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finals > finals qs: the sequel > Flashcards

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
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2
Q

State two simple non-pharmacological measures that you would advise in sleep apnoea

A

Weight loss
Stop smoking
Reduce alcohol

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3
Q

What FBC abnormality would you see in sleep apnoea? What would you see on an ABG?

A

Polycythaemia

Type 2 respiratory failure

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4
Q

If lifestyle modifications fail in sleep apnoea, what treatment may be suitable?

A

CPAP

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5
Q

What symptoms might you see in obstructive jaundice?

A

Pale stools

Dark urine

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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

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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
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8
Q

What are the causes of nephrotic syndrome?

A

Membranous nephropathy, FSGS, minimal change disease, penicillamine, gold, SLE

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9
Q

What organisms cause CAP?

A

Strep pneumoniae
H. influenzae
Mycoplasma pneumoniae
Staph aureus

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10
Q

What ABx for legionella?

A

Clarithromycin/rifampicine

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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

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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

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13
Q

Give 2 drug treatments for MS that reduce duration and frequency of relapses

A

Beta interferon

Natalizumab

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14
Q

What are the components of the triple assessment for breast cancer?

A

Clinical examination
Mammography
Histology

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15
Q

What is the most common histological type of breast Ca?

A

Adenocarcinoma

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16
Q

What are the risk factors for breast cancer?

A

FH, increasing age, uninterrupted oestrogen (nulliparity, late menopause, early menarche)

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17
Q

What are 5 common cancers that metastasize to bone?

A 
Prostate
Lung
Kidney
Breast
Thyroid
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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

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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

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20
Q

What drugs would you treat TB with and for how long?

A

RIPE - 2mo

RI - a further 4mo

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21
Q

What drugs would you give to close contacts of someone with TB?

A

Rifampicin and isoniazid

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22
Q

Give 4 drugs that can cause acute confusional state

A

Alcohol, BDZ, anticholinergics, opiates, steroids, levodopa

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23
Q

Give 4 neurological causes of acute confusional state

A

Head injury, brain mets, encephalitis, meningitis, SOL, subdural, extradural

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24
Q

Give 4 metabolic causes of acute confusional state

A

Uraemia, hypercalcaemia, hyponatraemia, hypoglycaemia, DKA

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25
Q

What investigations can you do for carpal tunnel syndrome?

A

Phalens and Tinel’s tests

Nerve conduction studies

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26
Q

What tests would you do to confirm prostate cancer?

A

PSA
Transrectal ultrasound
Prostate biopsy

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27
Q

Give 2 investigations which can assess the extent of disease in prostate cancer

A 
Transrectal USS
CT abdo and chest
Alk phos
Serum Ca
Isotope bone scan
XR axial skeleton
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28
Q

State 3 treatments for prostate cancer

A

Radical prostatectomy
Radiotherapy
Anti-androgen therapy e.g. goserelin
Orchidectomy

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29
Q

To what site does breast cancer commonly first metastasise?

A

Axillary LNs

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30
Q

What measurement on CXR would confirm cardiomegaly?

A

Cardiothoracic ratio of over 0.5

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31
Q

On CXR you see a double cardiac shadow on the right side of the heart. What might be the cause?

A

Enlarged left atrium

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32
Q

What ECG features would raise your suspicion of LVH?

A 
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
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33
Q

What are 2 long-term complications of untreated aortic stenosis?

A

Sudden death
Arrhythmia such as AF/VT
Left heart failure
Angina

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34
Q

A man with depression treated with fluoxetine says he feels better after 6w of treatment. What advice would you give and why?

A

Continue the drug for at least 6mo

Relapse is high before this time

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35
Q

What is the mechanism of action of fluoxetine?

A

Blocks reuptake of serotonin

Downregulates number of serotonin receptors in prefrontal cortex

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36
Q

What drugs would you expect a patient with sickle cell to be on?

A

Penicillin
Folic acid
Hydroxycarbamide

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37
Q

Name 3 factors that can precipitate a sickle cell crisis

A

Infection
Hypoxia
Exposure to cold

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38
Q

How do you manage a sickle cell crisis?

