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FINEFINEFINE Flashcards

1
Q

Appropriate therapy for MI

A

Aspirin + an antiplatelet (PY12 inhibitor) e.g. clopidogrel

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2
Q

MOA of spironolactone

A

Spironolactone is an aldosterone receptor antagonist in the disual tubules

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3
Q

Risk Factors For Hypertension

A 
Afro-Caribbean 
Overweight 
Alcohol and smoking 
High caffeine consumption 
Type A personality
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4
Q

A pansystolic murmur indicates

A

Mitral valve regurgitation

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5
Q

First line anti-hypertensive

A

If above 135/75 and under 65 then ramipril

If Afro-Caribbean then CC e.g. amlodipine

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6
Q

ST in ECG in MI

A

Can be either elevated or inverted

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7
Q

QRISK2/3

A

2= risk of MI

3 - risk of MI and stroke

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8
Q

ABCD2

A

Used to calculate risk of stroke after TIA

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9
Q

CHA2DS2

A

Stroke risk in patients with AF

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10
Q

Wells score

A

Used to determine risk of DVT or PE

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11
Q

What is relative risk ?

A

The ratio of the probability of an event occurring in an exposed group compared to the probability of an outcome in an unexposed group

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12
Q

Route of electrical conduction in the heart

A

SAN -> Atria -> AVN -> Bundle of His -> Purkinje Fibres -> Left/right bundle branches

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13
Q

What is Conn’s syndrome ?

A

A malignancy in the adrenal medulla causing the overproduction of catecholamine (namely adrenaline)

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14
Q

Zones of the adrenal gland and their productions

A

Glomerulus-MC-Aldosterone
Fasciculata- GC- Cortisol
Reticularis - Androgens
Medulla - Adrenaline

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15
Q

What could be used to stabilise BP and K+ in Conns ?

A

Spironolactone - K+ sparing diuretic

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16
Q

What is CCB

A

Amlodipine

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17
Q

What is Addison

A

A deficiency in cortisol production

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18
Q

What is Cushing’s

A

Overproduction of cortisol

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19
Q

What test differentiates DI ?

A

Water deprivation test with desmopressin

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20
Q

What HbA1 levels are required for DM diagnosis

A

48 mmol/mol

>7fasting >11 non-fasting

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21
Q

What is HbA1

A

Average blood glucose levels (usually 2/3 months)

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22
Q

Crows NESTS

A 
No blood 
Entire GI 
Skip lesions 
Terminal ileum and transmural thickness 
Smoking if a RF
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23
Q

CLOSE UP

A 
Continous inflammatoin 
Limited to rectum and colon 
Only superficial mucosa effected 
Smoking is protective 
Excrete blood and mucus 
Use aminosalicylates   
Primary sclerosing cholangitis
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24
Q

Gold standard for coeliac disease diagnosis

A

Endoscopy and intestinal biopsy

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25
Q

What AB would be present in a patient with coeliac disease ?

A

IgA tissue transgulataminase or IgA endomysial antibody

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26
Q

What is Rovsing’s sign and what is it indicative of ?

A

Pain in the right iliac fossa when the left is palpated

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27
Q

What is normal urine osmolality ?

A

800mol/L

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28
Q

Osmolarity

A

Number of particles per L of solution

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29
Q

Osmolality

A

A measure of the number of osmotically active solute particles dissolved in a kilogram of solvent

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30
Q

What histological changes is seen after extended periods of acid reflux

A

Metaplasia of stratified squamous epithelium to simple columnar

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31
Q

Most common cause of peptic ulcers ?

A

H.Pylori

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32
Q

First line treatment for peptic ulcers ?

A

PPI + Amoxicillan + clarithromycin/metronidazole

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33
Q

What cells do PPI’s act on ?

A

Parietal cells (which produce stomach acid)

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34
Q

Name a PPI

A

Omeprazole

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35
Q

Gold standard for loin pain ?

A

Non-contrast CT scan of kidney, ureter and bladder

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36
Q

Most common composition of renal stones ?

A

Calcium Oxalate

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37
Q

Second most common composition of renal stones ?

A

Calcium phosphate

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38
Q

What is tamsulosin used to treat ?

A

BPH

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39
Q

What is the MoA for Tamsulosin ?

A

Alpha-1 adrenergic antagonist

Relaxes smooth muscle in the bladder, neck and prostate, allowing for increased urinary flow

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40
Q

Side effect of tamsulosin

A

Postural hypertension
Alpha-1 adrenergic receptors can also be found in the smooth muscle of the blood vessels and therefore alpha blockers can lower vascular resistance resulting in postural hypotension, dizziness and syncope

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41
Q

Most common bacterial causes of urinary tract infections ?

A 
KEEPS 
Klebsiella 
E.coli 
Enterococcus 
Proteus/pseudomonas 
Staphylococcus saprophyticus
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42
Q

What kind of syndrome is MCD ?

A

Nephrotic

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43
Q

What are the classical presentations of nephrotic syndrome ?

A

Proteinuria
Hypoalnuminemia
Peripheral oedema

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44
Q

What are the stages for CKD ?

