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Flash Cards From Mocks > Fine ? > Flashcards

Fine ? Flashcards

1
Q

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?

A

Hyponatraemia

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2
Q

Why do patients with SIADH have hyponatraemia?

A

Too much water is reabsorbed and therefore blood constituents are diluted

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3
Q

Name a drug which could cause hypokalaemia ?

A

Salbutamol

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4
Q

Name a drug which can cause hyperkalemia ?

A

Ramipril

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5
Q

What test can diagnose a primary hyperaldosteronism ?

A

Aldosterone renin ratio

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6
Q

What PTH and Ca2+ levels suggest primary hyperparathyroidism ?

A

Normal PTH despite high Ca2+

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7
Q

What PTH and Ca2+ levels would be suggestive of secondary hyperparathyroidism ?

A

Ca2+ and P would be normal or low with PTH raised

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8
Q

Typical signs of Grave’s disease ?

A 
Tremor 
Palpitations 
Pretibial myxoedema 
Ophthalmopathy 
Weight gain
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9
Q

What is the pathology of Grave’s ?

A

TSH receptor antibodies

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10
Q

Which of the following is considered the gold standard diagnosis for phaeochromocytoma?

A

a) Elevated plasma free Metanephrine

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11
Q

What can occur with steroid withdrawal ?

A

Secondary adrenal insufficiency

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12
Q

Name a drug you would give in CML

A

Imatinib

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13
Q

MOA for Imatinib

A

Tyrosine kinase inhibitor

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14
Q

What would you expect to see on the blood film of a patient with multiple myeloma ?

A

Rouleaux formation

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15
Q

What is thrombotic thrombocytopenic purpura

A

Unknown pathology
Increased number of blood clots in the small arteries leads to an exhaustion of the bodies platelets and destruction of RBCs

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16
Q

Treatment for iron deficiency anaemia ?

A

Ferrous sulphate

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17
Q

Causes of thrombocytopenia

A

HIV
Alcohol excess
Myeloma
Heparin

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18
Q

The diagnostic test for sickle cell anaemia?

A

Hb electrophoresis

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19
Q

The infective stage of the malaria parasite?

A

Sporozite

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20
Q

What type of anaemia does chronic alcohol abuse result in ?

A

Macrocytic anaemia

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21
Q

Complications of ABVD chemo for Hodgkin’s lymphoma

A

Infertility
Cardiomyopathy
Peripheral neuropathy
Lung damage

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22
Q

ABVD chemo

A

Adriamycin
Bleomycin
Vinblastine
Dacarbazine

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23
Q

Septic arthritis RF

A 
Aged over 80 
Pre-existing joint disease 
DM 
Immunosuppression 
Recent joint surgery
Penetrating trauma 
Prosthetic joint
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24
Q

ABs associated with SLE

A

Anti-ANA

Anti-dsDNA

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25
Q

Hand characteristics of RA

A

Swan neck deformity
Boutonnière deformity
Ulnar deviation
Z-shaped deformity/Hitch-hikers thumb

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26
Q

ALP, Ca2+ and P seen in Paget’s disease

A

ALP: high
Ca2+ normal
P normal

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27
Q

Paget’s disease

A

Abnormal and uncontrolled bone resorption and deposition

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28
Q

Signs of SLE

A 
Photosensitivity 
Lupus nephritis 
Pleuritis  
Peritonitis 
Myocarditis 
Oral mucosa ulcers 
Alopecia
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29
Q

What marker is used to monitor SLE ?

A

ESR

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30
Q

How are the skin related symptoms of SLE treated ?

A

Hydroxychloroquine
NSAID
Corticosteroids

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31
Q

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?

A

Antiphospholipid syndrome

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32
Q

Give the typical presentation for fibromyalgia

A

Female 30-60

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33
Q

What reflex is lost with a nerve root lesion at S1 ?

A

Ankle jerk reflex

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34
Q

What spinal level is the knee jerk reflex associated with ?

A

L4/5

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35
Q

Pan-systolic murmur at the apex

A

Mitral regurgitation

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36
Q

GORD

A

Metaplasia from squamous to columnar

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37
Q

Which cells do PPIs act on?

A

Parietal cells

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38
Q

What is the most common composition of renal stones?

A

Calcium Oxalate

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39
Q

Following AKI which U&E should you be most concerned about ?

A

K

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40
Q

Furosemide can be used in which patients ?

A

Pulmonary oedema and chronic heart failure

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41
Q

Furosemide MOA

A

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

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42
Q

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?

A

Hodgkin’s lymphoma

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43
Q

Causes of iron deficiency anaemia?

A

Chronic kidney disease, GI bleed, NSAIDS, Pregnancy

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44
Q

Features of iron deficiency anaemia

A

Brittle hair and nails, Koilonychia, Pale conjunctivae, Systolic flow murmur

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45
Q

Side effects of amitriptyline

A

Blurred Vision
Confusion
Dry Mouth
Urinary retention

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46
Q

Amitriptyline is used for

A

Migraine prophylaxis

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47
Q

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?

