Flagged Qs Flashcards
1
Q
What antihypertensives are contraindicated in renovascular disease (eg renal artery stenosis)?
A
ACE inhibitors
2
Q
Which condition presents with fixed dilated pupil with conjunctival injection?
A
Acute closed-angle glaucoma
3
Q
What are the symptoms of acute closed angle glaucoma?
A
Ocular pain, decreased visual acuity, worse with mydriasis, haloes around lights
4
Q
What is the treatment for acute closed angle glaucoma?
A
Pilocarpine (cholinergic), timolol (beta-blocker), and brimonidine (alpha-agonist) are all used to reduce intra-ocular pressure (IOP), which is compromising the optic nerve.
5
Q
What dose of adrenaline is used in anaphylaxis?
A
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
6
Q
What dose of dose of adrenaline is used in cardiac arrest?
A
cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV
7
Q
Which intervention slows down mancular degeneration?
A
Stop smoking
8
Q
What is the the appropriate referral for age related macular degeneration?
A
Urgent Opthalmology referral in 1 week
9
Q
Which calcium channel blocker should not be prescribed with a beta blocker?
A
Verapamil - due to risk of complete heart block
10
Q
What is the first line treatment for angina?
A
Beta blocker or calcium channel blocker - rate limiting (eg verapamil or diltiazem)
11
Q
What is the second line treatment for angina?
A
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
12
Q
Which calcium channel blocker should be used in conjuction with beta blocker in angina?
A
a longer-acting dihydropyridine calcium channel blocker (e.g. amlodipine, modified-release nifedipine)
13
Q
Which calcium channel blocker should be used first line in angina (if not using beta blocker)?
A
if a calcium channel blocker is used as monotherapy a rate-limiting one such as verapamil or diltiazem should be used
14
Q
Patients may develop tolerance to this medication necessitating a change in dosing regime??
A
Isosorbide mononitrate
15
Q
Which anti-angina medication should be avoided in known heart failure?
A
Verapamil
16
Q
What occurs at 8 - 12 weeks (ideally < 10 weeks) during routine antenatal care?
A
Booking visit
general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
BP, urine dipstick, check BMI
17
Q
Which antenatal bloods/Ix are done at 8-12 wks (antenatal care)?
A
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
18
Q
When is the Early scan to confirm dates, exclude multiple pregnancy performed?
A
10 - 13+6 weeks
19
Q
When does Down’s syndrome screening including nuchal scan occur?
A
11 - 13+6 weeks
20
Q
When does the Anomaly scan occur?
A
18 - 20+6 weeks
21
Q
What occurs at 28 weeks?
A
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
22
Q
What occurs at 34 weeks?
A
Routine care as above
Second dose of anti-D prophylaxis to rhesus negative women*
Information on labour and birth plan
23
Q
When is anti D given?
A
28, 34 weeks
24
Q
What occurs at 36 weeks?
A
Routine care as above
Check presentation - offer external cephalic version if indicated
Information on breast feeding, vitamin K, ‘baby-blues’
25
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)
26
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
27
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.
28
How does Argyll-Robertson pupil present?
small, irregular pupils
no response to light but there is a response to accommodate
29
What are the common causes of AR pupil?
diabetes mellitus (most common in the UK)
syphilis
30
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
31
How does an aspergilloma present on CXR?
chest x-ray containing a rounded opacity. A crescent sign may be present
32
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'.
33
Which anti-coagulant should be used in AF with a history of valve disease?
warfarin is still preferred to a direct oral anticoagulant
34
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.
35
Which diagnosis should you consider in a disproportionate microcytic anaemia and a raised HbA2?
Beta-thalassaemia trait
36
Which diagnosis should be considered in young male smoker with symptoms similar to limb ischaemia
Buerger's disease (thromboangiitis obliterans)
37
What are the features of Buergers disease?
extremity ischaemia
intermittent claudication
ischaemic ulcers
superficial thrombophlebitis
Raynaud's phenomenon
38
What are the side effects of calcium channel blockers?
headache, flushing, ankle oedema
39
What is Capgras syndorme?
Capgras syndrome: the delusion that a friend or partner has been replaced by an identical-looking impostor
40
What causes blurring of vision again years after cataract surgery?
Posterior capsule opacification
41
How does central retinal artery occulsion present?
sudden, painless, unilateral vision loss.
42
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.
43
How does central retinal vein occlusion present?
sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
44
What are the features of fetal varicella syndrome?
rudimentary digits, limb hypoplasia and microcephaly
45
What are the features of Edwards syndrome?
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
46
What are the causes of Chorioretinitis
syphilis
cytomegalovirus
toxoplasmosis
sarcoidosis
tuberculosis
Must do HIV testing
47
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.
48
What are the common causes of cynanotic congential heart disease?
tetralogy of Fallot
transposition of the great arteries (TGA)
tricuspid atresia
49
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
50
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*
51
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.
52
What is first line in COPD?
SABA or SAMA
53
What is second line in COPD (with steroid responsiveness) ?
SABA + LABA/ICS
54
What is second line in COPD (without steroid responsiveness) ?
SABA + LABA/LAMA
55
What is third line in COPD?
SABA
LAMA/LABA/ICS
56
How does Dermatitis herpetiformis present?
itchy, vesicular skin lesions on the extensor surfaces
57
What is Dermatitis herpetiformis associated with?
Coeliac disease
58
What is stage 1 hypertension?
135/85 - 149/94
59
What is stage 2 hypertension?
>= 150/95
60
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 %
61
When should stage 2 hypertension be treated?
Treat all patients regardless of age
62
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
63
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
64
How is type 2 diabetes diagnosed?
fasting > 7.0
random > 11.1
if asymptomatic need two readings
65
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
66
What value of HbA1c is indicated pre-diabetes?
HbA1c 42-47mmol/mol (6.0-6.4%)
Or fasting glucose 6.1-6.9
67
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
68
What triad indicated pre-eclampsia?
new-onset hypertension
proteinuria
oedema
69
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
70
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
71
What urine protein/creatinine ratio indicates pre-eclampsia?
0.3 mg/dL
72
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
73
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
74
What is the first line treatment for urge urinary incontinence?
Bladder retraining
75
What is the first line treatment for stress urinary incontinence?
Pelvic floor training
76
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
77
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
78
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.
79
What is the difference between bullous pemphigold and pemphigus vulgaris?
no mucosal involvement: bullous pemphigoid
mucosal involvement: pemphigus vulgaris
80
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
81
What age if Perthes disease most common?
Boys - typically between the ages of 4-8 years.
82
Is which group is Slipped upper femoral epiphysis - SUFE most common?
SUFE affects children in their early teens and is associated with obesity.
83
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)
84
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
85
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
86
Which drugs interact with levothyroxine?
iron, calcium carbonate
absorption of levothyroxine reduced, give at least 4 hours apart
87
What do the following PFTs indicate?
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced
Obstructive lung disease
88
What are examples of obstructive lung disease?
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
89
What do the following PFTs indicate?
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increase
Restrictive
90
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
91
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
92
What is the difference between Dermatomyositis and polymyositis?
polymyositis is a variant of the disease where skin manifestations are not prominent
93
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.
94
What electrolyte disturbance is associated with isolated QTc elongation?
