finals qs: the sequel Flashcards
1
Q
What are the symptoms of sleep apnoea?
A
Repeated waking in night/sleep disturbance Snoring Stopping breathing in sleep Headache Decreased libido Daytime somnolence Decreased cognitive performance
2
Q
State two simple non-pharmacological measures that you would advise in sleep apnoea
A
Weight loss
Stop smoking
Reduce alcohol
3
Q
What FBC abnormality would you see in sleep apnoea? What would you see on an ABG?
A
Polycythaemia
Type 2 respiratory failure
4
Q
If lifestyle modifications fail in sleep apnoea, what treatment may be suitable?
A
CPAP
5
Q
What symptoms might you see in obstructive jaundice?
A
Pale stools
Dark urine
6
Q
Describe the surface markings of the pancreas
A
Head in loop of second part of duodenum
This is on Addison’s line - halfway between manubrial notch and symphisis pubis
Body extends upwards and to the left
7
Q
What are the most likely causes of obstructive jaundice? How might you investigate for these?
A
Gallstones Pancreatic cancer USS CT abdo ERCP/MRCP
8
Q
What are the causes of nephrotic syndrome?
A
Membranous nephropathy, FSGS, minimal change disease, penicillamine, gold, SLE
9
Q
What organisms cause CAP?
A
Strep pneumoniae
H. influenzae
Mycoplasma pneumoniae
Staph aureus
10
Q
What ABx for legionella?
A
Clarithromycin/rifampicine
11
Q
Give 2 Ix for MS and what they would show if they were positive
A
MRI brain and SC - plaques of demyelination
LP - oligoclonal IgG bands
Nerve conduction studies - reduced conduction in affected areas
12
Q
Give 5 symptoms of MS
A
Blurred vision, unilateral eye pain, vertigo, dysphagia, nystagmus, numbness, pins and needles, Uhthoff’s phenomenon, Lhermitte’s sign
13
Q
Give 2 drug treatments for MS that reduce duration and frequency of relapses
A
Beta interferon
Natalizumab
14
Q
What are the components of the triple assessment for breast cancer?
A
Clinical examination
Mammography
Histology
15
Q
What is the most common histological type of breast Ca?
A
Adenocarcinoma
16
Q
What are the risk factors for breast cancer?
A
FH, increasing age, uninterrupted oestrogen (nulliparity, late menopause, early menarche)
17
Q
What are 5 common cancers that metastasize to bone?
A
Prostate Lung Kidney Breast Thyroid
18
Q
What lab tests would you do on a biopsy of a breast lesion to determine the treatment they require?
A
Immunohistochemistry - stain cells based on presence of oestrogen, progesterone ans HER2
Receptor status - as need to determine if can use tamoxifen, herceptin
Poor prognosis = no receptors, good prognosis = lots of oestrogen receptors
19
Q
What tests would you do to confirm TB?
A
Sputum culture - Ziehl Neelsen stain for acid fast bacilli on Lowenstein-Jensen film
CXR
Mantoux
20
Q
What drugs would you treat TB with and for how long?
A
RIPE - 2mo
RI - a further 4mo
21
Q
What drugs would you give to close contacts of someone with TB?
A
Rifampicin and isoniazid
22
Q
Give 4 drugs that can cause acute confusional state
A
Alcohol, BDZ, anticholinergics, opiates, steroids, levodopa
23
Q
Give 4 neurological causes of acute confusional state
A
Head injury, brain mets, encephalitis, meningitis, SOL, subdural, extradural
24
Q
Give 4 metabolic causes of acute confusional state
A
Uraemia, hypercalcaemia, hyponatraemia, hypoglycaemia, DKA
25
What investigations can you do for carpal tunnel syndrome?
Phalens and Tinel's tests
| Nerve conduction studies
26
What tests would you do to confirm prostate cancer?
PSA
Transrectal ultrasound
Prostate biopsy
27
Give 2 investigations which can assess the extent of disease in prostate cancer
```
Transrectal USS
CT abdo and chest
Alk phos
Serum Ca
Isotope bone scan
XR axial skeleton
```
28
State 3 treatments for prostate cancer
Radical prostatectomy
Radiotherapy
Anti-androgen therapy e.g. goserelin
Orchidectomy
29
To what site does breast cancer commonly first metastasise?
Axillary LNs
30
What measurement on CXR would confirm cardiomegaly?
