Fine ? Flashcards
A 54 year-old patient presents with increased confusion. His family reports that over the past month he has become more irritable, and has complained about headaches and muscle cramps. He has recently been diagnosed with Small cell lung cancer. You suspect SIADH.
What U&E finding would you expect to see in SIADH?
Hyponatraemia
Why do patients with SIADH have hyponatraemia?
Too much water is reabsorbed and therefore blood constituents are diluted
Name a drug which could cause hypokalaemia ?
Salbutamol
Name a drug which can cause hyperkalemia ?
Ramipril
What test can diagnose a primary hyperaldosteronism ?
Aldosterone renin ratio
What PTH and Ca2+ levels suggest primary hyperparathyroidism ?
Normal PTH despite high Ca2+
What PTH and Ca2+ levels would be suggestive of secondary hyperparathyroidism ?
Ca2+ and P would be normal or low with PTH raised
Typical signs of Grave’s disease ?
Tremor Palpitations Pretibial myxoedema Ophthalmopathy Weight gain
What is the pathology of Grave’s ?
TSH receptor antibodies
Which of the following is considered the gold standard diagnosis for phaeochromocytoma?
a) Elevated plasma free Metanephrine
What can occur with steroid withdrawal ?
Secondary adrenal insufficiency
Name a drug you would give in CML
Imatinib
MOA for Imatinib
Tyrosine kinase inhibitor
What would you expect to see on the blood film of a patient with multiple myeloma ?
Rouleaux formation
What is thrombotic thrombocytopenic purpura
Unknown pathology
Increased number of blood clots in the small arteries leads to an exhaustion of the bodies platelets and destruction of RBCs
Treatment for iron deficiency anaemia ?
Ferrous sulphate
Causes of thrombocytopenia
HIV
Alcohol excess
Myeloma
Heparin
The diagnostic test for sickle cell anaemia?
Hb electrophoresis
The infective stage of the malaria parasite?
Sporozite
What type of anaemia does chronic alcohol abuse result in ?
Macrocytic anaemia
Complications of ABVD chemo for Hodgkin’s lymphoma
Infertility
Cardiomyopathy
Peripheral neuropathy
Lung damage
ABVD chemo
Adriamycin
Bleomycin
Vinblastine
Dacarbazine
Septic arthritis RF
Aged over 80 Pre-existing joint disease DM Immunosuppression Recent joint surgery Penetrating trauma Prosthetic joint
ABs associated with SLE
Anti-ANA
Anti-dsDNA
Hand characteristics of RA
Swan neck deformity
Boutonnière deformity
Ulnar deviation
Z-shaped deformity/Hitch-hikers thumb
ALP, Ca2+ and P seen in Paget’s disease
ALP: high
Ca2+ normal
P normal
Paget’s disease
Abnormal and uncontrolled bone resorption and deposition
Signs of SLE
Photosensitivity Lupus nephritis Pleuritis Peritonitis Myocarditis Oral mucosa ulcers Alopecia
What marker is used to monitor SLE ?
ESR
How are the skin related symptoms of SLE treated ?
Hydroxychloroquine
NSAID
Corticosteroids
A 28 year old woman presents to her with her 3rd recurrent miscarriage. She has a history of recurrent DVTs and one pulmonary embolism. On examination you identify a blotchy pattern on her skin. On investigation, her blood results show a prolonged APTT.
What condition is the top differential?
Antiphospholipid syndrome
Give the typical presentation for fibromyalgia
Female 30-60
What reflex is lost with a nerve root lesion at S1 ?
Ankle jerk reflex
What spinal level is the knee jerk reflex associated with ?
L4/5
Pan-systolic murmur at the apex
Mitral regurgitation
GORD
Metaplasia from squamous to columnar
Which cells do PPIs act on?
Parietal cells
What is the most common composition of renal stones?
Calcium Oxalate
Following AKI which U&E should you be most concerned about ?
K
Furosemide can be used in which patients ?
Pulmonary oedema and chronic heart failure
Furosemide MOA
Loop diuretic which inhibits the luminal NA-K-Cl co-transporter ascending limp of the loop of Henle
Thus causing more Na,CL and K to remain in the urine
A 24-year-old female presents to her GP with a single mass in her lower neck. It first appeared about 2 months ago. She recently moved to a new house and attributed her recent weight loss and night sweats to the stress of this. However, the lump in her neck has started to grow and she is getting worried as it now has a 3 cm diameter. On a recent girls night out, she found that it was very painful after drinking alcohol. What is the most likely diagnosis?
Hodgkin’s lymphoma
Causes of iron deficiency anaemia?