A 
Stage 1 100-90
Stage 2 89-60
Stage 3a 59-45
Stage 3b 44-30
Stage 4 29-15
Stage 5 < 15
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45
Q

How does furosemide work ?

A

Loop diuretic that works in the loop of Henle by blocking NKCC2 receptors

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46
Q

Histologically, how does one differentiate different types of leukaemia

A
  1. ALL - blast cells
  2. CLL - smudge cells
  3. CML - granulocyte maturation or Philadelphia chromosome
  4. AML - auer rods
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47
Q

Side effects of amitriptyline

A

Blurred vision, confusion, dry mouth and urinary retention

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48
Q

Phecohromocytoma

A

A neuroendocrine tumour of the chromaffin cells of the adrenal medulla (that can rupture)

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49
Q

A complication of clostridium difficile infection

A

Pseudomembranous colitis

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50
Q

What is co-amoxiclave ?

A

Amoxicillin + clavulanic acid

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51
Q

What is Neisseria spp ?

A

A gram negative diplococci

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52
Q

Deformities seen in Ra ?

A

Z thumb
Swan neck deformity (of finger)
Ulnar neck deviation
Boutonniere

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53
Q

In pseudogout what would be seen under light microscopy ?

A

Rhomboid positively bi-fringent crystals

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54
Q

What would be seen in gout under light microscopy ?

A

Needle shaped negatively bi-fingent crystals

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55
Q

What is first line treatment for osteoporosis ?

A

Aldonic acid

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56
Q

What is Denosumab ?

A

2nd line treatment for osteoporosis

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57
Q

Denosumab MoA

A

MCAB for RANK ligand

Decreases osteoclast activity

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58
Q

MoA for bisphosphonates

A

Inhibit bone resorption through inhibition of FPS enzyme which reduces osteoclast activity

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59
Q

Acute gout treatment

A

Colchine

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60
Q

X-ray findings for osteoarthritis

A

Loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts

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61
Q

Rupture of what artery is commonly responsible for extramural haemorrhage

A

Middle meningeal artery

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62
Q

Muscle tone with UMN lesion ?

A

Increased

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63
Q

What is a CHADS VASc score ?

A

A scoring system used to calculate the stroke risk of patients with atrial fibrillation

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64
Q

What are the variables in a CHADS VASc score ?

A 
Congestive heart failure 
Hypertension
Age 75+ 
DM 
Stroke 
// TIA,, Thromboembolism // 
Vascular disease 
Age (65-74) 
Sex (female)
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65
Q

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

A

Aortic stenosis

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66
Q

What is pulses paradoxus ? ?

A

When BP drops severely during inspiration

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67
Q

What sound does aortic regurgitation produce ?

A

Early diastolic decrescendo murmur

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68
Q

What sound does mitral regurgitation produce ?

A

Apical pansystolic murmur.

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69
Q

What sound does mitral stenosis produce ?

A

Apical mid diastolic rumble

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70
Q

What sound does pulmonary stenosis produce ?

A

Ejection systolic murmur heard the loudest on inspiration

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71
Q

What are the cardinal signs of heart failure produce ?

A

Fatigue, shortness of breath, ankle oedema

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72
Q

What patients would receive ramipril ? And which would get amlodipine ?

A

Ask someone

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73
Q

What stage would blood pressure of 145/95 be classed as ?

A

Stage 1

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74
Q

What are the blood pressure classes ?

Clinical readings

A

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

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75
Q

What are the blood pressure classes ?

Ambulatory readings

A

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

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76
Q

What is xanthelasma ?

A

Yellowish-white lumps of fatty material that accumulate under the skin on the inner parts of your upper and lower eyelids

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77
Q

What are signs of infective endocarditis ?

A

Splinter haemorrhages, Osler’s nodes, Janeway lesions, Roth spots and fever

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78
Q

What are Osler’s nodes

A

Painful, raised lesions found on the hand and feet

Associated with infective endocarditis

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79
Q

What are Janeway lesions

A

Irregular non tender hemorrhagic macules located on the palms, soles, thenar and hypothenar eminences of the hands and plantar surfaces of the toes
Associated with bacterial endocarditis

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80
Q

What are Roth Spots ?

A

White centred retinal haemorrhage associated most commonly with bacterial endocarditis

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81
Q

What are splinter haemorrhages ?

A

Haemorrhages located under the nail associated with endocarditis

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82
Q

What is a Mallory Weiss Tear ?

A

A tear in the mucosal lining that occurs due to sudden increase in intra-abdominal pressure
Symptoms include recurrent retching, vomiting which can force the stomach contents into the oesophagus which dilates and tears resulting in haematemesis

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83
Q

In what 4 ways can peptic ulcers develop ?

A

NSAID use
H.pylori infection
Mucosal ischemia
Increased acid secretion

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84
Q

How does small bowel obstruction present ?

A

Abdominal pain higher up in the abdomen
Early onset vomiting
Constipation and bloating
Appendectomy can lead to development of adhesions
If large bowel obstruction, then inability to pass stools would occur much closer to the onset of symptoms

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85
Q

What is the first line when investigating a bowel obstruction ?