A

Phenoxybenzamine

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48
Q

An 86-year-old lady has been diagnosed with osteoporosis. Which of these would be second line treatment for the condition?

A

Denosumab

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49
Q

Extradural haemorrhages associated with which blood vessel ?

A

MMA

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50
Q

Subdural haemorrhages associated with which blood vessel ?

A

Bridging veins

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51
Q

Symptoms of UMN disease

A 
Babinski reflex 
Increased muscle tone 
Muscle weakness 
Overactive reflexes
Spastic paralysis
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52
Q

What medications can be used to control jerky movements in Huntington’s ?

A

Risperidone

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53
Q

Risperidone MOA

A

Antipsychotic

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54
Q

What is the treatment for Guillian-Barre syndrome?

A

IV immunoglobulins

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55
Q

PE treatment

A

Direct oral anticoagulants (DOACs) - apixaban

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56
Q

What is the antibody involved in Goodpasture’s Syndrome?

A

Anti-glomerular basement membrane

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57
Q

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?

A

Radial nerve

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58
Q

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?

A

Progressive bulbar palsy

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59
Q

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 ?

A

Trigeminal neuralgia

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60
Q

What would be the most appropriate first line medication for trigeminal neuralgia to help prevent symptoms?

A

Carbamazepine

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61
Q

Subarachnoid CT

A

Star shaped

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62
Q

Subdural CT and common presentation

A

Crescent shaped
Alcoholics, elderly and children
Damage to bridging veins

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63
Q

Extradural CT

and common presentation

A

Lentiform bi-convex CT

Trauma MMA

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64
Q

Extradural treatment

A

IV mannitol

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65
Q

Subdural treatment

A

Burr drill craniectomy

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66
Q

Parkinson’s dual therapy

A

Co-careldopa

Co-beneldopa

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67
Q

Parkinson’s triad of symptoms

A

Bradykinesia
Rigidity
Resting tremor

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68
Q

Parkinson’s dopamine agonists

A

Bromocryptine

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69
Q

Parkinson’s MAOB-I

A

Selegiline

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70
Q

Epilepsy medications

A

Sodium valproate
Lamotrigine
Carbamazepine

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71
Q

Features of a frontal lobe seizure

A

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)

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72
Q

Features of a parietal lobe seizure

A

Sensory disturbances - tingling or numbness

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73
Q

Features of a temporal lobe seizure

A

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.

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74
Q

Features of a occipital lobe seizure

A

Visual phenomena

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75
Q

Wernicke’s Encephalopathy occurs due to deficiency in which vitamin ?

A

B1 (thiamine)

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76
Q

How does a pancoast tumour present ?

A

Damage to the sympathetic nerves resulting in anhidrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)

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77
Q

How does Brown-Sequard Syndrome present ?

A

Ipsilateral loss of position, vibration sensation and motor control at the level of the lesion

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78
Q

What does Hypotonia mean ?

A

Decreased muscle tone

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79
Q

Name some UMN symptoms ?

A 
Hyperreflexia 
Muscle wasting 
Spastic paralysis 
Positive Babinski sign
Clonus
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80
Q

Name some LMN symptoms ?

A 
Flaccid muscle tone 
Hyporeflexia 
Hypotonic 
Wasting atrophy 
Fasciculation 
Loss of voluntary movement
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81
Q

Loss of function in the right leg suggests dysfunction of what blood vessel ?

A

Left anterior cerebral artery

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82
Q

Loss of function in the right shoulder, arm, hand and face suggest dysfunction of what blood vessel ?

A

Left middle cerebral artery

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83
Q

Loss of/affected vision and coordination suggests dysfunction of which blood vessel ?

A

Posterior cerebral artery

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84
Q

What key part of the body does MND not affect ?

A

Eyes

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85
Q

What is Lambert Eaton syndrome ?

A

A presynaptic NMJ disorder where the muscles are unable to contract properly resulting in weakness, drooping eyelids, swallowing problems and dry mouth.

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86
Q

Non-motor symptoms of Parkinson’s disease

A

REM sleep disorder
Postural hypotension
Constipation
Depression

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87
Q

What condition is riluzole used to treat ?

A

MND - paritually ALS

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88
Q

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?

A

Charcot-Marie Tooth

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89
Q

What can lamotrigine be used to treat ?

A

Tonic clonic seizures - most useful in women of childbearing age

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90
Q

What is Phalen’s test ?

A

A test for CTS where the patient places the wrist in complete unforced flexion for at least 30 seconds

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91
Q

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?

A

L5

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92
Q

Name a tool which can be used to calculate a patient’s risk of a stroke when in AF

A

CHADS VASc

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93
Q

Name the components of a CHADS VASc score

A

CHF, HTN, Age (75+), DM/Stroke/TIA/TE = 2

VD, Age (65-74) Sex (female)

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94
Q

What does a collapsing pulse suggest ?

