Flagged Qs Flashcards
What antihypertensives are contraindicated in renovascular disease (eg renal artery stenosis)?
ACE inhibitors
Which condition presents with fixed dilated pupil with conjunctival injection?
Acute closed-angle glaucoma
What are the symptoms of acute closed angle glaucoma?
Ocular pain, decreased visual acuity, worse with mydriasis, haloes around lights
What is the treatment for acute closed angle glaucoma?
Pilocarpine (cholinergic), timolol (beta-blocker), and brimonidine (alpha-agonist) are all used to reduce intra-ocular pressure (IOP), which is compromising the optic nerve.
What dose of adrenaline is used in anaphylaxis?
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
What dose of dose of adrenaline is used in cardiac arrest?
cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
Which intervention slows down mancular degeneration?
Stop smoking
What is the the appropriate referral for age related macular degeneration?
Urgent Opthalmology referral in 1 week
Which calcium channel blocker should not be prescribed with a beta blocker?
Verapamil - due to risk of complete heart block
What is the first line treatment for angina?
Beta blocker or calcium channel blocker - rate limiting (eg verapamil or diltiazem)
What is the second line treatment for angina?
1) Increased to the maximum dose for monotherapy.
2) Consider adding a beta blocker or calcium channel blocked (visa versa) (e.g. amlodipine, modified-release nifedipine)
3) If cannot tolerate a beta blocker and calcium channel blocker addition when on monotherapy then consider adding:
a long-acting nitrate
ivabradine
nicorandil
ranolazine
Which calcium channel blocker should be used in conjuction with beta blocker in angina?
a longer-acting dihydropyridine calcium channel blocker (e.g. amlodipine, modified-release nifedipine)
Which calcium channel blocker should be used first line in angina (if not using beta blocker)?
if a calcium channel blocker is used as monotherapy a rate-limiting one such as verapamil or diltiazem should be used
Patients may develop tolerance to this medication necessitating a change in dosing regime??
Isosorbide mononitrate
Which anti-angina medication should be avoided in known heart failure?
Verapamil
What occurs at 8 - 12 weeks (ideally < 10 weeks) during routine antenatal care?
Booking visit
general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
BP, urine dipstick, check BMI
Which antenatal bloods/Ix are done at 8-12 wks (antenatal care)?
Booking bloods/urine
FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria
When is the Early scan to confirm dates, exclude multiple pregnancy performed?
10 - 13+6 weeks
When does Down’s syndrome screening including nuchal scan occur?
11 - 13+6 weeks
When does the Anomaly scan occur?
18 - 20+6 weeks
What occurs at 28 weeks?
Routine care: BP, urine dipstick, SFH
Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
First dose of anti-D prophylaxis to rhesus negative women
What occurs at 34 weeks?
Routine care as above
Second dose of anti-D prophylaxis to rhesus negative women*
Information on labour and birth plan
When is anti D given?
28, 34 weeks
What occurs at 36 weeks?
Routine care as above
Check presentation - offer external cephalic version if indicated
Information on breast feeding, vitamin K, ‘baby-blues’
What are the symptoms of anterior uveitis?
Anterior uveitis presents with acutely painful red eye, photophobia, small pupil, reduced visual acuity. It is often associated with pus in the anterior chamber (a hypopyon)
What is anterior uveitis assoicated with?
HLAB27
ankylosing spondylitis
reactive arthritis
ulcerative colitis, Crohn’s disease
Behcet’s disease
sarcoidosis: bilateral disease may be seen
Which antiplatelets should be given following ischaemic stroke?
Aspirin 300 mg daily for 2 weeks. Following this, clopidogrel 75 mg daily should be given long-term -if it can be tolerated and is not contraindicated.
How does Argyll-Robertson pupil present?
small, irregular pupils
no response to light but there is a response to accommodate
What are the common causes of AR pupil?
diabetes mellitus (most common in the UK)
syphilis
What is an aspergilloma?
An aspergilloma is a fungal mass that is found in pre-formed body cavities. It is generally secondary to tuberculosis.
