flash cards for wrong questions
When should amiodarone 300mg be administered for shockable rhythms?
After delivery of 3rd shock
What is seen on the ECG in wolf parkinson white?
Delta wave
What causes wolf Parkinson white?
Pre-excitation of an accessory pathway between atria and ventricles
What is first-line medication for rhythm control?
Bisoprolol or CCB - diltiazem
What is first line for papulopustular rosacea?
Topical ivermectin
What is first line for rosacea without the pustules?
Topical brimonidine
What are the obvious features of dermatomyositis?
Heliotrope rash and gottron’s papules
What is the most sensitive indicator for dermatomyositis?
Creatinine kinase
What is the muscle weakness conditions caused by Small cell cancer?
Lambert eaton syndrome
What is pathophysiology of labert eaton syndrome?
Anti VGCC antibodies
What is first-line drug for bed wetting in kids and what is the mechanism of action?
Desmopressin - it’s an AVP analogue
What measure is enough for diagnosing diabetes?
One random blood glucose measure 11.1 or more in a symptomatic patient
One fasting blood glucose 7 or more in symptomatic patient
One 2 hour glucose 11.1 or more in symptomatic patient
Hba11c more than 48
If asymptomatic two results are required from different days
Which brain tumour shows psamomma bodies?
Meningioma
What do meningiomas look like on T1 MRI?
Hypointense
In patients where adenosine is contraindicated - eg. asthmatics what drug should be used?
Verapamil
What are 3 side effects of bisoprolol?
Tiredness
Peripheral coldness
Bronchospasm
What are 4 side effects of CCB’s?
Ankle swelling
Headache
Flushing
In patients with reflux - can increase it as it relaxes the lower oesophageal sphincter
What is definitive treatment for brugada syndrome?
Implanatable cardiac defib
What UTI drug is okay in 1st and second trimester?
Nitrofurantoin
What drug is okay for third trimester UTI?
Trimethoprim
Why can’t nitrofurantoin be used in third trimester?
Risk of neonatal haemolytic anaemia
Which UTI drug is contraindicated with methotrexate?
Trimethoprim
Which UTI drug is contraindicated with G6PD deficiency?
Nitrofurantoin
Which pathogens are culture negative?
Kingella, cardiobacterium, Eikenella
For non sexual epididymo-orchitis what is first line?
Oral ofloxacin - as they cover e.coli
What is treatment for severe malaria?
IV artesunate
When should liraglutide be discontinued?
If within 12 weeks the patient has not lost 5% or more of their body weight
When should bariatric surgery be recommended and what type?
BMI 40 or over or 35 or over with significant obesity co-morbidities. And a rout y gastric bypass
What are the symptoms of systemic sclerosis (scleroderma)
CREST
Calcinosis
Raynauds
Eosophageal dysfunction
Sclerodactyl
Telengiectasia
What antibodies are found in dermatomyosists?
Anti-m2
Which pathogen is involved in food poisoning within 1-2 hours esp after eating dairy products?
Staph aureus
Can campylobacter cause bloody diarrhea?
Yes - 2-5 days after exposure
Which pathogen is involved in diarrhea for HIV and immunocompromised patients?
Cryptosporidium parvum
When is a CABG more advantageous than a PCI?
Over 65
T2DM
Complex 3 vessel disease
What is a serious side effect of azathioprine?
Neutropenia due to bone marrow suppression
What is a relative contraindication to thrombolytic therapy?
Systolic BP over 180 , diastolic over 110
What is the function of alpha 1 trypsin?
Protease inhibitor - it inhibits neutrophil elastase in lung
What is the pathophysiology of alpha 1 trypsin deficiency?
Deficiency of alpha 1 trypsin which is a protease inhibitor
What is the treatment for PBC?
Ursodeoxycholic acid and supplementation of fat soluble vitamins - A,D, E and K
Which heart defects are associated with carcinoid syndrome?
Pulmonary stenosis
Tricuspid regurg
Which drug is used to treat influenza in high risk people?
Oseltamivir
Which tumours are present in MEN1?
Pancreas
Parathyroid
Pituitary adenoma
Which gene is implicated in MEN1 vs MEN2?