Cardiothoracic ratio of over 0.5
31
On CXR you see a double cardiac shadow on the right side of the heart. What might be the cause?
Enlarged left atrium
32
What ECG features would raise your suspicion of LVH?
```
R wave in V5 or V6 of over 25mm
S wave in V1 or V2 of over 25 mm
Sum of S wave in V1 plus R wave in V6 of over 35mm
LBBB
Left axis deviation
P mitrale
```
33
What are 2 long-term complications of untreated aortic stenosis?
Sudden death
Arrhythmia such as AF/VT
Left heart failure
Angina
34
A man with depression treated with fluoxetine says he feels better after 6w of treatment. What advice would you give and why?
Continue the drug for at least 6mo
| Relapse is high before this time
35
What is the mechanism of action of fluoxetine?
Blocks reuptake of serotonin
| Downregulates number of serotonin receptors in prefrontal cortex
36
What drugs would you expect a patient with sickle cell to be on?
Penicillin
Folic acid
Hydroxycarbamide
37
Name 3 factors that can precipitate a sickle cell crisis
Infection
Hypoxia
Exposure to cold
38
How do you manage a sickle cell crisis?
Morphine
Oxygen
IV fluids
Empirical ABx
39
What is the pattern of inheritance of sickle cell disease?
Autosomal recessive
40
Why does sickle cell not usually clinically manifest until roughly 6 months of age?
Until 6 months there are still high levels of foetal haemoglobin
This masks the effect of sickle cell until HbF levels begin to fall
41
What is multiple myeloma?
| What is the commonest immunoglobulin expressed as part of the disease?
Malignant clonal proliferation of B-lymphocytic plasma cells
| IgG
42
State 4 symptoms a patient with multiple myeloma may complain of
```
Bone pain
Polydipsia
Recurrent infections
Bruising easily
Tiredness
Confusion
```
43
State 3 investigations you would perform in suspected multiple myeloma
```
FBC, U+E
Serum electrophoresis
Urine electrophoresis
Serum immunoglobulins
Serum calcium
Bone marrow sampling
Skeletal survey XR
```
44
Why are patients with multiple myeloma prone to bacterial infections?
Possible bone marrow infiltration
| Immunoparesis due to overexpression of one immunoglobulin and underexpression of any other immunoglobulins
45
State 2 acute complications of multiple myeloma
Hypercalcaemia
Spinal cord compression
Acute renal failure
Hyperviscosity
46
Name 3 causes of splenomegaly
Leukaemia, lymphoma, myelofibrosis
Malaria
Glandular fever
Liver cirrhosis with portal HTN
47
How could you use a blood film to differentiate between acute and chronic leukaemia?
Chronic will have white cells at all stages of life cycle
| Acute will have only immature white blast cells
48
What is the name of the chromosome associated with CML?
Philadelphia chromosome (t9;22)
49
Name the drug used to treat CML, its method of action and its route of administration
What other treatment options are available?
```
Imatinib
Tyrosine kinase inhibitor
Oral
Trial different tyrosine kinase inhibitor
BM transplant
```
50
What findings would you expect on an FBC in bone marrow failure?
Leucopaenia/neutropaenia
Thrombocytopaenia
Anaemia
51
A patient who you suspect may have a haematological malignancy has bone pain. What may be the cause of this?
Bone marrow infiltration
52
What supportive care is needed for patients undergoing bone marrow transplants for leukaemia?
Blood transfusions to help with symptoms of anaemia
Platelet transfusion to prevent haemorrhage
Prophylaxis and if necessary treatment with antibiotics/antivirals/antifungals
Counselling about diagnosis and treatment implications
53
You are giving a patients a blood transfusion after a car accident. 15 minutes into the first bag the nurse tells you his BP has dropped to 79/47 and temp has risen to 38.4. What may have happened and what is the first thing you would do?
Acute haemolytic transfusion reaction
| Stop the transfusion
54
Name one early (<24h) and one late (>24h) transfusion reaction
Early: acute haemolytic reaction, bacterial contamination, allergic reaction, anaphylaxis, transfusion-related acute lung injury, fluid overload, non-haemolytic febrile transfusion reaction
Late: iron overload, graft vs host disease, infection
55
What is the definition of a massive blood transfusion?
10 units of blood within 24h
56
How can macrocytic anaemia be classified into 2 categories? Name 2 causes in each category.