Chronic kidney disease, GI bleed, NSAIDS, Pregnancy
Features of iron deficiency anaemia
Brittle hair and nails, Koilonychia, Pale conjunctivae, Systolic flow murmur
Side effects of amitriptyline
Blurred Vision
Confusion
Dry Mouth
Urinary retention
Amitriptyline is used for
Migraine prophylaxis
James, a 38-year-old golfer, is diagnosed with a pheochromocytoma and is scheduled for surgery in several weeks. What is the first drug his endocrinologist should prescribe to him to prepare him for the upcoming surgery?
Phenoxybenzamine
An 86-year-old lady has been diagnosed with osteoporosis. Which of these would be second line treatment for the condition?
Denosumab
Extradural haemorrhages associated with which blood vessel ?
MMA
Subdural haemorrhages associated with which blood vessel ?
Bridging veins
Symptoms of UMN disease
Babinski reflex Increased muscle tone Muscle weakness Overactive reflexes Spastic paralysis
What medications can be used to control jerky movements in Huntington’s ?
Risperidone
Risperidone MOA
Antipsychotic
What is the treatment for Guillian-Barre syndrome?
IV immunoglobulins
PE treatment
Direct oral anticoagulants (DOACs) - apixaban
What is the antibody involved in Goodpasture’s Syndrome?
Anti-glomerular basement membrane
A 25-year-old man comes into A&E, after a motorcycle accident. He is unable to open his right fist and extend his wrist.
Which nerve is most likely to be affected?
Radial nerve
A 60-year-old man comes in with dysarthria, dysphagia and regurgitation of fluids which can sometimes result in choking. When he talks to you, his speech is quite nasal and hoarse. On examination, his tongue is flaccid, and jaw jerk is absent. His sensation is intact and normal. What is the most likely diagnosis?
Progressive bulbar palsy
Jane a 30-year-old lady is referred to migraine clinic with shooting pains across the left side of her face. The shooting pains occur randomly, and only last a few seconds. They occur across her left cheek and jaw, and do not affect her forehead or eye. They occur three or four times per day.
What condition ?
Trigeminal neuralgia
What would be the most appropriate first line medication for trigeminal neuralgia to help prevent symptoms?
Carbamazepine
Subarachnoid CT
Star shaped
Subdural CT and common presentation
Crescent shaped
Alcoholics, elderly and children
Damage to bridging veins
Extradural CT
and common presentation
Lentiform bi-convex CT
Trauma MMA
Extradural treatment
IV mannitol
Subdural treatment
Burr drill craniectomy
Parkinson’s dual therapy
Co-careldopa
Co-beneldopa
Parkinson’s triad of symptoms
Bradykinesia
Rigidity
Resting tremor
Parkinson’s dopamine agonists
Bromocryptine
Parkinson’s MAOB-I
Selegiline
Epilepsy medications
Sodium valproate
Lamotrigine
Carbamazepine
Features of a frontal lobe seizure
Motor features e.g. Posturing, peddling movements of legs. Jacksonian march (seizures march up and down the motor homunculus). Post-ictal Todd’s palsy (weakness, starts distally in limb then up to face)
Features of a parietal lobe seizure
Sensory disturbances - tingling or numbness
Features of a temporal lobe seizure
The most commonly affected in complex partial seizures. Presents with aura (deja vu, hallucinations, funny smells). Post-ictal confusion is also common in complex seizures.
Features of a occipital lobe seizure
Visual phenomena
Wernicke’s Encephalopathy occurs due to deficiency in which vitamin ?
B1 (thiamine)
How does a pancoast tumour present ?
Damage to the sympathetic nerves resulting in anhidrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)
How does Brown-Sequard Syndrome present ?
Ipsilateral loss of position, vibration sensation and motor control at the level of the lesion
What does Hypotonia mean ?
Decreased muscle tone
Name some UMN symptoms ?
Hyperreflexia Muscle wasting Spastic paralysis Positive Babinski sign Clonus
Name some LMN symptoms ?
Flaccid muscle tone Hyporeflexia Hypotonic Wasting atrophy Fasciculation Loss of voluntary movement
Loss of function in the right leg suggests dysfunction of what blood vessel ?
Left anterior cerebral artery
Loss of function in the right shoulder, arm, hand and face suggest dysfunction of what blood vessel ?
Left middle cerebral artery
Loss of/affected vision and coordination suggests dysfunction of which blood vessel ?
Posterior cerebral artery
What key part of the body does MND not affect ?
Eyes
What is Lambert Eaton syndrome ?
A presynaptic NMJ disorder where the muscles are unable to contract properly resulting in weakness, drooping eyelids, swallowing problems and dry mouth.
Non-motor symptoms of Parkinson’s disease
REM sleep disorder
Postural hypotension
Constipation
Depression
What condition is riluzole used to treat ?
MND - paritually ALS
You see an 8 year-old child in your clinic. His mother tells you that he has been complaining of weakness in his legs, particularly his feet. So far, he hasn’t complained of any issues above his knees. The child doesn’t have any pain. On examination you note that he has decreased touch and vibration sensation in his feet and that he has Pes cavus.