Men 1 - men 1 gene
Men 2- RET-proto-oncogene
Which tumours are associated with MEN2?
Parathyroid
Medullary thyroid
Phaechromacytoma
What drug is long term prophylaxis against further leeds in variceal patients?
Propranalol
Which drug is used in acute treatment of variceal bleeds?
Terlipressin
Which antibodies are positive in patient with autoimmune hepatitis type 1?
Anti smooth muscle antibodies
What are the symptoms of pellagra and which vitamin deficiency causes it?
DDD
Diarrhea
Dementia
Dermatitis - photosensitive rash
Lack of vitamin B3- niacin
If P waves are inverted in V2 - what is most likely cause of this ECG abnormality?
Rarm and LA electrodes have been reversed
What is treatment for children with cradle cap - seborrhaeic dermatitis that doesn’t go away with cleaning?
Topical clomitrazole 1%
Which wall is affected in wellen’s syndrome?
Anterior wall
Where is fibrosis usually caused in TB?
Upper lobes
What are the two drugs for BPH and which is used first? what is their mechanism and when would u use finasteride over tamsulosin?
Tamsulosin - alpha blocker (anatgonist)
Finasteride - 5-alpha -reductase inhibitor
Use finasteride first if there is history of orthostatis hypotension and falls
What does 5-alpha reductase actually mean?
Block the conversion of testosterone to dihydrotestosterone and therefore slow progression of BPH
Which medication can be used for reducing secretions from tumour sites?
Glycopyrronium
What is treatment for torsades de point?
IV magnesium sulfate
What are the symptoms of bacterial prostitis?
Boggy prostate
Fever
Tender prostate
Urgency
Fever
Dysuria
What is first line management of bacterial prostitis?
Ciprofloxacin 500mg BD
What is the mechanism of action of sulfonyurea?
Increased insulin secretion from beta cells
What is mechanism of thiazolidinediones?
Increased peripheral glucose uptake
What time definition is QT elongation in men and women?
Over 460ms i women
over 440 in men
What are the symptoms of whipple’s disease?
Large joint arthropathy
Gi features - malabsorption
Diarrhea
Weight loss
Hyperpigmentation
What is gold standard diagnosis for whipples disease?
Jejunal biopsy shows deposition of macrophages in lamina propria staining positive for acid-schiff
Treatment for whipple’s?
Co-trimoxazole
What drugs cause steven johnson syndrome?
Co-trimoxazole
Beta lactams like penicillin
Anti-convulsants
What is pattern of inheritance of charcot marie tooth?
Autosomal dominant
What are symptoms of charcot marie tooth?
Genetic peripheral neuropathy - distal motor and sensory deficits
Which pathogen causes rice water like stool?
Cholera
What are symptoms of giardia lamblia?
Contaminated water access, uncooked fruit , 1-3 week incubation
Treatment for giardia lamblia?
Metronidazole
Which diabetes drug cause lactic acidosis?
Metformin
What’s the genotype of androgen insensitivity
46XY - so resistance to testosterone - so phenotypically female - regression of mullerian duct structures
What is ovulatory dysfunctional uterine bleeding?
Excessive production of vasoconstrictive prostaglandins in endometrium during menstrual period leading to painful uterine contractions and prolonged bleeding.
What is management of genital herpes in expectant mothers?
Treat primary infection then oral aciclovir from 36 weeks and expectant delivery
What is the dose mother with HSV from 1st or second trimester should be offered?
400mg three times a day from 36 weeks onwards
If a pathogen is methicillin sensitive which antibiotic should be given?
Flucloxacillin
What is a positive Mc-Murrays test and what does it indicate?
Clunk when flexing knee up to chest - indicates a meniscal tear
Which line is safest to administer adrenaline through?
Central venous line
When does uterine rupture usually occur?
During labour more common in women with previous uterine surgery
What is management of uterine rupture?
Emergency exploratory laparotomy with C section and fluid recuss
Which disorder contains Barr bodies on histopathology?
Klienfelter’s syndrome
What is the genotype of klinefelter’s?
47 XXY
What is a barr body?
