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finals qs Flashcards

1
Q

Give 4 risk factors for ischaemic heart disease

A

DM, smoking, high BMI (obesity), FH, hypercholesterolaemia, HTN, increasing age, sedentary lifestyle

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2
Q

Which artery supplies the anterior territory of the myocardium?

A

Left anterior descending artery

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3
Q

Give 3 aspects in immediate management of anterior STEMI

A

ABCDE approach|Oxygen|Morphine|Aspirin 300mg|GTN spray|Contact cardiology|LMWH

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4
Q

What 3 management options are available to treat STEMI?

A

Primary PCI|Thrombolysis

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5
Q

Give 4 medications that must be started prior to discharge post STEMI

A

Statin|Beta blocker|Aspirin|ACE inhibitor|PRN GTN spray

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6
Q

What are the lateral leads in a 12 lead ECG? What vessel could be affected if there is ST elevation in these leads?

A

I, aVL, V5, V6|Circumflex

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7
Q

Give two cardiac enzymes that commonly rise following cardiac damage

A

Troponin (T/I), creatine kinase, CK-MB, AST, LDH

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8
Q

What driving advice would you offer a patient post MI?

A

Not allowed to drive for 4 weeks|Can drive from then on so long as not otherwise disqualified|DVLA do not need to be informed

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9
Q

Give 3 possible complications of coronary angiography

A

Bleeding|Rupture of vessel needing further intervention|Infection|Further MI|Stroke|Allergy to contrast|Death

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10
Q

What ECG changes may develop following STEMI?

A

Hyperacute T waves and then ST elevation (or new onset LBBB)|T wave inversion and pathological Q waves develop over the next few days

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11
Q

Give 2 possible triggers of angina

A

Exertion, cold weather, emotion, heavy meals, lying down, vivid dreams

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12
Q

Give 2 symptoms a patient may experience during an episode of angina

A

Heavy central chest pain|Shortness of breath|Sweating|Feeling faint/lightheaded

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13
Q

What blood tests would you request in a patient with new onset angina?

A

FBC - to check for anaemia as this can precipitate angina|TFTs - for thyrotoxicosis|Lipid profile for hypercholesterolaemia|U+E - for renal vessel disease/if considering ACEi

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14
Q

Name 3 tests (not bloods) that may be used to investigate angina

A

12 lead ECG|Exercise tolerance test|Echocardiogram|Coronary angiography

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15
Q

How does aspirin reduce the risk of coronary events?

A

Irreversibly inhibits cyclooxygenase, which prevents further production of TxA2 from platelets as they do not have a nucleus, shifting the balance of PGI2:TxA2 towards inhibiting platelet aggregation

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16
Q

Give 3 signs of acute pulmonary oedema you would look for on examination

A

Bibasal fine crepitations|Tachypnoea|Tachycardia|Raised JVP|Wheeze|Additional heart sounds/gallop rhythm|Dull percussion of bases|Cyanosis

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17
Q

Give 4 investigations you would request in a patient who you suspect has had an MI and acute pulmonary oedema

A

12 lead ECG|CXR|FBC|Cardiac enzymes|Coronary angiography

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18
Q

Name 1 drug that may have been used to treat acute MI with pulmonary oedema that could cause hypokalaemia

A

Furosemide

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19
Q

Name 2 drugs used in the treatment of acute pulmonary oedema

A

Furosemide, GTN/nitrates, morphine, oxygen

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20
Q

Give 2 ways in which you can replace potassium

A

Oral (sando-k)|KCl added into IVI

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21
Q

Which territory of the myocardium do leads II, III and aVF represent? Which vessel is responsible for this territory?

A

Inferior, RCA

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22
Q

What is the normal QRS interval?

A

<120ms

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23
Q

What is a capture beat?

A

Normal QRS complex between VT complexes

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24
Q

Give two drugs that may be used during an arrest

A

Adrenaline|Amiodarone|O2|Lignocaine/lidocaine

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25
Q

A patient on your ward arrests. His ECG shows a regular rhythm at a rate of approx 140, broad QRS complexes and an occasional capture beat. He has no palpable pulse. What is this rhythm and is it shockable?

A

Ventricular tachycardia, yes

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26
Q

What system is used to classify the severity of heart failure?

A

New York Heart Association

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27
Q

Give 3 symptoms of LVF

A

Dyspnoea, cough, production of pink frothy sputum, PND, decreased exercise tolerance, fatigue, wheeze

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28
Q

Give 3 signs of heart failure on a chest radiograph

A

Alveolar oedema in bat wing distribution|Kerley B lines|Cardiomegaly|Upper lobe diversion|Pleural effusion

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29
Q

Specifically, how and where does furosemide act?

A

Ascending loop of Henle in the nephron|Competitively inhibits the Na-K-2Cl co transporter, diminishing the osmotic gradient for water reabsorption

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30
Q

A patient is admitted to hospital with worsening confusion and is treated for a UTI. His admission ECG reveals a reverse tick pattern, ST depression and T wave inversion. What drug often used in heart failure causes this?

A

Digoxin

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31
Q

Give two side effects you would make a patient aware of before starting them on an ACEi

A

Dry cough|Renal impairment|Hypotension|Hyperkalaemia|Angioedema/urticaria

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32
Q

Give two signs that may be visible on the retina of someone with hypertensive retinopathy

A

Cotton wool spots|Flame haemorrhages|Papilloedema|Silver/copper wiring|A-V nipping

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33
Q

Give 3 complications of essential hypertension

A

Hypertensive nephropathy|Hypertensive retinopathy|Stroke|Ischaemic heart disease|Heart failure|Aneurysmal disease|PVD

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34
Q

What is the mechanism of action of simvastatin?

A

Inhibits HMG-CoA reductase, the rate-limiting step in cholesterol synthesis

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35
Q

What signs of hypercholesterolaemia may you find on examination?

A

Xanthelasmata, tendon xanthoma, corneal arcus

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36
Q

Name 3 common causes of AF

A

Pneumonia|Alcohol excess|MI/ACS|PE|Hyperthyroidism|Heart failure|Endocarditis

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37
Q

Name 2 features you would see on an ECG in AF

A

Irregularly irregular rhythm|Absent P waves

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38
Q

Name 2 symptoms of AF

A

Palpitations|Shortness of breath|Feeling dizzy/faint/syncope

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39
Q

Name 2 methods that could be used to cardiovert a patient with AF

A

Electrical - DC cardioversion|Chemical - flecainide

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40
Q

Name two drugs that may be used in a patient with AF

A

Propanolol|CCB|Digoxin|Warfarin

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41
Q

Name two complications of AF

A

Embolic events i.e. stroke, TIA, MI

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42
Q

Which organism is commonly responsible for infective endocarditis?

A

Strep viridans

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43
Q

Why might you ask for a urine dip in suspected infective endocarditis?

A

Microscopic haematuria

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44
Q

You examine the fundi of a patient with infective endocarditis and see a boat-shaped retinal haemorrhage with a pale centre. What is this called?

A

Roth spot

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45
Q

What criteria are used to make a diagnosis of infective endocarditis?

A

Duke criteria

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46
Q

Other than an early diastolic murmur, give 3 signs of aortic regurgitation

A

Collapsing pulse|Wide pulse pressure|Displaced apex beat|Quincke’s sign (nail-bed capillary pulsation)|De Musset’s sign|Austin Flint murmur

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47
Q

What organism is likely to cause IE in IVDUs?

A

Staph aureus

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48
Q

How should blood cultures be taken in a patient with suspected IE?

A

3 sets|3 sites|3 times

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49
Q

What Ix would you request in suspected IE?

A

BCs|Echo|ECG|CXR|Urine dip

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50
Q

Give two examples of pre-existing cardiac disease that increases the risk of patients developing endocarditis. What can preve

A

IVDU|Prosthetic valves|PDA|VSD|Coarctation|Mitral valve disease|Aortic valve disease

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51
Q

How can endocarditis be prevented in at-risk patients?

A

Prophylactic ABx prior to invasive procedures

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52
Q

Give 4 common triggers of asthma

A

House dust mite exposure|Cold air |Exercise|Emotional stress|Allergens e.g. household pets|Infections|Pollen|Cigarette smoke|Drugs e.g. NSAIDs, BB

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53
Q

What pattern is seen on spirometry in asthmatics?

A

Obstructive pattern (reduced FEV1:FVC ratio)

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54
Q

How can asthma be diagnosed using spirometry?

A

Improvement in FEV1 by >15% following administration of bronchodilator

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55
Q

Specifically, how does salbutamol improve symptoms in asthmatics?

A

Stimulates B2 receptors of respiratory tract, which increases sympathetic activity and relaxes bronchial smooth muscle

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56
Q

What pattern of spirometry do you see in COPD?

A

Obstructive

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57
Q

What physiological measurement is used to determine the severity of COPD?

A

FEV1

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58
Q

How should you manage an infective exacerbation of COPD?

A

Oxygen (88-92%)|ABG|ABx|Steroids|Salbutamol/ipratropium nebs|Chest physio|Consider NIV|Inform seniors

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59
Q

Give 2 signs on examination of consolidation

A

Reduced chest expansion|Dull percussion note|Bronchial breathing|Increased tactile vocal fremitus and vocal resonance

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60
Q

Give the 3 most likely organisms to cause CAP

A

S. pneumoniae|Haemophilus influenzae|Mycoplasma pneumoniae

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61
Q

Give 2 possible complications of pneumonia

A

Pleural effusion|Respiratory failure|Empyema|Lung abscess|Sepsis|AF|Shock|Pericarditis/myocarditis|Cholestatic jaundice

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62
Q

What signs on examination would you expect in pleural effusion?

A

Reduced chest expansion|Stony dull percussion|Diminished breath sounds

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63
Q

What signs on examination would you expect in pneumothorax?

A

Reduced chest expansion|Hyperresonant percussion|Diminished breath sounds

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64
Q

Give 2 reasons why cases of TB may be on the rise

A

HIV/AIDS prevalence|Use of immunosuppressive drugs|Poor socio-economic conditions, overcrowding|Increased immigration from areas of high prevalence of TB|Multidrug resistance

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65
Q

What antibiotics are used to treat active TB and for how long is each one taken?

A

Rifampicin (6mo)|Isoniazid (6mo)|Pyrazinamide (2mo)|Ethambutol (2mo)

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66
Q

Why are 4 antibiotics used in TB?