A

Abdominal X-ray

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86
Q

What is achalasia ?

A

A rare disorder where the lower oesophageal sphincter fails to open during swallowing to allow food to travel back up the oesophagus

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87
Q

When is a duodenal ulcer likely to cause pain ?

A

Several hours after eating due to presence of acid from the stomach entering the duodenum

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88
Q

When does a gastric ulcer cause pain ?

A

Abdominal pain that is relieved by eating

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89
Q

What is a diverticulum ?

A

A pouch or pocket in the bowel wall usually ranging in size from 0.5-1cm

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90
Q

What are haemorrhoids ?

A

Anal vascular cushions that become enlarged and swollen

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91
Q

What is the most common cause of AKI

A

Acute tubular necrosis

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92
Q

What is acute tubular necrosis ?

A

Where tubular epithelial cells of the kidney die impairing the kidneys ability to filter waste products

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93
Q

How does BPH cause AKI ?

A

Urinary tract is obstructed and this increases intra-tubular pressure which decrease GFR and so increases urea and creatinine remaining in the blood

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94
Q

eGFR 82, 32 and 46 are what stages ?

A

Stage 2, 3a and 3b

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95
Q

Which organisms most commonly cause a UTI ?

A 
Klebsiella 
E.coli 
Enterococcus 
Proteus  
Staphylococcus-saprophyticus
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96
Q

What is pyelonephritis ?

A

A type of UTI where the one or both kidneys become infected

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97
Q

What is prostatitis ?

A

Inflammation of the prostate
Characterised by pelvic or perineal pain lasting longer than 3 months
Trauma causing nerve damage in the LUT is a risk factor

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98
Q

What antibiotic is contraindicated in pregnancy ?

A

Trimethoprim

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99
Q

What is a complication of chlamydia, which involves reddening of the eyes, ankle and feet swelling ?

A

Reiter’s syndrome

  • Reactive arthritis
  • Conjunctivitis
  • Urethritis
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100
Q

Gold standard treatment for someone with thrombotic thrombocytopenic purpura? ?

A

Plasma exchange

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101
Q

What is the treatment for H.pylori caused peptic ulcers

A

Omeprazole + Amoxicillin + clarithromycin

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102
Q

What score can be used to determine the management of patients at risk of DVT ?

A

Wells DVT score

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103
Q

Complications of chemo

A 
Hair loss 
Secondary malignancy 
Infertility 
Nausea/vomiting 
Diarrhoea
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104
Q

What is the appropriate thromboprophylaxis regiment following a hip replacement ?

A

Dalteparin acutely and then maintain treatment with apixaban

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105
Q

What is the protein target of Rituximab- ?

A

MCAB which targets CD20 protein on B cells

Used to treat Non-Hodgkin’s lymphoma

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106
Q

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

A

IV Artesunate

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107
Q

What is the first line treatment in patients with uncomplicated malaria ?

A

Oral chloroquine

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108
Q

What are the 5 key signs of inflammation ?

A

Rubor, dolor, calor, tumour and loss of function

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109
Q

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

A

Leiomyosarcoma

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110
Q

Malignant tumour of the striated muscle ?

A

Rhabdomyosarcoma

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111
Q

What type of cells are associated with acute inflammation ?

A

Neutrophils

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112
Q

What type of cells are seen during inflammation ?

A

B-lymphocytes, macrophages, T-lymphocytes

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113
Q

What is acute cholecystitis ?

A

Acute inflammation of the gallbladder

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114
Q

What is the definition of a granuloma ?

A

Aggregate of epithelioid histiocytes

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115
Q

What are the components of atherosclerotic plaques ?

A 
Foam cells - lipid laden macrophages 
T-lymphocytes 
Smooth muscle cells 
Cholesterol, lipid deposits
Fragments of destroyed internal elastic lamina
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116
Q

Metaplastic change seen in Barrett’s oesophagus ?

A

Stratified squamous to simple columnar

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117
Q

What can alcohol excess, Budd-Chaiari syndrome, haemochromatosis and Wilson’s disease all result in ?

A

Liver failure

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118
Q

What is Budd Chaiari syndrome ?

A

A condition in which the hepatic veins are blocked or narrowed by a clot which causes blood to back up into the liver causing it to enlarge and eventually fail

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119
Q

What is Wilson’s disease

A

A rare genetic disorder characterised by excess copper stored in various body tissues, particularly the liver, brain and corneas of the eyes

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120
Q

What are Kayser-Fleischer Rings ?

A

Rust coloured rings around the iris in the eye caused by deposition of copper as a result of Wilson’s disease

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121
Q

What signs other than jaundice would you associate with liver failure

A

Asterixis
Dupuytren’s contractures
Leukonychia
Spider naevi

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122
Q

What is an asterisks ?

A

A flapping tremor of the hand, when the wrist is extended, sometimes said to resemble a bird flapping

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123
Q

What are Dupuytrens contractures ?