Other cavitary diseases predisposing to aspergilloma include sarcoidosis, bronchiectasis, and ankylosing spondylitis
How does an aspergilloma present on CXR?
chest x-ray containing a rounded opacity. A crescent sign may be present
How should asthma Mx be modified in pregnancy?
It shouldnt
The BNF advises that ‘inhaled drugs, theophylline and prednisolone can be taken as normal during pregnancy and breast-feeding’.
Which anti-coagulant should be used in AF with a history of valve disease?
warfarin is still preferred to a direct oral anticoagulant
Which medication can given a falsely low BNP
Aldosterone antagonists, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics can all falsely lower BNP levels, as can obesity.
Which diagnosis should you consider in a disproportionate microcytic anaemia and a raised HbA2?
Beta-thalassaemia trait
Which diagnosis should be considered in young male smoker with symptoms similar to limb ischaemia
Buerger’s disease (thromboangiitis obliterans)
What are the features of Buergers disease?
extremity ischaemia
intermittent claudication
ischaemic ulcers
superficial thrombophlebitis
Raynaud’s phenomenon
What are the side effects of calcium channel blockers?
headache, flushing, ankle oedema
What is Capgras syndorme?
Capgras syndrome: the delusion that a friend or partner has been replaced by an identical-looking impostor
What causes blurring of vision again years after cataract surgery?
Posterior capsule opacification
How does central retinal artery occulsion present?
sudden, painless, unilateral vision loss.
What the features of central retinal artery occulsion on examination?
relative afferent pupillary defect (RAPD), also known as Marcus Gunn pupil, which is an abnormal response to light in the affected eye due to a severe decrease in the number of functioning retinal ganglion cells. Fundoscopy typically reveals a pale retina with a cherry-red spot at the fovea due to obstruction of blood flow in the central retinal artery.
How does central retinal vein occlusion present?
sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
What are the features of fetal varicella syndrome?
rudimentary digits, limb hypoplasia and microcephaly
What are the features of Edwards syndrome?
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
What are the causes of Chorioretinitis
syphilis
cytomegalovirus
toxoplasmosis
sarcoidosis
tuberculosis
Must do HIV testing
When should COCP be stopped prior to surgery?
COCP should be discontinued 4 weeks before major elective surgery and all surgery to the legs or surgery which involves prolonged immobilisation of a lower limb.
A progestogen-only contraceptive may be offered as an alternative and the oestrogen-containing contraceptive restarted after mobilisation.
What are the common causes of cynanotic congential heart disease?
tetralogy of Fallot
transposition of the great arteries (TGA)
tricuspid atresia
What are the common causes of Acyanotic congenital heart disease?
ventricular septal defects (VSD) - most common, accounts for 30%
atrial septal defect (ASD)
patent ductus arteriosus (PDA)
coarctation of the aorta
aortic valve stenosis
What is the GMC advice about obtaining consent from children?
at 16 years or older a young person can be treated as an adult and can be presumed to have capacity to decide
under the age of 16 years children may have capacity to decide, depending on their ability to understand what is involved
where a competent child refuses treatment, a person with parental responsibility or the court may authorise investigation or treatment which is in the child’s best interests*
What age can children consent to sexual intercourse?
Children under the age of 13 years are not able to consent to sexual intercourse and hence any sexual activity would be regarded as rape under the law.
What is first line in COPD?
SABA or SAMA
What is second line in COPD (with steroid responsiveness) ?
SABA + LABA/ICS
What is second line in COPD (without steroid responsiveness) ?
SABA + LABA/LAMA
What is third line in COPD?
SABA
LAMA/LABA/ICS
How does Dermatitis herpetiformis present?
itchy, vesicular skin lesions on the extensor surfaces
What is Dermatitis herpetiformis associated with?
Coeliac disease
What is stage 1 hypertension?
135/85 - 149/94
What is stage 2 hypertension?
> = 150/95
When should stage 1 hypertension be treated?
Treat is <80 and any of the following
- Target organ damage
- Established CV disease
- Renal disease
- Diabetes
- Q risk >/=10 %
When should stage 2 hypertension be treated?
Treat all patients regardless of age
What are the symptoms of a cluster headache?