A

Aortic regurgitation

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95
Q

What does a irregularly irregular pulse suggest ?

A

Atrial fibrillation

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96
Q

What does a pulsus paradox mean ?

A

BP drops significantly during inspiration suggesting severe Asthma, COPD, blood loss and cardiac conditions

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97
Q

What is a radio-radial delay pulse ?

A

When the pulse is significantly stronger in one arm than the other seen in coarctation of the aorta

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98
Q

An ejection crescendo-decrescendo systolic murmur would be suggestive of which valvular pathology?

A

Aortic stenosis

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99
Q

What does an R wave in V1 and Slurred S wave in V6 suggest ?

A

Right bundle branch block

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100
Q

What does an R wave in V6 and Slurred S wave in V1 suggest ?

A

Left bundle branch block

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101
Q

What are the features of tetralogy of Fallot ?

A

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

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102
Q

How are blood pressure readings taken in a clinic classified ?

A

Clinic Readings: Stage 1= >140/90
Stage 2= >160/100
Severe HTN= >180/110

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103
Q

How are blood pressure taken by an ambulatory readings classed ?

A

145/95= Stage 1 HTN
165/105 =Stage 2 HTN
180/110= Severe HTN

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104
Q

Name some triggers of acid secretion ?

A

Gastrin release (from G cells)
Triggers release of histamine
Increases parietal cells mass
Decreases somatostatin (released from D cells)

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105
Q

What is Achalasia ?

A

A condition in which the lower oesophageal sphincter fails to open during swallowing causing a backup of food into the

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106
Q

Where are the majority of colon cancers found?

A

Distal colon

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107
Q

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.

A 
Diverticulitis
Ectopic Pregnancy
Food poisoning
Perforated ulcer
UTI
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108
Q

Causes of diverticulum?

A

Low fibre diet
Obesity
NSAIDs
Smoking

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109
Q

Differentials for rectal bleeding ?

A 
Anal Fistula
Anal Fissure
Inflammatory Bowel Disease
Haemorrhoids
Rectal Cancer
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110
Q

What is Reiter’s syndrome ?

A

Classic triad of conjunctivitis, urethritis and arthritis occurring after an injections

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111
Q

What is the urgent gold standard treatment for someone with TTP?

A

Plasma exchange

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112
Q

What does TTP stand for ?

A

Thrombotic thrombocytopenia pupura

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113
Q

Management of Venous Thromboembolism in post-hip replacement patients states

A

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

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114
Q

What is the ideal first line treatment for severe/complicated malaria?

A

IV Artesunate

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115
Q

Treatment for uncomplicated malaria ?

A

Oral chloroquine

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116
Q

What is the name for a malignant tumour of smooth muscle?

A

Leiomyosarcoma

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117
Q

Aetiology liver failure ?

A

Alcohol overuse
Budd-Chiari syndrome
Haemochromatosis
Wilson’s Disease

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118
Q

Aetiology for Pancreatitis

A 
GET SMASHED
Gall stones 
Ethanol excess 
Trauma 
Steriods 
Mumps 
Autoimmune 
Scorpion venom 
Hyperlipidemia 
ERCP or emboli 
Drugs
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119
Q

Side effects that can occur with Alendronic Acid use?

A

Oesophagitis

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120
Q

Medications which can cause Gout ?

A

Methotrexate

Thiazide and loop diuretics

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121
Q

Risk factors for pseudogout

A

IV fluids and parathyroidectomy (the benign tumour in his neck) as these can derange calcium levels.

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122
Q

What is an osteopenic suggesting T-score ?

A

-1 to -2.5

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123
Q

What is dsysdiadochokinesis

A

Loss of ability to perform rapid alternating movements

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124
Q

Name focal neurological signs caused by mass effect of brain tumours

A

Dysdiadokinesis, ataxia, nystagmus, intention tremor, slurred/stacatto speech, hypotonia

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125
Q

What is the commonest cause of an infective exacerbation of COPD?

A

Haemophilus Influenzae

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126
Q

Which type of lung cancer is most commonly seen in non-smokers?

A

Adenocarcinoma

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127
Q

Which type of lung cancer is most commonly seen in smokers ?

A

Small cell carcinoma

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128
Q

What is the best investigation in a patient with chronic diarrhoea and malabsorption ?

A

Small intestine biopsy

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129
Q

How does a large bowel obstruction present compared to a small bowel obstruction ?

A

Constipation before vomiting

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130
Q

How does a small bowel obstruction present compared to a large bowel obstruction ?

A

Vomiting before constipation

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131
Q

Features of primary sclerosing cholangitis

A

Patchy inflammation, fibrosis, and strictures in intra- and extrahepatic bile ducts.
Symptoms include pruritus and fatigue.

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132
Q

What histological features will an endoscopy with duodenal biopsy find if a patient has coeliac disease

A

Villous atrophy
Crypt hyperplasia
Intraepithelial lymphocytosis
Proliferation & invasion of lymphocytes

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133
Q

What is the name of the at home bowel cancer screening test kit ?