A

To combat multidrug resistance

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67
Q

A 26-y/o lady with TB presents with painful, purple nodules over her shins - what are these? Name 2 other causes of this

A

Erythema nodosum|Idiopathic, Crohn’s, UC, sarcoidosis, drugs (OCP, sulphonamides)|Strep infections|Chlamydia|Leprosy

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68
Q

What is the incidence of CF in the UK?

A

1 in 2500 live births

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69
Q

What is bronchiectasis?

A

Chronic infection of the large airways, causing their abnormal, permanent dilatation

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70
Q

Name two organisms that commonly colonise the lungs of CF

A

S pneumoniae|H influenzae|P aeruginosa|Burkholderia cepacia

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71
Q

Give 4 causes of bronchiectasis

A

Idiopathic|Post-infective (inadequately treated necrotising infections e.g. staph aureus, mycoplasma pneumoniae, pertussis, measles, TB, klebsiella)|Post-obstructive (FB, tumour, hilar lymphadenopathy, broncholithiasis)|Congenital (primary ciliary dyskinesia, Kartagener’s syndrome)|Immunodeficiency|Allergic bronchopulmonary aspergillosis|A1-antitrypsin deficiency|RA|UC

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72
Q

Give 2 complications of bronchiectasis

A

Pneumonia|Sepsis|Recurrent pneumonia/LRTIs|Haemoptysis|Resp failure|Cor pulmonale|PTX

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73
Q

Give 2 risk factors for PE

A

Known malignancy|Immobility|Pregnancy|COCP/HRT|Thrombophilia|Known DVT, prev DVT/PE|FH DVT/PE|Major trauma|Inflammatory disease|Nephrotic syndrome|Dehydration|Current infection

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74
Q

Name 2 investigations that may be required to confirm a diagnosis of PE

A

V/Q scan, CTPA

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75
Q

A patient is admitted with a PE and is started on LMWH and warfarin. What will her target INR be? She has no past Hx of VTE - how long should she be on warfarin for?

A

2-3|6 months

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76
Q

What measures can be taken to reduce the risk of VTE in a TKR patient?

A

Prophylactic LMWH, TED stocking, early mobilisation, intermittent pneumatic compression devices

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77
Q

Give 4 symptoms someone with lung Ca may present with

A

Cough|Haemoptysis|Dyspnoea|Chest pain|Hoarse voice|Weight loss|Anorexia|Horner’s syndrome

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78
Q

Name 3 imaging modalities that may be used to determine the extent of disease in lung Ca

A

CXR, CT, PET scan, bone scan

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79
Q

What staging system is used for SCC of the lung?

A

TNM

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80
Q

What is the test for SVC obstruction?

A

Pemberton’s test - lift arms above head and keep them there for a minute, see if it gets worse

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81
Q

Give 3 sites that lung Ca commonly metastasises to

A

Brain|Bone|Liver|Adrenals|Other parts of lung

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82
Q

What are the clinical features of SVC obstruction?

A

Dyspnoea|Headache|Swelling of arms, legs, face|Non-pulsatile dilated neck veins|Dilated collateral vessels of arms and chest|Blue face|Raised JVP|Stridor

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83
Q

52 y/o is diagnosed with IPF. What may you see on her CXR?

A

Reduced lung volume|Reticulonodular shadowing|Honeycomb lung

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84
Q

What are the spirometry findings in IPF?

A

FVC:Low|FEV1:Low|FEV1:FVC ratio: High/Normal

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85
Q

Extrinsic allergic alveolitis is a cause of pulmonary fibrosis. Give 2 causes of this

A

Farmer’s lung|Bird fancier’s lung|Maltworker’s lung|Humidifier fever|Mushroom worker’s lung|Cheese washer’s lung|Winemaker’s lung

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86
Q

Name 2 non-respiratory causes of pulmonary fibrosis

A

Systemic sclerosis|RA|Drugs (MTX, amiodarone, nitrofurantoin, bleomycin)|SLE|Sjogren’s|UC|Tuberous sclerosis|Neurofibromatosis

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87
Q

Give 3 respiratory causes of clubbing

A

Bronchial Ca|Mesothelioma|Bronchiectasis|Cryptogenic organising pneumonia |Chronic empyema|Chronic lung abscess

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88
Q

54 y/o man presents with fatigue, wife says he snores and has recently stopped breathing in night. He is obese with a large neck circumference. You ask him to complete a questionnaire. What is the diagnosis and what questionnaire is this?

A

Obstructive sleep apnoea|Epworth sleepiness scale

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89
Q

Give 3 risk factors for OSA

A

Obesity|Acromegaly|Enlarged tonsils|Enlarged adenoids|Nasal polyps|Alcohol

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90
Q

How is OSA diagnosed?

A

Sleep studies

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91
Q

Give 2 aspects in the management of OSA?

A

Weight loss|Avoid alcohol|Sleep upright|Mandibular advancement device|CPAP|Surgery e.g. tonsillectomy, adenoidectomy

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92
Q

What is cor pulmonale?

A

Right heart failure secondary to chronic pulmonary HTN

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93
Q

What CXR and ECG abnormalities may you see in a patient with cor pulmonale?

A

CXR: dilated right atrium, enlarged right ventricle, prominent pulmonary arteries |ECG: right axis deviation, P pulmonale, dominant R wave in V1, inverted T waves in the chest leads

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94
Q

Give 3 causes of bilateral hilar lymphadenopathy

A

Sarcoidosis|Lymphoma|Bronchial carcinoma|TB|Mycoplasma|Extrinsic allergic alveolitis

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95
Q

What will be seen in a trans bronchial biopsy of a patient with sarcoidosis?

A

Non-caseating granulomatous inflammation

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96
Q

Give 4 extrapulmonary manifestations of sarcoidosis

A

Skin - erythema nodosum|Eye - anterior uveitis, posterior uveitis, keratoconjunctivitis sicca|MSK - arthralgia, bone cysts|CNS - neuropathy, CN palsies|Cardiac - cardiomyopathy, ventricular dysrhythmias|Other - lymphadenopathy, hepatosplenomegaly, hypercalcaemia

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97
Q

What advice would you give a patient before starting long term corticosteroids?

A

Don’t stop taking them suddenly|Doses should be reduced gradually|Carry a steroid card at all times|Doses need to be increased at times of inter current illness|Always inform doctors and dentists prior to start of treatment or surgery|Inform of side effects

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98
Q

Give 6 side effects of long term corticosteroids

A

Endocrine - adrenal suppression, hyperglycaemia|Change in fat distribution - central obesity, buffalo hump, moon face|Skin - easy bruising, skin thinning|Eyes - cataracts|MSK - muscle wasting, osteoporosis, AVN of femoral head|Psych - psychosis, euphoria, emotional lability|HTN|Increased susceptibility to infection|Peptic ulceration

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99
Q

What signs on examination would you expect in pleural effusion?

A

Reduced chest expansion on affected side|Stony dull percussion

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100
Q

Where should you insert the needle in a pleural tap and why?

A

Above the rib|To avoid the neurovascular bundle that is located immediately below the ribs

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101
Q

If the protein content is high (<30 d/L) in a pleural tap sample, is it an exudate or transudate?

A

Exudate

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102
Q

If the LDH is high (>200IU/L) in a pleural tap sample, is it an exudate or transudate?

A

Exudate

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103
Q

What test would you ask the lab to carry out on a pleural tap sample from a pleural effusion?

A

Protein content|LDH|MC+S|Cytology|Glucose|Amylase|pH|Ziehl-Neelsen staining for acid-fast bacilli

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104
Q

A lady comes in with recurrent pleural effusion. Your consultant explains that you will drain the infusion then instil a chemical to “plug the gap”. What procedure is this and what chemical is used?

A

Pleurodesis with talc, bleomycin, tetracycline

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105
Q

A man has an eGFR of 52. What stage CKD is this?

A

CKD 3

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106
Q

Give 4 common causes of CKD

A

Diabetes|HTN|Glomerulonephritis|PKD|Renovascular disease|Pyelonephritis|Obstructive uropathy

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107
Q

A renal USS is arranged for a man with CKD - give 2 reasons why this has been arranged

A

Exclude obstruction|Assess renal size|Exclude PKD

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108
Q

Give 2 common side effects of ACEi

A

Dry cough|First-dose hypotension|Hyperkalaemia|Acute renal failure|Urticaria

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109
Q

Give 4 blood tests it is important to monitor in patients with diabetic nephropathy

A

U+E|Diabetic control|Ca2+|PO4|Alk phos|PTH|FBC

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110
Q

A 75 y/o lady is being readied by the renal team for RRT. Her eGFR is 14. What stage of CKD does she have?

A

CKD 5

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111
Q

Give 3 signs of end stage CKD you may see on examination

A

Pallor|Uraemic tinge|Purpura|Bruising|Brown discolouration of nails|Evidence of excoriation|Peripheral oedema|HTN|Pericardial rub|Evidence of pleural effusion|Proximal myopathy|Evidence of preparation for RRT

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112
Q

Explain the basic principles of haemodialysis

A

Blood and dialysis fluid flow either side of a semipermeable membrane|Molecules diffuse down their concentration gradients|Plasma biochemistry changes to become more like the dialysis fluid

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113
Q

Give 2 complications of peritoneal dialysis

A

Bacterial peritonitis|Local infection at catheter site|Constipation|Failure|Sclerosing peritonitis

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114
Q

What time period determines whether renal rejection is acute or chronic?

A

Six months

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115
Q

Why might renal transplant patients on immunosuppression see a dermatologist?

A

Increased risk of SCC due to long-term immunosuppression

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116
Q

A 74 y/o man has CKD 4 and recent bloods have shown a low calcium and high PTH. What form of hyperparathyroidism is this?

A

Secondary hyperparathyroidism

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117
Q

Give 2 actions of PTH

A

Increased osteoclast activity leads to increased Ca and PO4 release from bone|Increased Ca and PO4 reabsorption via kidney|Increased hydroxylation of vit D

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118
Q

At what 2 sites does hydroxylation of vitamin D occur?