Megaloblastic: B12 deficiency, folate deficiency
| Non-megaloblastic: alcohol, liver disease, hypothyroidism
57
What type of anaemia would you expect in beta thalassaemia major? What is the other name for beta thalassaemia major?
Microcytic hypochromic anaemia
| Cooley's anaemia
58
What signs might you find on examination in beta thalassaemia major?
```
Hepatosplenomegaly
Frontal bossing
Jaw enlargement
Flow murmur
Pallor
Tachycardia
```
59
What are the treatment options for beta thalassaemia major?
Blood transfusion, iron chelation therapy
60
Why do children with beta thalassaemia major not present until after 6 months of age?
Because up until 6 months there is a large amount of fetal haemoglobin which masks symptoms
61
What is the mode of inheritance of haemophilia A? Which clotting factor is deficient?
X linked recessive
| VIII
62
In haemophilia A, what would you expect the INR and APTT to be?
INR - normal
| APTT - prolonged
63
What treatments can be given to patients with haemophilia A to improve their clotting factor deficiency?
Recombinant factor VIII, FFP containing factor VIII, desmopressin
64
Name 2 investigations that may be requested in RA
Anti-CCP, rheumatoid factor
65
Name 3 findings you may find in the hands in patients with RA
```
Ulnar deviation
MCP swelling
Swan neck deformity
Boutonniere deformity
Z thumb
Wrist subluxation
```
66
What XR abnormalities would you see in the hand of someone with RA?
Loss of joint space
Soft tissue swelling
Juxta-articular osteopenia
Bony erosions
67
Give 4 extra-articular features of RA
```
Pulmonary fibrosis
Raynaud's
CTS
Rheumatoid nodules (elbow, pleura)
Felty's syndrome
```
68
A woman with RA has a palpable spleen and a neutrophil count of 1.10. Diagnosis?
Felty's syndrome
69
Give 4 causes of polyarthritis
```
RA
Psoriatic arthritis
Enteropathic arthritis
Osteoarthritis
Reactive arthritis
SLE
```
70
How is MTX administered and how often? What drug should be taken as well?
IM injection once weekly
| Folic acid
71
How is MTX administered and how often? What drug should be taken as well?
IM injection once weekly
| Folic acid
72
Name 4 precipitants of gout
Starting diuretics, surgery, starvation/dehydration, alcohol, foods rich in purines, aspirin, infection
73
What is the acute and long term treatment of gout?
Acute: NSAIDs, colchicine, steroids
| Long-term: allopurinol, febuxostat
74
Give 2 possible XR findings in gout
Soft tissue swelling
| Peri-articular erosions
75
What would you see on polarised light microscopy of the joint aspirate from a patient with gout?
Negatively birefringent needle shaped crystals
76
What joints are commonly affected by pseudogout?
Hips
| Wrists
77
Give 2 risk factors for pseudogout
Hypothyroidism, hyperparathyroidism, OA, increasing age, Wilson's disease
78
What would you see on polarised light microscopy of the joint aspirate from a patient with pseudogout?
Weakly positively birefringent rhomboid shaped crystals
79
Give 4 signs of osteoarthritis of the knee on examination
Antalgic gait, varus deformity, crepitation on movement, pain on movement, reduced ROM, fixed flexion deformity, joint effusion
80
Name 4 signs on XR of OA
Loss of joint space
Osteophytes
Subchodral sclerosis
Subchondral cysts
81
Name 4 management options for OA of the knee
Conservative (WL, exercise), physio, simple analgesia, opioid analgesia, intra-articular injections, joint replacement
82
A patient with SLE has recurrent miscarriages. What blood tests may be positive in this patient?
```
Anti-dsDNA, ANA, RhF
Antiphospholipid antibodies (anti-cardiolipin and lupus anticoagulants)
```
83
Give 2 effects of SLE that may been seen on the skin
Malar rash, discoid rash, photosensitive rash, vasculitic rash
84
Give 4 features of antiphospholipid syndrome
Recurrent miscarriage
Thrombocytopenia
Coagulation defects
Livedo reticularis
85
Give 2 drugs used to treat antiphospholipid syndrome
Heparin
Warfarin
Aspirin
Clopidogrel
86
Name 2 autoantibodies associated with dermatomyositis
Anti-Jo, anti-Mi2, RhF, ANA
87
What is Raynaud's phenomenon?