A

Morphine
Oxygen
IV fluids
Empirical ABx

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39
Q

What is the pattern of inheritance of sickle cell disease?

A

Autosomal recessive

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40
Q

Why does sickle cell not usually clinically manifest until roughly 6 months of age?

A

Until 6 months there are still high levels of foetal haemoglobin
This masks the effect of sickle cell until HbF levels begin to fall

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41
Q

What is multiple myeloma?

What is the commonest immunoglobulin expressed as part of the disease?

A

Malignant clonal proliferation of B-lymphocytic plasma cells

IgG

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42
Q

State 4 symptoms a patient with multiple myeloma may complain of

A 
Bone pain
Polydipsia
Recurrent infections
Bruising easily
Tiredness
Confusion
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43
Q

State 3 investigations you would perform in suspected multiple myeloma

A 
FBC, U+E
Serum electrophoresis
Urine electrophoresis
Serum immunoglobulins
Serum calcium
Bone marrow sampling
Skeletal survey XR
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44
Q

Why are patients with multiple myeloma prone to bacterial infections?

A

Possible bone marrow infiltration

Immunoparesis due to overexpression of one immunoglobulin and underexpression of any other immunoglobulins

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45
Q

State 2 acute complications of multiple myeloma

A

Hypercalcaemia
Spinal cord compression
Acute renal failure
Hyperviscosity

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46
Q

Name 3 causes of splenomegaly

A

Leukaemia, lymphoma, myelofibrosis
Malaria
Glandular fever
Liver cirrhosis with portal HTN

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47
Q

How could you use a blood film to differentiate between acute and chronic leukaemia?

A

Chronic will have white cells at all stages of life cycle

Acute will have only immature white blast cells

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48
Q

What is the name of the chromosome associated with CML?

A

Philadelphia chromosome (t9;22)

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49
Q

Name the drug used to treat CML, its method of action and its route of administration
What other treatment options are available?

A 
Imatinib
Tyrosine kinase inhibitor
Oral
Trial different tyrosine kinase inhibitor
BM transplant
50
Q

What findings would you expect on an FBC in bone marrow failure?

A

Leucopaenia/neutropaenia
Thrombocytopaenia
Anaemia

51
Q

A patient who you suspect may have a haematological malignancy has bone pain. What may be the cause of this?

A

Bone marrow infiltration

52
Q

What supportive care is needed for patients undergoing bone marrow transplants for leukaemia?

A

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
Q

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?

A

Acute haemolytic transfusion reaction

Stop the transfusion

54
Q

Name one early (<24h) and one late (>24h) transfusion reaction

A

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
Q

What is the definition of a massive blood transfusion?

A

10 units of blood within 24h

56
Q

How can macrocytic anaemia be classified into 2 categories? Name 2 causes in each category.

A

Megaloblastic: B12 deficiency, folate deficiency

Non-megaloblastic: alcohol, liver disease, hypothyroidism

57
Q

What type of anaemia would you expect in beta thalassaemia major? What is the other name for beta thalassaemia major?

A

Microcytic hypochromic anaemia

Cooley’s anaemia

58
Q

What signs might you find on examination in beta thalassaemia major?

A 
Hepatosplenomegaly
Frontal bossing
Jaw enlargement
Flow murmur
Pallor
Tachycardia
59
Q

What are the treatment options for beta thalassaemia major?

A

Blood transfusion, iron chelation therapy

60
Q

Why do children with beta thalassaemia major not present until after 6 months of age?

A

Because up until 6 months there is a large amount of fetal haemoglobin which masks symptoms

61
Q

What is the mode of inheritance of haemophilia A? Which clotting factor is deficient?

A

X linked recessive

VIII

62
Q

In haemophilia A, what would you expect the INR and APTT to be?

A

INR - normal

APTT - prolonged

63
Q

What treatments can be given to patients with haemophilia A to improve their clotting factor deficiency?