A

Liver, kidney

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119
Q

What is the term given to bone disease in patients with renal failure? Give 2 aspects of the management of this condition

A

Renal osteodystrophy|Phosphate restricted diet|Phosphate binders|Vit D analogues|Calcium supplements

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120
Q

What blood results would you get in tertiary hyperparathyroidism? Why has this developed in a patient with CKD4 who previously had secondary hyperparathyroidism?

A

High PTH, high Ca|Prolonged secondary hyperparathyroidism causing the parathyroid glands to act autonomously

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121
Q

How can AKI be sub-classified? Give 2 causes of each

A

Pre renal - hypovolaemia, sepsis, renal artery stenosis, ACEi, NSAIDs, CCF, cirrhosis|Renal - ATN, nephrotoxins, vasculitis, glomerulonephritis, HUS, malignant HTN, TTP, acute tubulointerstitial nephritis, pre-eclampsia|Post renal - renal caliculi, renal tumours, ureteric tumours, BPH, prostate cancer

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122
Q

Name 2 potentially life-threatening complications of AKI

A

Pulmonary oedema|Hyperkalaemia|Haemorrhage

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123
Q

Give 2 indications for dialysis in AKI

A

Refractory pulmonary oedema|Persistent hyperkalaemia|Severe metabolic acidosis|Uraemic encephalopathy|Uraemic pericarditis

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124
Q

Other than bloods, how would you investigate AKI?

A

ECG|CXR|Renal USS|ABG|Urinalysis

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125
Q

What is acromegaly?

A

Hypersecretion of GH by a tumour in the anterior pituitary

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126
Q

State 6 signs or symptoms you may find in acromegaly

A

Thick spade like hands|Frontal bossing|Macroglossia|Bitemporal hemianopia|Headache|Sweats|Wide spaced teeth|Prognathism|Voice changes|Sleep disturbance due to OSA|CTS|HTN

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127
Q

Why do people with acromegaly become clumsy?

A

Bitemporal hemianopia due to pituitary tumour pressing on optic chiasm

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128
Q

What serum blood test do you use to screen for acromegaly?

A

Serum IGF-1

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129
Q

How does an OGTT aid diagnosis of acromegaly?

A

Rapid increase in blood glucose should suppress GH secretion|This will not happen in a patient with acromegaly

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130
Q

What other endocrine disorder would you screen for in a patient newly diagnosed with acromegaly? What is the main cause of death in these patients?

A

DM|GH is anti-insulin and this leads to a state of insulin resisitance and eventually DM|CV disease

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131
Q

What surgery can cure acromegaly?

A

Trans-sphenoidal resection of pituitary tumour

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132
Q

Name some causes of hypothyroidism

A

Amiodarone|Radiotherapy|Autoimmune|Iodine deficiency|Cancer|Infection|Hypopituitarism

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133
Q

What might an FBC show in a patient with hypothyroidism?

A

Macrocytic anaemia

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134
Q

What will the TSH and T4 be in a patient with hypothyroidism?

A

TSH high |T4 low

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135
Q

What anatomical structure represents the site at which the thyroid gland originated before embryological descent?

A

Foramen caecum

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136
Q

What is Grave’s disease?

A

Autoimmune disease caused by TSH receptor antibodies

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137
Q

Name 3 signs you might look for on examination in Grave’s disease. Name 2 which are specific to Grave’s

A

Tachycardia, tachycardia|AF|Warm peripheries|Goitre|Thinning of hair|Brisk reflexes|Palmar erythema|High-output cardiac failure signs|Specific: pretibial myxoedema, eye disease (ophthalmoplegia, exopthalmos), thyroid acropachy

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138
Q

What would the TFTs show in Grave’s disease?

A

Low TSH|High T4

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139
Q

What drugs can be used to control tremor in Grave’s disease?

A

Beta blockers

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140
Q

Name 2 drugs that “block the thyroid”

A

Carbimazole|Propythiouracil

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141
Q

A 25-y/o lady comes in with symptoms of excessive thirst, weight loss, increase in urine production. Urine dip negative for glucose. What is the likely diagnosis?

A

Diabetes insipidus

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142
Q

Where is ADH secreted from?

A

Posterior pituitary

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143
Q

With the use of low, high and normal, what do you expect the urine and plasma osmolality to be in diabetes insipidus?

A

Urine - low|Plasma - high

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144
Q

What is the difference between the nephrogenic and cranial types of this condition?

A

Nephrogenic - lack of response to ADH in the kidney|Cranial - lack of production of ADH

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145
Q

How is the water deprivation test used to diagnose DI?

A

Patient is starved of any fluid intake|Normal response would be to concentrate urine and decrease urine output; however in DI there is continued large volume urine production with low osmolality

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146
Q

Name the drug used to treat cranial DI

A

Desmopressin

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147
Q

What is the syndrome of DI after massive post-partum haemorrhage called?

A

Sheehan’s syndrome

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148
Q

Give 2 ways of raising the blood glucose of an unconscious patient with a hypo

A

IM glucagon|IV glucose

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149
Q

Name 3 symptoms of neuroglycopenia

A

Coma|Confusion|Drowsiness|Seizures|Hemiparesis

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150
Q

What can repeated episodes of hypoglycaemia lead to?

A

A lack of awareness of hypoglycaemia

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151
Q

What advice would you give to avoid hypos?

A

Regular finger-prick monitoring|Never miss a meal|Keep emergency supply of glucose in pocket e.g. energy tablets|Adjust insulin in response to changes in diet, activity, illness

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152
Q

Name a cause of hypoglycaemia in non-diabetics

A

Alcohol binging|Liver failure|Addison’s|Insulin-secreting tumours|Pituitary insufficiency

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153
Q

Explain the OGTT

A

Patient fasts overnight|Drinks 75g of glucose in 300ml water|BM measured prior to drink then at 120 mins|DM diagnosed if BM at 120 min >11.1mmol/L|DM diagnosed if fasting >7mmol/L|Patient advised not to drink coffee or smoke in fasting period

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154
Q

Name 2 macrovascular and 2 microvascular complications of T2DM

A

Macro: CVA, MI/IHD, PVD|Micro: nephropathy, neuropathy, retinopathy

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155
Q

Name 3 different agents that could be used to treat T2DM

A

Metformin (biguanides), pioglitazone (thiazolidinedione), tolbutamide (sulfonylurea), insulin

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156
Q

What lifestyle advice would you give to a patient with newly diagnosed T2DM?

A

Lose weight, eat healthy, stop smoking

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157
Q

How do you confirm a DKA on bedside testing?

A

Urine dip - presence of ketonuria

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158
Q

Name 2 venous blood tests you would perform in a DKA

A

U+E - electrolyte abnormality, renal failure|FBC - may indicate infection

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159
Q

What is the initial management of a DKA?

A

Fluid replacement (aggressive)|Insulin sliding scale|Potassium replacement

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160
Q

Explain the pathophysiology of a DKA

A

Insulin deficiency produces glucose production in the liver|Lipolysis occurs|Fatty acids broken down to form ketone bodies which produce a metabolic acidosis

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161
Q

A 40 y/o man comes to you complaining of feeling tired all the time and loss of appetite. Has PMH of vitiligo. Examination unremarkable except for tanning of skin and buccal pigmentation.|What do you suspect the diagnosis and pathogenesis is?

A

Addison’s disease|Autoimmune (because of the vitiligo)

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162
Q

Name 2 tests you would perform to aid diagnosis of Addison’s

A

U+E|Short synacthen test

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163
Q

What would you expect the serum sodium and potassium to be in Addison’s?

A

Low sodium|High potassium

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164
Q

What drugs would you prescribe to a patient with Addison’s?

A

Glucocorticoids|Mineralocorticoids

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165
Q

What advice do you give to a patient with Addison’s regarding their steroid use?

A

Carry a steroid card and medic alert bracelet|Know how to change dose of medication in intercurrent illness|Carry an emergency ampoule of hydrocortisone in case you can’t ingest orally

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166
Q

What is the commonest cause of pathological hyperprolactinaemia?

A

Prolactinoma

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167
Q

Name 4 signs and symptoms of prolactinoma

A

Amenorrhoea|Bitemporal hemianopia|Galactorrhoea|Subfertility|Headache|Decreased libido

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168
Q

What imaging would you request in suspected prolactinoma?

A

MRI head

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169
Q

Why would you order visual field testing in suspected prolactinoma?

A

Prolactinoma may grow and press upon the optic chiasm|Causing a bitemporal hemianopia

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170
Q

What is the medical management of hyperprolactinaemia and what is its MoA? What other non-surgical treatment is available?

A

Cabergoline/bromocriptine|Dopamine agonist|Radiotherapy

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171
Q

A gentleman with longstanding T2DM presents with diminished sensation in his hands and feet. You diagnose a symmetrical polyneuropathy secondary to poor diabetic control. What term is used to describe the distribution of his dimished sensation?

A

Glove and stocking distribution

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172
Q

In diabetic sensory neuropathy, what is the first type of sense to diminish?

A

Vibration sense

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173
Q

What might you find on examination of a foot in a person with diabetic neuropathy?

A

Blunted sensation|Charcot’s joint|Painless ulcer|Diminished reflexes|High arched foot with clawing of the toes

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174
Q

Name 3 types of neuropathy that can occur in diabetic patients

A

Peripheral sensory neuropathy|Autonomic neuropathy|Diabetic amyotrophy|Mononeuropathy/mononeuritis multiplex|Acute painful neuropathy

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175
Q

How can you prevent progression of polyneuropathy in diabetic neuropathy?

A

Good glycaemic control

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176
Q

You discover a patient has diabetic neuropathy of the feet. What two other areas of the body must now be investigated?

A

Eyes - ophthalmology review|Kidneys - renal function tests

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177
Q

A man with diabetic neuropathy comes to you with intractable vomiting. What has caused this?