A

Faecal immunochemical test

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134
Q

Causes of peptic ulcers

A

NSAIDs
Helicobacter pyloric infection
Haemodynamic shock
Stress

135
Q

Signs of chronic liver disease

A

Palmar erythema
Clubbing
Dupuytren’s contracture
Spider naevi

136
Q

Name signs of oesophageal cancer

A

B symptoms
Slow onset difficulty swallowing
Haematopoiesis
Anorexia

137
Q

Name as many types of diarrhoea as possible

A 
Secretory 
Osmotic
Exudative 
Inflammatory 
Dysentery
138
Q

Features of inflammatory diarrhoea

A

Severe diarrhoea
Blood in stool
Fever
Abdominal pain

139
Q

What clinical tool is used to classify faees ?

A

Bristol stool chart

140
Q

What are red flags for GI cancers ?

A

Rectal bleeding
Abdominal mass
Change in bowel habit >6 weeks

141
Q

Symptoms of bowel obstruction

A

Vomiting (first in SBO)
Constipation (first in LBO)
Abdominal distention
Abdominal pain

142
Q

What radiological findings would confirm a SBO ?

A

Dilated jejunum/ileum

Absence of gas in bowel distal to obstruction

143
Q

Treatment/Management for SBO

A 
Rehydration with IV fluids 
Antiemetics 
Analgesia 
Nil by mouth
Insertion of nasogastric tube to decompress the bowel 
Urinary catheter
144
Q

Name a complication of SBO which would lead to emergency surgery

A

Bowel ischaemia or strangulation

145
Q

List 3 causes of gastritis

A 
Autoimmune 
Helicobacter pylori 
Alcohol abuse 
Bile reflux 
Mucosal ischaemia
146
Q

How do you prove H.pylori infection

A

H.pylori urea breath test

H.pylori faecal antigen test

147
Q

Name 3 clinical features of haemorrhoids

A 
Bright red bleeding 
Discomfort/pain 
Pruritus ani 
Mucus discharge 
Pain on passing stool (external haemorrhoids only)
148
Q

Pathology of haemorrhoids

A

Swelling and inflammation of veins in the rectum and anus

149
Q

Management of haemorrhoids

A 
Stool softeners/laxatives 
High fibre diet 
Adequate fluid intake 
Topical hydrocortisone 
Topical anusol 
Band ligation 
Haemorrhoidectomy 
Sclerotherapy
150
Q

Symptoms of IBS

A 
Abdominal pain or discomfort that is relieved by defecation 
Altered bowl frequency or stool form 
Bloating 
Symptoms made worse by eating 
Passage of mucus
151
Q

List 5 causes of acute diarrhoea

A 
E.coli 
Celiac disease (food allergy) 
Abx use - pseudomembranous colitis 
Drugs e.g. NSAIDs/chemo/PPIs 
Anxiety
152
Q

What AB associated with coeliac disease

A

IgA tissue transglutaminase

153
Q

List 4 potential complications of diverticulitis

A

Bowel obstruction
Bleeding
Mucosal inflammation
Bowel perforation

154
Q

First line and second line drug treatment for haematemesis from ruptured oesophageal varices

A

IV terlipressin

IV somatostatin

155
Q

Possible differentials for acute appendicitis

A

Crohn’s disease - causing acute terminal ileitis
Ectopic pregnancy
UTI
Diverticulitis

156
Q

Which tumour marker is most likely to be raised in suspected testicular cancer?

A

Alpha feto-protein (AFP)

157
Q

What is the gold standard investigation to confirm diagnosis of a transitional cell carcinoma ?

A

Cystoscopy

158
Q

What is the staging system used for prostate cancer?

A

Gleason scoring

159
Q

What are Anti-Ro and Anti-La Abs associated with ?

A

Sjogrens syndrome

160
Q

What Abs are associated with SLE ?

A

Anti-ANA

Anti-DsDNA

161
Q

What Abs are associated with vasculitis ?

A

Anti-ANCA

162
Q

What is the criteria for complicated UTIs ?

A 
Pregnant 
Males
Children
Recurrent UTIs
Elderly people
Patient’s with an abnormal urinary tract 
Systemic disease involving the kidney
163
Q

Name an alpha blocker used to treat BPH

A

Terazosin

164
Q

What would be the findings of a patient with nephrotic syndrome ?

A

Low plasma albumin
Proteinuria
High serum triglycerides

165
Q

What is the most common histological form of renal malignancy ?

A

Renal cell carcinoma

166
Q

What is a common complication of renal cell carcinoma and what is the cause ?

A

Hypertension caused by excessive renin secretion

167
Q

Name some symptoms of RCC

A

Loin pain, loin mass
Bilateral ankle oedema
Fever, weight loss and malaise
Enlarged lymph nodes

168
Q

What scoring system is used to stage renal cell carcinoma ?

A

TNM system

169
Q

Define hydrocele

A

Abnormal collection of fluid within the remnants of the processus vaginalis

170
Q

What medication is used to treat urge incontinence ?