What is the most likely diagnosis for this child?
Charcot-Marie Tooth
What can lamotrigine be used to treat ?
Tonic clonic seizures - most useful in women of childbearing age
What is Phalen’s test ?
A test for CTS where the patient places the wrist in complete unforced flexion for at least 30 seconds
Jane is a 28 year-old lady who is complaining of pain in the back of her legs, and the
outer side of her right leg. She also says that she is having problems lifting her ankle
up.
Which nerve root would cause this type of radiculopathy?
L5
Name a tool which can be used to calculate a patient’s risk of a stroke when in AF
CHADS VASc
Name the components of a CHADS VASc score
CHF, HTN, Age (75+), DM/Stroke/TIA/TE = 2
VD, Age (65-74) Sex (female)
What does a collapsing pulse suggest ?
Aortic regurgitation
What does a irregularly irregular pulse suggest ?
Atrial fibrillation
What does a pulsus paradox mean ?
BP drops significantly during inspiration suggesting severe Asthma, COPD, blood loss and cardiac conditions
What is a radio-radial delay pulse ?
When the pulse is significantly stronger in one arm than the other seen in coarctation of the aorta
An ejection crescendo-decrescendo systolic murmur would be suggestive of which valvular pathology?
Aortic stenosis
What does an R wave in V1 and Slurred S wave in V6 suggest ?
Right bundle branch block
What does an R wave in V6 and Slurred S wave in V1 suggest ?
Left bundle branch block
What are the features of tetralogy of Fallot ?
Ventricular septal defect and an overriding aorta which leads hypertrophy of the left ventricle, causing pulmonary stenosis and eventually hypertrophy of the right ventricle eventually leading to heart failure
How are blood pressure readings taken in a clinic classified ?
Clinic Readings: Stage 1= >140/90
Stage 2= >160/100
Severe HTN= >180/110
How are blood pressure taken by an ambulatory readings classed ?
145/95= Stage 1 HTN
165/105 =Stage 2 HTN
180/110= Severe HTN
Name some triggers of acid secretion ?
Gastrin release (from G cells)
Triggers release of histamine
Increases parietal cells mass
Decreases somatostatin (released from D cells)
What is Achalasia ?
A condition in which the lower oesophageal sphincter fails to open during swallowing causing a backup of food into the
Where are the majority of colon cancers found?
Distal colon
Differentials for a 19-year-old presents with abdominal pain in their umbilical region which has now migrated to the right iliac fossa. They are pyrexic and vomiting.
Diverticulitis Ectopic Pregnancy Food poisoning Perforated ulcer UTI
Causes of diverticulum?
Low fibre diet
Obesity
NSAIDs
Smoking
Differentials for rectal bleeding ?
Anal Fistula Anal Fissure Inflammatory Bowel Disease Haemorrhoids Rectal Cancer
What is Reiter’s syndrome ?
Classic triad of conjunctivitis, urethritis and arthritis occurring after an injections
What is the urgent gold standard treatment for someone with TTP?
Plasma exchange
What does TTP stand for ?
Thrombotic thrombocytopenia pupura
Management of Venous Thromboembolism in post-hip replacement patients states
Either
A low molecular weight heparin followed by low-dose aspirin
Or a low molecular weight heparin administered for 28 days in combination with anti-embolism stockings until discharge, or rivaroxaban
What is the ideal first line treatment for severe/complicated malaria?
IV Artesunate
Treatment for uncomplicated malaria ?
Oral chloroquine
What is the name for a malignant tumour of smooth muscle?
Leiomyosarcoma
Aetiology liver failure ?
Alcohol overuse
Budd-Chiari syndrome
Haemochromatosis
Wilson’s Disease
Aetiology for Pancreatitis
GET SMASHED Gall stones Ethanol excess Trauma Steriods Mumps Autoimmune Scorpion venom Hyperlipidemia ERCP or emboli Drugs
Side effects that can occur with Alendronic Acid use?
Oesophagitis
Medications which can cause Gout ?
Methotrexate
Thiazide and loop diuretics
Risk factors for pseudogout
IV fluids and parathyroidectomy (the benign tumour in his neck) as these can derange calcium levels.
What is an osteopenic suggesting T-score ?
-1 to -2.5
What is dsysdiadochokinesis
Loss of ability to perform rapid alternating movements
Name focal neurological signs caused by mass effect of brain tumours
Dysdiadokinesis, ataxia, nystagmus, intention tremor, slurred/stacatto speech, hypotonia
What is the commonest cause of an infective exacerbation of COPD?
Haemophilus Influenzae
Which type of lung cancer is most commonly seen in non-smokers?
Adenocarcinoma
Which type of lung cancer is most commonly seen in smokers ?
Small cell carcinoma
What is the best investigation in a patient with chronic diarrhoea and malabsorption ?