Hypocalcaemia
95
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.)
96
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.)
97
What electrolyte disturbance is associated with QTc shortening?
Hypercalcaemia
98
Which oesophageal cancer is associated with GORD / Barretts?
MOST common in UK
Also associated with smoking /obesity
ADENOcarcinoma
99
Which oesophageal cancer is associated with smoking/ alcohol/ achalasia / Plummer-Vinson syndrome / diets rich in nitrosamines?
SQUAMOUS CELL carcinoma
100
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.
101
Why should visual acuity be checked prior to starting ethambutol (TB Mx)?
SIDE EFFECT: optic neuritis: check visual acuity before and during treatment
102
What are the adverse effects of rifampicin?
potent liver enzyme inducer
hepatitis, orange secretions
flu-like symptoms
103
What are the adverse effects of isoniazid?
peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
hepatitis, agranulocytosis
liver enzyme inhibitor
104
What are the adverse effects of pyrazinamide?
hyperuricaemia causing gout
arthralgia, myalgia
hepatitis
105
What is the treatment regime for TB? INITIAL phase - first 2 months
(RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
106
What is the treatment for TB?
LATENT phase - following 4 months?
Rifampicin
Isoniazid
107
What is the empirical therapy for suspected bacterial meningitis in those aged <3 months?
IV Cefotaxime + amoxicillin
108
What is the empirical therapy for suspected bacterial meningitis in those aged 3 months - 50 years?
IV cefotaxime (or ceftriaxone)
109
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
110
What is the empirical therapy for meningococcal meningitis?
IV benzylpenicillin or cefotaxime (or ceftriaxone)
111
What is the empirical therapy for meningitis caused by listeria?
IV amoxicillin + gent
112
What prophylaxis should be offered to close contacts of those with meningococcal meningitis?
Oral ciprofloxacin or rifampicin
113
How long should methotrexate be stopped for prior to conception in both men and women?
6 months
114
What is the SSRI of choice post MI?
Sertraline
115
Which skin disorders are associated with T2DM?
Necrobiosis lipoidica
Infection (candidiasis staphylococcal)
Neuropathic ulcers
Vitiligo
Lipoatrophy
Granuloma annulare
116
What is used in the management of paracetamol overdose?
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
117
What is used in the management of Salicylate (eg aspirin) overdose?
urinary alkalinization with IV bicarbonate
haemodialysis
118
What is used in the management of opiods?
Naloxone
119
What is used in the management of benzodiazepines?
Flumazenil
120
What is used in the management of Tricyclic antidepressants?
IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity
121
What is used in lithium overdose?
IV rehydration
Haemodialysis
122
What is used in warfarin overdose?
Vitamin K, prothrombin complex
123
What is used in heparin overdose?
Protamine sulphate
124
What is used in beta blocker overdose?
if bradycardic then atropine
in resistant cases glucagon may be used
125
What is used in carbon monoxide poisoning?
100% oxygen
hyperbaric oxygen
126
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
127
What is the definition of severe UC?
>6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
128
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
129
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
130
What is used in the Mx of severe UC?
IV steroids
131
What are the THREE classic features of reactive arthritis?
Urethritis + arthritis +/- conjunctivitis
'Can't see, pee or climb a tree'
132
How do patients with Von Willebrand's disease usually present?
Epistaxis
Menorrhagia
More rarely (in type 3):
- haemoarthroses and muscle haematomas
133
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
134
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
135
What is a primary pneumothorax?
Absence of underlying condition
- tall thin adolescent male holding breath
136
What is a secondary pneumothroax?
Underlying condition
- marfans, CF, COPD, Lung Ca
137
What is the Mx of a primary pneumothroax (<2cm) with no SOB?
Discharge home
138
What is Mx of primary pneumothorax (>2cm) or with SOB?
Aspiration and if fails for chest drain
139
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.
140
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
141
How should genital herpes be treated?
oral aciclovir
142
How does primary hyperaldosteronism present?
HYPO kalaemia
HYPER natraemia
High blood volumer/HTN
Alkalosis (metabolic)
143
What are the causes of primary hyperaldosteronism? CONNS
- bilateral idiopathic adrenal hyperplasia (MOST common)
- adrenal adenoma:
- unilateral hyperplasia
- familial hyperaldosteronism
- adrenal carcinoma
144
What is the Mx of primary hyperaldosteronism?
Surgery (adrenal adenoma)
Aldosterone agonist - SPIRONOLACTONE (bialteral adrenocortical hypoerplasia)
145
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
146
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
147
What is first line Mx in NAFLD or non alcoholic steatohepatitis?
Weight LOSS
148
What are the features of HONK?
1.) Severe hyperglycemia
2.) Dehydration and renal failure
3.) Mild/absent ketonuria
149
What is the most important first step in Mx of HONK?
Fluid resuscitation
150
What are the three options for emergency contraception?
Copper IUD
Levonorgestrel
Ulipristal (ellaONE)
151
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)*
152
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
153
Which skin conditions are common in pregnancy?
Atopic eruption
Polymorphic eruption of pregnancy
Pemphigoid gestationis
154
What is the difference between Polymorphic eruption of pregnancy and
Pemphigoid gestationis
Polymorphic eruption of pregnancy is not associated with blistering
155
How do you convert from oral codiene (or tramadol) to oral morphine?
Divide by 10
eg 10mg codiene = 1mg morphine
156
How do you convert from oral morphine to oxycodone?
Divide by 1.5 - 2
157
How do you convert from oral morphine to subcut morphine?
Divide by 2
158
How much should the breakthrough dose of morphine be?
1/6th of the total daily dose
159
What is Livedo reticularis?
purplish, non-blanching, reticulated rash
160
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
161
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.
162
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
163
What is the treatment for fungal nail infections (onychomycosis) due to a dermatophyte infection?
oral terbinafine
For mild infections consider: amorolfine 5% nail lacquer
164
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
165
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
166
Which medications prolong QT interval?
HOT ASS MEC
Haloperidol
Ondasetron
TCA
Amioderone
Sotolol
SSRI (Citalopram)
Methadone
Erythromycin
Chloroqine
167
What is first line in psoriasis?
Potent corticosteroid + vitamin D analphue (ONCE daily)
168
What is second line in psoriasis?
Increase vitamin D analogue to TWICE daily
169
What is third line in psoriasis?
Increased corticosteroid to TWICE dail or coal tar prepartation (OD/BD)
170
What are the features of CREST syndome (limited systemic sclerosis)?
calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia
171
What is first line in managing ascites in liver cirrhosis?
Spironolactone
172
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
173
Which pathogen causes croup?
Parainfluenza virus
174
Which pathogen causes Bronchiolitis?
RSV
175
Which pathogen causes common cold?
Rhinovirus
176
What is the most common cause of CAP?
Streptococcus pneumoniae
177
Which pathogen causes:
- CAP
- Most common cause of bronchiectasis exacerbations
- Acute epiglottitis
Haemophilus influenzae
178
Which pathogen commonly causes pneumonia after flu?
Staphylococcus aureus
179
What is the most common cause of pneumonia in HIV patients?
Pneumocystis jiroveci (PCP)
180
What cause of atypical pneumonia causes haemolytic anaemia and erythema multiforme?