Episodic, intense, unilateral eye pain, lacrimation, restless
intense sharp, stabbing pain around one eye
pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
the patient is restless and agitated during an attack due to the severity
clusters typically last 4-12 weeks
accompanied by redness, lacrimation, lid swelling
nasal stuffiness
miosis and ptosis in a minority
What is the treatment for cluster headache
NICE recommend seeking specialist advice from a neurologist if a patient develops cluster headaches
acute
100% oxygen (80% response rate within 15 minutes)
subcutaneous triptan (75% response rate within 15 minutes)
prophylaxis
verapamil is the drug of choice
there is also some evidence to support a tapering dose of prednisolone
How is type 2 diabetes diagnosed?
fasting > 7.0
random > 11.1
if asymptomatic need two readings
What value of HbA1c is diagnostic of T2DM?
> /= 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus
< 48 mmol/mol (6.5%) does not exclude diabetes
What value of HbA1c is indicated pre-diabetes?
HbA1c 42-47mmol/mol (6.0-6.4%)
Or fasting glucose 6.1-6.9
How is impaired glucose tolerance diagnosed?
Fasting plasma glucose < 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
What triad indicated pre-eclampsia?
new-onset hypertension
proteinuria
oedema
What is the definition of pre-eclampsia?
new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy,
AND 1 or more of the following:
- proteinuria
- other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction
What are the features of severe pre-eclampsia?
hypertension: typically > 160/110 mmHg and proteinuria as above
proteinuria: dipstick ++/+++
headache
visual disturbance
papilloedema
RUQ/epigastric pain
hyperreflexia
platelet count < 100 * 106/l, abnormal liver enzymes or HELLP syndrome
What urine protein/creatinine ratio indicates pre-eclampsia?
0.3 mg/dL
What are the side effects of phenytoin? (loads)
Acute
initially: dizziness, diplopia, nystagmus, slurred speech, ataxia
later: confusion, seizures
Chronic
common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF), hirsutism, coarsening of facial features, drowsiness
megaloblastic anaemia (secondary to altered folate metabolism)
peripheral neuropathy
enhanced vitamin D metabolism causing osteomalacia
lymphadenopathy
dyskinesia
Idiosyncratic
fever
rashes, including severe reactions such as toxic epidermal necrolysis
hepatitis
Dupuytren’s contracture*
aplastic anaemia
drug-induced lupus
P450 inducer
What is leukoplakia?
Leukoplakia is a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers.
Needs biopsy
What is the first line treatment for urge urinary incontinence?
Bladder retraining
What is the first line treatment for stress urinary incontinence?
Pelvic floor training
Which medications can be used in urge incontinence?
oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)
Immediate release oxybutynin should, however, be avoided in ‘frail older women’
mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients
What treatment is offered to patients with stress incontinence if pelvic floor training fails?
surgical procedures: e.g. retropubic mid-urethral tape procedures
duloxetine may be offered to women if they decline surgical procedures
What are the features of Pemphigus vulgaris?
This condition is characterized by the presence of flaccid blisters and mucosal ulceration, which are easily ruptured when touched.
What is the difference between bullous pemphigold and pemphigus vulgaris?
no mucosal involvement: bullous pemphigoid
mucosal involvement: pemphigus vulgaris
What are the features of Perthes disease?
hip pain: develops progressively over a few weeks
limp
stiffness and reduced range of hip movement
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
What age if Perthes disease most common?
Boys - typically between the ages of 4-8 years.
Is which group is Slipped upper femoral epiphysis - SUFE most common?
SUFE affects children in their early teens and is associated with obesity.
What are the contraindications to sildenafil (Viagra)?
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
What are the side effects of Sildenafil ?
visual disturbances
blue discolouration (BLUE pill BLUE vision)
non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache
priapism
What is Holmes Adie syndrome?
- unilateral in 80% of cases
- dilated pupil
- once the pupil has constricted it remains small for an abnormally long time
- slowly reactive to accommodation but very poorly (if at all) to light
- Holmes-Adie syndrome
association of Holmes-Adie pupil with absent ankle/knee reflexes
Which drugs interact with levothyroxine?
iron, calcium carbonate
absorption of levothyroxine reduced, give at least 4 hours apart
What do the following PFTs indicate?