In activated and condensed X chromosome
Which drugs causes erythema nodusm?
COCP
Penicillin
Sulfonamides
What pathogen causes a chancroid?
Haemophilus ducreyi
What is antidote to lidocaine toxicity?
Intralipid
When is it abnormal for kids to develop a hand preference?
Before 12 months
What is a red flag when it comes to walking age for kids?
Not walking by 18 months
Where does the origin of the tear in lateral epicondylitis begin?
Extensor carpi radialis brevis - ERCB
Which fractures is the radial nerve more likely to be injured?
Mid shaft fractures
Which artery is in danger in supracondylar fractures?
Brachial artery
Which drug can be used for trigeminal neuralgia?
Carbamezapine
Which function tests do you need to do before beginning carbamezapine?
Liver function tests
What does aldosterone do to blood pressure and renin and potassium?
Aldosterone causes a reduction of potassium in blood and an increase of sodium. It increases BP by causing renin release and vasoconstriction and sodium reabsorption into blood
What is mechanism of action of spironolactone?
Aldosterone antagonist
What is mechanism of action of loop diuretics?
Inhibits co-transport of Na , potassium and chloride
What is the most common side effect of ondansteron?
Constipation
What can ondansteron do to the QT ?
Prolong it
In females who have high blood pressure what should be done for discharge?
Community midwife check their BP every other day until BP is below 150/100.
When can BP meds be stopped in women who had pre-eclampsia?
When BP drops below 130/80
Which rare congenital malformation is associated with primary ciliary dyskinesia?
Kartagener’s syndrome
What are the features of kartagener’s syndrome?
Subfertility
Recurrent sinus infection
Situs inversus - heart on right side of chest
What is the level of bifurcation of carina?
t4-t5
What is bartter syndrome?
Metabolic hypokalaemia
Alkalosis
Hypercalcueria
Normal BP
Which gene mutation causes achondroplasia - dwarfism?
Activation of fibroblast growth factor 3 receptor
Which genetic mutation causes marfan syndrome?
Fibrillin mutation
What is pleurodesis and when is it used?
Induces pleural inflammation to promote fibrosis and obliteration of pleural space - talc pleurodesis is popular - Can be used in malignant pleural effusions
If BP is not increasing in sepsis despite fluid bolus what should be given?
IV noradrenaline/ norepinephrine infusion - vasopressor support
Which biochemical marker is super raised in tumour lysis syndrome?
Urate - uric acid
What are the characteristics of perthes disease?
Insidious onset of limp with or without pain
In boys 4-6
What is diagnostic test for myeloma?
Serum light chains - look for bence jone sproteins
What drug is used to oppose a neuromuscular blockade?
Neostigmine
What hormone surges just before ovulation
LH
Which virus is indicated in SCC of oropharynx?
HPV
What is the meaning of continuous data?
On a scale eg. numbers
What is a nominal variable?
No ranking order - categories like hair colour, occupation
Which two drugs are okay with renal impairement?
Oxycodone and fentanyl
Why is warfarin used in valular heart failure for anticoagulation instead of DOACs?
DOACs are contraindicated in valvular heart disease
Where is broca’s area ?
Frontal lobe - left hemisphere
Where is wernicke’s area?
Left hemisphere temporal lobe
What is medical management for toxoplasmosis?
Administer sulfadiazine and pyrimethamine
Which anti-depressant is okay in children?
Fluoxetine
What is treatment for scarlet fever?
Phenoxymethylpenicillin
What is treatment for kawasaki?
IVIG and aspirin
What are the symptoms of Kawasaki?
CRASH
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hands and feet burn
When nitrofurantoin and trimethoprim is contraindicated for UTI was is given?
Pivmecillinam 400mg initial dose then 200mg TDS for three days
Which drug is common to cause drug induced lupus?
Isonizaid
Minocylcine
Phenytoin
Hydralazine
Which markers should be tested for in anti-phospholipid
Anti-cardiolipin
Lupus anticoagulant
Beta-2-glycoprotein
What is the most common viral cause of croup?
Parainfluenza
Which vaccine should be given to children who are at risk of RSV and bad RSV?