A

When 1 or more fingers bend in towards the palm

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124
Q

What are Leukonychia ?

A

White discoloration of the nail

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125
Q

What is a classical presentation of pancreatitis ?

A

Elevated amylase - severe surgical emergency

Pain the epigastric region radiating to the back

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126
Q

What is Primary Biliary Cholangitis ?

A

An autoimmune condition that damages the interlobular bile ducts in the liver
Very slow to present and often found as incidental finding due to raised ALP

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127
Q

How is Primary Biliary Cholangitis treated ?

A

Treat symptomatically so pruritus with rifampicin or cholestyramine
Late stage treatment is a liver transplant which is curative

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128
Q

What is Mumps ?

A

A viral infection which causes prodrome (flu-like symptoms) which occur a few days before parotid swelling

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129
Q

What is the presentation of ascending cholangitis ?

A

RUQ pain made worse by eating fatty meals and jaundice

Charcot’s triad = RUQ pain, fever and rigors

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130
Q

What is the first concern in a patient undergoing alcohol withdrawal ?

A

Seizures

And so chlordiazepoxide is prescribed

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131
Q

What is ascending cholangitis ?

A

Bacterial infection of the bile ducts as a result of infection

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132
Q

Wernicke’s Encephalopathy is a complication of alcoholism caused by the deficiency of which vitamin ?

A

Vit B1 (Thiamine)

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133
Q

What is Wernicke’s Encephalopathy ?

A

A complication of alcoholism caused by a mixture of diet and increased use of thiamine in patients with persistent high levels of blood alcohol

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134
Q

What are symptoms of Wernicke’s encephalopathy ?

A

Ataxia, confusion and ophthalmoplegia

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135
Q

What are the cancers most likely to metastasise to bone ?

A 
BLT KP 
Breast 
Lung 
Thyroid 
Kidney 
Pancreatic
136
Q

What is a common side effect of alendronic acid ?

A

Oesophagitis

137
Q

What does LOSS stand for ?

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

138
Q

What is Sjogren’s Syndrome ?

A

Autoimmune destruction of exocrine glands and often presents with arthritis
Often presents with arthritis, dry eyes and dry mouth

139
Q

How could one test for Sjogren’s Syndrome ?

A

Schrimer’s test

Involves placing a small strip of paper in the eye to measure tear production

140
Q

Which condition is an X-ray finding of pencil in a cup indicative of ?

A

Psoriatic arthritis

141
Q

First line treatment for moderate ankylosing spondylitis ?

A

Ibuprofen

PPI if long term NSAID use

142
Q

Risk Factors for pseudogout presentation

A

IV fluids and parathyroidectomy

143
Q

Prevention of acute gout attacks?

A

Colchicine

144
Q

Prevention of gout long term ?

A

Allopurinol

145
Q

What is osteopenia ?

A

Loss of bone mass

146
Q

What T score is indicative of osteopenia ?

A

-1 - - 2.5

147
Q

What is Reiter’s Triad ?

A

Conjunctivitis
Arthritis
Urethritis
(Can’t see, pee or tree)

148
Q

What is amaurosis fugax ?

A

Pointless, unilateral loss secondary to emboli such as blockage of the retinal artery

149
Q

First line for generalised seizures

A

Sodium valproate

150
Q

What is Cauda Equina Syndrome

A

Inability to open bowels/urinate, reduced anal tone, saddle anaesthesia
Caused by prolapsed disk going into the cauda equina and pressing onto the sacral nerves

151
Q

Patients with strokes should receive alteplase

152
Q

What is the most common cause of infectious exacerbation of COPD?

A

Haemophilus influenzae

153
Q

Which of the following is a sign of life threatening asthma attack ?

154
Q

How does a salbutamol inhaler work ?

A

Beta 2 adrenergic agonsit

Causing relaxation of the smooth muscle of the airways

155
Q

Side effect of salbutamol inhalers

156
Q

Most common lung cancer seen in non-smokers

A

Adenocarcinoma

157
Q

Lung cancer from asbestos

A

Mesothelioma

158
Q

Classic PE

A

Pleuritic chest pain
Shortness of breath
Haemoptysis

159
Q

First line treatment in patient with a STEMI within 2 hours of onset ?

A

Percutaneous cardiac intervention

160
Q

What is first line treatment in a patient with STEMI after 2 hours and before 12 hours ?

A

Fibrinolysis with IV tenecteplase

161
Q

What is the NICE recommended investigation for heart failure ?

A

NT-proBNP (BNP) levels

162
Q

What is 2nd line for hypertension treatment ?

A

Thiazide like diuretics, e.g. bendroflumethiazide

163
Q

Ejection systolic murmur

A

Aortic stenosis

164
Q

X-ray signs of heart failure

A 
ABCD 
Alveolar oedema 
Kerley B lines 
Cardiomegaly 
Dilated upper lobe vessels (pleural effusion)
165
Q

Difference between alveolar oedema and pleural effusion ?

