
Q

What blood test can rise in small bowel obstruction?

A

Serum amylase

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268
Q

Dermatophyte nail infection, mx?

A

oral terbinafine

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269
Q

Treatment of choice for essential tremor

A

Propanolol

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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

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271
Q

What is the most sensitive scan to diagnose diffuse axonal injury

A

MRI

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272
Q

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

A

?Dengue

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273
Q

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

A

Prompt consideration of an alternative diagnosis

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274
Q

Proximal aortic dissections are generally managed with?

A

Surgical aortic root replacement

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275
Q

Strong suspicion of PE but a delay in the scan:

A

Start on treatment dose anticoag meanwhile

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276
Q

Medial epicondylitis is aggravated by?

A

wrist flexion and pronation

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277
Q

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

A

Insertion of a chest drain

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278
Q

Mx of acute bronchitis? When is this different?

A

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.

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279
Q

Desmopression MOA

A

Vasopressin V2 receptor agonist

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280
Q

Mx of lung abscess

A

IV ABx

If no improvement, consider CT-guided percutaneous drainage

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281
Q

Subacute productive cough, foul-smelling sputum, night sweats

A

Lung abscess

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282
Q

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

A

an incarcerated hernia - these are typically painless

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283
Q

Most effective antipsychotic for negative Sx of schizo

A

Clozapine

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284
Q

What is a recognised respiratory complication of pancreatitis

A

ARDS

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285
Q

Are patients with pancreatitis given Abx?

A

Not routinely, fluids and analgesia are mainstay

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286
Q

Should patients with acute pancreatitis be kept NBM?

A

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

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287
Q

Which antihypertensive can cause peripheral oedema?

A

CCBs e.g. amlodipine

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288
Q

What happens to iodine uptate in subacute thyroiditis?

A

Decreased iodine uptake

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289
Q

Mx of BPH

A

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

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290
Q

What can be used in refractory pain for shingles?

A

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

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291
Q

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

A

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

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292
Q

Best anaesthetic agent in trauma? Why?

A

Ketamine. no drop in BP

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293
Q

How are patient’s diabetic medication managed during operations?

A

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

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294
Q

How do episcleritis and scleritis differ?

A

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

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295
Q

Gold standard for diagnosing CSF, if not can use?

A

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

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296
Q

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.

A

MS

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297
Q

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

A

sphincterectomy

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298
Q

Acute anal fissue (<1 week) Mx

A

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

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299
Q

Lateral anal fissure?

A

LOOK FOR OTHER CAUSES

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300
Q

Chronic anal fissure Mx

A

topical GTN

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301
Q

Mx of simple rib fractures

A

Conservative

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302
Q

Most common cause of sudden onset sensorineural hearing loss

A

Idiopathic

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303
Q

What Mx is used to prevent vasospasm in aneurysmal SAH

A

Nimodipine

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304
Q

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

A

reduced by 20%

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305
Q

Open and closed comedones, pustules and nodules

A

acne vulgaris

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306
Q

Liver failure following cardiac arrest think

A

Ischaemic hepatitis

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307
Q

Presbycusis presents qwith?

A

bilateral high-frequency hearing loss

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308
Q

Mx of diverticulitis flare

A

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

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309
Q

1st line treatment for pyoderma gangrenosum

A

Oral steroids

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310
Q

Hodgkin’s lymphoma - most common type

A

Nodular sclerosing

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311
Q

Which CCB most likely to precipitate HF

A

Verapamil (CONTRAINDICATED)

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312
Q

What medication to consider in all housebound patients?

A

Daily vitamin D supplements

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313
Q

Neonatal hypotonia: associated with

A

Prader Willi

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314
Q

What is Hutchinson’s Sign?

A

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

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315
Q

patients with unilateral deafness or tinnitus, worry about?

A

Accoustic neuroma

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316
Q

Loss of corneal reflex with unilateral hearing loss

A

Accoustic neuroma

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317
Q

What CNs are affected by vestibular schwannoma?

A

CN V, VII, VIII

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318
Q

What is rhinitis medicamentosa?

A

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

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319
Q

How are most intracranial aneurysms now treated?

A

Coiling by an interventional neuroradiologist

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320
Q

What can raised platelets be an indicator of?

A

Lung cancer

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321
Q

Timeline for determining cause of postoperative fever

A

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.

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322
Q

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

A

Thrombocytopenia, prothrombotic state

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323
Q

management for subluxation of the radial head

A

Passive supination of the elbow joint whilst flexed to 90 degrees

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324
Q

(paradoxically) prolonged APTT + low platelets

A

Antiphospholipid syndrome

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325
Q

Pancreatic pseudocyst Mx?

A

Manage conservatively initially, then consider radiological fine-needle aspiration

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326
Q

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

A

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

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327
Q

Discoid lupus erythematous Mx

A

topical steroids → oral hydroxychloroquine

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328
Q

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

A

Discoid lupus

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329
Q

Mx of HUS

A

supportive

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330
Q

What does metastatic bone pain respond to?

A

analgesia, bisphosphonates or radiotherapy

Trial these in order

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331
Q

Diverticulitis symptoms + pneumaturia or faecaluria?

A

?colovesical fistula

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332
Q

Common blood test results in alcoholic liver disease

A

Macrocytic anaemia and thrombocytopenia

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333
Q

the commonest extra-colonic malignancy of HNPCC?

A

Endometrial

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334
Q

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

A

audiogram and gadolinium-enhanced MRI head scan

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335
Q

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

A

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

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336
Q

Mx of heparin induced thrombocytopenai

A

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

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337
Q

Perioral dermatitis should be treated with?

A

topical or oral ABx

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338
Q

Leriche syndrome triad

A

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)
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339
Q

Local complication of gonorrhoea in males

A

urethral stricture

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340
Q

visual hallucinations associated with eye disease.

A

Charles bonnet syndrome

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341
Q

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

A

Overflow

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342
Q

What may patients develop following catheterisation for acute urinary retention?

A

post-obstructive diuresis

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343
Q

incubation period of Ebola virus

A

2 - 21 days

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344
Q

‘pigment-laden macrophages within the mucosa on PAS staining’.

A

Melanosis coli - caused by prolonged laxative use

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345
Q

Syphyllis test results

A

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

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346
Q

investigation of choice for a suspected pharyngeal pouch

A

Barium swallow combined with dynamic video fluoroscopy

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347
Q

IO access is attained at the?

A

Proximal tibia

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348
Q

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

A

FAST scan

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349
Q

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

A

Brandt-Daroff

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350
Q

most common cause of occupational asthma

A

Isocyanates

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351
Q

Sildenafil MOA

A

phosphodiesterase type V inhibitor

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352
Q

What type of chest pain can arise secondary to malignancy?

A

Pericarditis

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353
Q

Immunocompromised patients with poor dentition can develop what?

A

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

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354
Q

emergency medical management of acute angle-closure glaucoma

A

Alongside eye drops, IV acetazolamide

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355
Q

Ix for acute angle closure glaucoma

A

Both tonometry and gonioscopy

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356
Q

Sudden weight loss is associated with what liver conditiion?

A

NAFLDF

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357
Q

CCB SEs

A

headache, flushing, ankle oedema

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358
Q

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

A

enhanced liver fibrosis (ELF) testing

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359
Q

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

A

360° selective laser trabeculoplasty (SLT)

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360
Q

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

A

A Monteggia fracture

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361
Q

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

A

Galeazzi fracture

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362
Q

How to differ between galeazzi fracture and monteggia fracture

A

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)

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363
Q

distal radius fracture with dorsal displacement

A

Colles

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364
Q

distal radius fracture with volar displacement

A

Smiths

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365
Q

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

A

Boxers

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366
Q

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

A

Nerve block

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367
Q

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

A

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

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368
Q

What are chiari malformations often associated with? Why?

A

syringomyelia due to disturbed cerebrospinal fluid flow at the foramen magnum

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369
Q

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

A

Dex

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370
Q

What pneumonia is associated with cold sores?

A

Strep pneumoniae

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371
Q

Ix of lipoma

A

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

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372
Q

lump characteristics:
smooth
mobile
painless

Dx?

A

Lipoma

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373
Q

HIV + proctitis ?

A

? Lymphogranuloma venereum

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374
Q

A woman suddenly falls to the ground then lays motionless

A

Atonic seizure

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375
Q

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

A

MS

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376
Q

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

A

Hidradenitis suppurativa

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377
Q

Mx of shingles

A

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

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378
Q

What can loop diuretics do to bone health?

A

Worsen due to hypocalcaemia

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379
Q

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

A

Oxycodone

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380
Q

How can Primary and secondary aldosteronism can be differentiated?

A

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

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381
Q

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

A

Cyclizine

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382
Q

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

A

lipase

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383
Q

What are inflammatory markers in biliary colic?

A

Normal

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384
Q

SIADH MX

A

fluid restrict

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385
Q

Flashes and floaters?

A

vitreous/retinal detachment

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386
Q

Prolonged diarrhoea may result in what blood gas result?

A

metabolic acidosis associated with hypokalaemia

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387
Q

SVC obstruction can cause visual disturbances such as ?

A

blurred vision

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388
Q

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.

A

SVC obstruction

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389
Q

When is surgical excision given in fibroadenoma?

A

Breast fibroadenoma: surgical excision is usual if >3cm

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390
Q

shortened and internally rotated leg

A

Posterior hip dislocation

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391
Q

Normal pressure hydrocephalus neuroimaging findings:

A

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

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392
Q

What can doxasosin cause?

A

postural hypotension

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393
Q

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

A

HbA1c

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394
Q

Total anterior circulation infarcts - all 3 of the following:

A

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

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395
Q

Haemodialysis can give a falsely low?

A

HbA1C

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396
Q

management of acute relapse of MS

A

High dose steroids

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397
Q

Should you use ABx in pressure ulcer treatment?

A

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

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398
Q

Treatment for herpes simplex keratitis

A

topical aciclovir

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399
Q

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

A

Herpes simplex keratitis

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400
Q

Uncal herniation affects what cranial nerve?

A

3

Dilated pupil due to compression of the third cranial nerve

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401
Q

Chronic urinary retention is classed as high pressure urinary retention if

A

renal function is impaired or if there is hydronephrosis

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402
Q

What type of CXR is used to identify bowel perf

A

erect - shows pneumoperitoneum

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403
Q

Excessive use of breakthrough analgesia should raise suspicion for?

A

Compartment syndrome

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404
Q

Hartmann’s procedure

A

sigmoid colectomy and formation of end stoma

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405
Q

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

A

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

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406
Q

Pulsus paradoxus, think?

A

Cardiac tamponade

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407
Q

30-40 year old with basal emphysema and abnormal LFTs

A

?A1AT

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408
Q

What can reactive arthritis cause in the hands?

A

Dactylitis

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409
Q

Common SEs of adenosine

A

Flushing and chest pain

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410
Q

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

A

25-30 ml/kg/day

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411
Q

Acronym for causes of upper zone fibrosis:

A

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

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412
Q

Lower zone fibrosis acronym:

A

ACID

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

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413
Q

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

A

osteosarcoma

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414
Q

fixed dilated pupil with conjunctival injection

A

Acute closed-angle glaucoma

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415
Q

Neutrophil predominant leucocytosis with periumbilical pain?

A

think acute appendicitis

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416
Q

When is surgery indicated in patients with repeated endoscopic treatment?

A

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

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417
Q

What is the oral antibiotic of choice to treat erythrasma

A

Erythromycin

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418
Q

first-line treatment in opioid detoxification

A

Methadone or buprenorphine

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419
Q

Pneumothorax: persistent air leak or recurrent episodes . plan?

A

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

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420
Q

What pain meds to avoid in Myeloma?

A

NSAIDs, can precipitate renal failure

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421
Q

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

A

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

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422
Q

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

A

Brown-Sequard syndrome

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423
Q

What does NAC commonly cause on administration?

A

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

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424
Q

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

A

squamous cell carcinoma (SCC)

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425
Q

Mx of actinic keratosis

A

Fluorouracil crea,

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426
Q

C peptide levels in T1DM

A

Low

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427
Q

severe hypertension and bilateral retinal hemorrhages and exudates, think?

A

Malignant hypertension

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428
Q

What artery is at risk with duodenal arteries?

A

Gastroduodenal

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429
Q

itchy, violaceous papules on the flexor aspects of her wrists

A

Lichen planus - polygonal rash on flexor surgaces

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430
Q

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

A

Central retinal vein occlusion

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431
Q

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

A

positive femoral nerve stretch test

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432
Q

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

A

Superficial spreading melanoma

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433
Q

What can essential tremor also affect?

A

The vocal cords

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434
Q

Malignancy + raised CK?

A

Polymyositis

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435
Q

Salter Harris Classification

A

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)

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436
Q

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

A

X-ray, MRI

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437
Q

first-line for chronic plaque psoriasis

A

Topical potent corticosteroid + vitamin D analogue

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438
Q

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

A

Rate control - Beta blockers, if asthmatic - verapamil

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439
Q

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

A

Biliary stenting

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440
Q

The Parkland formula for fluid resuscitation in burns is:

A

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

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441
Q

1st line Iv for CO poisoning

A

ABG

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442
Q

first-line investigation for a suspected osteoporotic vertebral fracture

A

X-ray spine

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443
Q

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

A

do not do an LP, consider an alternative diagnosis instead

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444
Q

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

A

Nitrates

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445
Q

common cause of chronic wound infections

A

Pseudomonas, especially in diabetics

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446
Q

lemon tinge to the skin is associated with

A

Pernicious anaemia

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447
Q

pedunculated heterogeneous mass on echocardiogram

A

Atrial myxoma

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448
Q

pharmacological options for treatment of orthostatic hypotension

A

Fludrocortisone and midodrine

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449
Q

differential for chronic hepatitis B patients with acute flare up

A

Hep D superinfection

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450
Q

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

A

Alfacalcidol

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451
Q

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

A

Transvenous pacing

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452
Q

What important differential can present similarly to renal colic>

A

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.

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453
Q

Adult patients with a hydrocele require what?

A

an ultrasound to exclude underlying causes such as a tumour

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454
Q

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

A

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

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455
Q

Most common causes of massive splenomegaly in UK

A

CML/myelofibrosis

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456
Q

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

A

Lifelong warfarin

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457
Q

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

A

low dose aspirin

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458
Q

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

A

chronic kidney disease leading to secondary hyperparathyroidism

NOTE: This is different to osteomalacia where you would get low phosphate

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459
Q

An important adverse effect of aminoglycosides is

A

Ototoxicity

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460
Q

Aortic stenosis - most common cause:

A

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

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461
Q

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

A

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

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462
Q

What does meformin increase the risk of?

A

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

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463
Q

Herpes zoster ophthalmicus requires?