Mycoplasma pneumoniae
181
What cause of atypical pneumonia also causes Lymphopenia, deranged liver function tests and hyponatraemia? THINK AIR CON
Legionella pneumophilia
182
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
183
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
184
Which condition is associated with dactylitis?
Psoriatic arthritis
185
Which conditions are associated with Primary biliary cholangitis?
Sjogren's syndrome (seen in up to 80% of patients)
rheumatoid arthritis
systemic sclerosis
thyroid disease
186
How is PBC managed?
first-line: ursodeoxycholic acid
pruritus: cholestyramine
fat-soluble vitamin supplementation
liver transplantation
187
How does Retinitis pigmentosa classically present?
tunnel vision and night blindness
188
Which skin condition is associated with reactive arthritis?
Keratoderma blennorrhagica
189
Which drugs cause tinnitus?
QAAL
Quinine
Aspirin/NSAIDs
Aminoglycosides: Gentamycin
Loop diuretics: Furosemide
190
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)
191
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
192
Acronym to remember hypersensitivity reactions?
A - *A*naphylaxis
B - Anti*B*ody
C - Immune *C*omplex
D - *D*elayed
G - Graves/ Myasthenia Gravis
193
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
194
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
195
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
196
Which dementia is associated with visual hallucinations?
visual hallucinations
197
What is a troublesome side effect of finasteride (used in BPH)?
impotence
decrease libido
ejaculation disorders
gynaecomastia and breast tenderness
198
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
199
What is a chalazion?
A meibomian cyst presents as a firm painless lump in the eyelid
200
Which diagnosis should always be considered in chronic unilateral conjunctivitis resistant to treatment?
Orbital lymphoma
201
What is the most common ocular manifestation of rheumatoid arthritis?
keratoconjunctivitis sicca
202
What treatment is required for perforated ear drum?
Watch and wait
Refer to ENT if persists over 6 weeks
203
What happens to body temperature following ovulation?
Rises
204
What is first line treatment for diabetic neuropathy?
amitriptyline, duloxetine, gabapentin or pregabalin
205
Which anticoagulant is used to treat VTE in cancer treatment?
6 months of a DOAC
206
What cause of gastroenteritis has the longest incubation period?
Giardiasis
207
If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates what should be used?
Oral prednisolone
208
Which tumour marker is associated with ovarian Ca?
CA 125
209
Which tumour marker is associated with pancreatic cancer?
CA 19-9
210
Which tumour marker is associated with breast cancer?
CA 15-3
211
Which tumour marker is associated with Hepatocellular carcinoma, teratoma (testicular ca)?
AFP
212
Which tumour marker is associated with Colorectal cancer
CEA
213
Which tumour marker is associated with Prostatic carcinoma?
PSA
214
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
215
What is the treatment for acute sensorineural hearing loss?
High dose steroids and urgent ENT referral
216
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.
217
Which diabetic medication is linked to necrotising fasciitis of the genitalia or perineum (Fournier's Gangrene)?
SGLT-2 inhibitors
Dapagliflozin
218
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
219
What is the management for lichen planus?
Potent topical steroids
220
Which anti-emetic should be avoided in parkinsons?
Metoclopramide
221
What is the triad of shaken baby syndrome?
Retinal haemorrhages, subdural haematoma and encephalopathy
222
What is the best site for IM adrenaline in anaphylaxis?
anterolateral aspect of the middle third of the thigh
223
What is the target time frame for thrombectomy in acute stroke?
6 hours
224
What is the time frame for thrombomysis?
Within 4.5hours
Once haemorrhage has definitely been excluded
225
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
226
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
227
What is the follow up for a patient with negative hrHPV?
Normal recall
228
What is the follow up for a patient with positive hrHPV and negative cytology?
Repeat test in 12 months
IF STILL POSITIVE at 12 month repeat needs further testing in 12 months. If this is positive then requires colposcopy
229
What is the follow up for a patient with positive hfHPV and positive cytology?
COLPOSCOPY
230
What is the follow up if the smear test results if 'inadequate'?
repeat the sample within 3 months
if two consecutive inadequate samples then → colposcopy
231
What risk tool is used to assess osteoporosis risk?
FRAX tool
232
Who should be assessed using the FRAX tool?
They advise that all women aged >= 65 years and all men aged >= 75 years should be assessed.
Younger patients should be assessed in the presence of risk factors, such as:
previous fragility fracture
current use or frequent recent use of oral or systemic glucocorticoid
history of falls
family history of hip fracture
other causes of secondary osteoporosis
low body mass index (BMI) (less than 18.5 kg/m²)
smoking
alcohol intake of more than 14 units per week for women and more than 14 units per week for men.
233
When is BMD (bone mineral density) used with FRAX tool?
When there is an intermediate result that requires BMD testing to determine treatment
234
What is a section 136?
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
235
What is a section 135?
a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
236
What is a section 17a?
Supervised Community Treatment (Community Treatment Order)
can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication
237
What is a section 5(4)?
similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
238
What is a section 5(2)?
a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
239
What is a section 4?
72 hour assessment order
used as an emergency, when a section 2 would involve an unacceptable delay
a GP and an AMHP or NR
often changed to a section 2 upon arrival at hospital
240
What is a section 2?
admission for assessment for up to 28 days, not renewable
an Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors
one of the doctors should be 'approved' under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
treatment can be given against a patient's wishes
241
What is a section 3?
admission for treatment for up to 6 months, can be renewed
AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours
treatment can be given against a patient's wishes
242
What are causes of conductive hearing loss?
Ear wax
Foreign body
Infection (otitis media / otitis externa)
Fluid in middle ear
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
243
What are the causes of sensorineural hearing loss?
Sudden sensorineural hearing loss
Presbycusis
Noise exposure
Menieres disease
Labrinthitits
Acoustic neuroma
Neurological condition
Meningitis
Medications
244
What type of hearing loss do these results demonstrate?
Rinne result: Bone conduction > air conduction in affected ear, Air conduction > bone conduction in unaffected ear
Weber result: Lateralises to affected ear
245
What is Dermatitis herpetiformis?
An autoimmune skin disease associated with coeliac disease.
Itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)
246
What anticoagulation is recommended for cancer patients with VTE?
DOAC for 6 months
247
What is first line medicine management in raynauds if failed lifestyle advice?
Oral nifedipine
248
Which medications should be commenced following STEMI?
ACI inhibitor
Beta blocker
Statin
Aspirin
Clopidogrel/ ticagrelor (stop after 12 months)
249
How does Chondromalacia patellae present?
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy
250
Which strain of HPV is most commonly linked to cervical cancer?
Human papillomavirus infection (particularly 16,18 & 33) is by far the most important risk factor
251
Which strain of HPV is linked to genital warts?
HPV 6 and 11 are linked to the development of genital warts.
252
What is the biggest risk factor for bladder Ca?
Smoking
253
What usually causes erythema mulitforme (target lesions)?
Often triggered by infection
254
Which drugs cause erythema nodosum?
Penicillin
COCP
Erythema Nodosum
(Painful Coloured Shins)
255
When should metformin be stopped?
if eGFR <30
256
What ankle-brachial pressure index is suggestive of PAD?
An ankle-brachial pressure index of < 0.9 is suggestive of PAD
257
What drugs should a patient with PAD be commenced on?