A

Recombinant factor VIII, FFP containing factor VIII, desmopressin

64
Q

Name 2 investigations that may be requested in RA

A

Anti-CCP, rheumatoid factor

65
Q

Name 3 findings you may find in the hands in patients with RA

A 
Ulnar deviation
MCP swelling
Swan neck deformity
Boutonniere deformity
Z thumb
Wrist subluxation
66
Q

What XR abnormalities would you see in the hand of someone with RA?

A

Loss of joint space
Soft tissue swelling
Juxta-articular osteopenia
Bony erosions

67
Q

Give 4 extra-articular features of RA

A 
Pulmonary fibrosis
Raynaud's
CTS
Rheumatoid nodules (elbow, pleura)
Felty's syndrome
68
Q

A woman with RA has a palpable spleen and a neutrophil count of 1.10. Diagnosis?

A

Felty’s syndrome

69
Q

Give 4 causes of polyarthritis

A 
RA
Psoriatic arthritis
Enteropathic arthritis
Osteoarthritis
Reactive arthritis
SLE
70
Q

How is MTX administered and how often? What drug should be taken as well?

A

IM injection once weekly

Folic acid

71
Q

How is MTX administered and how often? What drug should be taken as well?

A

IM injection once weekly

Folic acid

72
Q

Name 4 precipitants of gout

A

Starting diuretics, surgery, starvation/dehydration, alcohol, foods rich in purines, aspirin, infection

73
Q

What is the acute and long term treatment of gout?

A

Acute: NSAIDs, colchicine, steroids

Long-term: allopurinol, febuxostat

74
Q

Give 2 possible XR findings in gout

A

Soft tissue swelling

Peri-articular erosions

75
Q

What would you see on polarised light microscopy of the joint aspirate from a patient with gout?

A

Negatively birefringent needle shaped crystals

76
Q

What joints are commonly affected by pseudogout?

A

Hips

Wrists

77
Q

Give 2 risk factors for pseudogout

A

Hypothyroidism, hyperparathyroidism, OA, increasing age, Wilson’s disease

78
Q

What would you see on polarised light microscopy of the joint aspirate from a patient with pseudogout?

A

Weakly positively birefringent rhomboid shaped crystals

79
Q

Give 4 signs of osteoarthritis of the knee on examination

A

Antalgic gait, varus deformity, crepitation on movement, pain on movement, reduced ROM, fixed flexion deformity, joint effusion

80
Q

Name 4 signs on XR of OA

A

Loss of joint space
Osteophytes
Subchodral sclerosis
Subchondral cysts

81
Q

Name 4 management options for OA of the knee

A

Conservative (WL, exercise), physio, simple analgesia, opioid analgesia, intra-articular injections, joint replacement

82
Q

A patient with SLE has recurrent miscarriages. What blood tests may be positive in this patient?

A 
Anti-dsDNA, ANA, RhF
Antiphospholipid antibodies (anti-cardiolipin and lupus anticoagulants)
83
Q

Give 2 effects of SLE that may been seen on the skin

A

Malar rash, discoid rash, photosensitive rash, vasculitic rash

84
Q

Give 4 features of antiphospholipid syndrome

A

Recurrent miscarriage
Thrombocytopenia
Coagulation defects
Livedo reticularis

85
Q

Give 2 drugs used to treat antiphospholipid syndrome

A

Heparin
Warfarin
Aspirin
Clopidogrel

86
Q

Name 2 autoantibodies associated with dermatomyositis

A

Anti-Jo, anti-Mi2, RhF, ANA

87
Q

What is Raynaud’s phenomenon?

A

Peripheral digital ischaemia

Caused by vasospasm which is precipitated by cold or emotion

88
Q

Give 4 causes of Raynaud’s phenomenon

A

Idiopathic, limited cutaneous systemic sclerosis, RA, SLE, dermatomyositis, EDS, Buerger’s disease

89
Q

Give 5 classical features of limited cutaneous scleroderma

A

Calcinosis, Raynaud’s, oesophageal dysmotility, sclerodactyly, telangiectasia

90
Q

Name 3 seronegative spondyloarthropathies

A

Psoriatic arthritis, enteropathic arthritis, reactive arthritsi

91
Q

What antigen tends to be positive in ank spond?