A

urgent ophthalmological review and 7-10 days of oral antivirals

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464
Q

Mx of asymptomatic mitral stenossi

A

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

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465
Q

treatment of choice for Bowen’s disease

A

Topical 5-fluorouracil

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466
Q

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

A

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

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467
Q

most commonly affected site in ischaemic colitis

A

Splenic flexure

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468
Q

Moderate/severe psoriatic arthropathy mx

A

methotrexate

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469
Q

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

A

Gallstone ileus

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470
Q

Key SE of ciprofloxacin

A

Achilles tendon rupture

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471
Q

imaging of choice in suspected renal colic

A

Non-contrast KUB

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472
Q

A third heart sound is one of the possible features of

A

left sided HF

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473
Q

Most common form of prostate cancer

A

Adenocarcinoma

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474
Q

What is a useful test of exocrine function in chronic pancreatits

A

Faecal elastase

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475
Q

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

A

Hypoxia and hypoglycaemia

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476
Q

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

A

Haemodialysis

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477
Q

Thyrotoxicosis with tender goitre =

A

subacute (De Quervain’s) thyroiditis

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478
Q

Visual changes secondary to drugs

A

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

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479
Q

What is a key investigation in patients with suspected encephalitis

A

PCR of cerebrospinal fluid for viruses

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480
Q

Joint aspirate in rheumatoid arthritis shows a

A

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

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481
Q

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

A

Spontaneous bacterial peritonitis

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482
Q

WHat should be prescribed adjunct to methotrexate in RA?

A

Folate to prevent myelosuppression

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483
Q

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

A

acute chest syndrome

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484
Q

Mx of acute chest syndrome

A

Analgesia, respiratory support and Abx, ?transfusion

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485
Q

Early Sx of MS

A

Lethargy

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486
Q

What movements are typically spared in MND

A

eye movements

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487
Q

What is Verapamil contraindicated in?

A

V tach and HF

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488
Q

Immediate Mx of suspected temporal arteritis

A

oral pred

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489
Q

refractory hypertension and reduced eGFR after starting ACE inhibitor

A

Renal artery stenosis

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490
Q

AF cardioversion drugs

A

amiodarone + flecainide

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491
Q

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

A

Candida

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492
Q

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

A

Wet AMD

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493
Q

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

A

an US

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494
Q

Crypt abscesses on histology?

A

UC

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495
Q

What should be corrected first before giving bisphosphonates?

A

Hypocalcemia/vitamin D deficiency should be corrected before giving bisphosphonates

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496
Q

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

A

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

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497
Q

Unilateral, purulaent discharge from eye

A

bacterial conjunctivitis

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498
Q

Transferrin in IDA

A

Transferrin will be high BUT transferring saturation will be low

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499
Q

CT head findings on alzheimers

A

widespread cerebral atrophy mainly involving the cortex and hippocampus

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500
Q

Quinsy Mx

A

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

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501
Q

Toxic multinodular goitre Mx

A

radioactive iodine is the treatment of choice

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502
Q

Gold standard Ix for MS

A

MRI head

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503
Q

What Mx slows bone healing

A

NSAIDs

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504
Q

Bladder still palpable after urination, think?

A

Retention with urinary overflow

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505
Q

How to differentiate between femoral and iliac artery claudication

A

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

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506
Q

What hormonal therapy is reccomended in turners

A

Growth

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507
Q

Woman with bone mets, most likely to originate from?

A

Breast

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508
Q

Example of nephrotoxic medications that should be stopped in AKI

A

NSAIDs, diuretics, ACE inhibitors, and metformin

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509
Q

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

A

Pulsus Paradoxus

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510
Q

bilateral, conductive pattern hearing loss, sometimes with associated tinnitus

A

Otosclerosis

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511
Q

Difference between presbycusis and otosclerosis

A

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.

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512
Q

Which thyroid cancer has best prognosi

A

Papillary

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513
Q

most common reason total hip replacements need to be revised

A

Aseptic loosening of implant

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514
Q

1st line Mx for glaucoma

A

Latanoprost - prostaglandin analogue

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515
Q

SE of phenytoin

A

Peripheral neuropathy

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516
Q

Mx of diabetic gastroparesis

A

Metoclopramide

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517
Q

What is a common complication from intraventricular haemorrhages

A

Hydrocephalus

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518
Q

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

A

Oral pred (40-50mg)

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519
Q

Pigmentation of nail bed affecting proximal nail fold suggests?

A

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

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520
Q

When should NIV be considered in COPD exacerbation?

A

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

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521
Q

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

A

acral lentiginous

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522
Q

Gold standard investigation for mesothelioma

A

Thoracoscopic biopsy

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523
Q

Most likely cause of AKI if poor response to fluid challenge

A

ATN

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524
Q

CKD on haemodialysis - most likely cause of death is?

A

IHD

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525
Q

What electrolyte abnormality predisposes patients to digoxin toxicity

A

hypokalaemia

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526
Q

treatment of choice for all patients with a displaced hip fracture

A

Hemiarthroplasty or total hip replacement

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527
Q

General rule for hip fractures

A

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

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528
Q

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

A

Ganglion cyst

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529
Q

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

A

Dex

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530
Q

How does myoglobulinuria cause renal failure?

A

By tubular cell necrosis

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531
Q

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

A

Excisional node biopsy

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532
Q

low T3/T4 and normal TSH with acute illness

A

Sick euthyroid syndrome

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533
Q

Gold standard Ix for MS causing optic neuritis

A

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

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534
Q

Isoniazid, an anti-TB medication, may induce?

A

Pellagra

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

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535
Q

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

A

Think neutropenic sepsis

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536
Q

What type of medications cause a raised INR?

A

Inhibitors of cP450

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

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537
Q

Creatinine level in tumour lysis syndrome

A

Raised

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538
Q

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

A

<50ml

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539
Q

Small cell lung cancer with progressive confusion and lethargy

A

Think SIADH, hyponatraemia causing cerebral oedema

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540
Q

What artery affected in epistaxis

A

Sphenopallatine

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541
Q

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

A

De Quervain’s tenosynocitis

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542
Q

Carotid artery stenosis Ix

A

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

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543
Q

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

A

Large bowel obstruction

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544
Q

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

A

Metformin

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545
Q

Hypotension + melaena?

A

Bleeding peptic ulcer

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546
Q

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

A

Reactive arthritis

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547
Q

SEs of GTN

A

Hypotension, tachycardia and headache

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548
Q

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

A

Subacute thyroiditis

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549
Q

What type of anaemia can phenytoin cause?

A

Macrocytic anaemia

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550
Q

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

A

Sialadenitis

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551
Q

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

A

Pharyngeal pouch (Zenker’s diverticulum)

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552
Q

What anaesthetic drug can cause adrenal suppression

A

Etomidate

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553
Q

Common cause of bilateral carpal tunnell syndrome

A

RA

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554
Q

Hypotension, dyspnoea, wheezing, angioedema during a blood transfusion

A

Anaphylaxis

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555
Q

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

A

Mid stream urine culture

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556
Q

What accounts for the majority of ocular complications in temporal arteritis

A

Anterior ischaemic optic neuropathy

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557
Q

‘Rheumatoid’-like joint problems but nail changes

A

Psoriatic arthritis

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558
Q

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

A

Metoclopramide

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559
Q

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

A

Mesalazine

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560
Q

The most common malignancy associated with acanthosis nigricans
is

A

GI adenocarcinoma

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561
Q

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

A

SGLT-2 inhibitors

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562
Q

Deep ulcer on toe/heel

A

?Arterial ulcer

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563
Q

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

A

Ghon complex - latent TB

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564
Q

Complication of discitis that can cause worsenining features

A

Epidural abscess

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565
Q

Indications for thoracotomy in haemothorax include

A

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

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566
Q

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

A

Transphenoidal surgery

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

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567
Q

Most common cause of chronic pancreatitis

A

Alcohol excess

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568
Q

How to differentiate acute cholecystitis and biliary colic

A

people with cholecystitis typically are systemically unwell

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569
Q

pain on hip extension in an IVDU

A

Psoas abscess

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570
Q

Failure to correct childhood squints may lead to what?

A

Ambylopia

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571
Q

Widened mediastinum on CXR

A

Think aortic dissection

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572
Q

Ix for Aortic dissection

A

CT angiography of CAP, if unstable doe transoesophagaeal echocardiography

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573
Q

Classification and Mx of aortic dissection

A

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)

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574
Q

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

A

Weight loss

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575
Q

Ethylene glycol toxicity management

A

fomepizole. Also ethanol / haemodialysis

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576
Q

respiratory secretions & bowel colic may be treated by

A

hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide

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577
Q

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

A

Radial

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578
Q

Severe vomiting → haematemesis

A

Mallory weiss syndrome

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579
Q

What joint condition can cause pyoderma gangrenosum

A

RA

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580
Q

HIV, neuro symptoms, multiple brain lesions with ring enhancement

A

Toxoplasmosi

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581
Q

HIV, neuro symptoms, single brain lesions with homogenous enhancement

A

CNS lymphoma

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582
Q

Most appropriate anti emetic in parkinsons

A

Domperidone

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583
Q

Tamoxifen increases the risk of what?

A

VTE and endometrial cancer

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584
Q

1st line Mx of hyperhidrosis

A

Topical aluminium chloride

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585
Q

Rough guidance on which conditions are AD and AR inheritance

A

Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias

Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II

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586
Q

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

A

Hydroxycarbamide

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587
Q

How may HOCM present

A

Exertional dyspnoea

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588
Q

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

A

Cubital tunnel syndrome is caused by compression of the ulnar nerve

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589
Q

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

A

Rectal varices

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590
Q

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

A

Subclavian steal syndrome

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591
Q

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

A

Yellow fever

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592
Q

gold standard for diagnosis of OSA

A

Nocturnal polysomnography

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593
Q

GRACE score higher than 3% in an NSTEMI?

A

PCI within 72 hours

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594
Q

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

A

Bile leak

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595
Q

weak pulses and aortic regurgitation in an aortic dissection

A

Think type A, IV labetalol and surgery

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596
Q

Types of respiratory failure

A

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

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597
Q

What skin condition can cold sores trigger?

A

Erythema multifiorme

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598
Q

Urine osmolality levels in ATN

A

<350`

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599
Q

methotrexate toxicity Mx

A

Folinic acid

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600
Q

non-falciparum malaria Mx

A

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

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601
Q

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

A

Erythema multiforme

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602
Q

Why is nephrotic syndrome prothrombotic

A

Loss of antithrombin 3

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603
Q

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?

A

Basal cell carcinoma

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604
Q

When should a thrombolytic drug be considered in CPr?

A

If a PE is suspected

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605
Q

Prerenal disease is suggested by what blood test result

A

Urine sodium <20

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606
Q

What electrolyte abnormality can SAH cause? How?

A

Hyponatraemia, SIADH

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607
Q

At what FRAX score should a DEXA scan be arranged?

A

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

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608
Q

What Abx can cause IPF

A

Nitrofurantoin

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609
Q

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

A

Episcleritis

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610
Q

preferred way to support nutrition in patents with motor neuron disease

A

PEG tube

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611
Q

Difference between BPPV and vestibular neuronitis

A

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

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612
Q

skin hypopigmentation and loss of sensation

A

Leprosy

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613
Q

classic features of irritable bowel syndrome

A

Abdominal pain, Bloating and Change in bowel habit

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614
Q

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

A

Exudate

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615
Q

Mx of wilson’s disease

A

Penicillamine

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616
Q

What Ix should all adults with suspected asthma have?

A

a bronchodilator reversibility (BDR) test

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617
Q

recurrent painless haematuria, poor renal function and a sensorineural deafness

A

Alport syndrome

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618
Q

recommended treatment for post-thrombotic syndrome

A

Compression stockings

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619
Q

What murmur often occurs secondary to pulmonary htn

A

Functional tricuspid regurgitation often occurs secondary to pulmonary hypertension

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620
Q

Critical limb ischaemia presents as?

A

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

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621
Q

STEMI management, what anticoagulants to give>

A

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

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622
Q

What type of nystagmus seen in BPPV?

A

Rotatory nystagmus is indicative of a positive Dix-Hallpike manoeuvre

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623
Q

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

A

Branchial cyst

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624
Q

Mx of acetazolamide

A

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

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625
Q

How can TB affect the joints?

A

Can cause a polyarthritis

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626
Q

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

A

Loop diuretics

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627
Q

Brain abscess Mx:

A

IV 3rd-generation cephalosporin + metronidazole

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628
Q

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

A

Combined HIV antibody/antigen tests

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629
Q

purplish, lace-patterned discolouration of the skin

A

Livedo reticularis

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630
Q

investigation of choice in genital herpes

A

NAAT

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631
Q

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

A

Dexamethasone

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632
Q

Abdominal wound dehiscence should initially be managed with

A

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

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633
Q

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

A

Pituitary apoplexy

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634
Q

first step in mx of patient with pleural effusion

A

Pleural aspirate

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635
Q

preferred method of access for haemodialysis

A

AV fistula

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636
Q

right iliac fossa, spouted and has a liquid output

A

Loop ileostomy

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637
Q

Where may gallstones present following cholecystectomy?

A

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

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638
Q

Mx of renal stones >20mm

A

Percutaneous nephrolithotoym

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639
Q

pulmonary, hepatic, cerebral and spinal AVMs

A

Hereditary haemorrhagic telengiectasia

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640
Q

Features of 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

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641
Q

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

A

Biliary stenting

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642
Q

Adrenaline induced ischaemia mx

A

Phentolamine

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643
Q

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

A

Budd-chiari syndrome

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644
Q

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

A

Methaodone or buprenorphine

Naloxone is used in emergency management

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645
Q

Low cortisol on 9am cortisol test implies

A

Addison’s, need to synchacth

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646
Q

Grades of hepatic encephalopathy

A

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

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647
Q

secondary prophylaxis of hepatic encephalopathy

A

Rifamixin and lactulose

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648
Q

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

A

Orbital cellulitis

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649
Q

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

A

Livedo reticularits

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650
Q

Management of myasthenic crisis

A

intravenous immunoglobulin, plasmapheresis

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651
Q

definitive management for theophylline toxicity

A

Haemodialysis

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652
Q

Obesity with abnormal LFTs

A

?NAFLD

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653
Q

unilateral tremor that improves with voluntary movement

A

Parkinson’s disease

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654
Q

Acute sensorineural hearing loss is an emergency and requires

A

urgent referral to ENT for audiology assessment and brain MRI

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655
Q

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

A

3 months

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656
Q

first-line investigation for a suspected osteoporotic vertebral fracture

A

X ray spine

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657
Q

treatment of choice for Bowen’s disease

A

Topical 5-fluorouracil

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658
Q

What type of ABx can lower the seizure threshold

A

Ciprofloxacin

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659
Q

Mx of subacute thyroiditis

A

NSAIDs - simple analgesia and conservative management

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660
Q

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

A

Subacute thyroiditis

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661
Q

hyperdense, crescentic collection around the left parietal lobe.