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced
Obstructive lung disease
What are examples of obstructive lung disease?
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
What do the following PFTs indicate?
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increase
Restrictive
What are exampled of restrictive lung disease?
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
What are the features of Dermatomyositis?
- heliotrope rash in the periorbital region
- Gottron’s papules - roughened red papules over extensor surfaces of fingers
- proximal muscle weakness +/- tenderness
- respiratory muscle weakness
- interstitial lung disease
- dysphagia, dysphonia
What is the difference between Dermatomyositis and polymyositis?
polymyositis is a variant of the disease where skin manifestations are not prominent
What are the complications fo thyroidectomy?
Anatomical such as recurrent laryngeal nerve damage.
Bleeding. Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema.
Damage to the parathyroid glands resulting in hypocalcaemia.
What electrolyte disturbance is associated with isolated QTc elongation?
Hypocalcaemia
What electrolyte disturbance is associated with T wave inversion, QTc prolongation and visible U waves?
Hypokalaemia
(Common causes: vomiting, thiazide use and Cushing’s syndrome.)
What electrolyte disturbance is associated with tall, peaked T waves, QTc shortening and ST-segment depression?
Hyperkalaemia
(Common causes: Addison’s disease, rhabdomyolysis, acute kidney injury and potassium-sparing diuretics.)
What electrolyte disturbance is associated with QTc shortening?
Hypercalcaemia
Which oesophageal cancer is associated with GORD / Barretts?
MOST common in UK
Also associated with smoking /obesity
ADENOcarcinoma
Which oesophageal cancer is associated with smoking/ alcohol/ achalasia / Plummer-Vinson syndrome / diets rich in nitrosamines?
SQUAMOUS CELL carcinoma
What is dresslers syndrome?
PERICARDITIS - Dressler’s syndrome tends to occur around 2-6 weeks following a MI. The underlying pathophysiology is thought to be an autoimmune reaction against antigenic proteins formed as the myocardium recovers.
Why should visual acuity be checked prior to starting ethambutol (TB Mx)?
SIDE EFFECT: optic neuritis: check visual acuity before and during treatment
What are the adverse effects of rifampicin?
potent liver enzyme inducer
hepatitis, orange secretions
flu-like symptoms
What are the adverse effects of isoniazid?
peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
liver enzyme inhibitor
What are the adverse effects of pyrazinamide?
hyperuricaemia causing gout
arthralgia, myalgia
hepatitis
What is the treatment regime for TB? INITIAL phase - first 2 months
(RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
What is the treatment for TB?
LATENT phase - following 4 months?
Rifampicin
Isoniazid
What is the empirical therapy for suspected bacterial meningitis in those aged <3 months?
IV Cefotaxime + amoxicillin
What is the empirical therapy for suspected bacterial meningitis in those aged 3 months - 50 years?
IV cefotaxime (or ceftriaxone)
What is the empirical therapy for suspected bacterial meningitis in those aged >50 years?
Also used for meningitis caused by H.influenza/pneumococcal meningitis?
IV cefotaxime (or ceftriaxone) + amoxicillin
What is the empirical therapy for meningococcal meningitis?
IV benzylpenicillin or cefotaxime (or ceftriaxone)
What is the empirical therapy for meningitis caused by listeria?
IV amoxicillin + gent
What prophylaxis should be offered to close contacts of those with meningococcal meningitis?
Oral ciprofloxacin or rifampicin
How long should methotrexate be stopped for prior to conception in both men and women?
6 months
What is the SSRI of choice post MI?
Sertraline
Which skin disorders are associated with T2DM?
Necrobiosis lipoidica
Infection (candidiasis staphylococcal)
Neuropathic ulcers
Vitiligo
Lipoatrophy
Granuloma annulare
What is used in the management of paracetamol overdose?
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
What is used in the management of Salicylate (eg aspirin) overdose?
urinary alkalinization with IV bicarbonate
haemodialysis
What is used in the management of opiods?