A

Autonomic gastroparesis

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178
Q

A 25 y/o man presents with a 3 month history of diarrhoea. List 4 differential diagnoses for chronic diarrhoea in this age group.|Name a basic and an invasive test you might do

A

IBD, IBS, infective, coeliac, colorectal Ca, medications, chronic pancreatitis, thyrotoxicosis|Basic: FBC (anaemia, raised WCC), raised CRP, B12 deficiency, stool MC+S, coeliac screen, amylase, TFT|Invasive: sigmoidoscopy and rectal biopsy, colonoscopy, barium enema, capsule endoscopy for small bowel disease

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179
Q

List 2 histological features of Crohn’s disease

A

Granuloma formation|Transmural inflammation|Lymphocytic infiltration

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180
Q

Contract Crohn’s and UC in the following domains: endoscopic appearance and distribution

A

Endo:|Crohn’s: skip lesions, cobblestone appearance|UC: uniform inflammation, thin walls, loss of vascular pattern|Distribution:|Crohn’s: mouth to anus, commonly terminal ileum|UC: rectum always affected, affects large bowel only

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181
Q

List 2 extraintestinal features of Crohn’s

A

Erythema nodosum|Pyoderma gangrenosum|Iritis/episcleritis|Enteropathic arthritis|Ank spond|Apthous ulceration

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182
Q

Why are steroid-sparing agents useful in the management of Crohn’s?

A

Avoids long-term side effects of steroids in frequent relapses

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183
Q

List 2 complications from long term Crohn’s disease

A

Malnutrition|Colonic carcinoma|Perianal abscess and fistula|Small bowel obstruction|Bowel perforation

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184
Q

Infliximab is a monoclonal antibody that can reduce Crohn’s disease activity. How does it work?

A

Anti-TNF|TNF is important in establishing inflammation and granuloma formation

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185
Q

List 4 causes of UGI bleed

A

Oesophagitis|Mallory-Weiss tear|Oesophageal varices|Peptic ulcers|Gastritis/duodenitis|Malignancy|Bleeding disorders|Aortic enteric fistula

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186
Q

What 3 medications can contribute to an UGI bleed?

A

NSAIDs|Aspirin|Anticoagulants|Corticosteroids

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187
Q

Why might you perform a PR in a patient with UGI bleed?

A

Presence of melaena is evidence of large blood loss

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188
Q

What diagnostic investigation is recommended in an UGI bleed?

A

Urgent OGD

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189
Q

What class of medication is given in an UGI bleed?

A

PPIs

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190
Q

What disease is oesophageal varices commonly associated with? How does this disease lead to varices?

A

Liver cirrhosis|Venous portal hypertension

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191
Q

Name a site of portosystemic anastamoses and the symptom it would cause

A

Superior rectal vein shunts cause haemorrhoids|Paraumbilical vein shunts cause caput medusae

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192
Q

Name an endoscopic treatment of oesophageal varices

A

Adrenaline|Sclerotherapy|Banding of varices|Argon plasma coagulation

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193
Q

Name 3 differentials for dyspepsia

A

PUD|GORD|Gastritis|Oesophagitis|Duodenitis|Malignancy

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194
Q

Name 2 symptoms that would alert you to the possibility of UGI malignancy in a patient with dyspepsia

A

Symptoms of anaemia|WL|Anorexia|Recently worsening symptoms|Dysphagia|Melaena|Haematemesis

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195
Q

List 2 risk factors for PUD

A

H.pylori infection|NSAIDs/steroids|Smoking|Delayed gastric emptying|Physiological stress e.g. ITU patients|Hypercalcaemia|Chronic renal failure

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196
Q

Explain the urease breath test for H.pylori

A

H.pylori bacteria produces urease to break down urea into ammonia and CO2|A radio isotope of carbon (C13 or 14) in the form of urea is ingested|If urease is present it breaks down urea and radioisotope CO2 can be measured

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197
Q

What is H.pylori eradication therapy?

A

PPI plus|Clarithromycin, and either amoxicillin or metronidazole for at least 2 weeks

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198
Q

What radiological investigation can you use for suspected perforation of peptic ulcer? What sign would you look for?

A

Erect CXR|Free air under diaphragm (pneumoperitoneum)

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199
Q

Abnormally high gastrin levels are associated with extensive and atypical ulceration. What condition causes this?

A

Zollinger-Ellison syndrome

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200
Q

What is the definition of GORD?

A

Excessive entry of gastric contents into the oesophagus through the gastro-oesophageal junction

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201
Q

List 2 exacerbating factors of GORD

A

Lying flat|Stooping, straining|Drugs|Alcohol|Obesity|Food|Hiatus hernia

202
Q

What could cause night time wheeze in a patient with GORD with no history of asthma?

A

Inhalation of small amounts of gastric contents

203
Q

What lifestyle advice would you give to a patient with GORD?

A

Weight loss|Smoking cessation|Reduce alcohol consumption|Avoid large meals|Avoid eating before bedtime|Sleep sat up

204
Q

A patient with GORD presents with worsening GORD symptoms despite PPI and difficulty swallowing. Name 2 causes of dysphagia in this case

A

Benign stricture secondary to GORD|Malignant stricture|Extrinsic pressure from lung Ca|Mediastinal LNs|Retrosternal goitre|Pharyngeal pouch|Oesophagitis|Bulbar palsy|Myasthenia gravis

205
Q

Explain the term “oesophageal metaplasia” and its cause

A

Change of lower oesophageal squamous epithelium into columnar epithelium, caused by recurrent damage from gastric contents refluxing into the oesophagus

206
Q

What is the gold-standard test for proving reflux?

A

Oesophageal pH manometry

207
Q

What is the surgical option for GORD treatment and how does it help reflux?

A

Nissen fundoplication - fundus is wrapped around oesophagus|Augments the high pressure zone, giving more strength to the GOJ

208
Q

Name a possible side effect to fundoplication

A

Dysphagia from compression of the GOJ|Dumping syndrome|Achalasia

209
Q

Give 3 symptoms of acute appendicitis

A

Anorexia|Nausea|Vomiting|Fever|Constipation|Diarrhoea

210
Q

Why is pain first felt in the periumbilical region in appendicitis? Why does it then migrate to the RIF?

A

Irritation of the visceral peritoneum by the inflamed appendix is felt in the T10 dermatome which corresponds to the periumbilical region|This is because the visceral peritoneum has no somatic inner action, so the brain perceives visceral signals as being from the same dermatome as where the visceral signals enter the spinal cord|As the appendix is found in the midgut the corresponding dermatome is T10|As the disease progresses, the parietal peritoneum becomes affected|As this receives somatic innervations, the pain is well localised to the area of inflammation

211
Q

What is Rosving’s sign?

A

Pain felt in the RIF when the LIF is palpated

212
Q

Give 2 differentials of appendicitis

A

Ectopic pregnancy, torsion/rupture of ovarian cyst, salpingitis|UTI, renal stone, testicular torsion|GI obstruction, constipation, strangulated hernia, Crohn’s, gastroenteritis, mesenteric adenitis, Meckel’s diverticulum, intussusception

213
Q

What is the definitive treatment of appendicitis?

A

Appendicectomy

214
Q

Give 2 possible complications of appendicitis

A

Perforation|Appendix mass (omentum and small bowel adhere to appendix)|Abscess|Sepsis|Paralytic ileus |Intestinal obstruction

215
Q

What is a diverticulum?

A

An outpouching of mucosa through the muscle wall

216
Q

Which section of the colon are diverticula commoner in?

A

Sigmoid|In this section the majority of water has been reabsorbed from the faeces, leading to high intraluminal pressures

217
Q

Define diverticulosis, diverticular disease and diverticulitis

A

The presence of diverticula in GIT|Symptomatic diverticula|Inflammation of diverticula

218
Q

Give 2 investigations that may be performed in acute diverticulitis

A

FBC|CRP|Blood cultures|CXR|AXR|CT|USS

219
Q

Give one mainstay of the conservative management of diverticulitis

A

Analgesia|ABx|Adequate hydration

220
Q

What are two possible complications of diverticulitis?

A

Perforation|Bleeding |Abscess|Strictures|Fistulas

221
Q

What is the definition of a hernia?

A

The protrusion of a structure through the wall of a cavity in which it is usually contained

222
Q

With relation to the pubic tubercle, how do you differentiate between an inguinal and femoral hernia?

A

The neck of an inguinal hernia appears superior and medial to the pubic tubercle|The neck of a femoral hernia appears inferior and lateral to it

223
Q

With relation to the inferior epigastric vessels, how do you differentiate between direct and indirect hernias?

A

Indirect inguinal hernias occur lateral to the inferior epigastric vessels|Direct inguinal hernias occur medial to these vessels

224
Q

Using embryology, explain how indirect inguinal hernias occur

A

Testes descend from posterior abdo wall into the scrotum following the processus vaginalis via an attachment called the gubernaculum|If the connection to the peritoneal cavity fails to close, then a patent processus vaginalis is present through which indirect inguinal hernias can occur

225
Q

Give 2 risk factors for inguinal hernias

A

Prematurity|Male sex|Chronic cough|Constipation|Obesity|Heavy lifting|Physical activity

226
Q

What is the difference between an obstructed and a strangulated inguinal hernia?

A

Obstructed - contents of GIT cannot pass through|Strangulated - ischaemia of the portion of bowel

227
Q

Give 2 complications following inguinal herniotomy surgery

A

Recurrence|Wound site infection|Mesh infection|Hydrocele|Intestinal damage|Bladder damage|Spermatic cord damage

228
Q

What line divides internal and external haemorrhoids?

A

Dentate line

229
Q

Give 3 symptoms of haemorrhoids

A

PR bleed|Pruritus ani|Mucous|Rectal fullness|Pain |Soiling

230
Q

Give 2 conservative management options and 2 procedures used to manage haemorrhoids

A

Increase fluid intake, increase fibre intake, analgesia, bed rest, topical therapies (anaesthetics/corticosteroids)|Rubber band ligation, sclerotherapy, cryotherapy, photocoagulation, haemorrhoidectomy

231
Q

Name 1 complication of haemorrhoids

A

Ulceration|Stricture|Thrombosis|Infection|Anaemia|Skin tags

232
Q

What investigations may be performed for haemorrhoids?

A

FBC, proctoscopy, sigmoidoscopy

233
Q

Name the arterial supply to the foregut, midgut and hindgut

A

Foregut - celiac trunk|Midgut - sup mesenteric artery|Hindgut - inf mesenteric artery

234
Q

What acid-base disturbance is typically seen in acute mesenteric ischaemia? What other disturbances may you see on blood tests?

A

Metabolic acidosis|Raised WCC, lactate, Hb, amylase

235
Q

What is the gold standard for imaging in acute mesenteric ischaemia?