A

Acute subdural haematoma

If hypodense - chronic

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662
Q

Migraine Mx

A

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

Topiramate not preferred in a woman of childbearing age

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663
Q

What Mx can cause osteonecrosis of the jaw

A

Bisphosphonate use

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664
Q

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

A

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

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665
Q

Mx of mild varicoceles

A

Reassure and observe

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666
Q

most likely operation to be done for symptomatic chronic subdural bleeds

A

burr hole evac

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667
Q

Increased, homogenous uptake on a radioactive iodine uptake test suggests

A

graaves disease

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668
Q

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

A

malignancy. Particularly bone cancer/ metastases

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669
Q

Mx of hyperacute transplant rejection

A

Removal of graft

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670
Q

anorectal pain and a tender lump on the anal margin

A

Thrombosed haemorrhoids

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671
Q

What medication provides symptomatic relief for MG

A

Pyridostigmine

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

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672
Q

asthma + aspirin sensitivity + nasal polyposis

A

Samter’s triad

AVOID ASPIRIN AND NSAIDS IN ASTHMA

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673
Q

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

A

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

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674
Q

Is strangulated hernia an open or laparoscopic procedure?

A

Open

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675
Q

Mx of gonorrhoea if patient refuses injection

A

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

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676
Q

BP med that can cause gingival hyperplasia

A

Amlodipine

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677
Q

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

A

Re-expansion in pulmonary oedema

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678
Q

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

A

Diverticulitis

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679
Q

Corneal abrasion Mx

A

topical antibiotics should be given to prevent secondary bacterial infection

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680
Q

Difference in abg between diarrhoea and vomiting

A

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

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681
Q

Can Abx be used as monotherapy in acne?

A

No, typically used adjunt to benzoyl peroxide

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682
Q

How should severe cellulits be treated

A

co-amoxiclav, cefuroxime, clindamycin or ceftriaxone

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683
Q

fasciculations

A

THink MND - typically spares ocular muscles

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684
Q

Rate of insulin infusion for DKA in adults

A

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

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685
Q

Most common organism found in central line infections

A

Staph epidermidis

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686
Q

Scrotal swelling you can’t get above:

A

Inguinal hernia

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687
Q

crypt abscesses

A

UC

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688
Q

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

A

CXR

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689
Q

Otalgia, fever, protruding ear and post-auricular tenderness

A

?mastoiditis, admit and IV ABx

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690
Q

How to differentiate between NMS and SS

A

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

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691
Q

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

A

Excisional node biopsy

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692
Q

Subdural haemorrhage results from bleeding of damaged?

A

bridging veins between the cortex and venous sinuses

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693
Q

Timolol MOA in gluacoma

A

Reduces aqueous secretion by ciliary body - reduces aqueous production

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694
Q

What supplementation is required prior to surgery for patients taking prednisolone

A

Hydrocortisone

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695
Q

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

A

AF with BBB

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696
Q

Urinary incontinence + gait abnormality + dementia

A

Normal pressure hydrocephalus

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697
Q

What anti hypetensive can cause reflex tachy

A

Nifedipine causes peripheral vasodilation which may result in reflex tachycardia

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698
Q

What should be corrected before giving bisphosphonates

A

Hypocalcaemia, vit D deficiency

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699
Q

How to differentiate between spider naevi and telengiectasia

A

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

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700
Q

What electrolyte abnormality can precipitate digoxin toxicity

A

Hypokalaemia

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701
Q

All patients with suspected upper GI bleed require?

A

An endoscopy within 24 hours of admission

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702
Q

red eye, photophobia and gritty sensation

A

Keratitis

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703
Q

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

A

Portal HTN that has caused the ascites

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704
Q

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

A

Tolvaptan

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705
Q

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

A

Urgent referral to ENT

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706
Q

presentation of dysentery after a long incubation period

A

Amoebiasis

Managed with oral metro

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707
Q

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

A

Propofol

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708
Q

`Necrotising fasciitis: most commonly affected site is

A

Perineum

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709
Q

Complete heart block following a MI?

A

RCA lesion

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710
Q

Dx of BPPV

A

Dix-hallpike

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711
Q

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

A

CPAP

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712
Q

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

A

successfully treated syphilis

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713
Q

Positive non-treponemal test + negative treponemal test

A

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

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714
Q

Positive non-treponemal test + positive treponemal test

A

consistent with active syphilis infection

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715
Q

What can uncal herniation secondary to subdural cause?

A

third nerve palsy - down and out eye

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716
Q

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

A

Focal impaired awareness seizure

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717
Q

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

A

?LBO - ?malignancy

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718
Q

low T3/T4 and normal TSH with acute illness

A

Sick euthyroid syndrome

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719
Q

most common cause of secondary hypertension

A

Primary hy-peraldosteronism

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720
Q

most common cause of puritus vulvae is

A

contact dermatitis

721
Q

Migraine triggers mneomonic

A

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

722
Q

If there is clubbing with hyperthyroidism, think?

723
Q

1st line drug in the management of ocular myasthenia gravis

A

Pyridostigmine

724
Q

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

A

Anastomotic leak

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

725
Q

What cancer marker is elevated in breast?

726
Q

Mx of venous ulceration

A

Compression bandaging

727
Q

‘Popeye’ deformity in the middle of the upper arm

A

Biceps rupture

728
Q

What skin condition may carbamezapine cause?

A

Steven Johnsons syndrome

729
Q

Surgery/metformin on day of surgery

A

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

730
Q

Diagnostic criteria for AKI

A

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

731
Q

What type of surgery is done in type A aortic dissection

A

Aortic root replacement, IV labetalol adjunt

732
Q

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

A

Subdural haematoma

733
Q

Mx of non-falciparum malaria

A

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

734
Q

Ix of accoustic neuroma

A

MRI of cerebellopontine angle

735
Q

Mouth manifestation of EBV. What is indicative of

A

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

736
Q

Medical causes of gingival hyperplasia

A

phenytoin, ciclosporin, calcium channel blockers and AML

737
Q

1st line treatment for seborrhoeic dermatitis

A

Topical ketoconzole

738
Q

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

A

Seborrhoeic dermatitis - Malassezia Furfur

739
Q

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

A

Nitrates and nicorandil

740
Q

Kussmaul’s sign? Feature of?

A

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

741
Q

What are used to detect occupational asthma

A

Serial peak flow measurements at work and at home

742
Q

Common electrolyte abnormality in SAH

A

Hyponatraemia

743
Q

What type of repair is done for symptomatic AAA

A

undergo endovascular repair (EVAR)

744
Q

Solitary firm papule/nodule that dimples on pinching

A

Dermatofibroma

745
Q

How to differentiate between TACO and TRALI

A

Transfusion Associated Circularory Overload: Hypertension, raised jugular venous pulse, afebrile, S3 present.

Transfusion Related Acute Lung Injury: Hypotension, pyrexia, normal/unchanged JVP

746
Q

What type of surgeries can lead to B12 deficiency

A

Gastrectomy, ileocaecal ersection

747
Q

What deficiency seen in coeliac?

A

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

748
Q

Mouth side effect of tetracyclines

A

Black hairy tongue

749
Q

Ix for all patients with suspected acute pericarditis

A

Transthoracic echo

750
Q

How to differentiate between bullous pemphigoid and pemphigus vulgaris

A

Blisters/bullae

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

751
Q

How does ATN respond to fluid challenges?

752
Q

hip/groin pain and a snapping sensation

A

Acetabular labral tears

753
Q

Postural headache but normal imaging ->

754
Q

How to differentiate between tetanus and botulism

A

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

755
Q

Adrenaline induced ischaemia mx

A

Phentolamine

756
Q

Disseminated gonococcal infection triad

A

tenosynovitis, migratory polyarthritis, dermatitis

757
Q

What medication can make perioral dermatitis worse?

758
Q

Order of Mx for symptomatic bradycardia

A

IV atropine 500mcg
Transcutaneous pacing
Transvenous pacing

759
Q

First line management of acute pericarditis involves combination of

A

NSAID and colchicine

760
Q

Criteria for oxygen support in ACS

A

<94 percent

761
Q

Medical Mx of ER +ve breast cancers

A

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

762
Q

Diarrhoea, fatigue, osteomalacia →

763
Q

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

A

Central retinal artery occlusion

764
Q

Normocytic anaemia, thrombocytopaenia and AKI following diarrhoeal illness

765
Q

Ix of choice for optic neuritis

A

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

766
Q

Best Ix for HIV

A

Combined antibody/antigen test

767
Q

Bubbly urine and nephritc picture

A

Enterovesical fistula?

768
Q

Most specific finding on ECG for acute pericarditis

A

PR depression

769
Q

Deterioration in patient with hepatitis B

A

?hepatocellular carcinoma

770
Q

Ix for diabetes insipidus

A

Water deprivation test

771
Q

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

A

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

772
Q

Mx of vestibular neuronitis

A

Acute: Prochloprazine
Chronic: Vestibular rehabilitation

773
Q

Hodgkin’s lymphoma - best prognosis + worst prognosis

A

Best prognosis - Lymphocyte predominant
Worst prognosis - lymphocyte depleted

774
Q

Aims of treatment in glaucoma

A

Reducing aqueous secretion and inducing pupillary constriction

775
Q

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

A

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

776
Q

What type of infection is indicated in contact lens wearers?

A

Acanthamoebic keratitis

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

777
Q

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

A

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

778
Q

What prophylaxis is needed for patients with nephrotic syndrome

A

LMWH prophylaxis

779
Q

Dysphagia, aspiration pneumonia, halitosis →

A

?pharyngeal pouch

780
Q

Finkelstein’s test

A

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

781
Q

Post splenectomy blood film features:

A

Howell- Jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes

782
Q

Mechanical valves - target INR

A

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

783
Q

Mx of nec fas

A

immediate surgical debridement nd IV antibiotics

784
Q

Best antibody for pernicious anaemia

A

IF antibody, can use gastric parietal cell if not

785
Q

Bilateral grittiness - think?

A

Blepharitis. Mx with hot compress and lid hygiene

786
Q

Mx of myasthenic crisis

A

IVIG, plasmapharesis

787
Q

What associated condition causes hallucinations with age related macular degeneration

A

Charles bonnet syndrome

788
Q

Mx of proximal pole scaphoid fractures

A

Urgent surgical screw fixation

789
Q

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

A

SCC - managed with excision and biopsy

790
Q

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

791
Q

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

A

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

792
Q

Key side effects of prostaglandin analogues include

A

increased eyelash length, iris pigmentation and periocular pigmentation

793
Q

Transcutaneous pacing AKA

A

External pacing

794
Q

Generalised tonic clonic seizure Mx

A

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

795
Q

Focal seizure Mx

A

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

796
Q

Absence seizures Mx

A

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

797
Q

Myoclonic seizures Mx

A

Myoclonic seizures
males: sodium valproate
females: levetiracetam

798
Q

Tonic or atonic seizure Mx

A

Tonic or atonic seizures
males: sodium valproate
females: lamotrigine

799
Q

treatment of choice for SLE

A

Hydroxychloroquine

800
Q

Difference in cauess of oral and genital herpes

A

Oral - HSV 1
Genital - HSV 2

801
Q

Long term management of diverticular didsease

A

Increased dietary fibre intake

802
Q

Breakthrough dose

A

1/6th dose of morphine

803
Q

codeine to morphine

A

divide by 10

804
Q

morphine to subcut morphine

A

divide by 6

805
Q

Increase morphine doses by how much if pain not controlled

806
Q

Recurrent episodes of natal cleft pain with discharge

A

?Pilonidal disease

807
Q

Important differential between viral labyrinthitis and vestibular neuronitis

A

VIRAL LABYRINTHITIS HAS HEARING LOSS

808
Q

Mx of otitis media with perf

A

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

809
Q

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

A

E. histolytica is known to digest hepatic tissue

810
Q

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

A

Normal or raised opening pressure

811
Q

Myeloma aspirate

A

Plasma cells

812
Q

EBV: associated malignancies:

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
nasopharyngeal carcinoma

813
Q

Hypoglycaemia with impaired GCS: give

A

IV glucose if there is access

814
Q

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

815
Q

speech fluent, comprehension abnormal, repetition impaired

A

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

816
Q

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

Comprehension is normal

A

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

817
Q

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

Comprehension is normal

A

Conduction aphasia

Arcuate fasciculus affected in stroke

818
Q

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

819
Q

Adverse skin reaction that carbamezapine can cause

A

Steven Johnson’s syndrome

820
Q

Contralateral homonymous hemianopia with macular sparing and visual agnosia

A

posterior cerebral artery

821
Q

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

A

blisters and erosions appear when the skin is rubbed gently

822
Q

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

A

Common peroneal nerve

823
Q

treatment of choice for essential tremor

A

Propanolol

824
Q

undoscopy typically shows a swollen pale disc and blurred margins

A

Anterior ischaemic optic neuropathy

825
Q

What anti hypertensive can ause increased HR?

A

Nifedipine - peripheral vasodilation - reflex tachycardia

826
Q

What is used for long-term prophylaxis of cluster headaches

827
Q

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

828
Q

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

A

Contrast-enhanced CT coronary angiogram

829
Q

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

A

Thrombocytopenia

830
Q

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

A

Hyperkalaemic metabolic acidosis

831
Q

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

832
Q

Nicorandil SE

A

ulceration of GI tract

833
Q

The most common site of metatarsal stress fractures is the?

A

2nd metatarsal shaft

834
Q

diagnostic investigation of choice for pancreatic cancer

A

High resolution CT scan

835
Q

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

A

Trochanteric bursitis

836
Q

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

A

Encephalopatny or pericarditis, indication for dialysis

837
Q

COPD - LTOT if 2 measurements of pO2

838
Q

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

A

Sulfasalazin e

839
Q

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

A

Carotid artery dissection

840
Q

empirical treatment of choice in native valve endocarditis

841
Q

Diabetic ketoacidosis: the IV insulin infusion should be started at

A

0.1 unit/kg/hour

842
Q

What are curlings ulcers

A

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

843
Q

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

A

Lemierre’s syndrome

844
Q

Pagets Mx

A

IV bisphosphonates

845
Q

Genital wart treatment

A

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

846
Q

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

847
Q

Which duct can be blocked by gallstones without causing jaundice?

848
Q

Facial rash plus lymphadenopathy think?

A

Sarcoidosis

849
Q

Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of

A

shaken baby syndrome

850
Q

How to differentiate between anterior and posterior shoulder dislocation

A

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

851
Q

What medication can make clopidogrel less effective?