Statin and clopidogrel
258
Which investigation should be performed prior to commencing Aromatase inhibitors (e.g. anastrozole) in breast Ca?
DEXA Scan
(as can caused osteoporosis)
259
What is akathisia?
Severe restlessness - common side effect of antipsychotic medication
260
How does mycoplasma pneumonia present?
The flu-like symptoms, bilateral consolidation and erythema multiforme
261
What classically presents with ROSE spots?
SALMONella Typhi
262
What dose regime for folic acid is recommended for all women pre-conception?
all women should take 400mcg of folic acid until the 12th week of pregnancy
263
What dose regime of folic acid should women at high risk of NTD take?
5mg folic acid until 12th week pregnancy
264
What conditions make women at high risk of NTD?
either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
- antiepileptic drugs
- coeliac disease
- diabetes
- thalassaemia trait.
- obesity
265
What is first line Ix in ?SAH
Non contrast CT head
266
What is the most common cause of hypothyroidism in children (IN THE UK)?
autoimmune thyroiditis
267
Which anti-emetic is best used in parkinsons patients?
Domperidone - does not readily cross blood brain barrier so reduced side effects
METOCLOPRAMIDE is contrindicated
268
Which drug should be given when variceal bleeding is suspected?
Terlipressin
269
How does syphilis usually present?
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)
270
How does actinic keratosis present?
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
271
What is the treatment for AK?
prevention of further risk
fluorouracil cream
topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
topical imiquimod: trials have shown good efficacy
cryotherapy
curettage and cautery
272
What are the absolute contraindications of the COCP
UKMEC 4
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
273
What are the UKMEC 3 conditions related to the COCP?
(UKMEC3 = disadvantages generally outweigh the advantages)
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
274
What is the most common cause of hepatocellular carcinoma in the UK?
hepatocellular carcinoma
275
What is the long term Mx for prevention of cluster headache?
VERAPAMIL
276
How does guillian barre typically present?
the weakness is classically ascending i.e. the legs are affected first
reflexes are reduced or absent
sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs
277
What investigations are used to confirm a diagnosis of guillian barre syndrome?
lumbar puncture
rise in protein with a normal white blood cell count (albuminocytologic dissociation) - found in 66%
nerve condution studies may be performed
decreased motor nerve conduction velocity (due to demyelination)
prolonged distal motor latency
increased F wave latency
278
What is the Mx for unilateral nasal polyp?
Refer to ENT
RED flag
279
What diagnosis should be considered in children who have persistent cough, worse at night, possibly associated with vomiting?
WHOOPING COUGH
280
What is the causative agent of whooping cough?
Bordetella pertussis
281
What are the adverse effects of pioglitazone?
Weight gain
Fluid retention
Liver impairment
Bladder Ca (increased risk)
282
How do you differentiate between viral labyrinthitis and vestibular neuronitis?
Neuronitis - No loss of hearing
Labythinthisis - Loss of hearing
283
What HbA1c is diagnostic of T2DM in symptomatic patients?
A HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus in a symptomatic patient.
284
What are the side effects of SSRIs?
GI upset
Increased risk of GI bleed - should have PPI if taking NSAID
hyponatraemia
285
What are the features of Subacute (De Quervain's) thyroiditis?
Usually occurs following viral infection
Features:
hyperthyroidism
painful goitre
raised ESR
globally reduced uptake on iodine-131 scan
286
What are the features of Trichomonas vaginalis (STI) ?
vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
287
How should someones usual insulin be adjusted in DKA when they have been commenced on a fixed rate insulin infusion?
Stop short acting
Continue long acting
288
What is the most common ankle sprain from inversion injury?
ATFL
289
After what point can vasectomy be considered a reliable contraception?
Not immediate
semen analysis must be performed and azoospermia confirmed before used as contraception
290
When should anti-retrovirals be commenced in those with HIV-1 infection?
Straight away in all individuals regardless of the CD4 count
291
What should be considered in patients who are found to have dermatomyositis?
Dermatomyositis is usually an autoimmune condition, being most common in women aged 50-70. However, it can also be a paraneoplastic disease, with ovarian, breast and lung tumours being the most common underlying cancers. The possibility of underlying malignancy should be considered, especially in older patients.
292
How do you differentiate between episcleritis and scleritis?
Episcleritis = PAINLESS
Scleritis = PAINFUL
Use phenylephrine drops - it blanches the redness in episcleritis but not scleritis
293
How should chickenpox exposure be managed in women <20 weeks gestation?
If any doubt - check for antibodies
if the pregnant woman <= 20 weeks gestation is not immune to varicella she should be given varicella-zoster immunoglobulin (VZIG) as soon as possible
294
How should chickenpox exposure be managed in women >20 weeks gestation?
if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure
295
How does radial tunnel syndrome present differently to lateral epicondylitis?
Radial tunnel syndrome presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
296
Which antiepeleptics are considered safest to use in pregnancy?
Lamotrigine
carbamazepine
levetiracetam
297
What is the management for acute ischaemic limb?
ABC approach
analgesia
intravenous unfractionated heparin
urgent vascular review
298
What is the antidote for warfarin?
vitamin K
299
What is the antidote for heparin?
protamine sulfate
300
What is the antidote for dabigatran?
idarucizumab
301
What is cataplexy?
Cataplexy describes the sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened). Around two-thirds of patients with narcolepsy have cataplexy.
302
What are the potential effects of amiodarone on the thyroid?
1) Amiodarone-induced hypothyroidism
- amiodarone can be continued if desirable
2) Amiodarone-induced thyrotoxicosis
303
What are the two types of Amiodarone-induced thyrotoxicosis?
AIT type 1 (goitre present, treat with carbimazole)
AIT type 2
(goitre absent, treat with prednisolone)
304
What is sialadenitis?
inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct
305
What the initial presenting features of Necrotising enterocolitis
feeding intolerance, abdominal distension and bloody stools
306
What is Necrotising enterocolitis?
Leading cause of death in pre terms
- AXR useful for diagnosis (shows dilated bowel, bowel wall oedema etc)
307
What are the features of wet age-related macular degeneration?
- steadily worsening loss of vision over the previous few months, followed by a sudden deterioration.
- O/E: central scotoma and red patches on the retina on fundoscopy
308
What are the features of
Necrobiosis lipoidica diabeticorum?
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia
309
In which group is leptospirosis
most common?
Farm workers
Sewage workers
Vets
Returning traveller
310
What are the clinical features of leptospirosis
the early phase is due to bacteraemia and lasts around a week
- may be mild or subclinical
- fever
- flu-like symptoms
- subconjunctival suffusion (redness)/haemorrhage
second immune phase may lead to more severe disease (Weil's disease)
- acute kidney injury (seen in 50% of patients)
- hepatitis: jaundice, hepatomegaly
aseptic meningitis
311
What is the treatment for leptospirosis?
high-dose benzylpenicillin or doxycycline
312
Which pathogen causes CAP in COPD patients?
Haemophilus influenzae
313
What causes shingles?
herpes ZOSTER infection
314
What drug is used in medical prophylaxis of oesophageal varices?