A

Angiography

236
Q

Give one essential component of the initial management prior to surgery for acute mesenteric ischaemia. What are the aims of surgery

A

Aggressive fluid resuscitation, ABx, heparin, analgesia|Resection of necrotic bowel, revascularisation

237
Q

What is the function of the red and white pulps of the spleen?

A

Red pulp - filter, destroys defunct red blood cells|White pulp - lymphoid tissue which acts as part of immune system

238
Q

Give 3 indications for splenectomy

A

Trauma|Spontaneous rupture|Hyper splendid|Neoplasia|Cysts|Splenic abscess

239
Q

What type of organisms are people susceptible to following splenectomy? How might you prevent infection?

A

Encapsulated bacteria|Lifelong prophylactic penicillin V|Vaccination - pneumococcal, meningococcal, influenza, HiB

240
Q

What are Howell-Jolly bodies?

A

Red blood cells where the nuclear remnant is still seen

241
Q

Name 5 causes of acute pancreatitis

A

Gallstones, alcohol, idiopathic, ERCP, trauma, steroids, mumps, scorpion stings, hyperlipidaemia, hypercalcaemia, drugs, hypothermia

242
Q

What blood test confirms acute pancreatitis?

A

Serum amylase|Can also do lipase

243
Q

Name 2 early and 2 late complications of acute pancreatitis

A

Shock, ARDS, sepsis, DIC, renal failure|Pancreatic pseudo cyst, pancreatic necrosis, abscess, thrombosis of splenic/duodenal arteries, chronic pancreatitis

244
Q

Describe the basis of management of acute pancreatitis

A

Fluids, analgesia, NGT, ICU

245
Q

What are the 4 main features of bowel obstruction?

A

Constipation|Vomiting|Colicky abdominal pain|Distension

246
Q

What features in a history would make you think small bowel over large bowel obstruction?

A

In small bowel obstruction pain is higher in abdomen, vomiting occurs earlier and abdo distension is less

247
Q

Give 4 common causes of bowel obstruction

A

Constipation|Adhesions|Hernias|Tumour|Diverticulitis

248
Q

What clinical sign would distinguish between an ileus and a mechanical obstruction?

A

Absence of BS = ileus|Tinkling BS = obstruction

249
Q

What investigation would help you to distinguish between a small- and large- bowel obstruction?

A

AXR

250
Q

What immediate management would you start in small bowel obstruction?

A

Bowel rest - drip and suck|NBM, NGT, IV fluids

251
Q

What is contained within bile?

A

Bile salts|Bile pigments|Cholesterol|Phospholipid|Electrolytes|Water

252
Q

Name 2 types of gallstones based on composition

A

Pigment stones|Cholesterol stones|Mixed stones

253
Q

What are the risk factors for developing gallstones?

A

Fair (Caucasian)|Fat|Forty|Fertile|Female

254
Q

What is Murphy’s sign?

A

2 fingers laid in RUQ and patient breathes in - causes pain and stops patient breathing in fully|It is positive if the when repeated in LUQ there is no pain

255
Q

What imaging would confirm a diagnosis of acute cholecystitis?

A

Biliary USS

256
Q

What is the initial management for acute cholecystitis?

A

NBM|IV fluids|Analgesia|ABx

257
Q

Name the 4 lobes of the liver

A

Right|Left|Caudate|Quadrate

258
Q

Which ligament divides the anterior of the liver into the anterior lobes?

A

Falciform ligament

259
Q

Name 3 common origins of secondary tumour to the liver

A

Breast|Lung|GIT|Uterus

260
Q

Name 3 causes of HCC

A

Viral hepatitis|Cirrhosis (alcoholic, PBC, haemochromatosis)|Parasites|Steroids|COCP

261
Q

What tumour marker is commonly raised in HCC?

A

Alpha-fetoprotein

262
Q

Give one example for each of the following causes of jaundice: prehepatic, intrahepatic/hepatocellular, cholestatic/obstructive

A

Prehepatic: anything that causes haemolysis (malaria, sickle cell, thalassaemia, G6PD deficiency, spherocytosis, Gilbert’s, Crigler-Najjar)|Intrahepatic: viral hepatitis, paracetamol OD, drugs, alcoholic hepatitis, liver tumour, sepsis, A1 antitrypsin, Budd-Chiari, autoimmune hepatitis, haemochromatosis|Obstructive: CBD bile stones, pancreatic cancer, PBS, PSC, fluclox, COCP, anabolic steroids

263
Q

What is bilirubin the breakdown product of?

A

Haemoglobin

264
Q

A patient complains of dark urine and pale stools. What is the cause of their jaundice likely to be?

A

Obstructive

265
Q

Why does conjugated bilirubin appear in the urine and unconjugated bilirubin doesn’t?

A

Conjugated bilirubin is water-soluble, so dissolves in urine making it dark

266
Q

What is the commonest histological type of pancreatic carcinoma?

A

Adenocarcinoma -> mutinous cystic adenoma -> islet cell tumours

267
Q

Name 3 signs and symptoms of pancreatic carcinoma

A

Jaundice|Epigastric pain|Back pain|WL|Epigastric mass|Dyspepsia|Fatigue|Hepatomegaly from mets

268
Q

What tumour marker can be used to monitor response to pancreatic cancer treatment?

A

Ca 19-9

269
Q

Name a complication of persistent jaundice

A

Pruritus|Liver dysfunction|ARF|Susceptibility to infection|Nutritional dysfunction

270
Q

What are the routes of spread of Hep A and Hep B?

A

Hep A - FO|Hep B - blood bourne

271
Q

List 2 at risk groups for Hep B

A

IVDU and their sexual partners|Sex workers|Healthcare workers|Haemophiliacs

272
Q

What does having antibodies to Hep B core antigen (anti-HBC) in the serum signify?

A

Past infection

273
Q

Name 2 long-term complications of Hep B

A

Fulminant hepatic failure|HCC|Chronic hepatitis|Cirrhosis|Glomerulonephritis|Cryoglobulinaemia

274
Q

What is the definition of an arterial aneurysm?

A

Abnormal dilatation to more than 150% of the original diameter of a blood vessel due to weakness in the vessel wall

275
Q

What is the difference between a true and a false aneurysm?

A

A true aneurysm is an abnormal dilatation of a blood vessel

A false aneurysm is a collection of blood around a blood vessel wall that communicates with the lumen

276
Q

A patient is found to have a 6cm AAA on screening. What should the next step in the management be?

A

Refer for surgical intervention if >5.5cm

277
Q

Name 2 causes of an AAA

A

Atheromatous degeneration

CTDs - Ehlers-Danlos, Marfan’s

Mycotic aneurysms from infection

278
Q

Name 4 complications of open AAA repair

A

Bleeding

Infection

VTE
MI

Spinal ischaemia

Renal failure

Mesenteric ischaemia

Distal thrombus causing limb ischaemia

Death

279
Q

When would you use EVAR instead of open AAA repair? What are the disadvantages of EVAR?

A

Would use if many comorbidities making open surgery too risky, morphology of AAA makes it amenable for EVAR, position of renal arteries, torturosisty of artery

Disadvantages include: not suitable for every type of aneurysm, long term f/u needed, high reintervention rate

280
Q

What is the diagnostic investigation in ruptured AAA?

A

Abdo CT with contrast

281
Q

Name the 4 layers of an arterial vessel wall, from inner to outer

A

Intima

Tunica media

Tunica externa

Adventitia

282
Q

Name a cell type that may be present in an anuerysmal wall

A

Lymphocytes

Macrophages

Fibroblasts

283
Q

Name 6 symptoms of acute limb ischaemia

A

Pallor

Pulseless

Pale

Perishingly cold

Paraesthesia

Paralysis

284
Q

What are 2 common causes of acute limb ischaemia?

A

Acute thrombosis and emboli

Aortic dissection, trauma, iatrogenic, peripheral aneurysm

285
Q

A patient needs to be transferred to a vascular unit for treatment of an ischaemic leg. What treatments can you initiate in the meantime?

A

Oxygen, analgaesia, heparin infusion, IV fluids

286
Q

Name 2 definitive treatments for acute ischaemic limb

A

Thrombolysis

Angioplasty

Embolectomy

Arterial bypass

287
Q

A patient with intermittent claudication now has pain at rest and has to hang his leg out of bed at night to relieve his pain. What are these symptoms a sign of?

A

Critical limb ischaemia

288
Q

What radiological investigations would you do in a TIA?

A

CT/MRI head

Carotid artery duplex scan

Echocardiogram

289
Q

What criteria make up the ABCD2 score?

A

Age

BP

Clinical features (weakness = 2, just speech = 1)

Duration (10-59m = 1, >60m = 2)

Diabetes

290
Q

List 4 vascular complications of DM

A

Nephropathy

Retinopathy

Peripheral neuropathy

Increased risk of MI and stroke

PVD

291
Q

List 4 causes of skin ulceration

A

Venous disease

Arterial disease

Neuropathy

Vasculitis

Infection

Malignancy

292
Q

How can you prevent a diabetic getting ulcers?

A

Improve glycaemic control

Regular chiropody for callus removal and pressure area care

Orthotics

Education

Re-vascularise

293
Q

What are the principles of managing an infected ulcer?

A

Broad spectrum ABx

Investigate for osteomyelitis

Debridement

Revascularisation

Amputation if all else fails

294
Q

What is the difference between primary and secondary intention in wound healing?

A

Primary: wound edges approximated, small scar

Secondary: wound left open, granulates from bottom up, large scar and slower

295
Q

What is the commonest cause of epistaxis?

What is the name of the area on the anterior nasal septum where epistaxis commonly originates?

A

Trauma

Little’s area/Kiesselbach’s plexus

296
Q

List 2 initial management steps in epistaxis

List 2 methods by which epistaxis may be stopped

A

Sit pt upright and lean forwards

Squeeze bottom part of nose

Apply ice pack to bridge of nose

Monitor pulse and BP, IV access, fluid resus if necessary

Cauterisation, packing, balloon/foley catheter, ligation of sphenopalatine/other artery

297
Q

What LN is commonly affected in tonsillitis?

A

Jugulodigastric LN

298
Q

What is Barrett’s oesophagus and what does it predispose you to?

A

Metaplasia of squamous to columnar epithelium in lower oesophagus

Adenocarcinoma of oesophagus

299
Q

Name 2 risk factors for oesophageal carcinoma

A

Barrett’s oesophagus, smoking, alcohol, obesity, achalasia, increasing age, male, FH

300
Q

How is oesophageal cancer staged? What are the treatment options?