Palivizumab
Which function tests do you have to do before starting lithium therapy?
Renal and thyroid function tests
What is acceptable limit for sperm morphology?
4% or more
What non pharma therapies can be used to treat palliative care?
CBT
Which mutation are associated with a poorer outcomes in AML ?
FLT3 internal tandem duplication.
Which mutation is associated with better outcomes in AML?
NPM1 mutation without concurrent FLT3 internal tnadem duplication
What is the best initial management for autism?
Applied behaviour analysis
What is appropriate treatment for complex facial fractures?
Open reduction and internal fixation
Is cervical os closed in threatened miscarriage?
Yes
What age can HPV vaccine be given till?
45 years old
When is chronic villus sampling done?
10-13 weeks - used for high risk pregnancies when NIV tests shown a high risk
When is quadrouple test done?
15-20 weeks
When is amniocentisis done?
15-20 weeks gestation
What is management of stable osetoprotic wedge compression fracture? + when do you refer?
Conservative management- refer if neuro symptoms , instability or persistant pain despite conservative measures
What colour is discharge with trichomonas?
Yellow-green frothy
At which mmol is giving biscuits okay to a diabetic with low blood sugar?
Over 4mmol
What is 1st line management of hypoglycaemic conscious patient?
Oral glucose gel
What is treatment for hypoglycaemia if oral glucose gel fails after 3 treatment cycles?
IM glucagon
What is the management of oral hairy leukoplakia
Refer to secondary care
How many days of treatment is recommended in men for UTI vs woman?
7 days in men and 3 days in women
In a near term pregnant woman with UTI what can yougive her?
Amoxcillin or cefalexin
Medication for bacterial meningitis?
Ceftriaxone
What is prophylactic for meningitis for contacts?
Ciprofloxacin single oral dose
What medication is used in pen allergic patients for meningitis?
Chloramphenicol is second line in patients with severe penicillin allergy
Which BP drug is contraindicated in heart failure?
CCB except amlodipine
Why is beta blockers and verapamil an issue together ?
Can cause severe brady
What type of CCB is amlodopine?
Dihydropyridine
Give an example of non dihydropyridine CCB?
Ditiazem
Verampamil
What is target INR for aortic valve replacement vs mitral?
Aortic - 3
Mitral 3.5
What is the dose of adrenaline to be used in cardiac arrest?
1mg-10ml 1:10000 IV or 1ml
What reaction is commonly known about for metronidazole?
Reaction with alcohol
Which antibiotic lowers seizure threshold?
Ciprofloxacin
Which collagen is affected in osteogenesis imperfecta?
Type 1 collagen
How often is screening done for HPV?
Every 3 years for women aged 25-49 with negative results. 50-64 it’s every 5 years
What is surgery for tumours located more than 8cm away from anal margin?
anterior resection
What is surgery for tumour located less than 8cm away from anal margin?
Abdomino-perineal resection
What is management for traumatic tension pneumothorax?
Wide bore cannula into 5th intercoastal space in mid axillary line
If there is dorsal displacementof distal fragment of radius what fracture is this?
Colles
What is bolam test?
Standard of care should be judged based on that of ordinary doctor not specialist
Who mainly gets chondrosarcoma’s?
Over 40 with pain and lump
What does ewing sarcoma look like on x-ray?
Onion peel
What does osteosarcoma look like on xray?
Sunburst
Where does ewing sarcoma usually occur?
Along long bone diaphysis
If fluffy popcorn appearance is seen on Xray which bone pathology is that?
Chondrosarcoma
Which pole (distal or proximal) is avascular necrosis due to scaphoid fracture associated with?
Proximal pole
What is most common type of carpal bone fracture?
Scaphoid
If ABG in COPD patient shows normal co2 what are the oxygen saturation targets?
94-98%
What is the antidote to benzo overdose?
Flumazenil
How can a benzo overdose present?
Slurred speech
Ataxia
Drowsy
What’s the difference in how long an OCD vs depressed person needs to continue on SSRI after they start feeling better?
Depression: 6 months
OC: 12 months
What is first line management for a symptomatic large (more than 2cm ) pneumothorax?