A

Antimuscarinics e.g. oxybutynin

171
Q

Name 3 types of nephrotic syndrome

A 
MCD 
IgA nephropathy 
Focal segmental glomerulosclerosis 
Membranous nephropathy 
Amyloidosis
Diabetic glomerulonephropathy
172
Q

What is the treatment for MCD ?

A

Corticosteriods

Adjunct ACE-I and prophylactic anticoagulation

173
Q

Name 4 classes of diuretic

A

Loop diuretics e.g. Furosemide
Thiazide diuretics e.g Chlorothiazide
Angiotensin receptor antagonists e.g. Azilsartan
ACE-inhibitors e.g. ramipril

174
Q

What may the secretion of be reduced in CKD ?

A

Erythropoietin

Vit D

175
Q

What is first line treatment for CKD hypertension and what can be a side effect

A

ACE-I e.g. ramipril, captopril or enalapril

Hyperkalaemia

176
Q

Signs and symptoms of patient with CKD

A 
Pruritus 
Fatigue 
Hypertension  
Swelling in arms and legs 
Increased need to urinate 
Anaemia
177
Q

Bones, stones, groans and moans

A

Hypercalcaemia

178
Q

Name 3 ways in which an AKI can be classified

A

eGFR
Creatinine levels
Urea levels

179
Q

What ratio would be used to monitor renal function ?

A

Urea:creatinine

180
Q

3 most common areas for a renal stone to become lodged

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

181
Q

Risk factors for renal stone formation

A 
Dehydration 
Infections 
Hypercalcaemia 
Corticosteroids 
Aspirain 
Diet: chocolate, tea and strawberries 
Gout/FHx
182
Q

Give examples of what a patient could do in the future to prevent the recurrence of renal stone formation

A

Maintain hydration
Low Ca2+
Reduce BMI
Exercise

183
Q

What antibiotic would you give to treat Neisseria gonorrhoeae

A

IM Ciprofloxacin

184
Q

Which ECG leads cover the lateral aspects of the heart ?

A

I, aVL and V5-6

185
Q

Which ECG leads cover the inferior aspects of the heart ?

A

II, III and aVF

186
Q

Which ECG leads cover the anterior/septal leads ?

A

V1-V4

187
Q

Which blood vessel perfuses the right atrium and right venticle

A

Right coronary artery

188
Q

Which leads cover the left ventricle ?

A

V1-4

189
Q

Which medications are involved in the management of a patient who has previous suffered an MI ?

A

Aspirin and clopidogrel
Propranolol
Ramipril
Atorvastatin

190
Q

ABCDE of Heart Failure

A 
Alveolar oedema 
Kerley B lines 
Cardiomegaly 
Dilation of the upper lobe vessels 
Pleural effusion
191
Q

Which heart conditions show ST-elevation ?

A

STEMI
Pericarditis
Prinzmetal angina

192
Q

What ECG changes would a NSTEMI show ?

A

ST depression
Deep T wave inversion
Pathological Q waves

193
Q

What ECG changes would unstable angina show ?

A

ST depression and flat T waves

But could be normal

194
Q

What is a Valsalvar manoeuvre ?

A

Acute management of supraventricular tachycardia (SVT)

Holding the nose and mouth during forceful expiration to return the vagus nerve to normal sinus rhythm

195
Q

Tool to assess risk of stroke for a patient in AF

A

CHADS VAS score

196
Q

Tool used for risk of stroke after suspected TIA ?

A

ABCD2

197
Q

What is the most appropriate diagnostic investigation for aortic stenosis

A

Echocardiogram

198
Q

How will a patient with aortic stenosis present ?

A

SOB with exertion
Angina
Syncope

199
Q

What investigation is essential for aortic stenosis diagnosis ?

A

Doppler echo

200
Q

What blood markers would be seen in a patient with heart failure ?

A

Raised BNP levels

Also troponin I, troponin T, creatine kinase

201
Q

Define atherosclerosis

A

The accumulation of the lipids, macrophages and smooth muscle cells in the intima of the large and medium sized arteries

202
Q

Classical symptoms of a heart attack

A 
Excessive sweating 
Anxiety/feeling of dread 
Short of breath
Pallor 
Nausea/vomiting 
Light headed/dizzy
Crushing chest pain
203
Q

Name the 4 cardiac defects seen in the tetralogy of fallot

A

Ventricular septal defect
Overriding aorta
Right ventricular hypertrophy
Pulmonary stenosis

204
Q

Define a thrombosis and an embolism

A 
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
205
Q

List the effect of the RAAS

A

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

206
Q

What is the difference between essential HTN and secondary HTN

A

Essential is HTN with unknown cause

Secondary is HTN with a identifiable cause

207
Q

Name diseases/conditions that can cause HTN

A 
CKD 
Graves 
Stress 
Primary hyperaldosteronism 
Renal artery stenosis
208
Q

Name 3 contraindications to performing a lumbar puncture

A

Cardiovascular compromise
Decreased GCS
Infection at site
Signs and causes of raised ICP

209
Q

What Ab can be given as prophylactic treatment for meningitis ?