Naloxone
What is used in the management of benzodiazepines?
Flumazenil
What is used in the management of Tricyclic antidepressants?
IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
What is used in lithium overdose?
IV rehydration
Haemodialysis
What is used in warfarin overdose?
Vitamin K, prothrombin complex
What is used in heparin overdose?
Protamine sulphate
What is used in beta blocker overdose?
if bradycardic then atropine
in resistant cases glucagon may be used
What is used in carbon monoxide poisoning?
100% oxygen
hyperbaric oxygen
What insulin regime is used for acute Mx of DKA?
insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin
What is the definition of severe UC?
> 6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
What is the difference between mild and moderate UC?
mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
What is used in the Mx of mild or moderate UC?
topical (rectal) aminosalicylate
In extensive disease or if not responding add in high-dose oral aminosalicylate
What is used in the Mx of severe UC?
IV steroids
What are the THREE classic features of reactive arthritis?
Urethritis + arthritis +/- conjunctivitis
‘Can’t see, pee or climb a tree’
How do patients with Von Willebrand’s disease usually present?
Epistaxis
Menorrhagia
More rarely (in type 3):
- haemoarthroses and muscle haematomas
What would you find on Ix for VWD?
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin
How is VWD managed?
tranexamic acid for mild bleeding
desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
factor VIII concentrate
What is a primary pneumothorax?
Absence of underlying condition
- tall thin adolescent male holding breath
What is a secondary pneumothroax?
Underlying condition
- marfans, CF, COPD, Lung Ca
What is the Mx of a primary pneumothroax (<2cm) with no SOB?
Discharge home
What is Mx of primary pneumothorax (>2cm) or with SOB?
Aspiration and if fails for chest drain
When should chest drain be inserted in secondary pneumothorax?
if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
When should aspiration be attempted in secondary pneumothroax?
Aspiration should be attempted if the rim of air is between 1-2cm.
If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours
How should genital herpes be treated?
oral aciclovir
How does primary hyperaldosteronism present?
HYPO kalaemia
HYPER natraemia
High blood volumer/HTN
Alkalosis (metabolic)
What are the causes of primary hyperaldosteronism? CONNS
- bilateral idiopathic adrenal hyperplasia (MOST common)
- adrenal adenoma:
- unilateral hyperplasia
- familial hyperaldosteronism
- adrenal carcinoma
What is the Mx of primary hyperaldosteronism?
Surgery (adrenal adenoma)
Aldosterone agonist - SPIRONOLACTONE (bialteral adrenocortical hypoerplasia)
How does salmonella (Typhoid/Enteric fever present)?
Often in Qs with recent travel*
1) Systemic upset
2) Realtive bradycardia
3) Abdominal pain/distention
4) CONSTIPATION (can also cause diarrhoea)
5) Rose spots - present on trunk in 40% patients
How is latent TB treated?
3 months of isoniazid (with pyridoxine) and rifampicin - patient <35
OR
6 months of isoniazid (with pyridoxine) - patients with HIV/transplant
What is first line Mx in NAFLD or non alcoholic steatohepatitis?
Weight LOSS
What are the features of HONK?
1.) Severe hyperglycemia
2.) Dehydration and renal failure
3.) Mild/absent ketonuria
What is the most important first step in Mx of HONK?
Fluid resuscitation
What are the three options for emergency contraception?
Copper IUD
Levonorgestrel
Ulipristal (ellaONE)
What is the mode of action of Levonorgestrel and what time frame can it be given?
acts both to stop ovulation and inhibit implantation
should be taken as soon as possible - efficacy decreases with time
must be taken within 72 hours of unprotected sexual intercourse (UPSI)*
What is the mode of action of Ulipristal and what time frame can it be given?
The primary mode of action is thought to be inhibition of ovulation
30mg oral dose taken as soon as possible, no later than 120 hours after intercourse
Which skin conditions are common in pregnancy?
Atopic eruption
Polymorphic eruption of pregnancy
Pemphigoid gestationis
What is the difference between Polymorphic eruption of pregnancy and
Pemphigoid gestationis
Polymorphic eruption of pregnancy is not associated with blistering
How do you convert from oral codiene (or tramadol) to oral morphine?