A

TNM system

Surgery, chemoradio, palliation

301
Q

Which cranial nerve is the recurrent laryngeal nerve a branch of? Which side is recurrent laryngeal nerve palsy commoner on and why?

A

Vagus

L - nerve follows a longer course than on the right so it is more susceptible to damage

302
Q

What is the only laryngeal muscle not supplied by the recurrent laryngeal nerve, and what nerve is it supplied by?

A

Cricothyroid

Superior laryngeal nerve

303
Q

Give 3 symptoms of vocal cord palsy

A

Hoarseness

Vocal fatigue and reduced vocal volume

SOB

Cough

304
Q

Give 2 causes of recurrent laryngeal nerve palsy

A

Tumours

Surgery

Aortic arch aneurysm

Bulbar/pseudobulbar palsy

Idiopathic

305
Q

List 5 causes of unilateral facial weakness

A

Stroke/TIA

Bell’s palsy

Tumours

Acoustic neuromas

Otitis media

MS

Ramsay Hunt syndrome

Parotid tumours

Trauma

GBS

306
Q

In the face, how can you discriminate between an UMN lesion and LMN lesion?

A

UMN lesions forehead sparing - as the forehead is bilaterally innervated

LMN (lesions that affect facial nerve) will also affect forehead

307
Q

What is the most likely cause of septic arthritis?

A

Staphylococcus aureus

308
Q

What fluids will you send for culture in septic arthritis?

A

Joint aspirate

Blood cultures

309
Q

What is your management plan in septic arthritis?

A

Joint aspirate and culture

IV ABx

Refer ortho for ?washout

310
Q

Name 2 risk factors for septic arthritis

A

Intra-articular injections

RA

DM

Immunosuppression

Penetrating injury

Gonoccocal infection

311
Q

What organism would you worry about in a septic arthritis of an artificial joint?

A

Staph epidermis

312
Q

Name the rotator cuff muscles

A

Teres minor

Supraspinatus

Infraspinatus

Subscapularis

313
Q

Where does the supraspinatus attach to the humerus?

A

Greater trochanter

314
Q

What muscle takes over abduction of the arm after the supraspinatus initiates movement (the first 10-15 degrees)?

A

Deltoid

315
Q

What two muscles are innervated by the accessory nerve?

A

Teres minor

Deltoid

316
Q

What 2 imaging methods are used to visualise the supraspinatus and to assess whether any labral tears are present?

A

MRI and USS

317
Q

What tests are used to test the ACL and PCL?

A

Anterior draw test and posterior draw/sag test

318
Q

How do you test the collateral ligaments of the knee?

A

Flex the knee to 20 degrees

One hand holds the ankle, the other stabilises the femur

The knee joint is then stressed in abduction to test the medial collateral ligament

And in adduction to test the lateral collateral ligament

If the knee “opens up” suggests a complete tear

319
Q

In the knee, what is the “unhappy triad”?

A

ACL tear

Medial collateral ligament tear

Medial meniscal damage

320
Q

What test is used to test for a meniscal tear?

A

McMurray’s

321
Q

What tendon may be transplanted to repair the ACL?

A

Patellar

Hamstring

Quadriceps

322
Q

An old lady has a fall. XR confirms a R displaced intracapsular #NOF.

What position would you expect to see on inspection of her R leg?

A

Shortened, externally rotated

323
Q

What system is used to classify intracapsular #NOF?

A

Garden system

324
Q

What complication may occur if the blood supply to the head of femur is disrupted by an displaced intracapsular fracture?

A

Avascular necrosis

325
Q

What operation is performed for a displaced intracapsular #NOF where there are concerns that the blood supply has been disrupted?

A

Arthroplasty (hemi/total)

326
Q

What procedure will be performed for an undisplaced intracapsular #NOF (therefore blood supply intact)?

A

Internal fixation

327
Q

What is a Colles’ fracture?

What displacement and angulation would be present?

How long will it take to heal?

A

Fracture of distal metaphysis of radius

Dorsal displacement and angulation

6-8w

328
Q

Define an open fracture

A

Communication between the fracture and the outside world

329
Q

Give 4 components of managing an open fracture

A

Analgesia

Fluid resuscitation

Assess neurovascular status and soft tissue damage

Sterile cover, splint

Broad spectrum ABx

Tetanus prophylaxis

Urgent theatre for debridement, surgical fracture stabilisation, wound closure

330
Q

What is the surgical management of compartment syndrome?

A

Urgent decompression via open fasciotomy

331
Q

What are the complications of open fractures?

A

Wound infection, tetanus infection, osteomyelitis, nerve damage, vascular damage, malunion, sepsis, DVT, death

332
Q
A
333
Q

Give 3 causes of secondary HTN

A

Coarctation of aorta

Phaeochromocytoma

Conn’s

Cushing’s

RAS

Acromegaly

334
Q

Why do you get different BP readings on different arms in coarctation of aorta? Which arm has higher BP?

A

Narrowing of aorta proximal to L subclavian artery

Right

335
Q

What signs might you see in hypertensive retinopathy?

A

AV nipping

Flame haemorrhages

Hard exudates

Cotton wool spots

Papilloedema

336
Q

Give 3 risk factors for NAI

A

Maternal depression

Domestic abuse

SCBU baby - delayed emotional attachment

Financial difficulty

337
Q

What are the differentials for red eye?

A

Keratitis

Acute angle-closure glaucoma

Anterior uveitis

Conjunctivitis

338
Q

What 3 findings on a slit lamp would support a diagnosis of anterior uveitis?

A

Cell and flare

Hypopyon

Keratic precipitates

Posterior synechiae

339
Q

Name 2 treatments for anterior uveitis

A

Prednisolone drops

Oral prednisolone

Atropine drops

340
Q

Name 2 infective causes of anterior uveitis

A

Herpes simplex

TB

VZV

341
Q

Name 6 clinical findings in SLE

A

Malar rash

Arthritis

Psychosis

Pericarditis

Fatigue, malaise

Nail fold infarcts

Photosensitivity

Raynaud’s

Renal failure

342
Q

What type of anaemia would you see in a patient with SLE?

A

Normocytic normochromic anaemia

343
Q

What is the histological reason for renal impairment in SLE?

A

Immune complex deposition on basement membrane

344
Q

Name 3 treatments used in SLE

A

Steroids - prednisolone

NSAIDs - ibuprofen

Immunosuppressants - MTX

345
Q

What are the core symptoms of depression?

A

Low mood

Anhedonia

Anergia

346
Q

What are the non-core symptoms of depression?

A

Sleep disturbance - EMW

Decreased libido

Decreased appetite

Thoughts of suicide or self harm

Poor concentration

347
Q

What drugs can cause low mood?

A

Beta-blockers

Corticosteroids

BDZs

Levodopa

348
Q

Name 2 signs on examination of ascites

A

Shifting dullness

Fluid thrill

349
Q

Name 3 signs in the hands in chronic liver disease

A

Clubbing

Dupuytren’s

Jaundice

Liver flap

Palmar erythema

350
Q

Name 2 investigations you could use to establish the cause of ascites

A

Abdo USS

Diagnostic paracentesis

LFTs

351
Q

Name 3 complications of chronic liver disease

A

Oesophageal varices

Coagulopathy

SBP

Hepatorenal syndrome

Hepatic encephalopathy

HCC

352
Q

What 4 investigations would confirm a diagnosis of TB?

A

Sputum culture - Lowenstein Jensen media, Ziehl Neelsen stain

Pleural fluid MC+S

HIV test

CXR

Quantiferon test

353
Q

Name 2 ECG signs of hyperkalaemia

A

Tall tented T waves

Broad QRS

Prolonged PR interval

354
Q

What 4 actions would you take in a patient with a potassium of 7.5

A

IV fluid bolus

High flow O2

Calcium gluconate

Insulin/dextrose

Salbutamol nebs

355
Q

What is the characteristic cell in Hodgkin’s lymphoma?

A

Reed-Sternberg cell

356
Q

Name 3 B symptoms in Hodgkin’s lymphoma

A

Weight loss

Night sweats

Fever

357
Q

What are the 3 defining features of a health economic evaluation?

A

Cost of both services

Benefits of both services

Comparing the cost and benefit of service and alternative service

358
Q

What are the 2 features comprising a QALY?

A

Number of years

Quality of life i.e. utility

359
Q

What system do health economists use to evaluate disabilty?

A

DALYs

360
Q

Define healthcare economic “efficiency”

A

Getting the maximum cost/health benefit outcomes from a service

361
Q

What is the term for when treatment if given elsewhere and benefit foregone for other patients?

A

Opportunity cost - money spent elsewhere because it gives better benefit

362
Q

What is an SAH?

A

Bleeding into the subarachnoid space (area between arachnoid membrane and pia mater)

363
Q

Why does SAH cause coma?

A

Raised ICP

364
Q

Name 4 common causes of coma

A

Hypoglycaemia

Hyperuricaemia

Miningococcal septicaemia

Trauma

Hypoxaemia

Seizures

365
Q

Why do you get a fixed dilated pupil in SAH?

A

parasympathetic nerves are in the superficial parts of the nerve, so tend to be more
vulnerable to compressive lesions and spared by vascular lesions- 3 rd nerve palsy
occulomotor

366
Q

Name 4 features of brainstem death

A

No resp effort in reaction to turning off ventilator

Fixed pupils unreactive to light

No corneal reflex

No cough reflex

No response to supra orbital pressure

367
Q

What screening should GPs do for microvascular damage in DM?

A

Retinal screening

U+E - urine albumin and serum creatinine

Foot care - monofilament to assess sensation

ABPI - autonomic damage

368
Q

2 causes of increasing floaters

A

diabetic retinopathy

retinal detachment

posterior vitreous detachment

369
Q

What is the most common type of bladder cancer?

Where else are these cells found?

A

Transitional cell carcinoma

Ureters

Urethra

370
Q

Name 4 risk factors for bladder cancer (TCC)

A

FH

Smoking

Frequent bladder infections

Working in rubber dye factory

371
Q

What LNs should be removed when removing bladder and prostate?