A

Alveolar oedema = fluid inside the lungs (alveoli)

Pleural effusion - fluid in the plural cavity

166
Q

Gold standard investigation for valvular disease

A

Echocardiogram

167
Q

ECG change in AF

A

Absent P waves

168
Q

ECG change in atrial flutter

A

Sawtooth flutter waves

169
Q

ECG change in Wolff-Parkinson-White Syndrome

A

Delta waves

170
Q

Wolff-Parkinson-White Syndrome

A

Where the heart has an extra signalling pathway between the atria and ventricles causing tachycardia

171
Q

ECG change in ECG change in acute pericarditis

A

Saddle-shaped ST segment elevation

172
Q

ECG change in myocardial ischaemia

173
Q

What is a good way to remember ECG changes seen in metabolic acidosis and hyperglycaemia ?

A

Go, Go long, go wide, go tall

174
Q

What are the ECG signs of metabolic acidosis and hyperglycaemia ?

A

Absent P waves
Long PR
Wide QRS a
Tall tented T waves

175
Q

What are Kussmual breaths ?

A

Rapid deep breaths that occur during metabolic acidosis as the patient tries to clear C02 from the body and reverse the acidosis

176
Q

What are the types of cardiomyopathy ?

A

Dilated, restrictive and hypertonic

177
Q

What are the causes of cardiomyopathy ?

A

Congenital, idiopathic, vasoconstrictive and infective

178
Q

What is cardiomyopathy ?

A

Where changes to the heart muscle lead it to become harder to pump blood around the body

179
Q

What would a narrow pulse pressure indicate e.g. 120/100 ?

A

Aortic stenosis

180
Q

What would a wide pulse pressure, e.g. 150/102 indicate ?

A

Aortic regurgitation

181
Q

What could a bounding pulse be indicative of ?

A

Septic shock

182
Q

In what type of shock does bradycardia occur ?

A

Anaphylactic and cardiogenic

183
Q

What does a tearing/shearing pain in the back usually indicate ?

A

Aortic dissection

184
Q

What is pleuritic chest pain indicative of ?

A

Pericarditis - especially if it is made worse by laying back and relieved by leaning forward

185
Q

What is epigastric pain which radiates to the back indicative of ?

A

Acute pancreatitis

186
Q

What investigation would you conduct in a patient with signs of shock and then abdominal aortic aneurysm

A

Ultrasound scan

187
Q

Symptoms of hyperthyroid disease

A

Diarrhoea, weight loss, increased appetite and irritability

188
Q

What is Grave’s disease ?

A

An autoimmune condition in which the body produces TSH receptor stimulating antibodies

189
Q

Typical presentation of Graves

A

Graves ophthalmopathy, diplopia, eye pain alongside hyperthyroid symptoms

190
Q

What is De Quervain’s thyroiditis ?

A

A viral infection which causes transient thyroiditis

Can result in both hyper and hypo

191
Q

What is the most common cause of secondary hypoadrenalism ?

A

Long term corticosteroid usage

192
Q

What can cause Addison’s ?

A

Autoimmune destruction of the adrenal cortex

193
Q

Diagnostic test for someone suspected of Addison’s

A

Synacthen test

194
Q

What is a Synacthen test ?

A

Synthetic ACTH to see if it can stimulate the adrenal glands

195
Q

Causes of SIADH

A

Alcohol withdrawal, head injury, pneumonia and small cell lung cancer

196
Q

Substances produced in abundance due to carcinoid syndrome

A

5-HT, substance P, insulin, ACTH and bradykinin

197
Q

Carcinoid syndrome crisis treatment

A

Somatostatin analogues then surgery is definitive

198
Q

What are Trousseau and Chvostek’s signs indicative of ?

A

Hypocalcaemia

199
Q

What is Trousseau’s sign ?

A

A wrist flexion when a BP cuff is inflated

200
Q

What is Chvostek’s sign ?

A

Tapping the facial nerve in the parotid gland causing ipsilateral facial muscle twitching

201
Q

Classical signs of hyperparathyroidism

A

High PTH, Ca and Low P
Pain when pass urine, bone pain and anxiety
Bones, stones, groans and psychiatric moans

202
Q

Which vessel would be the most likely to bleed as a result of a duodenal wall eroding posteriorly ?

A

Gastroduodenal artery

203
Q

What gastroduodenal artery is the terminal branch of which artery ?

A

Common hepatic artery

204
Q

Where is pain usually felt in patients with appendicitis ?

A

Periumbilical region

205
Q

What is angular stomatitis ?

A

Soreness at the corners of the lips seen in severe cases of coeliac disease

206
Q

What are aphthous ulcers ?

A

Mouth ulcers, commonly seen in more severe cases

207
Q

What is steatorrhea ?

A

Classic symptoms of coeliac disease

Stinking/fatty/loose stools

208
Q

How do PPIs work ?

A

Inhibit gastric acid secretion by blocking H+/K+ ATPase enzyme

209
Q

Most common cause of a small bowel obstruction

A

Surgical adhesions

210
Q

Rouleaux formation on a blood film is indicative of what condition ?