A non-cardioselective B-blocker (NSBB) eg PROPANOLOL
315
Which nerve palsy causes weakness of foot dorsiflexion and foot eversion? FOOT DROP
Common peroneal nerve lesion
316
What causes hyperacute (minutes to hours) rejection of kidney transplant?
pre-existing antibodies against ABO or HLA antigens
no treatment is possible and the graft must be removed
317
What causes acute graft failure (< 6 months)?
usually due to mismatched HLA. Cell-mediated (cytotoxic T cells)
318
Which cancer is associated with: Acanthosis nigricans
Gastric Ca
319
Which cancer is associated with: Acquired ichthyosis
Lymphoma
320
Which cancer is associated with: Acquired hypertrichosis lanuginosa
GI and lung ca
321
Which cancer is associated with: Dermatomyositis
Ovarian and lung Ca
322
Which cancer is associated with: Erythema gyratum repens
Lung Ca
323
Which cancer is associated: Erythroderma
Lymphoma
324
Which cancer is associated with: Migratory thrombophlebitis
Pancreatic cancer
325
Which cancer is associated with: Pyoderma gangrenosum (bullous and non-bullous forms)
Myeloproliferative disorders
326
Which cancer is associated with: Necrolytic migratory erythema
Glucagonoma
327
Which cancer is associated with: Sweet's syndrome
Haematological malignancy e.g. Myelodysplasia - tender, purple plaques
328
Which cancer is associated with: Tylosis
Oesophageal Ca
329
How should ?TIA be managed in GP?
Given 300mg aspirin and refer for specialist review within 24 hours
330
How do 'growing pains' usually present?
'benign idiopathic nocturnal limb pains of childhood'
never present at the start of the day after the child has woken
no limp
no limitation of physical activity
systemically well
normal physical examination
motor milestones normal
symptoms are often intermittent and worse after a day of vigorous activity
331
In which patients is cardiac resynchronisation therapy indicated? HF
patients with left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms
332
Which vitamin is teratogenic in pregnancy?
Vitamin A
333
Which conditions cause higher than expected HbA1c value?
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
334
Which conditions cause lower than expected HbA1c values?
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
335
Which drug is used first line for infertility in PCOS?
Clomifene
336
What testing would indicate premature menopause?
before the age of 45 and have blood tests demonstrating raised FSH/LH and low oestradiol.
337
What are the drug causes of gout?
diuretics: thiazides, furosemide
ciclosporin
alcohol
cytotoxic agents
pyrazinamide
338
At what age should children be able to:
Quietens to parents voice
Turns towards sound
Squeals
3 months
339
At what age should children be able to:
Double syllables 'adah', 'erleh'
6 months
340
At what age should children be able to:
Says 'mama' and 'dada'
Understands 'no'
9 months
341
At what age should children be able to:
Knows and responds to own name
12 months
342
At what age should children be able to:
Knows about 2-6 words (Refer at 18 months)
Understands simple commands - 'give it to mummy'
12-15 months
343
At what age should children be able to:
Combine two words
Points to parts of the body
2 years
344
At what age should children have
Vocabulary of 200 words
2.5 years
345
At what age should children be able to:
Talks in short sentences (e.g. 3-5 words)
Asks 'what' and 'who' questions
Identifies colours
Counts to 10 (little appreciation of numbers though)
3 years
346
At what age should children:
Asks 'why', 'when' and 'how' questions
4 years
347
What does ptosis and constricted pupil indicate?
Horners syndrome
348
What does light reflex absent, accommodation reflex present indicate?
Argyll-Robertson
349
What does mildly dilated pupil at rest, sluggish constriction to light indicate?
Holmes-Adie pupil
350
Which eye condition commonly presents with flashers/floaters?
vitreous/retinal detachment
351
What is the management for hypospadias?
Corrective surgery at 12 months
Children should NOT be circumcised prior
352
What are the rules for driving following MI/ACS?
4 weeks off driving
1 week off if PCI
No need to inform DVLA
353
What is the difference between Stevens-Johnson syndrome and Toxic epidermal necrolysis?
SJS = Rash affecting <10% of body surface area and mucosal involvement.
Toxic epidermal necrolysis also involves mucous membranes but the rash is more extensive affecting at least 30% of body surface area.
354
Which antibiotics is given for severe Campylobacter infections?
CIPROFLOXACIN
355
What medications can be used to treat muscle spasticity in MS? (1st line)
baclofen and gabapentin
356
What is a common cause of CHRONIC dry eyes?
Meibomian blepharitis
357
What should be tested prior to initiating Azathioprine?
thiopurine methyltransferase (TPMT)
358
What are the symptoms of digoxin toxicity?
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
359
What drugs may precipitate digoxin toxicity?
amiodarone, quinidine, verapamil, diltiazem, spironolactone, ciclosporin.
Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics
360
What is the most common cause for nephrotic syndrome in children/ young adults?
Minimal change disease/glomerulonephritis
361
What is the treatment for Addisons?
Hydrocortisone and fludrocortisone
362
How should unilateral glue ear be managed in adults?
Urgent ENT referral to exclude posterior nasal space tumour
363
What are the features of campylobacter infection?
- Prodrome (headache, malaise)
- Diarrhoea (often bloody)
- Abdominal pain (may mimc appendicitis)
post BBQ
364
How should medication be adjusted in patients with addisons and intercurrent illness?
double the glucocorticoids, keep fludrocortisone dose the same
365
Which medication used for migraine prophylaxis is linked to cleft lip/palate?
Topiramate
366
When can hormonal contraception be restarted after emergency contraception?
Immediately
QUICK START
367
What is first line for acne roseacea?
topical ivermectin
368
When should you refer to fertility specialists?
Regularly trying for 12 months and not conceived
Regularly trying for 6 months and >35 years female or other RF
369
Which antibiotics should be avoided in patients taking methotrexate?
Trimethoprim and co-trimoxazole
370
How do vestibular schwannomas (acoustic neuromas) present?
How do they affect the cranial nerves?
cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
371
What glucose levels indicate gestational diabetes?
FASTING and 2 HOUR
5678
fasting glucose is >= 5.6 mmol/L, or
2-hour glucose level of >= 7.8 mmol/L
372
What are the UKMEC 4 conditions for COCP contraindications?
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
373
What is the most common side effect for sildenafil?
Headache
374
What are the classical features of pagets disease?
the stereotypical presentation is an older male with bone pain and an isolated raised ALP
bone pain (e.g. pelvis, lumbar spine, femur)
classical, untreated features: bowing of tibia, bossing of skull
375
How does retinal detachment present?
Retinal detachment is a cause of sudden painless loss of vision. It is characterised by a dense shadow starting peripherally and progressing centrally
376
What is the first line treatment for capillary haemangiomas?
Propanolol
Then can try laser therapy or systemic steroids
377
What causes a painful genital ulcer (single) with associated lymphadenopathy ?
Chancroid is caused by Haemophilus ducreyi
378
What chromosome does Huntingtons affect?
Chromosome 4 (H has 4 arms!!)
379
Which electrolyte disturbances are common with rhabdomyolysis?
hypocalcaemia (myoglobin binds calcium)
elevated phosphate (released from myocytes)
hyperkalaemia (may develop before renal failure)
metabolic acidosis
380
How should you treat GCA/temporal arteritis which presents with visual symptoms/fundus changes?