A

initial lymphatic drainage from the bladder is primarily into the external iliac,
obturator, internal iliac (hypogastric), and common iliac nodes

372
Q

Give 2 symptoms of cauda equina at each of the following sites

Perianal skin

Lower limb

Anal and urethral sphincters

A

Perianal skin: decreased sensation and tone

Lower limb: upgoing plantars, pain, altered reflexes

Anal and urethral sphincters: decreased tone, incontinence

373
Q

What heart sound would you hear in pericarditis?

A

Pericardial rub

374
Q

Name 4 investigations for pericarditis

A

Echo

CXR

CRP, WCC, ESR

ECG

375
Q

What ECG changes would you see in acute pericarditis?

A

Diffuse ST elevation

PR depression

376
Q

Name 2 treatments for pericarditis?

A

NSAIDS

Colchicine

Steroids if immune mediated

377
Q

A patient with pericarditits becomes hypotensive, tachycardic, with low BP. What has happened?

A

Cardiac tamponade

378
Q

Name 2 causes of pericarditis

A

Recent viral infection

Bacterial infection e.g. TB

Recent MI (Dressler syndrome)

Chest trauma

AI disorders

Cancer

Uraemic pericarditis

379
Q

A patient is found to have a suspicious lung lesion on CXR and you are concerned he may have lung Ca with cerebral mets. Name 3 investigations you might do and why

A

HR CT chest to get more detailed image of lesion

PET scan for staging

Brain MRI to image cerebral mets

Lung lesion biopsy - for histological subtyping

380
Q

What is your immediate management of a fracture?

A

Pain relief

Immobilisation

381
Q

What are the important things to assess in a fracture?

A

Neurovascular status

Open vs closed

Displacement

Stable vs non stable

382
Q

What are the ECG findings in AF?

A

Irregularly irregular rhythm

Absent P waves

383
Q

What 3 medications can you use for rate control in AF? What is 1st line?

A

Beta blockers 1st line - propanolol

CCB - verapamil

Digoxin

384
Q

What anticoagulants could you consider in AF? How do they work?

A

Warfarin - inhibits clotting factors 2, 7, 9 and 10, vit K antagonist

Rivaroxaban - inhibits factor 10a

385
Q

Name 4 causes of facial nerve palsy

A

Ramsay Hunt syndrome

Bell’s palsy

Stroke

Acoustic neuroma

GBS

Congenital

386
Q

What causes Ramsay Hunt syndrome?

Where does this virus reside?

How would you treat it?

A

Varicella zoster

Geniculate ganglion

Aciclovir and prednisolone

387
Q

What are the symptoms of Ramsay Hunt syndrome?

A

Sensorineural deafness

Vertigo

Facial pain

Facial palsy

Vesicular rash

388
Q

A 55 year old lady presents with constipation and fatigue. Bloods show high Ca and PTH. What is the diagnosis? What would it be if PTH was low?

A

Primary hyperparathyroidism

Bone mets or malignancy

389
Q

What are the 3 actions of parathyroid hormone?

A

Stimulates osteoclasts to reabsorb bone mineral increasing serum Ca

Enhances absorption of Ca from small intestine

Suppresses Ca loss in urine

Increases converstion of inactive D into active vitamin D

390
Q

What are the symptoms of primary hyperparathyroidism?

A

Bone pain, osteoporosis

Depression, fatigue

Myalgia

Kidney stones

391
Q

What are the complications of untreated hyperparathyroidism?

A

Cardiac arrhythmias - short QT interval

Renal tubular damage - hypokalaemia, dehydration, acute kidney injury

392
Q

What is the treatment for severe hypercalcaemia?

A

IV fluids

Loop diuretic eg furosemide

Bisphosphonates

Calcitonin

393
Q

A 40 year old man presents with L sided flank pain, nausea and vomiting. Differentials?

A

Ureteric colic

MSK pain

Diverticulitis

Constipation

Pyelonephritis

394
Q

What is the investigation of choice in renal colic?

A

CT KUB

395
Q

A man with a hx of renal stones comes in with fever and flank pain. What has happened and how would you sort?

A

Pyelonephritis - ABx as per local guidance eg gentamycin

Consider stenting if obstructed

396
Q

How would you diagnose B thalassaemia?

A

FBC, blood film (microcytic hypochromic anaemia)

Hb electrophoresis

DNA testing

397
Q

How do you treat B thalassaemia major?

A

Regular transfusions

BM transplant

398
Q

Giving blood transfusions in B thalassaemia major has complications. Which organs may be affected and how? How could this be prevented?

A

Liver, heart, brain may be affected by iron induced oxidative stress

Iron chelation therapy

399
Q

Alpha thalassaemia major is never seen in primary care - why, and what is the pathophysiology?

A

Severe intrauterine haemolytic anaemia - babies die before/shortly after birth

400
Q

Name 4 risk factors for oropharyngeal cancer

A

Excessive alcohol, smoking, FH, HPV, asbestos exposure, diet low in fruit and veg

401
Q

A man come in with rectal bleeding, mixed in with the stool. Differentials?

A

Haemorrhoids

Anal fissure

Trauma

Fistula

IBD

Gastroenteritis

Bowel Ca

402
Q

What things would you want to examine in a patient with rectal bleeding?

A

Abdo palpation for masses

PR - for blood, masses

Inspect perianal area

Assess anaemic status

403
Q

What investigations would you organise in a patient with PR bleed and microcytic anaemia?

A

Colonoscopy and biopsy

Faecal calprotectin

IgA anti TTG, antiendomysial antibodies

404
Q

What are 3 treatments in conventional eczema regime?

A

Emollients

Steroid cream

Antihistamines oral

ABx if infected

405
Q

What factors may make eczema worse?

A

Stress, hot weather, washing powder or washing products, infection

406
Q

Describe the pathophysiology of anaphylaxis

A

Type 1 hypersensitivity

Degranulation of mast cells causes histamine release

407
Q

Name 4 methods of preventing VTE

A

TED stockings

Pneumatic compression stockings

Heparin/warfarin

Early mobilisation

Stopping meds e.g. OCP

IVC filters

408
Q

What 4 things must be measured before giving LMWH?

A

U+E

FBC (platelet count)

LFT

Weight

409
Q

What are some RFs for PE? Link them to Virchow’s triad

A

Active cancer, OCP, pregnancy, obesity - hypercoagulability

Immobility - stasis

Surgery/trauma - endothelial damage

410
Q

What are the ABCDE of examining a skin lesion?

A

Asymmetry

Border irregularity

Colour

Diameter

Evolving

411
Q

Name 4 RFs for melanoma

A

Pale skin (Causasian)

Sunlight exposure

Moles

FH

Lack of suncream

Increasing age

Immunosuppression

412
Q

What staging system is used in melanoma?

A

Breslow staging

413
Q

What tumour marker is used in melanoma?

A

s-100

414
Q

Name 2 risk factors for vitamin d deficiency

A

Institutionalised

Dark skin tone (black/asian)

Wearing clothing that covers large amounts of skin or lots of sunscreen

CKD

Malabsorption, poor diet

415
Q

How is vitamin d metabolised in the body?

A

Vit D3 made in skin, found in fish and eggs

Vit D2 found in salmon, mushroom, eggs

Liver convers vit D2 and D3 to 25(OH)D

25(OH)D converted to calcitriol (active form) by kidneys

416
Q

What does lack of vitamin D do to the bone?

A

lack of Vit D reduces calcitriol and therefore calcium level in the
blood, and increasing PTH which increases osteoclastic activity and bones become undermineralised- i.e osteomalacia

417
Q

Name 4 risk factors for gout

A

Diet - spinach, red meat

Alcohol

Smoking

Male

HTN

CKD

Myeloma

418
Q

Name 4 triggers of gout

A

Dehydration

Prolonged fasting

Alcohol

Aspirin

Starting allopurinol

Thiazide diuretics

419
Q

Name 2 acute treatments for gout

A

NSAIDs - diclofenac

Colchicine - natural product

420
Q

Why does gout favour smaller more distal joints?

A

Distal blood supply is cooler so crystals more likely to precipitate

421
Q

How does allopurinol act and how does it reduce chances of gout?

A

Xanthine oxidase inhibitor

Reduces serum uric acid levels

422
Q

What are the histological features of coeliac disease?

A

Crypt hyperplasia

Subtotal villous atrophy

Lymphocytic infiltration

423
Q

Name 4 fat soluble vitamins and their deficient state

A

A: night blindness

D: osteomalacia

E: ataxia

K: bleeding, bruising

424
Q

What skin rash may be present in coeliac disease?

A

Dermatitis herpetiformis

425
Q

What malignancy is associated with coeliac disease?

A

T cell lymphoma of small bowel - if non compliant with diet

426
Q

Name an antimalarial prophylaxis

A

Proguanil + chloroquine

Doxycycline

Malarone

427
Q

Why might malarial prophylaxis fail?

A

Poor compliance

Resistance

Not 100% effective

428
Q

Name 2 non-drug measures to prevent malaria

A

Cover up with long sleeves and trousers

Use DEET repellant

Mosquito nets

429
Q

What are the complications of cerebral malaria?

A

Confusion

Coma

Encephalopathy

Cerebral oedema

Covulsions

430
Q

What drugs can treat malaria?

A

Artemisinin combination therapy

Atovaquone-proguanil

Chloroquine

Quinine

431
Q

What 2 things would you test before starting lithium?

A

TFTs, U+E

432
Q

Name 3 neuro signs of lithium toxicity

A

Coarse tremor

Hyperreflexia

Coma

Ataxia

Nystagmus

433
Q

What are the 3 features of Horner’s syndrome?

A

Miosis

Ptosis

Anhydrosis

434
Q

Name 6 signs of MND

A

Hyperreflexia

Fasciculations

Muscle wasting

Spasticity

Dysarthria

Dysphagia

435
Q

Give 4 symptoms of bulbar palsy

A

Dysarthria

Dysphagia

Weak/wasted tongue

Fasciculating tongue

Disturbed emotional state

436
Q

What is an advanced directive?

A

A document where a patient makes provision for future healthcare decisions in the event that they become unable to make those decisions

437
Q

What malignant cell is involved in multiple myeloma?

A

Plasma cells

438
Q

What is present in the urine in multiple myeloma?

A

BJP

439
Q

Which is better for investigating bone lesions in MM: technicium bone scan or full skeletal X-ray survey? Provide rationale.