A

Benzylpenicillin

210
Q

What is seen histologically and from which artery is a biopsy taken from in Giant Cell Arteritis

A

Temporal artery

Multinucleated giant cells

211
Q

What can occur if a patient suddenly stops taking steroid medication ?

A

Withdrawal induced adrenal crisis

212
Q

What might you see on physical examination of a patient with a cluster headache ?

A 
Rhinorrhoea - runny nose 
Lid swelling 
Lacrimation - flow of tears 
Miosis - pupil constriction 
Sweating
213
Q

What is acute treatment for a cluster headache ?

A

100% oxygen

SC sumatriptan

214
Q

What is prophylaxis for a cluster headache ?

A

CCB

215
Q

What is encephalitis ?

A

Inflammation of the brain parenchyma usually caused by viral infection

216
Q

What is the most common cause of encephalitis in immunocompetent patients ?

A

Herpes simplex virus - type 1

217
Q

What would be diagnostic in a patient with encephalitis ?

A

Lumbar puncture and viral PCR

218
Q

What is first line treatment for encephalitis ?

A

IV acyclovir

219
Q

Name triggers for a migraine

A 
Cheese 
Caffeine 
Alcohol 
Anxiety/stress 
Sleep 
Exercise
220
Q

What would acute medical management for migraines be ?

A

NSAIDs e.g. ibuprofen

Triptans e.g. sumatriptan

221
Q

Risk factors for AD

A

FHx
Down’s syndrome
CVD
Advance age

222
Q

What pathological features are seen in AD

A 
Atrophy of the cortex (hippocampus) 
Amyloid plaques 
Tau neurofibrillary tangles 
Increased CSF proteins 
Damaged synapses
223
Q

What medication can be used to help manage symptoms of AD ?

A

Acetylcholinesterase inhibitors e.g. donepezil, galantamine and rivastigmine

224
Q

Classic triad of Parkinsons

A

Bradykinesia
Resting tremor
Rigidity

225
Q

Medical management of patient with Parkinsons

A 
MAO-B inhibitors e.g. selegiline 
Dopamine agonists e.g. ropinirole or pramipexole 
Levodopa + decarboxylase inhibitor 
Co-careldopa 
Co-beneldopa
226
Q

3 causes of Guillain-Barre Syndrome

A

Campylobacter jejuni
Cyclomegalovirus
Epistein Barr virus

227
Q

4 clinical features of Guillain-Barre Syndrome

A

Bilateral motor weakness
Paraesthesia
Respiratory involvement
HR changes and BP changes

228
Q

How is diagnosis of Guillain-Barre Syndrome

A

Lumbar puncture with raised CSF proteins

229
Q

What is treatment for Guillain-Barre Syndrome

A

IV immunoglobulins
Plasma exchange
Supportive in HUD or ITU

230
Q

What is the name for lack of sensation in gential area ?

A

Saddle anaesthesia

231
Q

What is a risk factor and why for cauda equina syndrome ?

A

Metastatic prostate cancer

Can reach the spine via venous blood flow and can metastasize and compress spinal cord

232
Q

Differentials for acute onset facial drooping

A

Bell’s palsy
Stroke
TIA

233
Q

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?

A

Brocca’s aphasia

234
Q

Which artery is affected in 90% of TIAs

A

Anterior cerebral artery

235
Q

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?

A

Generalised tonic-clonic seizure

236
Q

What test can confirm a clinical suspicion of generalised tonic-clonic seizure

A

Electroencephalogram EEG

237
Q

Seizure medications with aren’t tertrogenic

A

Lamotrigine Carbamazepine

Levetiracetam

238
Q

Name 2 tests for caral tunnel syndrome

A

Phalen’s test

Tinels test

239
Q

What nerve roots of the median nerve

A

C6-T1

240
Q

What can be given as treatment for trigeminal neuralgia to prevent symptoms

A

Carbamazepine

241
Q

Distinguishing feature of granulomatosis with polyangiitis ?

A

Saddle shaped nose

242
Q

Treatment for MG

A

Pyridostigmine
Prednisolone
Thymectomy

243
Q

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 ?

A

Temporal lobe complex partial seizure

244
Q

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?

A

Progressive bulbar palsy

245
Q

Nerve associated with opening, extending and flexing wrist

A

Radial nerve

246
Q

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?

A

Temporal lobe

247
Q

What is Brown-Sequard Syndrome ?

A

Ipsilateral loss of position, vibration sensation and motor control at the level of the lesion

248
Q

UMN signs

A

Hyperreflexia
HypotoniaC. Muscle wasting
Spastic paralysis
Positive Babinski Sign

249
Q

Dysfunction of what artery will cause loss of function in the right leg ?