A

Multiple myeloma

211
Q

Most common cause of large bowel obstructions

A

Malignant tumours

212
Q

What is a complication of strictures from Crohn’s disease ?

A

Small bowel obstruction

213
Q

What is a volvulus ?

A

Where a loop of the bowel twists round itself and causes an obstruction. Usually of the large bowel

214
Q

What are Virchow’s node ?

A

(Trosier’s sign) Enlargement of the left supraclavicular node commonly associated with gastric cancer

215
Q

First line treatment for mild ulcerative colitis ?

A

Mesalazine - 5ASA drug group

216
Q

First line treatment for moderate UC

A

Oral prednisolone

217
Q

First line treatment for severe UC

A

IV hydrocortisone

218
Q

Causes of macrocytic anaemia ?

A

Alcohol excess, bone marrow infiltration, B12/Folate deficiency and hypothyroidism

219
Q

Mechanism of macrocytic anaemia ?

A

Meiosis, cell division and impaired and hence cells are larger than normal

220
Q

Chronic disease is associated with what type of anaemia ?

A

Chronic disease

221
Q

Most common form of anaemia ?

A

Iron deficiency

222
Q

First line treatment for the most common form of anaemia ?

A

Oral iron supplements

223
Q

First line treatment for macrocytic anaemia ?

A

Folic acid

224
Q

What are Bite cells characteristic of ?

A

G6PD deficiency

225
Q

What condition risks developing into myeloma/multiple myeloma ?

A

Monoclonal gammopathy of undetermined significance

226
Q

Which blood cancer can puritus be a symptom of ?

A

Hodgkin’s lymphoma

227
Q

What pneumonia can be used for remembering multiple myeloma ?

A 
CRAB 
Calcium raised due to bone resorption 
Renal impairment 
Anaemia 
Bone - osteoporosis
228
Q

What are Heiz bodies ?

A

Features of G6PD deficiency

229
Q

What are features of iron deficiency anaemia ?

A

Abnormally shaped red blood cells
Pale blood cells
Red blood cells of varying sizes
Microcytic RBCs

230
Q

What is Kussmual breathing ?

A

Deep, laboured breathing that occurs in patients with diabetic ketoacidosis in an attempt to get rid of serum C02

231
Q

What are definitive features of acute liver failure ?

A

INR greater than 1.5
Onest of less than 26 weeks duration
Mental alteration without pre-existing cirrhosis
No previous liver disease

232
Q

Key presentations of acute pancreatitis

A 
Abdominal pain which radiates to the back 
Severe pain 
Periumbilical bruising (Cullen's sign) 
Flank bruising (Grey Turners sign)
233
Q

What is Cullen’s sign ?

A

Periumbilical bruising

234
Q

Grey Turner’s Sign ?

A

Flank bruising

235
Q

What is a classic presentation of cancer of the pancreatic head ?

A

Painless jaundice
Advanced age
Pale stools, dark urine - rules out liver

236
Q

What can benzene exposure be a risk factor for ?

A

Renal cell carcinoma

237
Q

Gold standard investigation for Wilson’s Disease

A

Liver biopsy

238
Q

What type of inheritance is liver disease secondary to a1-antitrypsin deficiency ?

A

Autosomal recessive

239
Q

What is first line treatment of hospitalised patients with cholera ?

A

IV rehydration fluids

240
Q

What type of virus is associated with vomiting and diarrhoea and commonly found in nursing homes and among the elderly ?

241
Q

What virus is likely to be associated with vomiting and diarrhoea among children ?

242
Q

What is the inheritance pattern for haemochromatosis ?

A

Autosomal recessive

243
Q

What is the presentation of haemochromatosis ?

A

Fatigue, ED, arthralgia, bronze skin, DM, CLD and CF

244
Q

What is the cause of haemochromatosis ?

A

Disorder of iron absorption and metabolism which results in iron accumulation

245
Q

What organism causes a severe form of pneumonia often found in natural/artificial water sources ?

A

Legionella pneumophila

246
Q

What is legionella pneumophila treated with ?

A

RIPE antibiotics

247
Q

What separates infection of legionella pneumophila and TB ?

A

TB has a longer history/presentation

248
Q

What is the immediate treatment in the community for a child with suspected meningococcal septicaemia ?

A

Benzylpenicillin

249
Q

What AB is used in the hospital setting to treat meningeal infections ?

A

IV cefotaxime

250
Q

What AB is used to treat children with mild respiratory tract infections ?

A

Amoxicillin and erythromycin

251
Q

What type of bacteria is Strep.pyogenes ?

A

A beta-haemolytic gram positive streptococcus

252
Q

What is the first AB given if UTI is suspected in a patient of child bearing age/ability ?

A

Nitrofurantoin

253
Q

What is the first AB given in UTI if there is no chance of the patient being pregnant ?

A

Trimethoprim

254
Q

MoA for trimethoprim

A

Inhibition of folate synthesis

255
Q

Medication used to treat viral encephalitis

256
Q

Most common viral cause of encephalitis

A

Herpes simplex virus

257
Q

ABs which inhibit nucleic acid synthesis

A

Ciprofloxacin
Metronidazole
Rifampicin
Trimethoprim

258
Q

What agar is used to culture mycobacterium tuberculosis ?