Small intestine biopsy
How does a large bowel obstruction present compared to a small bowel obstruction ?
Constipation before vomiting
How does a small bowel obstruction present compared to a large bowel obstruction ?
Vomiting before constipation
Features of primary sclerosing cholangitis
Patchy inflammation, fibrosis, and strictures in intra- and extrahepatic bile ducts.
Symptoms include pruritus and fatigue.
What histological features will an endoscopy with duodenal biopsy find if a patient has coeliac disease
Villous atrophy
Crypt hyperplasia
Intraepithelial lymphocytosis
Proliferation & invasion of lymphocytes
What is the name of the at home bowel cancer screening test kit ?
Faecal immunochemical test
Causes of peptic ulcers
NSAIDs
Helicobacter pyloric infection
Haemodynamic shock
Stress
Signs of chronic liver disease
Palmar erythema
Clubbing
Dupuytren’s contracture
Spider naevi
Name signs of oesophageal cancer
B symptoms
Slow onset difficulty swallowing
Haematopoiesis
Anorexia
Name as many types of diarrhoea as possible
Secretory Osmotic Exudative Inflammatory Dysentery
Features of inflammatory diarrhoea
Severe diarrhoea
Blood in stool
Fever
Abdominal pain
What clinical tool is used to classify faees ?
Bristol stool chart
What are red flags for GI cancers ?
Rectal bleeding
Abdominal mass
Change in bowel habit >6 weeks
Symptoms of bowel obstruction
Vomiting (first in SBO)
Constipation (first in LBO)
Abdominal distention
Abdominal pain
What radiological findings would confirm a SBO ?
Dilated jejunum/ileum
Absence of gas in bowel distal to obstruction
Treatment/Management for SBO
Rehydration with IV fluids Antiemetics Analgesia Nil by mouth Insertion of nasogastric tube to decompress the bowel Urinary catheter
Name a complication of SBO which would lead to emergency surgery
Bowel ischaemia or strangulation
List 3 causes of gastritis
Autoimmune Helicobacter pylori Alcohol abuse Bile reflux Mucosal ischaemia
How do you prove H.pylori infection
H.pylori urea breath test
H.pylori faecal antigen test
Name 3 clinical features of haemorrhoids
Bright red bleeding Discomfort/pain Pruritus ani Mucus discharge Pain on passing stool (external haemorrhoids only)
Pathology of haemorrhoids
Swelling and inflammation of veins in the rectum and anus
Management of haemorrhoids
Stool softeners/laxatives High fibre diet Adequate fluid intake Topical hydrocortisone Topical anusol Band ligation Haemorrhoidectomy Sclerotherapy
Symptoms of IBS
Abdominal pain or discomfort that is relieved by defecation Altered bowl frequency or stool form Bloating Symptoms made worse by eating Passage of mucus
List 5 causes of acute diarrhoea
E.coli Celiac disease (food allergy) Abx use - pseudomembranous colitis Drugs e.g. NSAIDs/chemo/PPIs Anxiety
What AB associated with coeliac disease
IgA tissue transglutaminase
List 4 potential complications of diverticulitis
Bowel obstruction
Bleeding
Mucosal inflammation
Bowel perforation
First line and second line drug treatment for haematemesis from ruptured oesophageal varices
IV terlipressin
IV somatostatin
Possible differentials for acute appendicitis
Crohn’s disease - causing acute terminal ileitis
Ectopic pregnancy
UTI
Diverticulitis
Which tumour marker is most likely to be raised in suspected testicular cancer?
Alpha feto-protein (AFP)
What is the gold standard investigation to confirm diagnosis of a transitional cell carcinoma ?
Cystoscopy
What is the staging system used for prostate cancer?
Gleason scoring
What are Anti-Ro and Anti-La Abs associated with ?
Sjogrens syndrome
What Abs are associated with SLE ?
Anti-ANA
Anti-DsDNA
What Abs are associated with vasculitis ?
Anti-ANCA
What is the criteria for complicated UTIs ?
Pregnant Males Children Recurrent UTIs Elderly people Patient’s with an abnormal urinary tract Systemic disease involving the kidney
Name an alpha blocker used to treat BPH
Terazosin
What would be the findings of a patient with nephrotic syndrome ?
Low plasma albumin
Proteinuria
High serum triglycerides
What is the most common histological form of renal malignancy ?
Renal cell carcinoma
What is a common complication of renal cell carcinoma and what is the cause ?
Hypertension caused by excessive renin secretion
Name some symptoms of RCC
Loin pain, loin mass
Bilateral ankle oedema
Fever, weight loss and malaise
Enlarged lymph nodes
What scoring system is used to stage renal cell carcinoma ?
TNM system
Define hydrocele
Abnormal collection of fluid within the remnants of the processus vaginalis
What medication is used to treat urge incontinence ?