Aspiration
What is diagnostic test for hirshprung disease?
Rectal biopsy at least 1.5cm above the pectinate line
What pH after paracetamol ingestion is grounds for a transplant?
pH less than 7.3 24 hours after overdose
What are 4 grounds for liver transplant except pH after paracetamol overdose?
- Prothrombin time over 100 secs
- Creatinine over 300 umol
- grade 3 or 4 encephalopathy
On blood test what is serum copper like in Wilson’s?
It’s low - because all copper is in tissues rather then blood
What side effect does amitriptyline have when it comes to urine?
Urinary retention
For a person with a AA 3-4.4 cm what is management?
12 monthly US
For a person with 4.5- 5.4 cm AA what is management?
3 Monthly US
What is first line medication for giardiasis?
Metronidazole
What is characteristic findings of giardisis?
Rose petals on stool microscopy
diarhhea and cramps
What are the signs and symptoms of boerhaave syndrome?
Subcut emphysema
Pleural effusion - usually left sided
Severe chest pain and vomiting
Hamman sign
What is hamman sign?
Hamman sign is the sound of crunching or popping due to air trapped in the chest cavity (outside the lungs). can be between s1 and s2
What milk should be used in baby with potential cow milk intolerance?
Hydrolysed milk
What are the symptoms of toddlers diarhhea?
6 months to 5 years of age
No growth loss
Usually in daytime after high amounts of fruit juice and high fibre
Non bloody, chronic and watery.
Should self resolve by 5
What is most appropriate diagnostic test for neuroleptic malignant syndrome?
Creatinine kinase
When is abortion allowed in the uk for normal baby vs defect baby?
Normal - under 24 weeks
Defect - anytime
What feature of c. diff makes it hard to destroy?
Spore formation
What is management of someone with MS who has neuropathic bladder?
Intermittent self catheter
Which anti hypertensive is known to cause ankle swelling?
Amlodipine
Which anti hypertensive is known to cause a cough?
ACE inhibitors
What is most common nephrotic syndrome?
Membranous nephropathy
What would biopsy show with membranous nephropathy?
Subepithelial immune complex deposits
What is the most common nephrotic syndrome in children?
Minimal change disease
What indicates pseudohypoparathyroidism?
High parathyroid
Low calcium
With no renal issues
What classification system is used to stage cellulitis?
Erons classification
What are the 4 levels of eron’s classification?
class 1: no signs of systemic issues and no uncontrolled comorbidities
class 2: Systemically unwell or systemically well but there is a comorbidity
Class 3: significant systemic unwell and unstable comorbidities
Class 4: life threatening / necrotising fascitis
Other than urine output dropping below 0.5 ml/kg an hour what else is a sign of AKI?
Creatinine rise 1.5x baseline
When should patients treated for h.pylori be followed up?
4-8weeks re tests. At least 4 weeks after antibiotics used and 2 weeks after PPI use
What causes waterhouse-friderichson syndrome
Neisseria meningitidis (usually) cause disseminated intravascular coagulation (DIC), leading to widespread clotting and bleeding, including in the adrenal glands.
which levels are elevated in sarcoidosis?
Serum ACE and hypercalcaemia
What is genotype of turner syndrome?
45XO
What is virchows triad?
Hypercoagulability
stasis
vessel wall injury
Can topical chloramphenicol be used in pregnant women?
No - can cause neonatal grey baby syndrome
Which nerve is implicated in carpal tunnel?
Median nerve
If median nerve implicated what area of body sensation is altered?
lateral 3.5 digits
What is the most common cause of viral myocarditis?
Coxackie B virus
What is gold standard test for CF?
Sweat test
What is sweat test/
Pilocarpine put on part of skin then sweat is used to measure chloride in there. More chloride in sweat = CF likely
Which nerve supplies the superior oblique?
Fourth nerve - trochlear
Which nerve supplies the lateral rectus?
6th nerve - abducens
Which tumour markers are elevated in testicular teratoma?
AFP
HCG
When can metformin be taken vs not taken?