IV methylprednisolone
(PO pred is ok if no visual symptoms or fundus changes)
381
What presents with the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
Primary biliary cholangitis
382
What is the first line management of acute seizure?
If not ceased after 5 mins give
- Rectal diazepam (10mg for adults)
- Buccal midazolam (10mg for adults)
383
When should vaccines be given for premature children?
As per chronological age
NOT adjusting
384
Which ECG changes are normal in athletes?
sinus bradycardia
junctional rhythm
first degree heart block
Mobitz type 1 (Wenckebach phenomenon)
385
When can a second dose of adrenaline be given in anaphylaxis?
5 minutes following first dose
386
Which diabetes medication is contraindicated in heart failure?
PIOGLITAZONE
387
What presents with:
classical triad: haematuria, loin pain, abdominal mass
pyrexia of unknown origin
left varicocele (due to occlusion of left testicular vein)
Renal cell carcinoma
388
Which bacteria is commonly associated with guillien barre syndrome?
Campylobacter jejuni
389
What are the contraindications to MMR vaccine?
severe immunosuppression
allergy to neomycin
children who have received another live vaccine by injection within 4 weeks
pregnancy should be avoided for at least 1 month following vaccination
immunoglobulin therapy within the past 3 months (there may be no immune response to the measles vaccine if antibodies are present)
390
What are the features of horners syndrome?
miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)
391
What are the features of a third nerve palsy?
Ptosis + dilated pupil
392
What is the treatment for genital warts?
Solitary, keratinised warts VS multiple non-keratinised warts
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
393
What is Sheehans syndrome?
Sheehan's syndrome (otherwise known as postpartum hypopituitarism) is a reduction in the function of the pituitary gland following ischaemic necrosis due to hypovolaemic shock following birth. The symptoms can be varied due to the damage in the pituitary and can sometimes take years to develop.
E.g. amenorrhoea, problems with milk production and hypothyroidism
394
What are the features of carbon monoxide poisoning?
headache: 90% of cases
nausea and vomiting: 50%
vertigo: 50%
confusion: 30%
subjective weakness: 20%
severe toxicity: 'pink' skin and mucosae, hyperpyrexia, arrhythmias, extrapyramidal features, coma, death
395
When should PPIs be stopped before UGI endoscopy?
2 weeks prior
396
How do you calculate doses for breakthrough pain with morphine?
1/6th daily dose
397
What is Roseola infantum?
Common disease of infancy caused by human herpes virus.
Presents with fever FOLLOWED by maculopapular rash
398
How does aspirin / salicylate overdose present?
Hyperventilation, tinnitus, sweating, lethargy, nausea and vomiting, Seizures, coma
leads to a mixed respiratory alkalosis and metabolic acidosis
399
When should bone protection be commenced in patients likely to have steroid treatment for >3 months?
Immediately
400
What is a section 2? MHA
- Admission for assessment for 28 days
- AMHP + recommendation of two doctors
- Treatment can be given against patient wishes
401
What is a section 3? MHA
- Admission for 6 months
- AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours
- Treatment can be given against patient wishes
402
What is a section 4? MHA
- A 72 hour assessment order
- Used in an emergency
- a GP and an AMHP or NR
403
What is a section 5 (2)? MHA
- a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
404
What is a section 5 (4)? MHA
- similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
405
What is a section 17a? MHA
Supervised Community Treatment (Community Treatment Order)
406
What is a section 135? MHA
a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
407
What is a section 136? MHA
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
408
hypothyroid + tender goitre =
subacute (De Quervain's) thyroiditis
409
What are the features of carcinoid syndrome?
flushing
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis
410
How should carcinoid syndrome be investigated?
urinary 5-HIAA
plasma chromogranin A y
411
What is an Epsteins pearl?
a congenital cyst found in the mouth
No treatment is usually required
412
How does CML present?
60-70 years
Anaemia: lethargy
weight loss and sweating are common
splenomegaly may be marked → abdo discomfort
An increase in granulocytes at different stages of maturation +/- thrombocytosis
decreased leukocyte alkaline phosphatase
may undergo blast transformation (AML in 80%, ALL in 20%)
413
How do you differentiate between AML and CML on blood film?
Blast cells = acute leukaemia!
414
What is the treatment for CML?
imatinib is now considered first-line treatment
inhibitor of the tyrosine kinase associated with the BCR-ABL defect
very high response rate in chronic phase CML
415
What should be monitored if commencing hydroxychloroquine?
Antimalarial drug commonly used in SLE
VISUAL ACUITY
can result in severe and permanent retinopathy
416
Following ACS what should all patients be discharged with / offered
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin
417
What are the complications of cholesteatoma?
Local invasion causing:
vertigo
facial nerve palsy
cerebellopontine angle syndrome
418
What is the difference between viral labyrinthitis and vestibular neuritis?
Presents very similarly BUT hearing loss is NOT a feature of vestibular neuritis
419
How do focal aware seizures present?
These are seizures that affect a small (focal) part of one of the brain's lobes and the person remains conscious throughout. It is likely this seizure originates from the temporal lobe, and seizures of this type can lead to hallucinations (auditory, gustatory, olfactory), epigastric rising and in some cases, automatisms.
420
Which anaesthetic agent is best used when there are concerns about post op N&V?
Propofol is a useful medication that provides both anaesthetic effects and anti-emetic effects.
421
What is the first line treatment for primary open-angle glaucoma?
latanoprost
421
What tests are used for HIV screening and diagnosis?
HIV p24 antigen and HIV antibody
422
Which medications are used to treat chlamydia in pregnancy?
Azithromycin, erythromycin or amoxicillin
423
Which bacteria can cause gastroenteritis after reheating rice
It also have the shortest incubation period
Bacillus cereus
B CEREUS ABOUT reheating rice
424
What is the management for PRIMARY haemorrhage post tonsillectomy?
6-8 hours post procedure
Urgent ENT
Surgical exploration
425
What is the management for SECONDARY haemorrhage post tonsillectomy?
5 and 10 days post procedure
Haemorrhage 5-10 days after tonsillectomy is commonly associated with a wound infection and should therefore be treated with admission + antibiotics
426
What medication is associated with spider naevi?
combined oral contraceptive pill
427
Which organism is responsible for causing scarlett fever?
Group A haemolytic streptococci
427
When can each contraceptive be relied upon if not commenced on first day of period?
Contraceptives - time until effective (if not first day period):
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
428
What is the most specificity antibody for rheumatoid arthritis?
Anti-CCP
- Highest specificity for RA
- Recommended for all patients with ?RA who test RF negative
429
How does optic neuritis present?
unilateral decrease in visual acuity over hours or days
poor discrimination of colours, 'red desaturation'
pain worse on eye movement
relative afferent pupillary defect
central scotoma
430
What are the causes of optic neuritis?
multiple sclerosis: the commonest associated disease
diabetes
syphilis
431
How long should DOAC treatment be for in provoked vs unprovoked DVT?
3 months (provoked)
6 months (unprovoked)
432
Following successful DC cardioversion, how long should anticoagulation be continued in AF?
Life long
433
When should insulin be started in gestational diabetes?
If fasting glucose >7.0 (at initial review)
Or if fasting glucose <7 and failed diet/ exercise/ metformin
434
When should cyclical HRT be prescribed vs continuous HRT ?