A

Omeprazole

852
Q

Infective exacerbation of COPD: first-line antibiotics are

A

Amox, clarithro, or foxy

853
Q

When to use cryoprecipitate in bleeding

A

Low fibrinogen

854
Q

Dysplasia on biopsy in Barrett’s oesophagus requires

A

Endoscopic mucosal therapy

855
Q

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

A

Sitagliptin

856
Q

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

A

renal impairment, hypokalaemia and hyponatraemia - metabolic acidosis

857
Q

What may lower lobe pneumonia present with?

A

Upper quadrant abdo pain

858
Q

Mx for post LP headache

A

Caffeine and fluids

859
Q

Marker for carcinoid tumours

A

Urinary 5-HIA

860
Q

Haptoglobin level in haemolysis

A

Low - Haptoglobin binds to free haemoglobin

861
Q

What contraceptive method can cause drug induced cholestasis

862
Q

first-line investigation in suspected prostate cancer

A

Multiparametric MRI

863
Q

first-line for spasticity in multiple sclerosis

A

Baclofen and Gabapentin

864
Q

inferior myocardial infarction and AR murmur should raise suspicions of

A

Ascending aorta dissection

865
Q

False positive VDRL/RPR:

A

‘SomeTimes Mistakes Happen’ (SLE, TB, malaria, HIV)

866
Q

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

A

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

867
Q

Dermatitis, diarrhoea, dementia/delusions, leading to death

868
Q

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

A

stalk compression is consistent with a non-functioning pituitary adenoma

869
Q

Prostatitsi Mx

A

quinolone for 14 days e.g. cipro

870
Q

Systemic lupus erythematosus with proteinuria on urinalysis

A

Lupus nephritis

871
Q

What type of tumours can secrete pituitary hormones

A

Carcinoid tumours

872
Q

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

A

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.

873
Q

abdominal pain, diarrhoea and flushing which are the classical features

A

Carcinoid syndrome

874
Q

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

A

think non-cardiac cause of abnormal ECG

875
Q

Best ABx for MRSA

876
Q

A double pulse felt in systole is called a

A

bisferiens pulse or pulsus bisferiens

Caused by mixed aortic valve disease

877
Q

Mx to prevent relapse in MS

A

Natalizumab

878
Q

Ix for Takayasu’s

A

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

879
Q

What strain HPV RF for oropharyngeal cancer

880
Q

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

881
Q

Most important causes of VT clinically

A

Hypokalaemia, then hypomagnesaemia

882
Q

Mx of small cell lung cancer

A

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.

883
Q

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

A

urgent hospital admission

884
Q

DKA resolution is defined as

A

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

885
Q

GCS - motor response

A
  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None

To be counted as localising, the arm must be brought above the clavicle, else it should be scored as ‘flexing’

886
Q

GCS - Verbal

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
887
Q

GCS - Eye

A
  1. Spontaneous
  2. To speech
  3. To pain
  4. None
888
Q

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

A

Paracetemol OD

889
Q

Pigmented gallstones are associated with

A

Sickle cell anaemia

890
Q

Mx of autonomic dysreflexia

A

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

891
Q

Schistosomiasis Mx

A

Praziquantel

892
Q

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

A

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

893
Q

LP findings for GBS

A

Protein risen, normal WCC

894
Q

firm, smooth, tender and pulsatile liver edge

895
Q

Mx of botulism

A

Botulism antitoxin

896
Q

What metaboli distrubance can cholera present with

A

Hypoglycaemia

897
Q

Parkland formula

A

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

898
Q

Dermatitis in acral, peri-orificial and perianal distribution

A

?Zinc deficiency

899
Q

initial management of acute limb ischaemia

A

analgesia, IV heparin and vascular review

900
Q

Mx of acute bronchitisi

A

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.

901
Q

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

A

Takayasu’s arteritis

902
Q

eGFR variables

A

CAGE - Creatinine, Age, Gender, Ethnicity

903
Q

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

A

Transient elastography

904
Q

Laughter → fall/collapse

A

?cataplexy

905
Q

Recognised complication of NG feeding

906
Q

Widened Qrs

907
Q

first line test for diagnosis of small bowel overgrowth syndrome

A

Hydrogen breath testing

908
Q

Facial rash plus lymphadenopathy think

A

Sarcoidosis

909
Q

Features and Mx of anterior dislocation of shoulder

A

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

910
Q

Features and Mx of posterior shoulder dislocation

A

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

911
Q

Multiple sclerosis patient with bladder dysfunction. What Ix?

A

get an ultrasound KUB first to assess bladder emptying

912
Q

Knee osteo pain ladder

A

Topical NSAIDs
Oral NSAID + PPi

913
Q

Mx of MRSA

A

Vanco 1st
Linezolid 2nd

914
Q

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

A

Metaphysis

915
Q

What urinary Ix done for phaeo

A

Metanephrines NOT catecholamines

916
Q

What are common complications of seborrhoeic dermatitis

A

Otitis externa and blepharitis

917
Q

The universal donor of fresh frozen plasma is

A

AB RhD negative blood

918
Q

New onset AF is considered for electrical cardioversion if

A

it presents within 48 hours of presentation

919
Q

Definition of upper GI bleed

A

haemorrhage with an origin proximal to the ligament of Treitz

920
Q

Cellulitis (near the eyes or nose) Mx

921
Q

Mechanism of controlled ventilation in raised ICP

A

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

922
Q

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

923
Q

What endocrine abnormality can cause a euvolaemic hyponatraemia

A

Hypothyroidism

924
Q

widespread cerebral atrophy mainly involving the cortex and hippocampus

A

Alzheimer’s

925
Q

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

A

Asymmetric dosing regimes

926
Q

What type of pill is best in women with acne

A

COCP, swap from POP if on this

927
Q

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

A

Ace inhibitors

928
Q

Pulmonary embolism and renal impairment. What Ix

A

V/Q scan is the investigation of choice

929
Q

Renal colic. Mx of pain if NSAIDs contraindicated

A

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

930
Q

first-line imaging of choice when investigating thyroid nodules

A

Ultrasonography

931
Q

most common and important viral infection in solid organ transplant recipients

932
Q

White cells present on urine dip and AKI

933
Q

Defunctioning the bowel indicates what type of stoma

A

Loop ileostomy

934
Q

triad of encephalopathy, jaundice and coagulopathy

A

Liver failure

935
Q

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

A

Fluid restrict

936
Q

How does airway management differ in spinal cord injury?

A

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

937
Q

What Ix must be done regularly post op

A

Electrolyte panel to check for post operative ileus

938
Q

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

A

Infectious mononucleosis

939
Q

What is the most common cause of hypernatraemia in the elderly

A

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

940
Q

Compartment syndrome is most commonly associated with what fractures?

A

Supracondylar and tibial shaft

941
Q

What therapy is avoided if there is thyroid eye disease

A

Radioactive Iodine

942
Q

Important SEs of penicillins

A

Toxic epidermal necrolysis

943
Q

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

A

Urethral stricture

944
Q

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

A

Herpes simplex

Enteroviruses are most common cause of viral meningitis

945
Q

Metabolic ketoacidosis with normal or low glucose:

A

Think alcohol

946
Q

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

A

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

947
Q

Best anaesthetic agent for haemodynamically unstable patients

948
Q

Mx of salicyclate OD

A

IV sodium bicarb

949
Q

What Sx are a red flag for patients with chronic rhinosinusitis

A

Unilateral

950
Q

red eye and reduced vision following intraocular surgery.

A

Endophthalmitis

951
Q

How many days before surgery is warfarin stopped

952
Q

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

A

cholestyramine

953
Q

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

954
Q

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

A

Aspergilloma

955
Q

reatment of choice for small bowel bacterial overgrowth syndrome

956
Q

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

A

Sideroblastic anaemia

957
Q

Ix for mycoplasm

958
Q

Cardiac deformity associated with ADPKD

A

Mitral valve prolapse

959
Q

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

A

Pre operative axillary US

960
Q

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

A

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

961
Q

SE of vincristine

A

Periphereal neuropathy

962
Q

Strongest association of H.pylori

A

Duodenal ulcer

963
Q

SE of ciclosporin

A

Hepatotoxicity + nephrotoxicity

964
Q

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

A

Seborrhoeic dermatitis

965
Q

Restless leg syndrome - management includes

A

opamine agonists such as ropinirole

966
Q

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

A

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

967
Q

What condition should metformin be stopped in?

A

MI, risk of lactic acidosis

968
Q

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

A

Rhythm e.g. amiodorone

969
Q

Grave’s disease, orange peel shin lesions

A

Pretibial myxoedema

970
Q

Thin, intracystic eggshell calcification throughout the bladder.

A

Schistosomiasis –> think SCC of bladder

971
Q

How to start fluid resus in children

A

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

972
Q

What pulse is HOCM associated with

A

Bisfieriens - double pulse

973
Q

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

A

warfarin or a direct thrombin or factor Xa inhibitor

If not, clopi

974
Q

Type of melanoma that invades aggressively and metastasies early

975
Q

electrolyte abnormality that PPis can cause

A

Hyponatraemia

976
Q

Difference in menorrhagia with thyroid issues

A

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

977
Q

Mx of toxoplasmosi

A

Immunocompetent patients with toxoplasmosis don’t usually require treatment

Pyrimethamine and sulphadiazine are management options for immunocompromised patients.

978
Q

Ank spond Xray findings

A

subchondral erosions, sclerosis
and squaring of lumbar vertebrae

979
Q

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

A

Leptospirosis

980
Q

aynaud’s phenomenon with extremity ischaemia

A

Buerger’s disease - Thromboangiitis obliterans

981
Q

What is a RAPD

A

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

982
Q

Management of SCC in cosmetically important sites

983
Q

Management of SCC of skin

A

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

984
Q

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

A

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

985
Q

Septic arthritis ABx therapy duration

986
Q

Most important prognostic factor in melanoma

A

Invasion depth of the tumour

987
Q

Asthma Mx pathway for >12

A

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

988
Q

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

A

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

989
Q

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

A

Herpes simplex keratitis

Treat with topical aciclovir

990
Q

What should patients be screened for before starting rituximab treatment

991
Q

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

A

Osmotioc laxativev such as a macrogol

992
Q

Which opioid is licensed for neuropathic pain

993
Q

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

A

Secondary care for treatment

994
Q

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

A

Cardiac tamponade - pericardiocentesis

995
Q

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

A

oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis

996
Q

Red eye - glaucoma or uveitis?

A

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

997
Q

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

A

Whole breast radiotherapy

998
Q

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

A

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

999
Q

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

A

Myocarditis

1000
Q

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

A

bronchodilator reversibility (BDR) with spirometry

1001
Q

What may topical steroids cause in patients with darker skin

A

Patchy depigmentation

1002
Q

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

A

Squamous cell

1003
Q

Achilles tendonitis Mx

A

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

1004
Q

Ix of choice for gastric cacner

A

Oesophago-gastro-duodenoscopy with biopsy

1005
Q

Prosthetic heart valves - antithrombotic therapy:

A

bioprosthetic: aspirin
mechanical: warfarin + aspirin

1006
Q

Mirror image nuclei

A

Hodgkin’s lymphoma

1007
Q

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

A

Nodular melanoma

1008
Q

blood in the eye anterior chamber known as

A

Hyphema –> urgent referral to on call opthal

1009
Q

Most common organism causing cholangitis

1010
Q

Infective endocarditis causing congestive cardiac failure is an indication for WHAT

A

Emergency valve replacement surgery

1011
Q

Most common primary site of brain mets

1012
Q

What clotting time does warfarin prolong

1013
Q

Most likely SSRI to lead to QT prolongation and torsades

A

Citalopram

1014
Q

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

A

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

1015
Q

what type of oesophagael cancer does achalasia increase risk of

1016
Q

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

A

Urgent imaging

1017
Q

Ix of choice for suspected psoas

1018
Q

Definitive Mx of sickle cell crisis

A

Exchange transfusion

1019
Q

Mx of HAP

1020
Q

Mx of polycythaemia Vera

A

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

1021
Q

Dx that can result in both corneal opacities and optic neuritis

A

Amiodarone

1022
Q

When to treat subclinical hypothyroidism

A

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

1023
Q

Mx of amiodarone induced hypothyroidism

A

Keep amiodarone and add levo

1024
Q

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

A

Falciparum malaria

1025
Q

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

A

Cardiac resynchronisation therapy

1026
Q

Pancytopaenia 5 years post-chemotherapy/radiotherapy →

A

Myelodysplastic syndrome

1027
Q

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

A

axillary node clearance

1028
Q

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

A

technetium-labelled HIDA scan may be done

1029
Q

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

1030
Q

Hiccups in palliative care

A

chlorpromazine or haloperidol

1031
Q

Quinine can cause what

A

Hypoglycaemia

1032
Q

What type of CP450 medications increase warfarin

A

INhibitors INcrease warfarin

1033
Q

How does NMS typically present on blood tests

A

Raised CK and WCC

1034
Q

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

A

Serum osmolality

1035
Q

Anisocoria worse in bright light implies a problem with which pupil

A

the dilated pupil

1036
Q

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

1037
Q

treatment option for patients with metastatic HCC

1038
Q

SE of sulfasalazine in men

A

Low sperm count

1039
Q

Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis

A

Lymphogranuloma Venereum

1040
Q

Classical presentaiton of cauda equina? Late signs include?

A

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

1041
Q

Mx of refractory anaphylaxis

A

IV adrenaline + IV fluids

1042
Q

Avoid what anti emetic in bowel obstruction

1043
Q

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

A

Alcohol XS

1044
Q

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

A

Pneumocystitis jiroveci

1045
Q

Ciclosporin side-effects

A

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

1046
Q

screening test for APKD

1047
Q

oral ulcers, genital ulcers and uveitis

1048
Q

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

A

Sensitivity

1049
Q

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

A

Specificity

1050
Q

Acute heart failure with hypotension Mx

A

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

1051
Q

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

A

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

1052
Q

Mx of Paracetemol OD if presentation >8 hours

A

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

1053
Q

Mx of paracetemol OD if presentation >24 hours

A

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

1054
Q

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

A

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

1055
Q

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

A

Ataxic gait

1056
Q

Mx of servere AI hepatitis

1057
Q

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

1058
Q

How to differ between radial tunnel syndrome and lateral epidondylitis

A

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

1059
Q

muscle relaxant of choice for rapid sequence induction for intubation

A

Suxamethonium

1060
Q

Risk of 0.9% NaCL in large columes

A

Hyperchloraemic metabolic acidosis

1061
Q

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

1062
Q

Mx of prolactinoma

A

Dopamine agonist
Then surgery if indicated

1063
Q

exquisitely tender red-eye in a patient with SLE

1064
Q

Biggest risk of hyphema

1065
Q

Which nerve damaged in wrist drop?

A

Radial, often caused by fracture of shaft of humerus

1066
Q

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

A

?Pleomorphic adenoma

1067
Q

Alcoholic ketoacidosis is managed with

A

Saline infusion and thiamine

1068
Q

Should morphine always be given in patients with ACS?