Antimuscarinics e.g. oxybutynin
Name 3 types of nephrotic syndrome
MCD IgA nephropathy Focal segmental glomerulosclerosis Membranous nephropathy Amyloidosis Diabetic glomerulonephropathy
What is the treatment for MCD ?
Corticosteriods
Adjunct ACE-I and prophylactic anticoagulation
Name 4 classes of diuretic
Loop diuretics e.g. Furosemide
Thiazide diuretics e.g Chlorothiazide
Angiotensin receptor antagonists e.g. Azilsartan
ACE-inhibitors e.g. ramipril
What may the secretion of be reduced in CKD ?
Erythropoietin
Vit D
What is first line treatment for CKD hypertension and what can be a side effect
ACE-I e.g. ramipril, captopril or enalapril
Hyperkalaemia
Signs and symptoms of patient with CKD
Pruritus Fatigue Hypertension Swelling in arms and legs Increased need to urinate Anaemia
Bones, stones, groans and moans
Hypercalcaemia
Name 3 ways in which an AKI can be classified
eGFR
Creatinine levels
Urea levels
What ratio would be used to monitor renal function ?
Urea:creatinine
3 most common areas for a renal stone to become lodged
Pelviureteric junction
Pelvic brim
Vesicoureteric junction
Risk factors for renal stone formation
Dehydration Infections Hypercalcaemia Corticosteroids Aspirain Diet: chocolate, tea and strawberries Gout/FHx
Give examples of what a patient could do in the future to prevent the recurrence of renal stone formation
Maintain hydration
Low Ca2+
Reduce BMI
Exercise
What antibiotic would you give to treat Neisseria gonorrhoeae
IM Ciprofloxacin
Which ECG leads cover the lateral aspects of the heart ?
I, aVL and V5-6
Which ECG leads cover the inferior aspects of the heart ?
II, III and aVF
Which ECG leads cover the anterior/septal leads ?
V1-V4
Which blood vessel perfuses the right atrium and right venticle
Right coronary artery
Which leads cover the left ventricle ?
V1-4
Which medications are involved in the management of a patient who has previous suffered an MI ?
Aspirin and clopidogrel
Propranolol
Ramipril
Atorvastatin
ABCDE of Heart Failure
Alveolar oedema Kerley B lines Cardiomegaly Dilation of the upper lobe vessels Pleural effusion
Which heart conditions show ST-elevation ?
STEMI
Pericarditis
Prinzmetal angina
What ECG changes would a NSTEMI show ?
ST depression
Deep T wave inversion
Pathological Q waves
What ECG changes would unstable angina show ?
ST depression and flat T waves
But could be normal
What is a Valsalvar manoeuvre ?
Acute management of supraventricular tachycardia (SVT)
Holding the nose and mouth during forceful expiration to return the vagus nerve to normal sinus rhythm
Tool to assess risk of stroke for a patient in AF
CHADS VAS score
Tool used for risk of stroke after suspected TIA ?
ABCD2
What is the most appropriate diagnostic investigation for aortic stenosis
Echocardiogram
How will a patient with aortic stenosis present ?
SOB with exertion
Angina
Syncope
What investigation is essential for aortic stenosis diagnosis ?
Doppler echo
What blood markers would be seen in a patient with heart failure ?
Raised BNP levels
Also troponin I, troponin T, creatine kinase
Define atherosclerosis
The accumulation of the lipids, macrophages and smooth muscle cells in the intima of the large and medium sized arteries
Classical symptoms of a heart attack
Excessive sweating Anxiety/feeling of dread Short of breath Pallor Nausea/vomiting Light headed/dizzy Crushing chest pain
Name the 4 cardiac defects seen in the tetralogy of fallot
Ventricular septal defect
Overriding aorta
Right ventricular hypertrophy
Pulmonary stenosis
Define a thrombosis and an embolism
Embolism = blockage of a vessel caused by a forgien body e.g. blood clot or air bubble Thrombosis = formation of blood clot inside a blood vessel which obstructs the flow
List the effect of the RAAS
Increased sympathetic activity
Increased tubular reabsorption of Na, Cl and K+ excretion and H20 retention
Increased aldosterone secretion resulting in increased Na reabsorption in the DCT
Arteriolar vasoconstriction
ADH secretion leading to H20 reabsorption
Overall salt and water retention and increase in BP
What is the difference between essential HTN and secondary HTN
Essential is HTN with unknown cause
Secondary is HTN with a identifiable cause
Name diseases/conditions that can cause HTN
CKD Graves Stress Primary hyperaldosteronism Renal artery stenosis
Name 3 contraindications to performing a lumbar puncture
Cardiovascular compromise
Decreased GCS
Infection at site
Signs and causes of raised ICP
What Ab can be given as prophylactic treatment for meningitis ?