A

Left anterior cerebral artery

250
Q

Subarachnoid medical before surgery

A

Nimodipine (CCB)

251
Q

Non-motor symptoms of Parkinsons

A

REM sleep disorder
Postural hypotension
Constipation
Depression

252
Q

Medication which aids with MND and ALS

A

Riluzole

253
Q

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?

A

Charcot-Marie Tooth

254
Q

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

A

Lamotrigine

Topiramate

255
Q

Medical management of Huntingtons

A

Antipsychotics e.g Haloperidol or Sulpiride
Anti-depressants e.g Sertraline
Sulpiride
Benzodiazepines e.g. Diazepam
Dopamine-depleting agents e.g. tetrabenazine

256
Q

Which nerve root is dysfunctional in foot drop

A

L5

257
Q

Which gene is mutated in cystic fibrosis?

A

Transmembrane conductance regulator gene

258
Q

Isoniazid side effects

A

Fever, jaundice and nausea

259
Q

Pyrazinamide side effects

A

Hyperuricemia (gout) and therefore hepatotoxicity

260
Q

Ethambutol side effects

A

Optic neuritis, colour blindness

261
Q

What’s the most common type of lung cancer?

A

Adenocarcinoma

262
Q

In bronchiectasis, what’s the common finding on CT?

A

Signet ring sign

263
Q

What kind of lung disease is TB ?

A

Restrictive

264
Q

What is CURB-65 used to calculate ?

A

Mortality risk assessment for HAP

265
Q

What are CURB-65 components

A 
Confusion
Urea >7mmol/l
RR >30/min
BP <90/60
Age over 65
266
Q

What causes type 1 respiratory failure ?

A

Low Co2 with normal CO2: Occurs as a result of a ventilation-perfusion mismatch

267
Q

What causes type 2 respiratory failure ?

A

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.

268
Q

Examples of Type 1 Failure

A 
Nephrotic syndrome (deficient ventilation)  
Pulmonary embolism (deficiency perfusion) 
Asthma (deficient ventilation) 
COVID-19 (deficiency ventilation)
269
Q

Examples of Type 2 Failure

A

COPD
Pneumonia
Reduced strength of respiratory muscles e.g. Guillain-Barre/MND
Opiate overdose

270
Q

Most common causative organism in HAP

A

Pseudomonas aeruginosa

271
Q

What is the most appropriate site for a needle thoracostomy to treat this tension pneumothorax?

A

2nd intercostal space, midclavicular line, on the same side as the pneumothorax

272
Q

Which of the following signs would further support a diagnosis of tension pneumothorax?

A

Tracheal deviation away from the affected lung, hypotension and hypoxia

273
Q

What is the Gold-standard imaging technique for diagnosing a PE?

A

CT pulmonary angiography (CTPA)

274
Q

Which TLRs are intracellular receptors ?

A

3,7,8 and 9

275
Q

What does TLR-2 do ?

A

Detects Lipoteichoic acid on gram positive bacteria as well as TB and other mycobacteria

276
Q

What does TLR-4 do ?

A

LPS on the surface of Gram negative bacteria

277
Q

Which innate immune cells display TLR-4 ?

A

All of them

278
Q

What does TLR-7 do ?

A

Detect single stranded RNA

279
Q

What does TLR-9 do

A

Detect unmethylated nucleotide motifs

280
Q

What types of organisms does TLR-10 specifically detect ?

A

Listeria and influenza

281
Q

What is the MOA for B-lactams

A

Inhibiting the synthesis of the peptidoglycan layer of the bacterial cell walls

282
Q

What is the MOA for Polymyxins

A

Target the cell membrane of gram negative bacteria

283
Q

What is the MOA for Sulfonamides and trimethoprim

A

Inhibit folate synthesis (and so are teratogenic)

284
Q

What is the MOA for Macrolide

A

ABs target 50S ribosomal subunits

285
Q

Example of a macrolide ABs

A

Erythromycin
Azithromycin
Clarithromycin

286
Q

What is dobutamine and what is it used for ?

A

B1-agonist which acts as a positive inotrope that increased heart muscle contractility and tries to increase cardiac output

287
Q

Name an Alpha-1 blocker and what is it used for ?

A

Doxazosin - Competitively antagonises noradrenaline for alpha-1 receptors on the post-synaptic membrane causing a relaxation of the smooth muscle
Used in BPD

288
Q

Desmopressin

A

An ADH analogue as is used to distinguish between neurogenic and cranial DI

289
Q

TLR5 detects

A

Flagellin

290
Q

What type of lymphocyte would you find in CSF of a patient suffering from bacterial meningitis

A

Neutrophils

291
Q

Which of the following mechanisms best describe the way furosemide acts as a
diuretic?

A

Na+/K +/2Cl-2 inhibitor in the thick ascending loop of Henle

292
Q

Thiazide diuretics MOA

A

Inhibit NaCl transport at the distal convoluted tubules

293
Q

Spironolactone is a

A

ARA causing Na+ excretion and decreased K+ and H+ excretion in the collecting tubules

294
Q

SLE is which type of hypersensitivity reaction ?