If taken 1/2 times a day then can take. If taken 3 or more then lunchtime dose should be omitted. If minor surgery its fine. Major surgery withold it
What is the most effective way to reduce contrast induced nephropathy?
Saline before and after the surgery
What is investigation pathway for kids with recurrent UTI?
An ultrasound is typically the first imaging test.
DMSA may be performed later to assess for scarring, particularly in children with recurrent or atypical UTIs.
MCUG is used selectively, especially in infants or if VUR or structural abnormalities are strongly suspected.
What is hallmark on cytology of brachial cyst?
Presence of cholesterol crystals
Difference in location of thyroglossal vs bracial cyst?
Brachial:lateral
Thyroglossal : midline
What is correct site for epidural?
L2-L3 or L3-4
What is treatment of hypotension due to epidural?
1L hartmanns over 20 mins
When is fibrinolysis indicated in MI patients?
If PCI over 120 mins
What is vitamin B3?
Niacin
What is deficiency of niacin called?
Pellagra
What are symptoms of pellagra?
4 D’s :
Diarrhea
Dementia
Dermatitis
Death
If a patient comes in with hyperpigmented band around neck what is it called and indicates?
Casals necklace: chronic alcohol excess
What creatinine kinase is used for MI?
CK-MB - myocardium one
What Creatinine kinaseis for skeletal muscle?
CK-MM
Why is CK-MB useful to detect for re-infarct?
It clears earlier than troponin so if a CK-MB is 3 times normal usually indicates re-infarcts
What vein inabdomen can cause variocele?
left renal vein or left testicular vein - issues can be due to a renal tumour so if there is isolated varicocele left kidney must be imaged using ultrasound
What is first line treatment for focal seziure?
Lamotrigine
Leviteractam
Which is the main lymphatic drainage of the ovary?
Para aortic nodes
What is the most common pathogen involved in cellulitis?
Streptococcus
In someone with cardiac disease what is fluid maintence rules?
20-25ML/kg
How many hours does a person have to present in to get a PCI?
Present within 12 hours but PCI has to be available within 2 hours
Which epilepsy drug causes warfarin to be broken down more vs inhibits its breakdown vs being a cytochrome p450 iducer or inhibitor?
Carbamezapine is an inducer - leading to decrease in INR
Sodium valproate is an inhibitor - so can lead to increased INR
What action of trazadone means it causes priapism
a adrenergic blocking activity
What is peri op advice for aspirin and clopidogrel?
Stop 7 days before surgery
What is peri op advice for bisoprolol?
Take even on day of surgery
What score is used to calculate risk of major bleeds in patient with anticoag?
ORBIT
What is hasbled score?
assess the risk of major bleeding in patients with atrial fibrillation (AF) who are being considered for anticoagulation therapy
What is cullens sign?
Bruising in perumbilical region
What is pneumonic to remember pancreatitis severity?
PANCREAS
PaO2
Age over 55
Neutrophils
Calcium over2
Renal function - urea over 16
Enzymes LDH over 600
Albumin over 32
Sugar blood glucose over 10.
3 or more points = severe and need HDU
If a patient takes more than 20mg of pred a day what is operative strategy?
IV hydrocortisone during induction and usual morning dose
When is Electrocardioversion used in AF management?
If the AF onset is within 48 hours.
Following electrocardioversion for AF how long should person be on anticoag?
3 weeks prior and 4 weeks after
What is first line medication for acute prostatitis?
Oral ciprofloxacin
Which BP medication can cause hyperkalaemia and why?
ACEs as they block action of aldosterone
What is gold standard for diagnosing coeliac?
Endoscopy with duodenal biopsy
What is treatment for staph scalded skin syndrome?
IV flucloxacillin and topical fusidic acid
What is medical treatment for toxic shock syndrome?
IV clindamycin and meropenem
What is management of a patient with Angina still experiencing angina after beta blocker or CCB?
Switch to the other vice versa
Which ECG sign is most specific for pericarditis?
PR depression
What mustthe serum osmolality be in HHS?
Greater than 320/kg
What is diagnostic test for carcinoid tumour?
Urinary 5-HIAA
Diagnostic test of phaeochromacytoma?