A

Lowenstein-Jensen

259
Q

What agar is used to culture anaerobic bacteria such as fusobacteria ?

A

Blood agar

260
Q

What agar is used to culture campylobacter jejuni

A

Charcoal agar

261
Q

What agar is used to culture aerobic bacteria ?

A

Chocolate agar

262
Q

Give an example of an aerobic bacteria ?

A

Step.pneumonia

263
Q

What agar is used to culture gram -ve bacilli ?

264
Q

Examples of non-lactose fermenting aerobic bacilli with negative oxidase tests ?

A

Proteus
Salmonella
Shigella

265
Q

Give an example of a non-lactose fermenting aerobic bacillus that gives a positive oxidase test

A

Pseudomonas

266
Q

Most common cause of infective endocarditis in IVDUs ?

267
Q

Most common cause of infective endocarditis after mouth/oral surgery

A

Strep.viridans

268
Q

Most common bacteria to colonise prosthetic valves

A

Staph. epidermis

269
Q

What are Lancefield A bacteria associated with and name a bacterial cause ?

A

Strep.pyogenes - strep throat/ scarlet fever

270
Q

What are Lancefield B bacteria associated with and name a bacterial cause ?

A

Strep.agalactiae - can cause neonatal meningitis

271
Q

Test to distinguish between staph and strep

A

Catalase
Staph = +ve
Step = -ve

272
Q

What bacteria can a coagulase test differentiate between ?

A

S.aureus (+ve) and S.epidermidis (-ve)

273
Q

COPD grade 1

A

Breathless with strenuous exercise

274
Q

COPD grade 2

A

Short of breath when hurrying or walking up hill

275
Q

COPD grade 3

A

Short of breath when walking on flat or slower than people of the same age

276
Q

COPD grade 4

A

Stops for breath after walking 100m on flat

277
Q

COPD grade 5

A

Too breathless to leave house

278
Q

First line for suspected lung cancer ?

279
Q

Investigation for staging lung cancer ?

280
Q

Post 2 weeks of hospitalisation for pneumonia what does a stony dull percussion at the right lung base and an CXR finding of blunting of the right costophrenic angle with homogenous opacity of the lower zone of the right lung suggest ?

A

Parapneumonic pleural effusion

281
Q

What AB is associated with Wegner’s granulomatosis (GPA) ?

282
Q

What ABs are associated with RA ?

A

Anti-CCP (most specific)

Anti-rheumatoid factor

283
Q

What AB is seen in SLE ?

A

Anti-DsDNA

284
Q

What are oxygen and C02 levels in T2RF

A

High C02, Low Oxygen

285
Q

What are 02 and C02 levels in T1RF

A

Low 02, normal C02

286
Q

What does atelectasis mean ?

A

Lung collapse

287
Q

What is Bronchiectasis ?

A

Permanent dilation of the airways due to chronic lung disease or infection

288
Q

What does a FEV1/FVC of <0.7 indicate ?

A

Obstructive disease

289
Q

Name 2 restrictive lung conditions ?

A

Fibrosis and sarcoidosis

290
Q

What kind of condition is silicosis ?

A

Occupational lung disorder

291
Q

Causes of bronchiectasis ?

A

Bronchogenic carcinoma, CF, immotile ciliary syndrome and pneumonia

292
Q

First line COPD management

A

Smoking cessation and vaccination (influenza and pneumococcal)

293
Q

Second line COPD

A

SABA + SAMA

294
Q

COPD 3rd Line management of steroid responsive asthmatic

A

LABA + inhaled corticosteroid (Beclometasone)

295
Q

COPD 3rd line management of steroid non-responsive/asthmatic

A

Add LABA + LAMA

296
Q

4th line COPD

A

Oral theophylline

Long term oxygen therapy

297
Q

2nd line in asthmatic patient already prescribed salbutamol

A

Beclometasone

298
Q

What are NICE guidelines for Beclometasone therapy ?

A

Use SABA three times or more a week
Have asthma symptoms 3 times a week or more
Are woken at night by symptoms one weekly or more

299
Q

What is a side effect of rifampicin ?

A

Orange or red urine

300
Q

Investigation for sarcoidosis ?

A

Tissue biopsy

301
Q

What is a T1 hypersensitivity reaction ?

A

IgE mediated quick onset after exposure (allergic)

302
Q

What is a T2 hypersensitivity reaction ?

A

Cytotoxic/antibody-mediated (cytotoxic)

303
Q

What is a T3 hypersensitivity reaction ?

A

Immune complex/IgG/IgM mediated (immune complex deposition)

304
Q

What is a T4 hypersensitivity reaction ?

A

Delayed or cell mediated

305
Q

Give an example of a T1 hypersensitivity reaction ?

A

Bee sting, latex, penicillin

306
Q

Give an example of a T2 hypersensitivity reaction ?