A

HLA-B27

92
Q

Describe the classical radiographic changes in ank spond

A

Bamboo spine - calcification of intervertebral ligaments, fusion of spinal facet joints and formation of bridging syndesmophytes

93
Q

Describe the classical radiographic changes in ank spond

A

Bamboo spine - calcification of intervertebral ligaments, fusion of spinal facet joints and formation of bridging syndesmophytes

94
Q

What signs might you hear on auscultating the heart and lungs in ank spond?

A

Lungs - fine inspiratory crackles typically at apices

Heart - early diastolic murmur (aortic regurg)

95
Q

Name 5 different types of psoriasis

A

Chronic plaque psoriasis, flexural psoriasis, guttate psoriasis, pustular psoriasis, erythrodermic psoriasis

96
Q

Where on the body can psoriasis occur?

A

Extensor surfaces of arms and legs, ears, scalp, lower back

97
Q

Name 3 organisms that commonly cause reactive arthritis

A

Chlamydia, campylobacter, salmonella, shigella, yersinia

98
Q

What are the 3 features of Reiter’s syndrome?

A

Conjunctivitis, urethritis, arthritis

99
Q

Name 2 ANCA +ve small vessel vasculitis and 2 ANCA -ve small vessel vasculitis

A

+ve - Wegener’s, Churg-Strauss

-ve - HSP, Goodpasture’s

100
Q

Name 1 medium and 1 large vessel vasculitis

A

Medium - Kawasaki’s disease, PAN

Large - Takayasu’s, temporal arteritis

101
Q

Name 4 systemic conditions in which vasculitis is a feature of the disease

A

IE, Behcet’s, RA, SLE, IBD

102
Q

Name 4 causes of mononeuritis multiplex

A

DM, HIV, RA, sarcoidosis, Wegener’s

103
Q

Name the 4 first rank symptoms of schizophrenia

A

3rd person auditory hallucinations
Thought disorder
Delusional perception
Passivity phenomena

104
Q

Name 3 features of an auditory hallucination that would suggest schizophrenia

A

3rd person
Running commentary
Arguing or conversing with each other
Command

105
Q

What bloods would you do in a psychotic patient?

A

Tox screen, blood alcohol levels
TFTs
Lupus autoantibodies?

106
Q

What are your differentials in a patient presenting with psychosis?

A 
Schizophrenia
Drug induced psychosis
Puerperal psychosis
Mania
Severe depression with psychotic features
Organic cause e.g. thyroid
107
Q

Name 2 psychological treatments for schizophrenia

A

CBT

Family therapy

108
Q

What 2 non-blood tests are needed for annual monitoring of clozapine?

A

Monitor weight

ECG

109
Q

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?

A

Acute severe

110
Q

What are your 3 immediate management steps in acute severe asthma?

A

O2
Salbutamol nebs
Oral/IV steroids

111
Q

What are 2 IV treatments you can give in acute severe asthma in a child?

A

Aminophylline

Magnesium sulfate

112
Q

What questions would you ask in a child who has just been discharged after an asthma attack to ascertain his asthma control?

A

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
Q

What bloods would you perform in a septic screen in an unwell child?

A

VBG, BCs, FBC, CRP, U+E, clotting

114
Q

What 2 features would you expect in the CSF of a patient with Guillian Barre?

A

Raised protein

Normal WCC

115
Q

Name 2 microorganisms that cause GBS

A

Campylobacter, CMV, EBV

116
Q

Name 2 causes of generalised demyelinating peripheral neuropathy

A

GBS
CMT
CIDP
B12 deficiency

117
Q

Name 2 treatments for GBS

A

IV Ig

Methylprednisolone

118
Q

What drugs can be used for migraine prophylaxis?

A

Propopranolol, topiramate, valproate, gabapentin

119
Q

Name 3 RFs for IUGR

A 
Smoking/drinking in pregnancy
Multiple pregnancy
Infection
Pre-eclampsia
Congenital abnormalities of baby
120
Q

How can you investigate IUGR?

A

Foetal anomaly scan

Uterine artery doppler

finals (8 decks)

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