Urinary VMA - VMA is breakdown of catecholamines
What is treatment of severe crohns?
Infliximab
What is treatment for severe UC?
Ciclosporin
For an aortic anyeurysm what is the rate of growth that would warrant a 2 week referral to vascular surgeons?
1cm per year and is larger than 4cm
What is diagnostic test for hereditary spherocytosis?
Eosin - 5 - maleimide binding test
What are fibrinogen levels like in DIC?
Low
What is the treatment for oculogyric crisis?
Procyclidine
What is first line management for achlasia then second line if surgery not okay?
Surgical myotomy
Botulinum toxin
What scan is used to detect meckels diverticulum ?
Technetium scan 99
What is the symptoms of meckels diverticulum?
Abdo pain + rectal bleeding
Which chromosome is involved in digeorge?
22q11.2 deletion
Is electrocution a recognised cause of posterior shoulder dislocation?
Yes
What is staining for amyloidosis?
Apple green birefringence when stained with congo red under polarised light
What collagen is affected in ALport syndrome?
Type 4
What is symptoms of alport syndrome?
Kidney disease
Visual issues
Hearing loss
Which drug overdose presents with resp alkalosis ?
Aspirin
Where is there a swelling is osgood schlatter disease?
Tibial tuberosity
When should COCP be stopped before surgery? and when can it be restarted
4-6 weeks before due to increased risk of VTE can be restarted at least 2 weeks after surgery
What pathogen causes hand foot and mouth?
Coxackie virus 16
Which pathogen causes scarlet fever?
Strep pyogenes
What are the symptoms of intussusception?
Severe colick pain
Vomit
Passage of blood stained mucus
Target sign on ultrasound
Palpable mass on abdomen
What is management of intussussepsion?
Rectail air or contrast enema
What does thiazide diuretics do to sodium and chloride?
Reduce active reabsorption in distal tubules
What is diagnostic investigation for thalassaemia?
Haemoglobin electrophoresis
What haemoglobin is found to be increased in thalassaemia?
HbF or HbA2
What genetic mutation is involved in fragile X syndrome?
CGG trinucleotide repeat expansion in FMR1 gene
What can a mass superiour to ischium on rectal exam indicate?
Obturator hernia
What abnormality in pregnancy is created with lithium use?
Ebstein anomaly
How long does it take for transient tachypnoea of newborn to dissapear?
72 hours
What can help prevent air emboli whe inserting a central line?
Trendelenburg position - lie 15 degrees down
What is despopressins role on factor 8 the clotting factor?
Desmopressin stimulates release of vWF from storage sites in endothelial cells therefore improving stability of factor 8 . Therefore desmopressin can be given immediately before surgery or after trauma to reduce excessive bleeds
What is investigation of hydrocephalus?
MRI or CT head
If there is a young patient with paroxysmal AF what is treatment?
Oral flecainide or sotalol
When is a carotid endarterectomy needed?
If carotid artery stenosis is 70-99% with symptoms such as stroke or TIA in corresponding areas
What is the most common cause of HAP?
Pseudomonas aerginosa
In patients with sjorgens disease which tubuar acidosis is common?
Renal tubular acidosis type 1 : hypokalaemic, hyperchloraemic, with a normal anion gap
How often should patients with low grade dysplasia due to barrett’s have endoscopy?
Every 6 months
When is a 3 way catheter used vs a 2 way foley?
3 way if there is haematuria or debris to be irrigated. 2 way just for acute urinary retention
Which cancer is increased if you have PBC?
Hepatocellular carcinoma
Which antibodies are present in PBC?
Anti-mitochondrial
What cancer is increased risk of having if you have PSC?
Cholangiocarcinoma
What antibodies are seen in PSC?
Anti nuclear - ANA
What is the most common cause of renal cell cancer?
Renal clear cell carcinoma
Which renal cell cancer is usually seen in young men with sickle cell?
Renal medullary carcinoma
Which scoring system is used to assess patients risk of developing a pressure ulcer?
Waterlow score
Which mental health medication can cause SIADH?
Citalopram - SSRI’s!!!
What is first line pharma treatment for idiopathic intracranial hypertension?