A

Full skeletal x-ray as technicium scan as technicium looks at osteoblastic activity.
Plasma cells secrete IL-6 which inhibits osteoblast and stimulates osteoclastic activity

440
Q

Name 2 methods in which patient could get funding for cancer treatments not recommended by NICE in the NHS

A

Individual funding through PCT

Cancer drug fund from charity

Private funding

441
Q

Give 4 classic clinical features of plaque psoriasis skin lesions

A

Well-demarcated

Silver scaly plaque

Erythematous rash

Hyperproliferation (thickening of skin)

442
Q

Give 2 clinical signs that distinguish between psoriatic arthritis and RA

A

DIPS affected in psoriatic

Nail changes in psoriasis

443
Q

What class of drug is diclofenac? Which enzyme does diclofenac inhibit? What 2 substances does it prevent from forming?

A

NSAID

COX

Prostaglandin, thromboxin A2

444
Q

What is the mechanism of action of steroids in the nucleus and cytoplasm?

A

1) nucleus – lipid soluble molecules pass through the cell membrane – bind with nuclear receptors in cytoplasm, translocation to nucleus binds to nuclear DNA, leading to increase transcription of the relevant gene product.
2) cytoplasm – binds with steroid receptors in the cytoplasm. In combination enters the nucleus where it controls protein synthesis and enzymes that regulate vital cell activities.

445
Q

Name 2 side effects of MTX and how a patient might prevent them

A

Teratogenic - use contraception

Anaemia (BM suppression) - take folate

446
Q

What are the features of Conn’s syndrome?

A

Hypertension

Lethargy

Muscle weakness

Polyuria and polydipsia

Persistent hypokalaemia

447
Q

What hormone level is elevated in Conn’s and what organ is it from?

What hormone level is low in Conn’s and what organ is it from?

A

Aldosterone - adrenal glands

Renin - kidneys

448
Q

Name 2 clinical signs of Korsakoff syndrome

A

Confabulation

Anterograde amnesia

Personality changes

449
Q

What is the first line rx for DT?

A

Diazepam, haloperidol

450
Q

Name 2 organisms commonly found in COPD exacerbation related pneumonia

A

H influenzae

Strep pneumoniae

451
Q

How is COPD diagnosed on spirometry?

A

FEV1/FVC ratio 0.7 or les

FEV1 <80% predicted

452
Q

Name 3 drug treatments of one lifestyle intervention important in COPD

A

SABA

LABA

LAMA

Stop smoking

453
Q

Draw an image describing the HPT axis

A
454
Q

How does a goitre form in hypothyroidism?

A

TSH stimulates the thyroid to produce T3 and T4 when the pituitary realises T3 and T4 is too low

This causes thyroid hyperplasia

455
Q

How long does it take for a patient to feel the effects of thyroxine?

A

3 months

456
Q

Give 6 risk factors for osteoporosis

A

Steroid use

Hyperparathyroidism

Alcohol

Low testosterone

Low BMI

Early menopause

Renal failure

Female sex

Increasing age

Smoking

457
Q

What drug treatment would you give in an acute attack of IBD?

A

IV hydrocortisone

458
Q

How might you manage erythema nodosum?

A

Analgesia

Raise leg

Compression stockings

Steroids

459
Q

How do you differentiate between lower and upper motor neurone lesions causing facial nerve palsy?

A

UMN = forehead sparing

460
Q

A patient with an acoustic neuroma has hearing loss and facial weakness. Where is the acoustic neuroma located?

A

Cerebellopontine angle

461
Q

What are the symptoms of acoustic neuroma?

A

Hearing loss

Facial nerve palsy

Tinnitus

Signs of raised ICP

Vertigo

Nystagmus

462
Q

What amount of proteinuria signifies nephrotic syndrome?

A

>3.5g/24h

463
Q

What are the biochemical abormalities in nephrotic syndrome?

A

Hypoalbuminaemia

Hyperlipidaemia

Proteinuria

464
Q

Describe the body’s response to nephrotic syndrome, and how does that worsen the condition

A

Hyperlipidaemia is a consequence of increased synthesis of lipoproteins as a direct consequence of low plasma albumin

Reduced clearance of triglycerides

465
Q

Name 3 pharmacological and 1 lifestyle treatment for nephrotic syndrome

A

Fluid and salt restriction

Furosemide

Bendroflumethiazide

ACEi for proteinuria

LMWH for thrombosis risk

Statin

466
Q

What pathological change would you see in the glomerular basement membrane in someone who has diabetic nephropathy?

A

Basement membrane thickening followed by mesangioexpansion and modular sclerosis

467
Q

What is the most likely cause of mitral stenosis?

A

Rheumatic fever

468
Q

State the pathophysiology behind the following in relation to how they occur due to mitral stenosis:

AF - pressure buildup causes enlargement of left atrium

RV heave - increased flow across narrow valve

Raised JVP - pulm htn and right heart failure

A
469
Q

With reference to Starling’s law, explain how mitral stenosis causes dyspnoea

A

Increased pressure in atrium due to stenosis

Backlog to pulmonary criculation leads to fluid overload

This causes increased hydrostatic pressure causing fluid to shift from vascular to interstitium causing oedema and shortness of breath

470
Q

What features in a history would make you think of COPD rather than asthma?

A

Middle age

Smoking Hx

No diurnal variation

Sputum production

Lack of fx of atopy

Chronic dyspnoea

Progressive

471
Q

Name 2 methods to help patients stop smoking

A

NRT

Buproprion

Champix (nicotine receptor partial agonist, reduces craving and makes smoking less pleasurable)

472
Q

What treatments may be suitable for end stage/severe COPD?

A

Theophylline

Mucolytics

CPAP

LTOT

Lung volume reduction, bullectomy

473
Q

Name 4 risk factors for acute pancreatitis

A

Alcohol

Gallstones

Prev ERCP

Scorpion stings

Mumps

Trauma, tumour

Autoimmune

Hypercalcaemia

Hyperlipidaemi

474
Q

Why do patients with acute pancreatitis become hyperglycaemic?

A

Beta cells in islets of langerhans damaged by inflammation and calcification

This reduces insulin production

Insulin drives glucose into cells so a lack of this would mean that serum glucose is increase

There is an endocrine insufficiency

475
Q

What is a normal Allen’s test? Why do you perform it before an ABG?

A

It means both arteries (radial and ulnar) are patent and the palmar arches are functioning

It is important before ABG to ensure that the hand will have an adequate blood supply in case one of the arteries is damaged

476
Q

Name 4 features you may find on examination in Parkinson’s disease

A

Pill rolling resting tremor (improves with movement)

Cogwheel rigidity

Bradykinesia

Shuffling festinant gait

Micrographic handwriting that tails off

477
Q

State 2 classes of drugs used in Parkinson’s and give examples

A

Dopamine agonist - ropinirole

Dopamine - levodopa

Peripheral decarboxylase inhibitor - carbidopa

MAO-B inhibitor - selegiline

478
Q

State 2 histological hallmarks of Parkinson’s disease

A

Decrease in dopaminergic neurons in the substantia nigra

Lewy bodies

479
Q

What would you find in a CT head in Parkinson’s?

A

Nothing!

480
Q

Name 4 symptoms of hypercalcaemia

A

Polyuria, polydipsia

Renal stones

Bone pain

Abdominal pain, constipation

Depression

Reduced QT interval

Nausea, vomiting

481
Q

Name 1 drug treatment of hypercalcaemia and its pharmacology

A

Bisphosphonates - decrease action of osteoclasts

482
Q

What electrolyte abnormalities would you expect in a patient with Addison’s disease?

A

Low sodium

High potassium, urea, creatinine

483
Q

What test would you perform to diagnose Addison’s disease?

A

Short Synacthen test

Failure of exogenous ACTH to increase serum cortisol is diagnostic

484
Q

Name 2 treatments for Addison’s disease

A

Hydrocortisone

Fludrocortisone

485
Q

Name 2 signs or symptoms of an Addisonian crisis

A

Nausea, vomiting, diarrhoea

Dehydration

Muscle aches

Shock

486
Q

What chromosomal abnormality is associated with CML? Can this be passed on to family?

A

Philadelphia chromosome t9;22

No, spontaneous mutation

487
Q

Where would you do a bone marrow biopsy in ?CML?

A

Trephine biopsy - posterior superior iliac spine

488
Q

Name a treatment that may be used in CML

A

Imatinib - tyrosine kinase inhibitor

489
Q

Name 2 signs you may find on examination of the genitals in an STI

A

Urethral discharge

Ulcers

Warts

Lymphadenopathy

490
Q

A patient with chlamydia develops knee pain and sore eyes. What complication has occured?

A

Reiter’s syndrome

491
Q

Name 4 sexual behaviours that increase the risk of contracting HIV

A

Anal sex

Unprotected sex

MSM

Multiple partners, promiscuous behaviour

492
Q

A patient has burns with no blistering but reduced pin-prick sensation - what level of burns is this? What complication might they develop?

A

3rd degree

Hyperkalaemia due to lysis of cells

493
Q

Give 4 signs of inhalation injury

A

Tachypnoea

Facial burns

Hoarse voice

Respiratory distress

Harsh cough

Stridor

Soot in saliva

Inflamed oropharynx

494
Q

Define hospital-acquired infection

A

Acquired after 48h of admission

495
Q

How can you manage a patient with diarrhoea from an infection control perspective on the ward?

A

Side room (quarentine)

Barrier nursing, use of PPE

Hand washing

Involve infection control nurses

496
Q

Name 4 viral causes of pharyngitis and cervical lymphadenopathy

A

EBV

Measles

Adenovirus

Rhinovirus

HSV

Influenza

HIV

497
Q

What features would you find on examination of the mouth and pharynx in glandular fever?

A

Erythema

Palatal petechiae

Tonsillar enlargement

Uvular oedema

Lymphadenopathy

498
Q

What tests can be used to confirm glandular fever?

A

Monospot

Heterophil antibody

499
Q

Why would a patient with glandular fever get splenomegaly and deranged LFTs?

A

Mild hepatitis is common

500
Q

What may be used in severe EBV?

A

Steroids and aciclovir

501
Q

What may you find in an FBC of a man with OSA?

A

Raised Hb (polycythaemia)

502
Q
A

finals (8 decks)

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