Women should be prescribed cyclical combined HRT if their LMP was less than 1 year ago and continuous combined HRT if they have:
- taken cyclical combined for at least 1 year or
- it has been at least 1 year since their LMP or
- it has been at least 2 years since their LMP, if they had premature menopause (menopause below the age of 40)
435
Which drug reduces the risk of peripheral neuropathy associated with isoniazid?
Pyridoxine
436
What monitoring is required when taking with statins?
LFTs
437
What monitoring is required when taking ACEI?
U&E
438
What monitoring is required when taking Amiodarone?
TFT, LFTs
TFT, LFTs, UEC and CXR prior to commencing
439
What monitoring is required when taking Methotrexate?
FBE, UEC, LFTs
440
What monitoring is required when taking Azathioprine?
FBE, LFTs
441
What monitoring is required when taking Lithium?
Lithium level, TFTs, UEC
442
What monitoring is required when taking Sodium valproate
LFTs
LFTs and FBE prior to treatment commencing
443
What monitoring is required when taking Glitazones?
LFTs
444
What complication is associated with psoralen + ultraviolet A light (PUVA) therapy?
Squamous cell carcinoma
445
What should the target CBGs be for pregnant women with GDM once treatment has been commenced?
fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L
446
What is the starting dose for levothyroxine in hypothyroidism?
Initiated at 25 mcg OD for >50, cardiac disease, severe hypothyroidism
Initiated at 50 - 100 mcg OD for those <50
447
What is the most common reason for THR revision?
Aseptic loosening
448
Which medication is used to stop hiccups in palliative care?
Chlorpromazine
449
How long should you stop driving post seizure post first unprovoked seizure?
6 months - if no structural abnormalities on brain imaging/ EEG
If not, 12 months
450
When are patients able to drive following syncope?
simple faint: no restriction
single episode, explained and treated: 4 weeks off
single episode, unexplained: 6 months off
two or more episodes: 12 months off
451
What is the mechanism of action for statins?
Statins inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis
452
What drug is used in the management of insecticide poisoning?
atropine
453
What is the Kobner phenomenon?
trauma precipitating new vitaligo lesions
454
What type of murmur is associated with Turners syndrome?
Ejection systolic - bicuspid aortic valve
455
What is the failure rate in Male Sterilisation?
1 in 2000
456
What is the cause of a lack of red reflex in a new born?
Retinoblastoma
457
What is the most common cause of travellers diarrhoea?
E.coli
458
Which follow up test is used after a diagnosis of NAFLD?
In patients with non-alcoholic fatty liver disease, enhanced liver fibrosis (ELF) testing is recommended to aid diagnosis of liver fibrosis
459
What should be considered in metabolic acidosis with a normal / low glucose?
Alcoholic ketoacidosis
460
What is the most common reason for arrest post MI?
VF
461
How does left ventricular anerysm present?
POST MI
Persistent ST elevation
LV failure
Thrombus may form increasing stroke risk
462
How does left ventricular wall rupture present?
POST MI
Acute heart failure secondary to tamponade - raised JVP, pulsus paradoxus, diminished heart sound
463
How does ventricular septal defect present?
POST MI
acute heart failure associated with a pan-systolic murmur.
464
How does acute mitral regurg present?
More common with infero-posterior infarction and may be due to ischaemia or rupture of the papillary muscle. Acute hypotension and pulmonary oedema may occur. An early-to-mid systolic murmur is typically heard.
465
What is the target hba1c in T2DM on metformin / lifestyle mx?
It's worthwhile thinking of the average patient who is taking metformin for T2DM, you can titrate up metformin and encourage lifestyle changes to aim for a HbA1c of 48 mmol/mol (6.5%), but should only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)
466
What is the target hba1c for T2DM on any drug which can cause hypoglycaemia (eg lifestyle + sulphonurea)?
Target hBa1c = 53
467
How does X-linked recessive inheritance work?
E.g. Haemophilia A
X-linked recessive disorders are transmitted by heterozygote females (carriers) and male-to-male transmission is not seen. Affected males can only have unaffected sons and carrier daughters.
468
What drugs are used to induce remission in Crohns disease?
1st line: glucocorticoids (oral, topical or intravenous)
2nd line: 5-ASA drugs (e.g. mesalazine)
469
Which drugs are used to maintain remission in Crohns disease?
azathioprine or mercaptopurine is used first-line to maintain remission
470
How does Caput Seccedanum present?
Scalp oedema which CROSSES SUTURE lines
CS = caput seccedanum = crosses sutures
471
Which investigations is essential prior to starting treatment for TB?
Liver function tests
472
What is seen on a blood film in Myeloma?
Rouleaux Formation
473
How does extradural haematoma present?
Typically following acceleration-deceleration injury or blow to side of the head
Patients may present with a lucid interval
474
Which antibiotic is used to treat whooping cough?
azithromycin or clarithromycin if the onset of cough is within the previous 21 days
475
How does a sickle cell aplastic crisis present?
caused by infection with parvovirus
sudden fall in haemoglobin
bone marrow suppression causes a reduced reticulocyte count
476
How does a sickle cell sequestrian crisis present?
sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia
associated with an increased reticulocyte count
477
What is the typical blood picture in DIC?
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
478
What is the difference between Heberden's nodes and
Bouchard's nodes?
Heberden's nodes - swelling of the distal interphalangeal joints.
Bouchard's nodes - swelling of proximal interphalangeal joints
479
Which disordershich disorders does genetic anticipation occur?
Trinucleotide repeat disorders, including Huntington's disease and Myotonic dystrophy
With genetic anticipation, hereditary diseases have an earlier age of onset through successive generation
480
What medication is used to treat bile acid malabsorption?
Floating poo
Cholestyramine
481
Which extra intestinal manifestations are more common in Crohns?
Gallstones are more common secondary to reduced bile acid reabsorption
482
Which extra intestinal manifestation is more common in UC?
Primary sclerosing cholangitis
483
What is the treatment for anterior uveitits?
steroid + cycloplegic (mydriatic) drops
484
Which antibiotics are used to treat invasive bacterial diarrhoea (with bloody stool and fever) cause by salmonella?
Ciprofloxacin
485
Which antibiotic is used to treat non invasive diarrhoea and travellers diarrhoea?
Clarithromycin
486
What are the features of herpes simplex keratitis?
history of eye pain, watering, and photophobia in combination with a characteristic dendritic ulcer seen on examination
Treat with topical aciclovir
487
Which malarial drug is contraindicated in epilepsy and is only taken once weekly?
Chloroquine
488
What testing is used for investigation for anaphylaxis of bees/wasps?
Radioallergosorbent test (RAST)
Used for food allergies, inhaled allergens (e.g. Pollen) and wasp/bee venom
489
What are the side effects of methotrexate?
Myelosuppression
Liver cirrhosis
Pneumonitis
490
What are the side effects of Sulfasalazine?
Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease
491
What are the side effects of Leflunomide?
Liver impairment
Interstitial lung disease
Hypertension
492
What are the side effects of Hydroxychloroquine?
Retinopathy
Corneal deposits
493
What are the side effects of prednisolone?
Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts
494
What are the side effects of Etanercept
Demyelination
Reactivation of tuberculosis
495
When should OGTT be performed in women with a history of gestational diabetes?
as soon as possible at booking
496
What are common features of paediatric migraine?
GI disturbance
Nausea, vomiting and abdominal pain
497
How does primary hyperparathyroidism present?
bones, stones, abdominal groans and psychic moans
High Ca, Low Phos, High or inappropriately normal PTH
498
What do Auer rods on a blood film indicate?
acute promyelocytic leukaemia
499
How does trichomonas vaginalis present?
abnormal vaginal discharge and strawberry cervix
Treat with oral metronidazole
500
What are the contraindications when commencing sildenafil for erectile dysfunction?
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
501
What is cataplexy?
Cataplexy describes the sudden and transient loss of muscular tone caused by strong emotion
502
What xray changes are seen in pseudogout?
x-ray: chondrocalcinosis
503
Which medication interacts with statin to increase risk of myopathy / rhabdomyolysis?
erythromycin/clarithromycin
504
When can women be given the pertussis vaccine in pregnancy?
16-32 weeks
505
How does roseola infantum present?
RASH
common 6 months - 2 years
fever followed later by rash
febrile seizures common
506
What investigation is used in assessing Vesicoureteric reflux (VUR) in children?
micturating cystourethrogram
507
What are the most common type of cysts?
Follicular cysts
508
Which hernias lie superior and medial to pubic tubercle?
Inguinal hernias
509
Which medication exacerbates plaue psoriasis?
Beta blockers
510
What causes a petechial rash with NO fever in children?
ITP
511
What is used for Post-exposure prophylaxis for HIV?
oral antiretroviral therapy for 4 weeks
512
What is used in management for meningitis in children <3 months?
IV amoxicillin (or ampicillin) + IV cefotaxime
513
What is used in management for meningitis in children >3 months?
IV cefotaxime (or ceftriaxone)
514
What is used for first line investigation in prostate cancer?
Multiparametric MRI
515
Which cardiac congenital abnormality is most commonly associated with Downs Syndrome?
Atrioventricular septal defects
516
When should patients be reviewed after commencing an SSRI?
After 1 week if <25
After 2 weeks if >25
517
What presenting with bilateral parotid glad swelling and dry cough
Sarcoidosis
518
What is a good first line antiemetic for intracranial causes?
Cyclizine
519
How should once daily insulin doses be changed prior to surgery?
Reduce by 20% on the day prior, day of surgery and the day following surgery
520
How should twice daily biphasic insulins be adjusted for surgery?
No change in day prior
Halve the morning dose on day of, no change to evening dose
Halve the morning dose on day following, no change to evening dose
521
Which valve is most commonly affected in infective endocarditis in IVDU?
Tricuspid
(otherwise mitral is most common)
522
What is the first line treatment for prolactinomas?
Dopamine agonists (e.g. cabergoline, bromocriptine)
523
What is the main reason for using inhaled corticosteroids in COPD?
Reduced exacerbations
524
What diabetes medication should be used in T2DM after metformin in those with a Hx of CVD, high CVD risk or Chronic heart failure?
Empagliflozin
SLGT 2 inhibitors
525
Which virus causes Karposi's sarcoma (in HIV) ?
HHV-8 (human herpes virus 8)
526
What is calcitonin a tumour marker for?
meduallary thyroid cancer
527
What is the difference between viral labyrinthisis and vestibular neuronitis?
Hearing loss - labyrinthitis
No hearing loss - vestibular neuronitis
528
What are the symptoms of SSRI discontinuation syndrome?
Discontinuation symptoms
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
529
How should acute dystonia secondary to anti-psychotics be managed?
Procyclidine
530
What should be commenced at the same time as allopurinol?
NSAIDs or colchicine for COVER
531
Which conditions give higher than expected HbA1c levels?
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
Due to increased life span of red blood cells
532
Which conditions given lower than expected HbA1c levels?
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
533
Which are the non scarring alopecia?
male-pattern baldness
drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
nutritional: iron and zinc deficiency
autoimmune: alopecia areata
telogen effluvium
hair loss following stressful period e.g. surgery
trichotillomania
534
Which types of alopecia are scarring?
trauma, burns
radiotherapy
lichen planus
discoid lupus
tinea capitis*
535
Which transfusion carries the highest risk of infection?
Platelets
536
Which parkinsons medication causes hallucinations?
Dopamine agonists
e.g. ropinirole
537
What is akanthsia?
Severe restlessness
- Can be caused by antipsychotics
538
Which is present on a blood film in DIC?
schistocytes
539
What is tardive dyskinesia?
late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw
540
What is sildenafil PDE 5 inhibitors used for in neonates?
Treating pulmonary hypertension
541
Which drug causes a blue tinge to vision?
Sildenafil
- Blue pill blue vision
542
Which drug causes a green/yellow tint to vision?
Digoxin
- Yellow/green tint to vision
543
How does a c-peptide level help you distinguish between type 1 and type 2 diabetes?
T1DM: low or undetectable level of plasma C-peptide due to absolute insulin deficiency.
T2DM: elevated c-peptide
544
When should patients with ascites be commenced on prophylactic antibiotics?
In patients with advanced cirrhosis and low ascitic fluid protein (<15 g/L), there is an increased risk of developing spontaneous bacterial peritonitis (SBP).
Oral CIPROFLOXACIN / NORFLOXACIN is used
545
Which cancer is associated with BRAC2 in Men
Increased risk of breast cancer in both
Increased risk of ovarian cancer in women and prostate cancer in men
546
What are the features of thyroid storm?
hyperthermia, tachycardia, jaundice, and altered mental status
547
What are the B symptoms with Hodgkins lymphoma ?
POOR PROGNOSIS
- Weight loss >10% in 6 months
- Fever >38
- Night sweats
548
What is the triad of shaken baby syndrome?
Retinal haemorrhages, subdural haematoma and encephalopathy
549
What is curlings ulcer?
Curling’s ulcer is a stress ulcer that can occur after severe burns
550
Which childhood syndrome is associated with aortic stenosis
+ small upturned nose, long philtrum, a small chin and puffy eyes??
Williams syndrome
551
What are the xray features of silicosis ?
Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes
552
What is a good way to remember notifiable diseases?
If you have a vaccine against it you notify
553
What is the most common extra intestinal manifestation in crohns / UC?
Arthritis
554
What is the diagnostic criteria for hyperemesis gravidarum?
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
555
What is the first line treatment for CML?
imatinib = tyrosine kinase inhibitor
556
What is the first line treatment for Kawasaki?
High dose aspirin
557
Which medication should be avoided in HOCM?
ACE inhibitors
558
What should be considered in Disproportionate microcytic anaemia ?
beta-thalassaemia trait
559
What is a differential in raised paraproteins?
MGUS
560
How does phaechromocytoma present?
a triad of sweating, headaches, and palpitations in association with severe hypertension
561
What are the causes of low ALP and low calcium
Osteomalacia
Renal failure
562
What are the causes of high ALP and high calcium
Bone metastases
Hyperparathyroidism
563
Which anti malarial drug should be avoided in patients with depression and epilepsy and is taken weekly?
Mefloquine
564
What is cotard syndrome?
characterised by a person believing they are dead or non-existent