Benzylpenicillin
What is seen histologically and from which artery is a biopsy taken from in Giant Cell Arteritis
Temporal artery
Multinucleated giant cells
What can occur if a patient suddenly stops taking steroid medication ?
Withdrawal induced adrenal crisis
What might you see on physical examination of a patient with a cluster headache ?
Rhinorrhoea - runny nose Lid swelling Lacrimation - flow of tears Miosis - pupil constriction Sweating
What is acute treatment for a cluster headache ?
100% oxygen
SC sumatriptan
What is prophylaxis for a cluster headache ?
CCB
What is encephalitis ?
Inflammation of the brain parenchyma usually caused by viral infection
What is the most common cause of encephalitis in immunocompetent patients ?
Herpes simplex virus - type 1
What would be diagnostic in a patient with encephalitis ?
Lumbar puncture and viral PCR
What is first line treatment for encephalitis ?
IV acyclovir
Name triggers for a migraine
Cheese Caffeine Alcohol Anxiety/stress Sleep Exercise
What would acute medical management for migraines be ?
NSAIDs e.g. ibuprofen
Triptans e.g. sumatriptan
Risk factors for AD
FHx
Down’s syndrome
CVD
Advance age
What pathological features are seen in AD
Atrophy of the cortex (hippocampus) Amyloid plaques Tau neurofibrillary tangles Increased CSF proteins Damaged synapses
What medication can be used to help manage symptoms of AD ?
Acetylcholinesterase inhibitors e.g. donepezil, galantamine and rivastigmine
Classic triad of Parkinsons
Bradykinesia
Resting tremor
Rigidity
Medical management of patient with Parkinsons
MAO-B inhibitors e.g. selegiline Dopamine agonists e.g. ropinirole or pramipexole Levodopa + decarboxylase inhibitor Co-careldopa Co-beneldopa
3 causes of Guillain-Barre Syndrome
Campylobacter jejuni
Cyclomegalovirus
Epistein Barr virus
4 clinical features of Guillain-Barre Syndrome
Bilateral motor weakness
Paraesthesia
Respiratory involvement
HR changes and BP changes
How is diagnosis of Guillain-Barre Syndrome
Lumbar puncture with raised CSF proteins
What is treatment for Guillain-Barre Syndrome
IV immunoglobulins
Plasma exchange
Supportive in HUD or ITU
What is the name for lack of sensation in gential area ?
Saddle anaesthesia
What is a risk factor and why for cauda equina syndrome ?
Metastatic prostate cancer
Can reach the spine via venous blood flow and can metastasize and compress spinal cord
Differentials for acute onset facial drooping
Bell’s palsy
Stroke
TIA
When you speak to this patient, he appears to understand what you are saying, but is struggling to speak and is slurring his words. What type of aphasia is this?
Brocca’s aphasia
Which artery is affected in 90% of TIAs
Anterior cerebral artery
An 18-year-old female comes in having had a two seizures in the last 24 hours. Her mother describes she just dropped to the floor with no warning and started ‘fitting’ where she would tense and then contract and relax rapidly. She lost control of her bladder and bit her tongue. She was confused both times for several hours after.
What type of seizure is this?
Generalised tonic-clonic seizure
What test can confirm a clinical suspicion of generalised tonic-clonic seizure
Electroencephalogram EEG
Seizure medications with aren’t tertrogenic
Lamotrigine Carbamazepine
Levetiracetam
Name 2 tests for caral tunnel syndrome
Phalen’s test
Tinels test
What nerve roots of the median nerve
C6-T1
What can be given as treatment for trigeminal neuralgia to prevent symptoms
Carbamazepine
Distinguishing feature of granulomatosis with polyangiitis ?
Saddle shaped nose
Treatment for MG
Pyridostigmine
Prednisolone
Thymectomy
70-year-old man comes into your clinic with history of seizures. His wife attends with him and describes he lost awareness and was confused when he came round. During the period of lost awareness, she describes he was fiddling with the buttons on his jacket and was smacking his lip
Which lobe is affected ?
Temporal lobe complex partial seizure
A 60-year-old man comes in with dysarthria, dysphagia and regurgitation of fluids which can sometimes result in choking. When he talks to you, his speech is quite nasal and hoarse. On examination, his tongue is flaccid, and jaw jerk is absent. His sensation is intact and normal. What is the most likely diagnosis?
Progressive bulbar palsy
Nerve associated with opening, extending and flexing wrist
Radial nerve
A 24-year-old male presents to A&E after having a seizure. On questioning, he said
that he felt the seizure coming on, smelt strange smells, and experienced deja vu. He
then had periods where he had no idea what was happening and afterwards he was
incredibly confused.
What lobe was the patient having a complex seizure in?
Temporal lobe
What is Brown-Sequard Syndrome ?
Ipsilateral loss of position, vibration sensation and motor control at the level of the lesion
UMN signs
Hyperreflexia
HypotoniaC. Muscle wasting
Spastic paralysis
Positive Babinski Sign
Dysfunction of what artery will cause loss of function in the right leg ?