A

Hemolytic reactions, Goodpasture syndrome

307
Q

Give an example of a T3 hypersensitivity reaction ?

308
Q

Give an example of a T4 hypersensitivity reaction ?

A

Chronic graft rejection

309
Q

What is Goodpasture’s syndrome ?

A

ABs specific to a type of collagen in the glomerular basement membrane
Leading to inflammation and destruction of the basement membrane leading to pulmonary haemorrhage adn kidney failure

310
Q

What are the differentials of Goodpasture’s syndrome ?

A

Idiopathic pulmonary hemosiderosis, RA and SLE

311
Q

Rupture of which vessel is associated with subarachnoid haemorrhage ?

A

Berry-aneurysm

312
Q

Rupture of which vessel is associated with an extradural haemorrhage ?

A

Middle meningeal artery

313
Q

Rupture of which vessel is associated with an subdural haemorrhage ?

A

The bridging veins

314
Q

Severe, sudden-onset occipital headache with associated vomiting, photophobia, and neck stiffness. Her past medical history includes refractory hypertension. A CT head is reported to show hyper-attenuated areas in the basal cisterns. What is the most likely diagnosis?

A

Subarachnoid

315
Q

What type of haemorrhage is most commonly associated with elderly/alcoholics or those on anti coagulation or platelet therapy ?

A

Subdural haemorrhage

316
Q

Hx more chronic - headache/ fluctuating consciousness/ cognitive decline. CT head: sickle-shaped/crescent shaped haematoma

A

Subdural haemorrhage

317
Q

Typically caused by trauma to the temple and a tear in the middle meningeal artery. Hx of brief loss of consciousness, followed by lucid period before rapid deterioration with headache, vomiting, confusion, focal neurology. CT head: Lens-shaped/ Lentiform/ Bi-convex haematoma

A

Extradural

318
Q

Cardinal triad of Parkinson’s Disease

A

Bradykinesia, rigidity and tremor

319
Q

Epidemiology for cluster headache

A

Male, smoking 30-50yo, circadian periodicity (tend to happen at the same time each day)

320
Q

Acute management of cluster headache

A

High flow 100% oxygen + SC sumatriptan

321
Q

Preventative management of cluster headache

322
Q

A 14-year-old girl, Anna, presents to A&E. Her mum says she has had a ‘seizure’ approximately an hour ago. Her mum, who witnessed the incident, says Anna told her she felt ‘weird’ whilst they were watching TV together. Anna then appeared to stare into the distance and was unresponsive to her mum’s voice, whilst picking at her clothes and chewing. Afterwards, Anna was ‘confused’. What is the most likely diagnosis?

A

Temporal lobe seizure

323
Q

A 19-year-old man presents to A&E with a fever, headache, vomiting, photophobia, and drowsiness. On examination, neck stiffness and a positive Kernig’s sign are elicited. Given the patient’s reduced GCS and as a highly proficient FY1, you order a CT head to rule any intracranial pathology / raised ICP before conducting a lumbar puncture. You send both blood and CSF samples to be cultured. After 24 hrs of successful empirical treatment, the lab reports the results of the CSF gram stain: Gram positive diplococci seen. Given the most likely diagnosis and the histopathology, which pathogen is most likely responsible for his symptoms?

A

Streptococcus Pneumoniae

324
Q

A 75-year-old woman presents to A&E with new-onset right arm and lower facial weakness. On examination, power in the right upper limb is reduced. Power in the left upper limb and both lower limbs is not substantially affected. Of note, she also has impaired language comprehension, although she is speaking fluently. Which vessel is most likely to be affected?

A

Left middle cerebral artery

325
Q

Rupture of which vessel is locked in syndrome associated with ?

A

Basilar artery

326
Q

Rupture of which vessel would cause right sided hemiparesis, sensory loss, lower extremity affected > upper ( upper>lower in middle cerebral artery)

A

Left anterior cerebral artery

327
Q

Rupture of which vessel would cause left sided hemiparesis, sensory loss lower extremity > upper

A

Right anterior cerebral artery

328
Q

Rupture of which vessel would cause left sided hemiparesis, sensory loss upper > lower

A

Right middle cerebral artery

329
Q

Initial treatment in a patient with a suspected TIA

A

Aspirin 300mg daily

330
Q

Treatment once TIA/ischemic Stroke confirmed

A

Aspirin 300mg + clopidogrel

331
Q

Second line anti-thrombotic therapy

A

Clopidogrel + Dipyridamole

332
Q

How does cauda equina syndrome present ?

A

Begins at L1/2 (where the spinal cord terminates)

LMN signs only

333
Q

LMN signs of CES

A 
Lower back pain 
Decreased limb power and reflex 
Sphincter disturbances 
Impotence 
Saddle paraesthesia
334
Q

How does Brown Syndrome ?

A

Lateral hemisection of the spinal cord) features ipsilateral weakness below the lesion, ipsilateral loss of proprioception + vibration, contralateral loss of pain + temperature

335
Q

Conus medullaris syndrome

A

Similar to cauda equina but with UMN features

Flash Cards From Mocks (5 decks)

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