A

Type 3 - involves antibody-antigen complexes

295
Q

What is involves in a Type 1 hypersensitive reaction ?

A

Mass cell degranulation mediated by antigen-IgE linkage on their surface e.g. anaphylaxis and atopy

296
Q

What is involves in a Type 2 hypersensitive reaction ?

A

IgM and IgG linkage of antigens on the surface of cells to tissue components e.g. Goodpasture’s syndrome, autoimmune haemolytic anaemia

297
Q

What is involves in a Type 4 hypersensitive reaction ?

A

Mediated by T-cells

298
Q

What is involves in a Type 5 hypersensitive reaction ?

A

Stimulatory antibodies e.g. Grave’s disease

299
Q

Which leukocyte in this man’s peripheral blood can become pulmonary macrophages?

A

Monocytes

300
Q

Which Ab is responsible for the initial humoral immune response

A

IgM

301
Q

What is secreted by virally infected cells ?

A

Interferon-A

302
Q

Name some AIDS defining illnesses

A 
Kaposi's sarcoma 
Pneumocystis jirovecii pneumonia 
Extrapulmonary Cryptococcus 
Mycobacterium avium complex 
Oesophageal candidiasis
303
Q

Which is the most common AIDS defining illness ?

A

Pneumocystis jirovecii pneumonia (~40%)

304
Q

CXR findings in pneumocystis jiroveci pneumonia

A

Bilateral mid and lower zone interstitial shadowing

305
Q

Treatment for penumocystis jiroveci pneumonai

A

Co-trimoxazole and IV pentamidine

306
Q

What is Kaposi’s sarcoma

A

present in ~35% of AIDs-defining illnesses and is a HIV related cancer and is associated with HHV8

307
Q

Which pathogen is most commonly isolated in cases of chronic diarrhoea associated with HIV?

A

Campylobacter

308
Q

Rifampicin SE

A

Red tears / sweat / saliva/ pee

309
Q

Isoniazid SE

A

Fever, jaundice and nausea

310
Q

Pyrazinamide SE

A

Hyperuricemia (gout) and therefore hepatotoxicity

311
Q

Ethambutol SE

A

Optic neuritis, colour blindness

312
Q

Obstructive lung disease

A

Asthma
COPD
Bronchiectasis
Bronchiolitis

313
Q

Name processes that can happen at the end of acute inflammation?

A

Resolution
Suppuration (pus)
Organisation
Progression to chronic inflammation

314
Q

Define a Granuloma

A

An aggregate of epithelioid histiocytes

315
Q

You suspect a patient has Sarcoidosis, which blood marker do you investigate?

A

ACE - released by granulomas

316
Q

Give the classes of drug used to treat i) arterial thrombosis ii) venous thrombosis (2)

A

Arterial - antiplatelets e.g. aspirin/clopidogrel

Venous - anticoagulants e.g warfarin or heparin

317
Q

Give the names of a benign neoplasm of the secretory epithelium and a malignant neoplasm of connective tissue?

A

Adenoma

Sarcoma

318
Q

What are the most common cancers that spread to bone?

A 
Breast 
Lung
Thyroid 
Kidney 
Prostate
319
Q

What is the sequence of events that take place for metastasis to occur?

A

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

320
Q

Give 3 examples of antigen-presenting cells?

A

Macrophages
Dendritic cells
B cells

321
Q

Describe how you would identify a bacteria as Salmonella using Microbiology
tests including differentiating it from Shigella?

A

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

322
Q

Age group that make up 50% of new infections

A

19-24

323
Q

Name the different types of polymorphonuclear leukocytes which is the most
abundant?

A

Neutrophil, basophil and eosinophil

Neutrophil is most abundant

324
Q

What is the role of the Major Histocompatibility Complex (MHC)

A

To present antigen showing self or non-self on cell surface

325
Q

Eosinophils, Basophils and Mast Cells are mainly associated with what type of infection and what type of reaction?

A

Hypersensitivity reaction

Parasitic infection

326
Q

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?

A

Efficacy and efficacy relate to receptors
Agonists show affinity and efficacy
Antagonists show affinity only

327
Q

What class of drug is Candesartan?

A

Angiotensin 2 receptor blocker

328
Q

Which common condition often diagnosed in childhood is a contraindication of beta blockers and why?

A

Asthma

Beta blockers would cause a constriction of the airways smooth muscle

329
Q

What do NSAIDs inhibit and what is the result?

A

Inhibit COX

Prevents the conversion of arachidonic acid to prostaglandin

330
Q

What are the 4 stages of Pharmacokinetics?

A

Absorption
Distribution
Metabolism
Excretion

331
Q

What is the definition of bioavailability?

A

Amount of a drug taken up into the systemic circulation of a proportion of the amount administered

332
Q

What T score suggests osteopenia

A

-1 to -2.5

333
Q

What T score denotes osteoporosis

A

Flash Cards From Mocks (5 decks)

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