A

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

1069
Q

What antihypertensive can worse glucose tolerance

1070
Q

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

1071
Q

Flashers and floaters in vision without vision loss

A

Posterior vitreous detachment

If with vision loss, retinal detachment

1072
Q

What may a raised CRP in SLE indicate

A

Underlying infection

1073
Q

Latent tuberculosis treatment options:

A

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

1074
Q

What Mx should all patients with PAD takeq

A

Clopi and statin

1075
Q

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

A

Tumour lysis syndrome. Mx is rasburicase

1076
Q

lump in the midline between umbilicus and the xiphisternum

A

Epigastric hernia

1077
Q

Mx of suspected neutropenic sepsis

A

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

1078
Q

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

A

Jaw thrust

1079
Q

Complication of Klebsiella

1080
Q

Ix of choice for avascular necrosis of the hi[

1081
Q

Alternative to spirinolactone if gynaecomastia troublesome in HF

A

Eplerenone

1082
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

1083
Q

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

A

Hyponatraemia correction - osmotic demyelination syndrome
Hypernatreamia correction - cerebral oedema

1084
Q

Types of AKI

A

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

1085
Q

1st line treatment for compacted ear wax

A

Olive oil drops

1086
Q

1st line treatment for digoxin toxicity

1087
Q

What antibodies in drug induced lupus

A

anti-histone

1088
Q

Renal tubular acidosis leads to what ABG picture

A

hyperchloraemic, normal anion gap metabolic acidosis

1089
Q

t SCC is associated with what infection

1090
Q

What Mx for prevention of calcium stones

A

Potassium citrate

1091
Q

HerpesVirus FAmily

A

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).

1092
Q

Persistent mouth ulcer

1093
Q

Alterntative to atropine in symtpomatic brady

A

Adrenaline

1094
Q

Earliest and most common Sx of spinal cord compression

1095
Q

Medical Mx of raynauyd

A

Nifedipine

1096
Q

Renal transplant + Infection?

1097
Q

What is diclofenac contraindicated in?

1098
Q

In type 1 diabetics, blood glucose targets:

A

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

1099
Q

continuous dribbling incontinence after prolonged labour

A

Vesicovaginal fistula

1100
Q

most common complication of thyroid eye disease

A

Exposure keratopathy

1101
Q

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

A

Physiological reaction to surgery

1102
Q

treatment for acute clot retention

A

Continuous bladder irrigation via a 3 way urethral catheter

1103
Q

Unruptured sigmoid volvulus is primarily managed by

A

Flatus tube insertion

1104
Q

HOCM Auscultation

A

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

1105
Q

Criteria for LTOT

A

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

1106
Q

Alternative to amiodorane in ALS

1107
Q

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

A

Bromonidine gel

1108
Q

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

A

Pneumatic dilatation

1109
Q

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

A

Endoscopic band ligation

1110
Q

What % reduction aimed for in HDL cholesterol

1111
Q

ASymmetrical spreading lymphadenopathy

A

Hodkin’s

1112
Q

Widespread convulsions without conscious impairment is likely to represent a

A

Pseudoseizure

1113
Q

Lymph node pain when drinking alcohol is very specific

A

Hodgkin’s lymphoma

1114
Q

Plucking of clothes is typically seen in WHAT lobe seizures

1115
Q

Triad for insulinoma

A

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

1116
Q

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

1117
Q

What is the ulnar paradox

A

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.

1118
Q

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

A

left ventricular free wall rupture

1119
Q

What are cotton wool spots in diabetic retinopathy

A

Areas of infarction

1120
Q

NSTEMI (managed with PCI) antiplatelet choice:

A

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

1121
Q

The main components for managing sickle cell crisis should be

A

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

1122
Q

most common cause of hypopituitarism

A

non secreting pituitary macroadenomas

1123
Q

HIV, diarrhoea, Ziehl-Neelsen stain showing protozoa

A

Cryptosporidium parvum

1124
Q

‘empty delta sign’ seen on venography

A

Saggital sinus thrombosis

1125
Q

treatment of choice for facial hirsutism

A

Topical eflornithine

1126
Q

The transfusion threshold for patients without ACS

1127
Q

Motion sickness Mx

A

hyoscine > cyclizine > promethazine

1128
Q

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

A

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.

1129
Q

The causes of massive splenomegaly are as follows:

A

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

1130
Q

Pulse pressure in AS vs AR

A

AS - narrow
AR - widefned

1131
Q

Mx of perforated eardrum

A

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

1132
Q

What is a positive straight leg raise suggest?

A

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.

1133
Q

Squints may be classified as to where the eye deviates toward

A

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

1134
Q

night blindness + tunnel vision

A

Retinitis pigmentosa

1135
Q

Mx of allopurinol if recurrent episodes of gout

A

Continue

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

1136
Q

How to remember skewed distributions

A

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

1137
Q

CN6 palsy manifesting as diplopia could be the first sign of

A

Brain mets

1138
Q

nvestigation of choice for suspected Boerhaave’s syndrome

A

CT contrast swallow

1139
Q

Rotator Cuff muscles

A

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

1140
Q

In hypothermia, what can rapid rewarming lead to?

A

Peripheral vasodilation and shock

1141
Q

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

A

Double duct sign - pancreatic cancer

1142
Q

Avoid what antiemetic in bowel obstruction

A

Metaclopramide

1143
Q

Mx of renal stones

A

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

1144
Q

Mx of uretic stoens

A

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

1145
Q

Gold standard Ix for cerebral venous sinus thrombosis

A

MR venogram

1146
Q

What medication presdisposes to vitreous haemorrhage

A

Blood thinning agents

1147
Q

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

A

Dorsal carpal branch of the radial artery

1148
Q

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

A

Pompholyx eczema

1149
Q

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

1150
Q

How to diagnose orthostatic hypotension/

A

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

1151
Q

‘unrecordable’ blood sugar measurement with confusion and abdominal pain

1152
Q

What can be used to shrink nasal polyps

A

Topical corticosteroids

1153
Q

how to differentiate between PAD and spinal stenosis

A

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

1154
Q

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

A

?intracranial venous thrombosis

1155
Q

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

A

Guttate psoriasis

1156
Q

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

1157
Q

Initial Mx of open fractures

A

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

1158
Q

most effective treatment for prominent telangiectasia in rosacea

A

Laser therapy

1159
Q

Ix for budd chiari

A

US doppler flow

1160
Q

Pagets Mx

A

Bisphosphonates

1161
Q

Normal/raised total gas transfer with raised transfer coefficient:

1162
Q

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

A

fibromuscular dysplasia

1163
Q

Blood stained discharge from nipple is likely to be associated with

A

Intraductal papilloma

1164
Q

What nerve is at risk during total hip replacement

A

Sciatic nerve

1165
Q

What value of schobers test is suggestive of AS

A

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

1166
Q

Renal impairment, respiratory symptoms, joint pain, systemic features

A

ANCA associated vasculitis

1167
Q

Mx of ramsay hunt

A

oral aciclovir and steroids

1168
Q

Hypokalaemia, osteomalacia

1169
Q

Samter’s triad

A

aspirin sensitivity, asthma and nasal polyps

1170
Q

What endocrine abnormality can haemochromatosis cause?

A

Cranial DI

1171
Q

How does lithium cause nephrogenic DI

A

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

1172
Q

What type of ABx lowers seziure threshold

A

Quinolones

1173
Q

Ix of choice for bladder cancer

A

Flexi cysto

1174
Q

Options for pharmacological cardioversion in AF

A

‘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.’

1175
Q

Clinical features of psoas abscessses

A

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.

1176
Q

Visual defect in craniopharyngioma compared to pituitary adenoma

A

Craniopharyngioma - Inferior bitemporal hemianopia
Pituitary adenoma - Superior bitemporal hemianopia

1177
Q

First line Mx of suspected laryngopharyngeal reflux

A

A trial of PPi

1178
Q

abdominal, neurological and psychiatric symptoms. Think?

A

Acute intermittent prophyria

1179
Q

What ovarian tumour can cause endometrial hyperplasia?

A

Granulosa cell tumours

1180
Q

Urethritis in a male, negative for Gonorrhoea and Chlamydia

A

Mycoplasma genitalium

1181
Q

What does cryoprecipitate contain

A

factor VIII, fibrinogen, von Willebrand factor and factor XIII

1182
Q

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

A

Superior temporal gyrus, inferior

1183
Q

HIV, neuro symptoms, single brain lesions with homogenous enhancement

A

CNS Lymphoma

1184
Q

Anterior uveitis is most likely to be treated with a

A

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.

1185
Q

Elderly patient dizzy on extending neck

A

Vertebrobasilar ischaemia

1186
Q

Ankylosing spondylitis - x-ray findings

A

subchondral erosions, sclerosis
and squaring of lumbar vertebrae

1187
Q

Refeeding syndrome metabolic picture

A

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

1188
Q

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?

A

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.

1189
Q

Most common cause of wound infection post op

A

Staph Aureus

1190
Q

presence of a cardiac tamponade is suggested by Becks Triad

A

Hypotension
Muffled heart sounds
Raised JVP

1191
Q

Medical Mx of NMS

A

Bromocriptine

1192
Q

What electrolyte abnormalities suggest dehydration

A

Urea raised disproportionately compared to creatine

1193
Q

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

A

Non shockable rhythm

1194
Q

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

A

HIV seroconversion

1195
Q

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

1196
Q

Blood test results for wilson’s

A

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

1197
Q

What may exacerbate orthostatic hypotension

A

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

1198
Q

Reynold’s pentad

A

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

1199
Q

Erysipelas is localised skin infection caused b

A

Strep Pyogenes

1200
Q

Abdominal pain, constipation, neuropsychiatric features, basophilic stippling

A

Lead poisoning

1201
Q

Treatment of choice for scavies

A

Permethrin

1202
Q

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

A

Dextrocardia

1203
Q

Mx of achalasia

A

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

1204
Q

HIV, neuro symptoms, widespread demyelination

1205
Q

What type of CVD can present with neurological complaints

A

Aortic dissection

1206
Q

AS management

A

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

1207
Q

Recurrent chest infections + subfertility

A

think primary ciliary dyskinesia syndrome (Kartagener’s syndrome)

1208
Q

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

A

Flail chest

1209
Q

Difference in emphysema distribution in COPD and A1AT

A

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

1210
Q

Most common complication following meningitis

A

Sensorineural hearing loss

1211
Q

Avoid cyclizine in what chronic heart condition

A

Heart failure - can cause a drop in CO

1212
Q

Medical causes of AIN

A

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

1213
Q

Thyrotoxic storm is treated with

A

beta blockers, propylthiouracil and hydrocortisone

1214
Q

Axillary freckles are indicative of

1215
Q

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

A

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

1216
Q

Pneumonia, peripheral blood smear showing red blood cell agglutination

A

Mycoplasma

1217
Q

Hypocalcaemia: prolonged QT interval is an indication for

A

urgent IV calcium gluconate

1218
Q

What should be performed in patients with suspected acute limb ischaemia

A

Handheld arterial doppler examination

1219
Q

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

A

raised ICP until proven otherwise so LP is contraindicated

1220
Q

What is prescribed adjunt to methotrexate in RA

A

Folate to prevent myelosuppression

1221
Q

Clinical findings in ankylosing spondylitis include

A

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

1222
Q

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

A

Cardiac toxicity, echo

1223
Q

When to offer spironolactone in HF

A

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

1224
Q

first-line for spasticity in multiple sclerosis

A

Baclofen and gabapentin

1225
Q

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

A

Gastric volvulus

1226
Q

Blurring of optic disc margin on fundoscopy

A

Papilloedema

1227
Q

Reversible Causes of cardiac arrest

A

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

1228
Q

combination of a high reticulocyte count and severe anaemia indicates

1229
Q

GI complication of radiotherapy for prostate cancer

1230
Q

1st line for lower back pain

1231
Q

Psoas abscess Mx

A

Percutaneous drainage and IV ABx

1232
Q

What diabetic medication is associated with UTI

1233
Q

Diastolic murmur + AF. Dx?

A

Mitral Stenosis

1234
Q

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

A

?Bronchiectasis

1235
Q

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

A

> 75% of best or predicted

1236
Q

triad of CVD, high lactate and soft but tender abdomen

A

Mesenteric ischaemia

1237
Q

Mx of mild to moderate Sx in carpal tunnel syndrome

A

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

1238
Q

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

A

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

1239
Q

Empyema Mx

A

Prompt drainage alongside ABx therapy

1240
Q

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

A

direct access X-ray to assess for bone sarcoma

1241
Q

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

A

Liver failure

1242
Q

Mx of suspected myxoedema coma

A

IV thyroid replacement and IV hydrocortisone

1243
Q

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

1244
Q

Fever/back pain with pain on extension of the hip

A

Iliopsoas abscess

1245
Q

Post-tonsillectomy haemorrhage Mx

A

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.

1246
Q

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

A

AIN, commonly caused by ABs

1247
Q

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

A

Bacterial sinusitis - double sickening

1248
Q

Alcoholic ketoacidosis is Mx with

A

IV fluids and thiamine

1249
Q

Osteomalacia Mx

A

Vit D supplements

1250
Q

Mx of Crohn’s

A

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

1251
Q

Is insluin used in HHS?

A

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

1252
Q

Brown sequard syndrome cause? Features?

A

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

1253
Q

Dx of SBP

A

paracentesis. Confirmed by neutrophil count >250 cells/ul

1254
Q

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

A

Neurogenic thoracic outlet syndrome

1255
Q

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

A

implantable cardioverter-defibrillator

1256
Q

Binocular vision post-facial trauma is suggestive of

A

Depressed fracture of the zygoma

1257
Q

pepperspot appearnce on skull X ray

A

Primary hyperparathyroidism

1258
Q

Axillary node clearance is associated with

A

arm lymphedema and functional arm impairment

1259
Q

n acute asthma, the BTS guidelines only recommend ABGs for

A

Patients with o2 sats <92

1260
Q

ECG finding in cardiac tamponade

A

Electrical alternans

1261
Q

How to differentiate causes of bitemporal hemianopia

A

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

1262
Q

Mobitz II is an indication for what long term management

1263
Q

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

A

Myringoplasty

1264
Q

Empyema aspirate features

A

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

1265
Q

Non-resolving unilateral discharge suggests

A

Cholesteatoma

1266
Q

Triad of Sx for Fat embolism

A

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

1267
Q

What type of retinopathy is treated with panretinal laser photocoagulation

A

Proliferative retinopathy

1268
Q

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

A

Posterior hip dislocation

1269
Q

Persistent PUO and lymphadenopathy with high WCC?