Peripheral digital ischaemia
| Caused by vasospasm which is precipitated by cold or emotion
88
Give 4 causes of Raynaud's phenomenon
Idiopathic, limited cutaneous systemic sclerosis, RA, SLE, dermatomyositis, EDS, Buerger's disease
89
Give 5 classical features of limited cutaneous scleroderma
Calcinosis, Raynaud's, oesophageal dysmotility, sclerodactyly, telangiectasia
90
Name 3 seronegative spondyloarthropathies
Psoriatic arthritis, enteropathic arthritis, reactive arthritsi
91
What antigen tends to be positive in ank spond?
HLA-B27
92
Describe the classical radiographic changes in ank spond
Bamboo spine - calcification of intervertebral ligaments, fusion of spinal facet joints and formation of bridging syndesmophytes
93
Describe the classical radiographic changes in ank spond
Bamboo spine - calcification of intervertebral ligaments, fusion of spinal facet joints and formation of bridging syndesmophytes
94
What signs might you hear on auscultating the heart and lungs in ank spond?
Lungs - fine inspiratory crackles typically at apices
| Heart - early diastolic murmur (aortic regurg)
95
Name 5 different types of psoriasis
Chronic plaque psoriasis, flexural psoriasis, guttate psoriasis, pustular psoriasis, erythrodermic psoriasis
96
Where on the body can psoriasis occur?
Extensor surfaces of arms and legs, ears, scalp, lower back
97
Name 3 organisms that commonly cause reactive arthritis
Chlamydia, campylobacter, salmonella, shigella, yersinia
98
What are the 3 features of Reiter's syndrome?
Conjunctivitis, urethritis, arthritis
99
Name 2 ANCA +ve small vessel vasculitis and 2 ANCA -ve small vessel vasculitis
+ve - Wegener's, Churg-Strauss
| -ve - HSP, Goodpasture's
100
Name 1 medium and 1 large vessel vasculitis
Medium - Kawasaki's disease, PAN
| Large - Takayasu's, temporal arteritis
101
Name 4 systemic conditions in which vasculitis is a feature of the disease
IE, Behcet's, RA, SLE, IBD
102
Name 4 causes of mononeuritis multiplex
DM, HIV, RA, sarcoidosis, Wegener's
103
Name the 4 first rank symptoms of schizophrenia
3rd person auditory hallucinations
Thought disorder
Delusional perception
Passivity phenomena
104
Name 3 features of an auditory hallucination that would suggest schizophrenia
3rd person
Running commentary
Arguing or conversing with each other
Command
105
What bloods would you do in a psychotic patient?
Tox screen, blood alcohol levels
TFTs
Lupus autoantibodies?
106
What are your differentials in a patient presenting with psychosis?
```
Schizophrenia
Drug induced psychosis
Puerperal psychosis
Mania
Severe depression with psychotic features
Organic cause e.g. thyroid
```
107
Name 2 psychological treatments for schizophrenia
CBT
| Family therapy
108
What 2 non-blood tests are needed for annual monitoring of clozapine?
Monitor weight
| ECG
109
A child is having an asthma attack. O2 sats 89, cannot complete full setences, wheeze, breathless, HR 140,
RR40. What is the severity of the attack?
Acute severe
110
What are your 3 immediate management steps in acute severe asthma?
O2
Salbutamol nebs
Oral/IV steroids
111
What are 2 IV treatments you can give in acute severe asthma in a child?
Aminophylline
| Magnesium sulfate
112
What questions would you ask in a child who has just been discharged after an asthma attack to ascertain his asthma control?
How often is he using his blue inhaler?
What are his triggers and does he avoid them where possible?
How often is his sleep disturbed by coughing?
113
What bloods would you perform in a septic screen in an unwell child?
VBG, BCs, FBC, CRP, U+E, clotting
114
What 2 features would you expect in the CSF of a patient with Guillian Barre?
Raised protein
| Normal WCC
115
Name 2 microorganisms that cause GBS
Campylobacter, CMV, EBV
116
Name 2 causes of generalised demyelinating peripheral neuropathy
GBS
CMT
CIDP
B12 deficiency
117
Name 2 treatments for GBS
IV Ig
| Methylprednisolone
118
What drugs can be used for migraine prophylaxis?
Propopranolol, topiramate, valproate, gabapentin
119
Name 3 RFs for IUGR
```
Smoking/drinking in pregnancy
Multiple pregnancy
Infection
Pre-eclampsia
Congenital abnormalities of baby
```
120
How can you investigate IUGR?
Foetal anomaly scan
| Uterine artery doppler