Left anterior cerebral artery
Subarachnoid medical before surgery
Nimodipine (CCB)
Non-motor symptoms of Parkinsons
REM sleep disorder
Postural hypotension
Constipation
Depression
Medication which aids with MND and ALS
Riluzole
You see an 8 year-old child in your clinic. His mother tells you that he has been
complaining of weakness in his legs, particularly his feet. So far, he hasn’t
complained of any issues above his knees. The child doesn’t have any pain. On
examination you note that he has decreased touch and vibration sensation in his feet
and that he has Pes cavus.
What is the most likely diagnosis for this child?
Charcot-Marie Tooth
A 20 year-old woman presents to A&E following a suspected seizure. She lost
consciousness and her boyfriend reported jerking movements that lasted about a
Minute. What should be prescribed and what shouldn’t
Lamotrigine
Topiramate
Medical management of Huntingtons
Antipsychotics e.g Haloperidol or Sulpiride
Anti-depressants e.g Sertraline
Sulpiride
Benzodiazepines e.g. Diazepam
Dopamine-depleting agents e.g. tetrabenazine
Which nerve root is dysfunctional in foot drop
L5
Which gene is mutated in cystic fibrosis?
Transmembrane conductance regulator gene
Isoniazid side effects
Fever, jaundice and nausea
Pyrazinamide side effects
Hyperuricemia (gout) and therefore hepatotoxicity
Ethambutol side effects
Optic neuritis, colour blindness
What’s the most common type of lung cancer?
Adenocarcinoma
In bronchiectasis, what’s the common finding on CT?
Signet ring sign
What kind of lung disease is TB ?
Restrictive
What is CURB-65 used to calculate ?
Mortality risk assessment for HAP
What are CURB-65 components
Confusion Urea >7mmol/l RR >30/min BP <90/60 Age over 65
What causes type 1 respiratory failure ?
Low Co2 with normal CO2: Occurs as a result of a ventilation-perfusion mismatch
What causes type 2 respiratory failure ?
Low Co2 and High Co2: Occurs as a result of alveolar hypoventilation which prevents the patient from being able to adequately oxygenate and eliminate enough CO2 from their blood.
Examples of Type 1 Failure
Nephrotic syndrome (deficient ventilation) Pulmonary embolism (deficiency perfusion) Asthma (deficient ventilation) COVID-19 (deficiency ventilation)
Examples of Type 2 Failure
COPD
Pneumonia
Reduced strength of respiratory muscles e.g. Guillain-Barre/MND
Opiate overdose
Most common causative organism in HAP
Pseudomonas aeruginosa
What is the most appropriate site for a needle thoracostomy to treat this tension pneumothorax?
2nd intercostal space, midclavicular line, on the same side as the pneumothorax
Which of the following signs would further support a diagnosis of tension pneumothorax?
Tracheal deviation away from the affected lung, hypotension and hypoxia
What is the Gold-standard imaging technique for diagnosing a PE?
CT pulmonary angiography (CTPA)
Which TLRs are intracellular receptors ?
3,7,8 and 9
What does TLR-2 do ?
Detects Lipoteichoic acid on gram positive bacteria as well as TB and other mycobacteria
What does TLR-4 do ?
LPS on the surface of Gram negative bacteria
Which innate immune cells display TLR-4 ?
All of them
What does TLR-7 do ?
Detect single stranded RNA
What does TLR-9 do
Detect unmethylated nucleotide motifs
What types of organisms does TLR-10 specifically detect ?
Listeria and influenza
What is the MOA for B-lactams
Inhibiting the synthesis of the peptidoglycan layer of the bacterial cell walls
What is the MOA for Polymyxins
Target the cell membrane of gram negative bacteria
What is the MOA for Sulfonamides and trimethoprim
Inhibit folate synthesis (and so are teratogenic)
What is the MOA for Macrolide
ABs target 50S ribosomal subunits
Example of a macrolide ABs
Erythromycin
Azithromycin
Clarithromycin
What is dobutamine and what is it used for ?
B1-agonist which acts as a positive inotrope that increased heart muscle contractility and tries to increase cardiac output
Name an Alpha-1 blocker and what is it used for ?
Doxazosin - Competitively antagonises noradrenaline for alpha-1 receptors on the post-synaptic membrane causing a relaxation of the smooth muscle
Used in BPD
Desmopressin
An ADH analogue as is used to distinguish between neurogenic and cranial DI
TLR5 detects
Flagellin
What type of lymphocyte would you find in CSF of a patient suffering from bacterial meningitis
Neutrophils
Which of the following mechanisms best describe the way furosemide acts as a
diuretic?