A

Look for lymphoma

1270
Q

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

A

Diabetes maculopathy

1271
Q

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

1272
Q

first-line treatment for magnesium sulphate induced respiratory depression

A

Calcium gluconate

1273
Q

Lactational amenorrhoea is a reliable method of contraception as long as

A

amenorrhoeic, baby <6 months, and breastfeeding exclusively

1274
Q

painful arc of shoulder abduction

A

Subacromial impingement

1275
Q

What may periureteric fat stranding indicate?

A

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

1276
Q

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

1277
Q

Mx of acromegaly

A

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

1278
Q

Medication overuse headache Mx

A

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

1279
Q

Diagnostic criteria for ARDS;

A

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

1280
Q

First line management of acute pericarditis involves combination of

A

NSAID and colchicine

1281
Q

Electrolyte abnormality seen in chronic alcoholism

A

hypomagnasaemia

1282
Q

Eczema herpeticum is a primary infection of the skin caused by

A

HSV and uncommonly coxsackie

1283
Q

Signs of systemic sepsis with changing lower limb neurology

A

Possible epidural abscess

1284
Q

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

1285
Q

Myoedema coma typically presents with?

A

Confusion and hypothermia

1286
Q

What type of NSAID is contraindicated in CVD

A

Diclofenac

1287
Q

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

A

Blood film

1288
Q

What Ix is required in all patients with unknown AKI aetiology

1289
Q

How to differentiate between aplastic and sequestration crisis in SCA

A

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

1290
Q

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

A

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

1291
Q

What to give before beta blockade in phaeo

A

PHaeochromocytoma - give PHenoxybenzamine before beta-blockers

1292
Q

What to do if patient undergoing major bleeding when on warfarin

A

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.

1293
Q

What can be seen on fundoscopy in a fat embolism

A

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

1294
Q

Most common cause of SVCO

A

Lung cancer - specifically small cell

1294
Q

Useful marker for re-infarction in MI

A

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

1295
Q

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

A

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

1296
Q

antisynthetase syndrome

A

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.

1297
Q

Which malignancy’s can progress to AML.

A

Myelodysplasia and polycythaemia vera

1298
Q

crescent sign on hip X ray

A

Avascular necrosis of hip - caused by csteroids

1299
Q

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

A

Bronchiectasis

1300
Q

When is ABG warranted in acute asthma

A

in patients with o2 sats <92%

1301
Q

what joint involvement is characteristic of hand osteoarthritis

A

Carpometacarpal and distal interphalangeal joint involvement is characteristic of hand osteoarthritis

1302
Q

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

A

CT adrenal glands

1303
Q

Best Mx for renal colic

A

IM diclofenac if no GI bleeed

1304
Q

DIlated pupil, females, absent leg reflexes

A

Holmes ADIe

1305
Q

What is the most common underlying cause of a vitreous haemorrhage

A

Proliferative diabetic retinopathy

1306
Q

Mx of severe urticaria

A

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

1307
Q

Medical Mx of IBS

A

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

2nd line: Amitriptylline

1308
Q

Enzyme deficiency in gilbert’s

A

UDP glucoronyl transferase

1309
Q

Medical Mx of pyelonephritis in pregnancy

1310
Q

Irregular pattern on fluoroscein staining of eye

A

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

1311
Q

Cancers associated with SIADH

A

Lung, prostate, thymus, lymphoma

1312
Q

How to differentiate between aplastic and sequestration crisis in SCD?

A

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

1313
Q

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

A

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

1314
Q

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?

A

Left ventricular free wall rupture

1315
Q

empirical antibiotic of choice for neutropenic sepsis

A

Piperacillin with tazobactam (Tazocin)

1316
Q

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

A

Neurogenic thoracic outlet syndrome

1317
Q

Does campylobacter always require treatment?

A

NO, can be managed supportively unless severe - then mcrolide

1318
Q

Symptomatic aortic stenosis Mx

A

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

1319
Q

Middle-aged, personality changes, involuntary movements

A

Hungtington’s disease

1320
Q

Fever, loin pain, nausea and vomiting

A

acute pyelonephritis

1321
Q

Ix for gout

A

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

1322
Q

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

A

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

1323
Q

Sudden deterioration with ventilation suggests

A

Tension pneumothorax

1324
Q

What ECG finding can SAH cause

A

Torsades du Pointes

1325
Q

Ix for cardiac tamponade

1326
Q

Secondary amenorrhoea: low-level gonadotrophins indicate

A

a hypothalamic cause e.g. excess exercise

1327
Q

Causes of optic neuritis

A

MS, diabetes, syphillis

1328
Q

Eye complication of sarcoid

A

Anterior uveitis

1329
Q

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

A

NSAIds should be prescribed in preference to transexamic acid

1330
Q

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

A

ACEi, beta blocker, DAPT, statin

1331
Q

Medications to avoid in HF

A

Verapamil, Flecainide, Thizaolidinediones, NSAIDs, glucocorticoids

1332
Q

What Mx can cause discolouration to vision? What colour

A

Sildenafil - blue
Digoxin - yellow/green

1333
Q

What mx can cause cataracts

1334
Q

What mx can cause corneal opacities

A

Amiodarone, indomenhacin

1335
Q

What Mx can cause optic neuritis

A

Amiodarone, metro, ethambutol

1336
Q

Mnemonic for cP450 enzyme inhibitors

A

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

1337
Q

Mnemonic for cP450 enzyme inducers

A

The mnemonic CRAP GPs can be used to easily remember common CYP450 inducers.

Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas

1338
Q

What Mx can sildenafil not be given adjunct

A

Nitrates and nicorandil

1339
Q

What is Lhermitte’s sign?

A

shock like sensation radiating down the spine induced by neck flexion

1340
Q

What is Uhthoff’s phenomenon

A

Worsening multiple sclerosis symptoms during rising body temperature

1341
Q

Difference between swan neck and boutonniere deformity

A

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.

1342
Q

PSP triad

A

early dysphagia, recurrent falls, gaze palsy

1343
Q

Organisms causing post splenectomy sepsis

A

Think NHS:
Neisseria
Haemophilus
Streptococcus

1344
Q

Difference in optic disc between CRVO and vitreous haemorrhage

A

CRVO has optic disc swelling, VH doesn’t

1345
Q

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

A

Dexamethasone

1346
Q

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

A

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.

1347
Q

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

A

Beta blocker

1348
Q

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

A

Fluid restrict

1349
Q

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

A

> 75% of best or predicted

1350
Q

What is required to diagnose dementia?

A

Neuroimaging

1351
Q

What does COPD standby medication consist of?

A

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

1352
Q

What makes lateral epicondylitis worse?

A

resisted wrist extension/suppination whilst elbow extended

1353
Q

Supraspinatus tendonitis. How does it present?

A

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

1354
Q

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

A

Tension pneumothorax

1355
Q

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

A

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

1356
Q

Perforated tympanic membrane Mx

A

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

If done by otitis media, give amox

1357
Q

What do T and Z score mean?

A

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.

1358
Q

DIC typical blood picture

A

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

1359
Q

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

1360
Q

Useful anaesthetic agent in trauma

A

Ketamine, doesn’t count a drop in BP

1361
Q

Hyoscine hydrobromide or hyoscine butylbromide MOA

A

muscarinic antagonist

1362
Q

How long before surgery to stop HRT?

1363
Q

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

1364
Q

Best test for ACL injury

A

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

1365
Q

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

A

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

1366
Q

Mx of SCFE

A

Internal fixation

1367
Q

Risk of tamoxifen

A

pre and perimenopausal (VTE)

1368
Q

Risk of anastrazole

A

Osteoporosis

1369
Q

Mx of pseudomonas in CF

A

Oral cipro

1370
Q

Rivaroxaban and apixaban can be reversed by

A

Andexanet alpha

1371
Q

Warfarin can be reversed by

1372
Q

Heparin can be reversed by

A

Protamine sulphate

1373
Q

Dabigatran can be reversed by

A

Idaricizumab

1374
Q

painless haematuria and HTN ina young patient

1375
Q

What test can be used to confirm Gilbert’s?

A

bilirubin rises post IV nicotinic acid

1376
Q

DIfference between chalazion and stye

A

Chalzion - cyst - painless
Stye - abscess - painful

BOTH USUALLY CAUSED BY STAPH AUREUS

Treated with hot compresses, and only topical ABx if associated conjunctivitis

1377
Q

Brown-squard syndrome

A

paralysis and loss of proprioception ipsilaterally, loss of temperature and pain contralaterally

Lesion at mid-thoracic level

1378
Q

Hoow to differentiate between blepharitis and conjunctivitis

A

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

Conjunctivitis - discharge

1379
Q

Ix for AAA

A

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.

1380
Q

What is hypermetropia a risk factor for?

A

acute angle glaucoma

1381
Q

What is myopia a risk factor for?

A

Retinal detachment, open angle glaucoma

1382
Q

Initial emergency Mx for acute angle closure glaucoma

A

IV acetazolamide

1383
Q

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

A

Prostaglandin analogues - latanoprost

Adverse effects include brown pigmentation of the iris, increased eyelash length

1384
Q

Pharamcology summary of glaucoma

1385
Q

How to differentiate between episcleritis and scleritis clinically

A

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

1386
Q

wber syndrome affects ther

1387
Q

Lateral medullary syndrome affects the

1388
Q

What can untreated neck goitre lead to?

A

Tracheomalacia, sudden onset shortness of breath

1389
Q

amber material under the retinal pigment epithelium in both eyes

A

Drusen, between Bruchen’s membrane and retinal pigment epithelium

1390
Q

What nerve affected in collesf racture

1391
Q

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

A

3months after correction

1392
Q

gallstones in the gallbladder

A

cholecyystolithiasis

1393
Q

Gallstones in the CBD

A

choledocholithiasis

1394
Q

Jaundice, pruritus, dark urine and pale stool suggest

A

bile duct obstruction

1395
Q

Differentiating bronchitis and pneumonia

A

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.

1396
Q

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

1397
Q

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

A

humidified air, codeine, morphine, oral corticosteroids

1398
Q

Meckels diverticulum can be a risk factor for what?

A

Intusussception

1399
Q

Criteria to admit in new onset A fib

A

Tachycardic (>150), hypotensive

1400
Q

Relative bradycardia compared to temperature

A

Faget’s sign

Think Typhoid

1401
Q

Hypertrophic pulmonary osteoarthropathy triad

A

Periostitis, clubbing and painful arthropathy of large joints

Asx with lung cancers

1402
Q

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

A

Cholesteatoma

1403
Q

Mx that can be used in Meniere’s prevention

A

Betahistine

1404
Q

When should pred be considered in bell’s palsy

A

If presentaiton within 72 hours

1405
Q

Which anti-epileptics cause thrombocytopenia

A

Carbamezapine and sodium valproate

1406
Q

When to double dose of levonorgestrel?

A

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

1407
Q

What should be given prior to colonoscopy?

A

Magnesium citrate prep

1408
Q

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

A

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.

1409
Q

Extra-renal manifestations of ADPKD

A

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

1410
Q

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

A

Somatostatinoma

1411
Q

Mx of postpartum thyroiditis

A

Propanolol

1412
Q

Damage to hypoglossal nervse causes tongue to deviate which way?

A

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

1413
Q

Garden spade deformity

A

Smith’s fracture

1414
Q

Humeral shaft fracture causes damage to which nerve

1415
Q

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

A

Cyclizine, good for ENT causes of N&V

1416
Q

Positive valgus stess test

1417
Q

Positive varus stress test

1418
Q

Difference in location radial fractures between adult and children

A

Children - radial neck
Adult - radial head

1419
Q

What is Nelson’s syndrome?

A

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.

1420
Q

Bilateral sciatica?

A

?Cauda equina

1421
Q

IVC obstruction triad. Caused by?

A

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

1422
Q

Leriche syndrome triad

A

claudication, impotence and decreased pulses due to aortoiliac occlusion

1423
Q

What Ix if suspecting abscess secondary to PID?

1424
Q

second line to chloramphenicol for bacterial conjunctivitis

A

Fusidic acid

1425
Q

At what Hb threshold can you operate?

A

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

1426
Q

Mx of entamoeba

1427
Q

Mx of campylobacter

A

Macrolide, if not - cipro

1428
Q

Mx of salmonella

1429
Q

Mx of shigella

1430
Q

Oral candidiasis Mx

A

Localised: Oral miconazole
Extensive: Oral Fluconazole

1431
Q

DIC blood results

A

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

1432
Q

Antihistamine creasm

A

Calamine lotion, topical menthol 1%

1433
Q

Winging of scapula. What nerve affected?

A

Long thoracic

1434
Q

What electrolyte abnormality can trimethoprim cause?

1435
Q

What can predispose to ovarian torsion?

A

Malignancy

1436
Q

What Ix for suspected SVCO

A

Contrast CT

1437
Q

Most common cause of UTI in immunosuppresssed

A

Pseudomonas

1438
Q

Initial Mx of cardiac tamponade

A

CHECK BP

IF UNSTABLE, oxygen and fluids

THEN pericardiocentesis

1439
Q

Pregnant patient with stones with renal stones. Ix?

1440
Q

First line Mx for restless leg syndrome

A

Dopamine agonist e.g. pramipexole or ropinirole

1441
Q

Difference between bulbar and pseudobulbar palsy

A

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.

1442
Q

Pt with phaeo triad. Initialy Ix in GP?

A

Refer to see specialist on same day

1443
Q

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

A

Review and remeasure BP in 1 week

1444
Q

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

A

Unfractionated heparin

1445
Q

STEMI Mx

1446
Q

NSTEMI Mx

1447
Q

Bone pain/swelling in children. Potential Dx?

A

Bone sarcoma, urgent X ray within 48 huours

1448
Q

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

A

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

1449
Q

Samter’s triad

A

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

1450
Q

Mx of sigmoid volvlulus

A

Flexible sigmoidoscopy

1451
Q

Which of measles or rubella has conjunctivitis

1452
Q

What CTD can cause menorrhagia

A

Ehler Danlos

1453
Q

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

A

Offer colonoscopy as likely a strong genetic basis

1454
Q

Bounding pulse

A

Acute CO2 retention

1455
Q

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

A

Haloperidol

1456
Q

Best antiemetic in parkinsons

A

DomperidoneBe

1457
Q

Best class of medication in parkinsons to treat tremor

A

Antimuscarinics

1458
Q

What cancer can cause thrombocytosis?

A

Lung cancer

1459
Q

Options for rhythm control in AF

A

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

1460
Q

How to differentiate biliary colic and acute cholecystitis?

A

Acute cholecystitis has raised inflammatory markers, biliary colic has normal

1461
Q

Diagnostic feature of empyema

A

Loculated pleural effusion on ultrasound

1462
Q

MEN 1 is associated with

A

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

1463
Q

MEN 2a is characterised by

A

thyroid medullary carcinoma, pheochromocytoma, and parathyroid tumours

1464
Q

MEN 2b is associated with

A

thyroid medullary carcinoma, pheochromocytoma, and mucocutaneous ganglioneuromas.