Divide by 10
eg 10mg codiene = 1mg morphine
How do you convert from oral morphine to oxycodone?
Divide by 1.5 - 2
How do you convert from oral morphine to subcut morphine?
Divide by 2
How much should the breakthrough dose of morphine be?
1/6th of the total daily dose
What is Livedo reticularis?
purplish, non-blanching, reticulated rash
What is the most common bacteria causing osteomyelitis?
Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate
What is polycythaemia vera?
This is a myeloproliferative disorder characterised by an increase in red cell volume, hence the raised haemoglobin. It is often accompanied by overproduction of platelets and neutrophils.
How does polycythaemia vera present?
pruritus, typically after a hot bath
splenomegaly
hypertension
hyperviscosity
arterial thrombosis
venous thrombosis
haemorrhage (secondary to abnormal platelet function)
low ESR
What is the treatment for fungal nail infections (onychomycosis) due to a dermatophyte infection?
oral terbinafine
For mild infections consider: amorolfine 5% nail lacquer
What are the features of achalasia?
Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc
What are the features of a pharyngeal pouch?
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough. Halitosis
Which medications prolong QT interval?
HOT ASS MEC
Haloperidol
Ondasetron
TCA
Amioderone
Sotolol
SSRI (Citalopram)
Methadone
Erythromycin
Chloroqine
What is first line in psoriasis?
Potent corticosteroid + vitamin D analphue (ONCE daily)
What is second line in psoriasis?
Increase vitamin D analogue to TWICE daily
What is third line in psoriasis?
Increased corticosteroid to TWICE dail or coal tar prepartation (OD/BD)
What are the features of CREST syndome (limited systemic sclerosis)?
calcinosis, Raynaud’s phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia
What is first line in managing ascites in liver cirrhosis?
Spironolactone
When should patients with ascites be given SBP prophylaxis and what is used?
Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis
Which pathogen causes croup?
Parainfluenza virus
Which pathogen causes Bronchiolitis?
RSV
Which pathogen causes common cold?
Rhinovirus
What is the most common cause of CAP?
Streptococcus pneumoniae
Which pathogen causes:
- CAP
- Most common cause of bronchiectasis exacerbations
- Acute epiglottitis
Haemophilus influenzae
Which pathogen commonly causes pneumonia after flu?
Staphylococcus aureus
What is the most common cause of pneumonia in HIV patients?
Pneumocystis jiroveci (PCP)
What cause of atypical pneumonia causes haemolytic anaemia and erythema multiforme?
Mycoplasma pneumoniae
What cause of atypical pneumonia also causes Lymphopenia, deranged liver function tests and hyponatraemia? THINK AIR CON
Legionella pneumophilia
What are the adverse effects of loop diuretics?
hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
ototoxicity
hypocalcaemia
renal impairment (from dehydration + direct toxic effect)
hyperglycaemia (less common than with thiazides)
gout
What are the key referral points for delayed childhood development?
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months
Which condition is associated with dactylitis?
Psoriatic arthritis
Which conditions are associated with Primary biliary cholangitis?
Sjogren’s syndrome (seen in up to 80% of patients)
rheumatoid arthritis
systemic sclerosis
thyroid disease
How is PBC managed?
first-line: ursodeoxycholic acid
pruritus: cholestyramine
fat-soluble vitamin supplementation
liver transplantation
How does Retinitis pigmentosa classically present?
tunnel vision and night blindness
Which skin condition is associated with reactive arthritis?
Keratoderma blennorrhagica
Which drugs cause tinnitus?
QAAL
Quinine
Aspirin/NSAIDs
Aminoglycosides: Gentamycin
Loop diuretics: Furosemide
Which drugs are P450 enzyme inducers?
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
Which drugs are P450 enzyme inhibitors?
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
Acronym to remember hypersensitivity reactions?
A - Anaphylaxis
B - AntiBody
C - Immune Complex
D - Delayed
G - Graves/ Myasthenia Gravis
What are the features of diabetic maculopathy?