Na+/K +/2Cl-2 inhibitor in the thick ascending loop of Henle
Thiazide diuretics MOA
Inhibit NaCl transport at the distal convoluted tubules
Spironolactone is a
ARA causing Na+ excretion and decreased K+ and H+ excretion in the collecting tubules
SLE is which type of hypersensitivity reaction ?
Type 3 - involves antibody-antigen complexes
What is involves in a Type 1 hypersensitive reaction ?
Mass cell degranulation mediated by antigen-IgE linkage on their surface e.g. anaphylaxis and atopy
What is involves in a Type 2 hypersensitive reaction ?
IgM and IgG linkage of antigens on the surface of cells to tissue components e.g. Goodpasture’s syndrome, autoimmune haemolytic anaemia
What is involves in a Type 4 hypersensitive reaction ?
Mediated by T-cells
What is involves in a Type 5 hypersensitive reaction ?
Stimulatory antibodies e.g. Grave’s disease
Which leukocyte in this man’s peripheral blood can become pulmonary macrophages?
Monocytes
Which Ab is responsible for the initial humoral immune response
IgM
What is secreted by virally infected cells ?
Interferon-A
Name some AIDS defining illnesses
Kaposi's sarcoma Pneumocystis jirovecii pneumonia Extrapulmonary Cryptococcus Mycobacterium avium complex Oesophageal candidiasis
Which is the most common AIDS defining illness ?
Pneumocystis jirovecii pneumonia (~40%)
CXR findings in pneumocystis jiroveci pneumonia
Bilateral mid and lower zone interstitial shadowing
Treatment for penumocystis jiroveci pneumonai
Co-trimoxazole and IV pentamidine
What is Kaposi’s sarcoma
present in ~35% of AIDs-defining illnesses and is a HIV related cancer and is associated with HHV8
Which pathogen is most commonly isolated in cases of chronic diarrhoea associated with HIV?
Campylobacter
Rifampicin SE
Red tears / sweat / saliva/ pee
Isoniazid SE
Fever, jaundice and nausea
Pyrazinamide SE
Hyperuricemia (gout) and therefore hepatotoxicity
Ethambutol SE
Optic neuritis, colour blindness
Obstructive lung disease
Asthma
COPD
Bronchiectasis
Bronchiolitis
Name processes that can happen at the end of acute inflammation?
Resolution
Suppuration (pus)
Organisation
Progression to chronic inflammation
Define a Granuloma
An aggregate of epithelioid histiocytes
You suspect a patient has Sarcoidosis, which blood marker do you investigate?
ACE - released by granulomas
Give the classes of drug used to treat i) arterial thrombosis ii) venous thrombosis (2)
Arterial - antiplatelets e.g. aspirin/clopidogrel
Venous - anticoagulants e.g warfarin or heparin
Give the names of a benign neoplasm of the secretory epithelium and a malignant neoplasm of connective tissue?
Adenoma
Sarcoma
What are the most common cancers that spread to bone?
Breast Lung Thyroid Kidney Prostate
What is the sequence of events that take place for metastasis to occur?
Invasion - erosion of tissue boundaries
Intravasion - gasin access to metastatic route e.g. blood/lymph
Evasion of host defence
Extravasation - colonisation of new site
Angiogenesis - develops its own blood supply
Give 3 examples of antigen-presenting cells?
Macrophages
Dendritic cells
B cells
Describe how you would identify a bacteria as Salmonella using Microbiology
tests including differentiating it from Shigella?
Gram-stain: salmonella is gram negative (pink)
Bacilli appearance = rod shaped
MacConkey Agar (tests for lactose fermentation) - salmonella does not (plate remains clear, fermenters go pink)
Serotyping to confirm
Age group that make up 50% of new infections
19-24
Name the different types of polymorphonuclear leukocytes which is the most
abundant?
Neutrophil, basophil and eosinophil
Neutrophil is most abundant
What is the role of the Major Histocompatibility Complex (MHC)
To present antigen showing self or non-self on cell surface
Eosinophils, Basophils and Mast Cells are mainly associated with what type of infection and what type of reaction?
Hypersensitivity reaction
Parasitic infection
The action of a drug can be either receptor-related or tissue-related, which of these do the principles of affinity and efficacy influence? What do agonists / antagonists show?
Efficacy and efficacy relate to receptors
Agonists show affinity and efficacy
Antagonists show affinity only
What class of drug is Candesartan?
Angiotensin 2 receptor blocker
Which common condition often diagnosed in childhood is a contraindication of beta blockers and why?
Asthma
Beta blockers would cause a constriction of the airways smooth muscle
What do NSAIDs inhibit and what is the result?
Inhibit COX
Prevents the conversion of arachidonic acid to prostaglandin
What are the 4 stages of Pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
What is the definition of bioavailability?
Amount of a drug taken up into the systemic circulation of a proportion of the amount administered
What T score suggests osteopenia
-1 to -2.5
What T score denotes osteoporosis