1465
Q

Mx of post-herpetic neuralgia

1466
Q

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

A

Brown-sequard syndrome

1467
Q

best Ix for mesenteric ischaemia

1468
Q

CHADSVASC score

A

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).

1469
Q

Diagnostic Ix for achalasia

A

Oesophagael manometry

1470
Q

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

A

PFO, do an echo

1471
Q

Mx of gastrinoma

A

Somatostatin analogue - Octreotide

1472
Q

Weber classification of fractures

A

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

1473
Q

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

A

Holmes-adle pupil.

1474
Q

Ix for holmes-adle pupil

A

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).

1475
Q

What type of disorders can manifest with bleeding problems?

1476
Q

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

A

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

1477
Q

What anti parkinson medication can cause compulsive behabiours

A

Dopamine agonists e.g. ropinirole

1478
Q

What artery likely affected in bleeding duodenal ulcer

A

Gastroduodenal

1479
Q

Small, numerous opacities in upper lung zones with hilar lymphadenopathy

1480
Q

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

1481
Q

Mx of hyperkalaemia

A

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.

1482
Q

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

A

Bronchiolitis obliterans

1483
Q

What excess vitamins can cause kidney stones?

1484
Q

What artery affected in temporal arteritis?

A

Superficial temporal artery

1485
Q

What artery affected in peptic (gastric) ulcer?

A

Left gastric

1486
Q

Normocytic anaemia. What Ix?

1487
Q

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

A

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

1488
Q

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

A

Chondrosarcoma

1489
Q

What to do if major bleeding on warfarin?

A

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.

1490
Q

What to if minor bleeding on warfarin?

A

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.

1491
Q

What to do if no bleeding on warfarin?

A

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.

1492
Q

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

A

toxic shock syndrome

1493
Q

What nerve is associated with tear formation?

A

Intermediate nerve, branch of facial nerve

1494
Q

Mx of cataract

A

phacoemulsification

1495
Q

definitive treatment in PSC

A

Liver transplanatation

1496
Q

Mx of scleritis

A

oral NSAIDs

1497
Q

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

A

Methotrexate

1498
Q

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

A

Fibromuscular dysplasia, managed with antihypertensives and renal artery balloon angioplasty

1499
Q

Echo findings on HOCM

A

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.

1500
Q

What electrolyte abnormality can cause peptic ulcer disease?

A

Hypercalcaemia

1501
Q

What sided varicocele is worrying? Why?

A

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.

1502
Q

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

A

tinea capitis

1503
Q

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

A

Vasopressor, e.g. noradrenalien

1504
Q

What antihypertensive can cause angioedema?

1505
Q

Best Ix for sialadenitis

A

US guided fine needle aspiration

1506
Q

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

A

bronchiolitis obliterans

1507
Q

history of hereditary haemorrhagic telangiectasia and his presentation of exertional dyspnoea

A

pulmonary AV malformation

1508
Q

Mx of sepsis in ascending cholangitis

A

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

1509
Q

In major trauma, best support for hypotension?

A

Packed red blood cells (through a fluid warmer)

1510
Q

Mx of toxic shock syndrome

A

IV clindamycin and vancomycin

1511
Q

What bone affected in otosclerosis?

1512
Q

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

A

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.

1513
Q

Sx of carpal tunnel syndrome following FOOSH?

A

Lunate bone dislocation

NOTE: Scaphoid most common fracture, lunate most common dislocation

1514
Q

What location of gallstone is an ERCP appropriate?

1515
Q

A mnemonic to learn the degrees of burns could be

A

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

1516
Q

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

A

toxic shock syndrome

1517
Q

What should be prescribed adjunt to retinoids in women?

A

Contraception

1518
Q

What murmur in proximal aortic dissection

A

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

1519
Q

primary anticoagulation recommended in acute limb ischaemia

A

IV unfractionated heparin

1520
Q

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

1521
Q

Normal QT interval

A

<420 seconds

1522
Q

What dermatological emergency can psoriasis lead to? MX?

A

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.

1523
Q

keratin pearls on biopsy

1524
Q

1st line Mx for AIH

A

Azathioprine and prednisolone

1525
Q

What can large fibroids cause?

A

Urinary retention - think if there is suprapubic tenderness

1526
Q

Initial Mx of hypocalcaemia

A

Observe, if symptomatic or <1.95 then give calcium gluconate

1527
Q

Gold standard Ix for salivary gland stoens

A

Sialography

1528
Q

Bat wing pattern on CXR, history of immunodeficiency

1529
Q

first like Ix for suspected hypocalcaemia

A

ECG - prolonged QT

1530
Q

Mx of acute cholecystitis

A

Analgesia, IV fluids, IV abx, abdo USS

1531
Q

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

1532
Q

Mx of diabetic retinopathy with maculopathy

A

Anti-VEGF injection

1533
Q

exudates forming a ring around a dot haemorrhage near the fovea

A

Diabetic retinopathy with maculopathy

1538
Q

Mx of proliferative diabetic retinopathy

A

Panretinal photocoagulation

1538
Q

Suddent onset breathless in CF?

A

Pneumothoraces, PE not common

1539
Q

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

A

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.

1540
Q

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

A

GI endoscopy - look for causes of bleeding

1541
Q

1st line Ix for carotid artery stenosis

A

US carotid

1542
Q

Constipation secondary to opiate use? Mx?

A

Senna - stimulant

1543
Q

anaemic, with tachycardia and a gallop rhythm

A

HF due to anaemia

1544
Q

Ix for giardiasis

A

SMall bowel biopsy

1545
Q

Most common composition of gallstones

A

Cholesterol

1546
Q

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

A

unfractionated heparin, and thrombolysis should be considered

1547
Q

Causes of toxic shock syndrome

A

Retained tampon, packing in epistaxis

1548
Q

What management in PAD when an ulcer has developed?

A

Angioplastyu

1549
Q

Grading of diabetic retinopathy

A

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).

1550
Q

Mx of diabetic retinopathy

A

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.

1551
Q

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

A

abrupt - urinary clot, flush

Gradual - dehydration and hypovolaemia, fluid bolus

1552
Q

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

1553
Q

First Ix for retinoblastoma

A

US of affected eye

1554
Q

What antibodies are in HDN

1555
Q

Men with recurrent bacteriuria, consider what Dx?

A

Chronic bacterial prostatitis

1556
Q

first line Ix in someone with delayed puberty

A

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

1557
Q

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

A

muscular dystrophy

1558
Q

typical signs of a patient with an anastomotic leak

A

atrial fibrillation, increasing confusion and signs of sepsis

1559
Q

Mx of portal hypertension

A

Propanolol

1560
Q

Long term treatment of choice for oesophogael varices

A

Band ligation of large varices

1561
Q

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

A

Pulmonary hypertension

1562
Q

What can sinusitis predispose to?

A

Cerebral abscess

1563
Q

aortic dissection, spontaneous pneumothorax and upward lens dislocation

1564
Q

cough that is worse at night. Dx?

A

Acute bronchitis

1565
Q

Cavitating lesions. What vasculitis?

A

cANCA - Wegners

1566
Q

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

A

testicular appendage

1567
Q

first line Mx for aspiration pneumonia

1568
Q

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

A

Parotid gland adenocarcinoma

1569
Q

Best drug for MND

1570
Q

What vitamin deficiency can tuberculosis medication cause?

1571
Q

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

A

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

1572
Q

1st line Ix in someone with amenorrhoea

A

Pregnancy test

1573
Q

What must be ruled out before Dx of hyperprolactinaemia?

A

Hypothyroidism
Chronic renal failure
Pregnancy

1574
Q

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

A

If invading ethmoidal sinus, medical management is cef and mtro

1575
Q

Peripheral, spiculated lung mass

A

Adenocarcinoma (also most common lung cancer)

1576
Q

Mx of sliding hiatus hernia

A

Initial lifestyle management and PPI

Then fundoplication

Paraoesophagael surgery done for paraoesophagael hernia

1577
Q

Toxin cause of hypomagnasaemia

1578
Q

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

A

Mycoplasma

1579
Q

How to differentiate between TEN, staphylococcal scaled skin syndrome

A

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

1580
Q

First line Ix for salivary gland stones

1581
Q

alpha synuclein

A

Parkinson’s/Lewy body

1582
Q

Neurofibrillary tangles

A

Alzheimers

1583
Q

Spongioform complexes

1584
Q

Which dopamine agonist best for prolactinoma

A

Cabergoline

1585
Q

Abx options for COPD infective exacerbations

A

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

1586
Q

Abx threshold in tonsilitis

A

CENTOR score >3

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

1587
Q

Common causes of drug induced lupus? Antibody?

A

isoniazid (used for TB), procainamide, hydralazine, minocycline and phenytoin

Anti-histone antibody

1588
Q

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

A

Congenital syphillis, use ben pen

1589
Q

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

1590
Q

Abx for pseudo aeruginosa

1591
Q

Alternative pain medication to IM diclofenac in patients with PUD

A

IV paracetamol

1592
Q

SE of doxorubicin

A

Dilated cardiomyopathy

1593
Q

SE of cyclophosphomide

A

Haemorrhagic cystitis

1594
Q

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

A

Haemodialyse, this is an AKI that is leading to uraemia

1595
Q

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

A

?oral hairy leukoplakia, reger to secondary care

1596
Q

Mx of ascending cholangitis

A

if septic, ERCP for biliary drainage and IV ABx

1597
Q

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

A

Obesity, tetracyclines

Acne often associated with it as tetracyclines used for that

1598
Q

What dose of dex in metastatic spinal cord comrpession

1599
Q

Indications for acute dialysis include

A

refractory hyperkalaemia, fluid overload, toxin ingestion, and uraemia.

Suspect in anyone with high creatinine, think AKI being the cause first

1600
Q

Ix for IIH

A

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

1601
Q

What sign means that mastitis requires ABx

A

nipple fissure - give fluclox

1602
Q

What UTI medication can cause a fasely low GFR

A

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

1603
Q

What are antibodies in bullous pemphigoid directed against

A

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

1604
Q

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

A

SGLT-2 causing DKA. Check meds

1605
Q

Medication for steroid induced diabetes

A

Sulphonylurea e.g. gliclazide

1606
Q

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

1607
Q

Mx of someone on a mab who presents with fever

A

Admit for further investigations

1608
Q

Mnemonic to remember KCC for liver transplanatation

A

“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

1609
Q

Best Ix to do prior to initiation for acetylcholinesterase inhibitors

A

ECG, for QT

1610
Q

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

1611
Q

Best anticoagulant for cavernous sinus thrombosis

1612
Q

immediate management of ACAG

A

Pilocarpine eye drops, carbonic anhidrase inhibitors

1613
Q

When are carbonic anhidrase inhibitors contraindicated

1614
Q

Anti epileptic that can cause pancreaitits

1615
Q

Mx of MRSA infectivite endocarditis

A

Vanco and rifamp

1616
Q

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

A

Erythroderma, think background of eczema or psoriasis

1617
Q

Delayed presentation of viral thyroiditis

1618
Q

Best initial Ix for cushings

A

Overnight dexamethasone suppressiont est

1619
Q

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

A

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

1620
Q

Mx of colicky pain due to peristalsis in malignant obstruction

A

Hycosine butylbromide

1621
Q

hyponatraemia and hyperkalaemia in a neonate. Dx?

A

CAH, may have a fused labia and urogenital sinus

1622
Q

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

A

Congenital diaphragmatic hernia

1623
Q

Yawning in a neonate. Potential Dx?

A

Opioid withdrawal due to maternal drug use

1624
Q

fever and foul smelling discharge following invasive testing for antenatal conditions

A

Chorioamnionites

1625
Q

What is haemotympanum a sign of? Ix?

A

Basal sjull fracture, urgent CT head within an hour

1626
Q

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

1627
Q

What should be screened for prior to initiation of infliximab?

A

TB - can either do CXR to check for ghon focus, or IGRA to test for latnet TB

1628
Q

Mx of overflow diarrhoea due to constipation in an adult

A

Phosphate enema

1629
Q

What drugs to avoid in alzheiemrs

A

Anticholinergiics - e.g. oxybutynin

1630
Q

Best blood test for rheumatic

A

Anti-streptolysin O test

1631
Q

Common SE of nebulised salbutamol

A

Tachycardia

1632
Q

What reflex may be absent on someone with a vitreous haemorrahge

A

red reflex

1633
Q

Best marker for re-infarction

1634
Q

Best Ix for infective endocarditis

1635
Q

Surgical management of cauda equina syndrome

A

Surgical decompression and laminectomy

1636
Q

Mx of non-epileptic seizures

A

Refer for psychotherapy

1637
Q

Ix for mesenteric ischaemia

A

CT angiography, do lactate too

1638
Q

What medication can be used for aspirin overdose?

A

Sodium bicarbonate

1639
Q

Oesophogael candidias. Do what testing?

1640
Q

Most important management of acute chest crises

A

Pain management

1641
Q

What blood marker may be low in haemolysis?

A

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

1642
Q

What Ix before trastuzumab?

1643
Q

What can recurrent episodes of otitis media lead to?

A

Tympanosclerosis - characterised by chalky white patches on tympanic membrane and conductive hearing loss

1644
Q

Most common cause of intracerebral haemorrhage

A

Hypertensive vasculopathy

1645
Q

inguinal lymphadenopathy following painless penile ulcer, think?

A

Lymphogranuloma venerum - give doxy

1646
Q

anticoag not working with DOAC, swap to?

1647
Q

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.

A

Lemierre syndrome - infective thrombophlebeiutis, can lead to septic emboli and stroke

1648
Q

history of chronic pancreatitis presents with post-prandial vomiting and abdominal pain

A

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

1649
Q

If IgA deficient, test for coeliac?

A

IgG TTG, then duodenal biopsy

1650
Q

Medical management of acute limb ischaemia is with

A

High flow o2 and unfractionated heparin infusion

1651
Q

Mx of acute breathlessness post thyroidectomy

A

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.

1652
Q

Significant AKI with Hx of intraabdominal malignancy, what ix?

A

US renal tract

1653
Q

How to differ between medical and surgical third nerve palsys?

A

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

1654
Q

Thyroid eye disease with visual disturbance. Mx?

A

Surgical decompression of the optic nerve

1655
Q

Ix for leprosy? Mx? AKA?

A

Skin swab, rifampicin (monthly) and dapsone (daily), AKA hansen’s disease

1656
Q

Fluid management for insulinoma

A

Dextrose and potassium supplement

1657
Q

Metabolic acidosis ina patient with CKD

A

Could be progression to end stage CKD, causes low bicarboante and increased resp rate and hypocarbia to compensate partially

1658
Q

Worsening renal function with dark brown urine should raise suspicion of

1659
Q

Peripheral nuropeathies in different locations across the body randomly with background of ischaemia, inflammatory or infection. Dx? Mx?