Diabetic maculopathy describes any structural abnormality due to diabetes affecting the macula - the rest of the retina is NORMAL
What are the features of Non-proliferative diabetic retinopathy on fundoscopy?
microaneurysms
blot haemorrhages
hard exudates
cotton wool spots
In severe cases:
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant
What are the features of Proliferative diabetic retinopathy on fundoscopy?
retinal neovascularisation - may lead to vitrous haemorrhage
fibrous tissue forming anterior to retinal disc
more common in Type I DM, 50% blind in 5 years
Which dementia is associated with visual hallucinations?
visual hallucinations
What is a troublesome side effect of finasteride (used in BPH)?
impotence
decrease libido
ejaculation disorders
gynaecomastia and breast tenderness
What are the symptoms of Posterior vitreous detachment?
Send to opthalmologist to assess for risk of retinal detachement
Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
What is a chalazion?
A meibomian cyst presents as a firm painless lump in the eyelid
Which diagnosis should always be considered in chronic unilateral conjunctivitis resistant to treatment?
Orbital lymphoma
What is the most common ocular manifestation of rheumatoid arthritis?
keratoconjunctivitis sicca
What treatment is required for perforated ear drum?
Watch and wait
Refer to ENT if persists over 6 weeks
What happens to body temperature following ovulation?
Rises
What is first line treatment for diabetic neuropathy?
amitriptyline, duloxetine, gabapentin or pregabalin
Which anticoagulant is used to treat VTE in cancer treatment?
6 months of a DOAC
What cause of gastroenteritis has the longest incubation period?
Giardiasis
If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates what should be used?
Oral prednisolone
Which tumour marker is associated with ovarian Ca?
CA 125
Which tumour marker is associated with pancreatic cancer?
CA 19-9
Which tumour marker is associated with breast cancer?
CA 15-3
Which tumour marker is associated with Hepatocellular carcinoma, teratoma (testicular ca)?
AFP
Which tumour marker is associated with Colorectal cancer
CEA
Which tumour marker is associated with Prostatic carcinoma?
PSA
Which are the causes of Oligohydramnios?
Premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia
What is the treatment for acute sensorineural hearing loss?
High dose steroids and urgent ENT referral
Exam tip to remember SN vs Conductive hearing loss?
Pro tip: if you ever forget how conductive and sensorineural hearing loss lateralising just plug one of your ears with your finger and hum. You will hear it yourself humming louder in your plugged ear. Thus webers lateralises towards the affected ear in conductive hearing loss and away from affected ear in sensorineural hearing loss.
Which diabetic medication is linked to necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)?
SGLT-2 inhibitors
Dapagliflozin
What are the adverse effects of SGLT-2 inhibitors?
urinary and genital infection (secondary to glycosuria). Fournier’s gangrene has also been reported
normoglycaemic ketoacidosis
increased risk of lower-limb amputation: feet should be closely monitored
What is the management for lichen planus?
Potent topical steroids
Which anti-emetic should be avoided in parkinsons?
Metoclopramide
What is the triad of shaken baby syndrome?
Retinal haemorrhages, subdural haematoma and encephalopathy
What is the best site for IM adrenaline in anaphylaxis?
anterolateral aspect of the middle third of the thigh
What is the target time frame for thrombectomy in acute stroke?
6 hours
What is the time frame for thrombomysis?
Within 4.5hours
Once haemorrhage has definitely been excluded
What are the absolute contraindications to thombolysis?
- Previous intracranial haemorrhage
- Seizure at onset of stroke
- Intracranial neoplasm
- Suspected subarachnoid haemorrhage
- Stroke or traumatic brain injury in preceding 3 months
- Lumbar puncture in preceding 7 days
- Gastrointestinal haemorrhage in preceding 3 weeks
- Active bleeding
- Pregnancy
- Oesophageal varices
- Uncontrolled hypertension >200/120mmHg
What are the relative contraindications to thombolysis?
- Concurrent anticoagulation (INR >1.7)
- Haemorrhagic diathesis
- Active diabetic haemorrhagic retinopathy
- Suspected intracardiac thrombus
- Major surgery / trauma in the preceding 2 weeks