A

Mononeuritis multiplex. Check for cause

1660
Q

Low grade Barrets Mx? High grade Mx?

A

Low grade - high dose PPi and surveillance
High grande - endomucosal resection

1661
Q

Most important spirometry measure for restrictive conditions e.g. GBS and MG

1662
Q

Little to no improvement when started on co-benyldopa in PD. Think?

A

Parkinson plus syndrome - do lying and standing BP for MSA, do vertical gaze test for PSP

1663
Q

What should be given after dexamethasone in metastatic spinal cord compression?

A

Radiotherapy given within 24 hours to prevenet premanent neurological damage

1664
Q

What CN’s are within the cavernous sinus?

1665
Q

Cranial nerves and brainstem

A

Midbrain - 3,4
Pons - 5,6,7,8
Medulla - 9-12

1666
Q

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?

A

Caervnous sinus syndrome, likely due to a thrombus secodnary to cavernous sinus infection

1667
Q

Best first Ix for ?diabetes insipidus

A

Serum and urine osmolality

1668
Q

no clinical features suggestive or urge or stress incontinence, recent Hx of radiotherapy to the pelvis. Constant urinary leakage. Dx?

A

Vesicovaginal fistula

1669
Q

Best marker of prognostic function of liver damage

A

PT or INR, APTT usually spared

1670
Q

Dorsal column

A

Fine touch, vibration and proprioception

1671
Q

Spinothalamic

A

Pain and temperature

1672
Q

What to give in UTI if trimethoprim or nitrofurantoin contraindicated?

A

Pivmecillinam

1673
Q

Diagnostic test for strep pneumoniae

A

urinary antigen

1674
Q

1st line treatment for allergic conjunctivitis

A

topical mast cell stabilizer (sodium cromoglycate) and topical antihistamine (antazoline).

1675
Q

Best malaria prophtylaxis

A

atovaquone-proguanil

1676
Q

What HTN cut off is required before giving BP control instead of aleteplase?

1677
Q

1st line Mx for otitis externa

A

Topical cirpo and hydrocortisone

1678
Q

100 mg of oral morphine per 24 hours is approximately equivalent to WHAT dose of transdermal fentanyl

A

25 μg/hour of transdermal fentanyl

1679
Q

What tests required for brain death diagnosis

A

Clinical neuro examination and apnoea test

1680
Q

Gene affected in FAP

1681
Q

Gene affected in lynch syndrome

1682
Q

Gene affected in Li-fraumeni

1683
Q

1st line test for Tb
Gold standard

A

1st line - sputum acid fast b acilli smear
Gold standard - sputum culture

1684
Q

Symptomatic Mx of large fibroids

A

First line - transexamic acid/mefenamic acid
Then GnRH

1685
Q

Alternative to HRT for patients with vasomotor Sx

A

Clonidine or SSRI

1686
Q

1st line Mx for uncomplicated malaria

A

ACT - artemisin combination therapy

1687
Q

Features of mild NPDR

A

Microaneurysms onlyF

1688
Q

Features of moderate NPDR

A

microaneurysms, intraretinal haemorrhages and hard exudates.

1689
Q

Features of severe NPDR

A

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.

1690
Q

Features of proliferative diabetic retinopathy

A

neovscularisation - panretinal photocoagulation

1691
Q

Diffuse bilateral interstitial infiltrates following immunosuppression. Think?

1692
Q

What anatomical feature increaes risk of primary acute angle closure gaucom

A

Narrow anterior chamber angle

1693
Q

etinal whitening in a sector of the retina, scattered flame-shaped haemorrhages and venous dilatation and tortuosity in the affected area are consistent with

A

Branch retinal vein occlusion

1694
Q

painless, firm plaque on the dorsal side of the penis and penile curvature during erections are characteristic of

A

Peyronie’s disease

1695
Q

new neurological deficits and increased intracranial pressure in post operative period for neurosurgery

A

Think cerebral oedeam

1696
Q

Best short term feeding approach if patient struggling with dysphagia

A

NG tube feedin

1697
Q

initial management for this patient with complex maxillofacial fractures involving the maxilla and zygomatic bones

A

Open reduction and initial fixation

1698
Q

Initial Mx for ASD

A

applied behaviour analysis therapty

1699
Q

Best graft for cosmetic results

A

Full thickeness skin graft

1700
Q

Mx of arteriovenous malformation

A

Emobolisation of the malformation, eliminationg the abnormal connection between artery and vein

1701
Q

Ideal medication for a depressed patient who wants to stop smoking

A

Buproprion, it is an atypical antidepressant

1702
Q

Gold standard for bariatric surgery

A

Roux en Y gastric bypass

1703
Q

Mx of obesity

A

> 35 BMI with no co-morbidities and motivation to lose wight - orlistat and dietary/exercise advice
35 with comorbiditis or >40 - gastric bypass

1704
Q

Urinary Sx with PMHx of STIs

A

Urethral stricture

1705
Q

Who should be referred for consideration of an Aortic valve replacement

A

Aortic stenosis with LVEF or <55

1706
Q

dry cough, increasing shortness of breath on exertion, hypoxia, finger
clubbing and bibasal crepitations. Hx of smoking. Dx?

1707
Q

lower back pain, pain in the left leg,
and tingling in the left big toe. What dermatome? What sign also seen,

A

L5 dermatome, foot drop also seen

1708
Q

most likely
causative organism for diarrhoea in an HIV positive patient with protozoa seen on microscopy

A

Cryptosporidium Parvum

1709
Q

Damage to the hypoglossal nerve on one side will cause the tongue to deviate
towards which side?

A

Towards the lesion, e.g. if tongue deciates to right, right hypoglossal affected

1710
Q

zig-zagging and flashing lights, headache, nausea,
and vomiting are typical features of

A

Migraine with aura

1711
Q

Mx of severe, acute urticaria

A

Oral Corticosteroids e.g prednisolone, NOT TOPICAL

1712
Q

Signs of optic neuritis with no optic disc swelling on fundoscopy. Cause?

A

Retrobulbar cause

1713
Q

Initial Mx of nephrotic syndrome

A

Loop diuretic, then consider pred

1714
Q

Mx of postpartum thyroiditis

A

Thyroid phase - propanolol
Hypothyroid phase - levo

1715
Q

Anti diabetic drug that needs stopping before CT scan with contrast

A

Mettformin, nephrotoxic

1716
Q

Inital Mx of post operative low urine output, tachycardia and hypotension

A

Fluid challenge - likely due to hypovolaemia

1717
Q

presence of bilateral pleural
effusions and upper lobe blood vessel diversion on chest X-ray suggests WHAT is causing breathlessness

A

Cardiac cause

1718
Q

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

A

Central retinal artery occlusion

1719
Q

symptoms of a painful red eye without
discharge and a diffuse area of redness on the sclera are suggestive of ? Mx

A

Scleritis, urgent assessment by opthalmologist

1720
Q

When to use amitriptyline over duloxetine for neuropathic pain

A

Renal impairment (<30)

1721
Q

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

1722
Q

copious sputum production, and the history of childhood pneumonia and
recurrent chest infections. Dx>

A

Bronchiectasis due to CF

1723
Q

What Sx can bronchiectasis cause in an exacerbation

A

Haemoptysis

1724
Q

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?

A

Diverticulitis

1725
Q

broad complex ectopic beats suggest what as the origin?

A

Ventricular ectopics

1726
Q

Long history yet small size of the lesion, together with the description of a
raised, pale border. Most likely Dx?

1727
Q

What indicates the need to start Abx in a patient with a long term catheter?

A

Systematic unwellness e.g. fever and mild confusion - suggestive of UTi

1728
Q

bilateral renal masses, reduced renal function and
haematuria.

A

PCKD. Do an US

1729
Q

Worrying feature of a migraine

A

Abrupt onset

1730
Q

elevated blood pressure,
radiofemoral delay, and chest X-ray findings of notching of the ribs in the midclavicular line are suggestive of

A

Aortic coarctation

1731
Q

e history of sinusitis, oral ulceration and
haemoptysis and the bilateral pulmonary nodules on chest X-ray

A

Granulomatosis with polyangiitis

1732
Q

sore throat, malaise, intermittent fever, swollen
tonsils, yellow-tinged sclerae, and tender lymph nodes

A

Infectious mononucleosis

1733
Q

How to reduce risk of oral candidiasis with beclometasone

A

Use a large volume spacer

1734
Q

Mx of empyema

A

Chest drain insertion

1735
Q

Gold standard treatment for OSA

1736
Q

Histological
examination of testicular mass shows areas of mature cartilage and columnar epithelium.

1737
Q

low testosterone and low LH and
FSH levels, the most likely cause of hypogonadotrophic hypogonadism

A

Pituitary adenoma

1738
Q

Acute HF after recent MI, likely due to?

A

Papillary muscle rupture

1739
Q

upper temporal defect in both visual fields.

A

Optic chiasm compression from an inferior approach

1740
Q

Most common cause of non-bullous impetigo

A

Staph auresu

1741
Q

presence of a rash with folliculitis on the chest. What immunosuppressive disease can cause this?

A

HIV serovoncersion - late stage

1742
Q

Gram-positive cocci arranged in
pairs

A

Strep pneumoniae

1743
Q

What part of memory is affected most in alzheimers’

A

Short term

1744
Q

Mx of neuropathic bladder due to multiple sclerosis

A

Intermittent self catheterisation

1745
Q

What feature of C diff makes it hard to destroyq

A

Spore formation

1746
Q

multiple tender ulcers on the
preputial skin following recent sexual intercourse is suggestive of

A

HSV infection

1747
Q

crampy
abdominal pain, poor appetite, sore throat, fever, cervical lymphadenopathy,
and tenderness in the right iliac fossa, suggest

A

Mesenteric adenitis

1748
Q

exaggerated lumbar lordosis and the palpable depression above L5
can be clinical findings of

A

Spondylololisthesis, where one vertebra slips out of line with the one above it. Usually occurs in lumbar spine. Neurological examination usually noraml

1749
Q

h large for gestation uterus and severe early onset pre-eclampsia

A

Molar pregnancy

1750
Q

Most likely route of spread of lung cancer

A

Haematogenosu

1751
Q

facial swelling, fullness, and
prominent chest veins are consistent with s

1752
Q

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

1753
Q

Persistent painless lymphadenopathy. Think?

A

CLL or Non-hodgkin’s. Non-hodgkin’s will not have a significant lymphocytosis

1754
Q

1st line treatment for children and adolescents with anorexia

A

Family therapy

1755
Q

Standard treatment for hepatic encephalopathy. How does it work

A

Latulose, works by reducing the ammount of ammonia in the blood

1756
Q

Best method of IOL if bishop’s score low?

A

vaginal prostaglandin gel

1757
Q

What can be used for slowly progressing labour

A

Membrane sweep, NOT USED FOR INDUCTION

1758
Q

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?

A

Chronic maxillary sinusitis, maxillary sinus most commonly involved

1759
Q

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

A

Subacromial bursitis

1760
Q

What virus is associated
with squamous cell carcinoma of the oropharynx, which includes the tonsils
(typically palatine tonsils and lingual tonsils)

1761
Q

What can be used to reduce breathlessness in end stage heart failure with metastases?

1762
Q

1st line Mx of hodgkin’s

1763
Q

Most appropriate strategy to prevent colon cancer in someone with GAP

A

Panproctocolectomy

1764
Q

fear of public speaking,
avoidance behaviour, and recognition that his fears are irrational are
consistent with a diagnosis of

A

Social phobia

1765
Q

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?

A

suggest residual effects of neuromuscular blockade, use neostigmine to reverse

1766
Q

What procedure can provide palliation of dysphagia in patients with oesophagael cancer?

A

Placement of an oesophagael stent

Particularly useful in those with advanced or metastatic disease who aren’t candidates for curative treatment

1767
Q

back pain, fatigue, normocytic
anaemia, thrombocytopenia and renal failure. Dx?

1768
Q

What can be given in septic shock to maintain blood pressure

A

Noradrenaline/epinephrine infusion, increases SVR and maintains blood pressure

1769
Q

duct-like
structures lined by regular, low columnar cells separated by loose fibrous
tissue, with well-defined margins is consistent with what breast lump

A

FIbroadenoma

1770
Q

Pulling the pinna, or pressure on the tragus often
exacerbates the pain of what condition

A

Otitis externA

1771
Q

Only reccomended treatment for asystole

A

Adrenaline/epinephrine

1772
Q

Best airway device to protect lungs from regurgitated stomach contents

A

Tracheal tube

1773
Q

Most common pathogen in leg cellulitis

A

Strep pyogenes

1774
Q

Breast condition that characteristically causes pain associated with the menstrual cycle

A

Fibrocystic disease

1775
Q

Test for what if recurrent candidiasis

1776
Q

In chronic lithium use, what test shouold be done prior to water deprivation if complaints of polyuria/polydipsia

A

Serum calcium, rule out hypercalcaemia as a cause due to hyperparathyroidism

1777
Q

What can be given prior to a contrast scan in a patient with existing CKD?

1778
Q

Best Ix for cervical spine fracture

A

CT scan of the neck

1779
Q

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

A

Supraventricular premature beats

1780
Q

Most common cause of prosthetic joint infections

A

Staph aureus

1781
Q

Mx of paralytic ileus post op

A

Drip and suck - NG tube and IV fluids

1782
Q

Proctitis and lymphadenopathy in MSM

A

Lymphogranuloma vnereum

1783
Q

increased ratio of LH:FSH along with
oligomenorrhoea and BMI in the overweight range indicates

1784
Q

Best treatment option for metastatic spinal cord compression to preserve neurological function

A

External beam radiotherapy

1785
Q

Difference between inflammatory and mechanical back pain

A

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.

1786
Q

Septic shock, still hypotensive with IV fluids, give?

A

Vasopressors - adrenaline

1787
Q

pain on abduction of the right shoulder that is worse with the arm in internal
rotation and when abduction is resisted. Dx?

A

Supraspinatus tendiopathy, can be diagnosed clincially - NSAIDs and physio is Mx

1788
Q

Terminal restlessness should be
managed with

1789
Q

Drug causes of IPF

A

Nitrio, Bleomycin, Methotrexate, amiodarone

1790
Q

What arrythmia can safely be excluded if patient is conscious?

1791
Q

Post ictal weakness following a focal seizure

A

Todd’s paresis, seen in focal frontal lobe seizures

1792
Q

Painful shin rash + cough

1793
Q

Mx of TEN

A

Supportive, move to ICU

1794
Q

Mxx of hyperthyroidism in pregnancy

A

1st trimester: Propyl
2nd trimester: Carbimazole