Acetazolamide it reduces the CSF
What is phosphate, calcium and ALP like in paget?
ALP is raised. everything else is normal
In osteomalacia what is calcium, alp and phosphate like?
High ALP, low calcium, low phosphate
In osteoporosis what is the bone profile?
Normal
What metabolic disorder does vomiting and diarrhea cause?
Vomiting - alkalosis
Diarrhea - acidosis
What is first line treatment of atrial flutter?
Bisoprolol
First line medication for toxoplasmosis?
IV pyrimethamine and sulphadiazine
If HIV patient has single ring enhancing lesion what is this ?
Brain abscess
What is treatment for brain abscess?
IV ceftriaxone and metronidazole
What sign is most apparent for babies to know they have congestive heart failure?
Hepatomegaly
Which antibody test is first line in coeliac then second line?
First line anti-ttg -IGA then the IGG ones
What is treatment of guttate psoriasis?
Topical emollient and reassurance
What is mechanism of action of tamsulosin?
Alpha blocker - relaxes protastatic smooth muscle
What is mechanism of action of finasteride?
5-alpha reductase inhibitor that shrinks prostate
What are symptoms of potter’s syndrome?
Twisted posture baby
Dysplastic kidneys
Bbay is squashed due to oligohydramnios
What measure is used to confirm that tube for anaesthetics is in right place?
End tital CO2
Is allopurinol an inducer or inhibitor of CYP450?
Inhibitor
Does hyper or hypokalaemia increase risk of digoxin toxicity?
Hypokalaemia
What is definitive imaging of chronic pancreatitis?
MRCP
What is faecal elastase levels in pancreatitis?
Low levels due exocrine pancreatic dysfunction
What is mechanism of action dipyridamole?
Anti-platelet - PDE3 enzyme inhibitor
What is mechanism of action of warfarin?
Vitamin K inhibitor
Which area is McBurney sign felt in?
RLQ - 1/4 from asis to umbilicus
What is Rovsing’s sign?
When LLQ palpated RUQ feels pain
What does WHO recommend for breastfeeding?
Exclusive breast fed for 6 months then combo of breast food and food for 2 years or beyond
What is an easy test to check a woman is ovulation?
21 day progesterone - if same or more than 30mmol in two cycles then patient is ovulating . Remember to adjust for cycle length
When does progesterone peak in a womans cycle?
7 days after ovulation
What BP is needed to start labetalol in pregnant woman?
150/100 - 159/109 and above
If pregnant woman BP is 140/90 -149/99 what is management?
Admit to hospital and monitor
What are the risk factors for endometrial cancer?
Obesity
Diabetes
Hypertension
Where does a cervical carcinoma metastases to in terms of lymph nodes?
Pelvic lymph nodes along iliac arteries
What is the features of felty syndrome?
Rheumatoid arthritis
Swollen spleen
Decreased white cell count
Repeated infections
At what age in a upper GI endoscopy urgently required if patient has weight loss and new reflux?
Over 55
When is percutaneous nephrolithotomy done?
Renal calculi in renal pelvis
Which cells in which organ produce intrinsic factor?
Parietal cell in the stomach
What is the increase in amylase required for pancreatitis to beexpected?
3x UPPER LIMIT OF NORMAL
What is genotype in kleinfleters?
47 XXY
What is diagnostic markers for kleinfelters?
FSH> LH
Which conditions is argyll robertson pupils seen in?
nEUROSYPHILLIS and diabetes
What is the cushing’s triad?
Increased blood pressure
Bradycardia
Irregular breathing
Which diabetes drug class is associated with hypoglycaemia?
sulfonylurea
Which diabetes drug class is associated with euglycaemic DKA
SGLT2
What are features of an anastamotic leak?
Rigid abdomen
Purulent abdominal drain
Tachycardia
Fever
What is imaging for anastamotic leak?
CT abdo pelvis with contrast
How is pancreas pseudocyst diagnosed?
Ultrasound or CT -
What size pseudocyst of pancreas needs drainage?
more than 6cm
What medication can be used to prevent calcium stones?
Thiazide diuretic
What does a fourth heart sound suggest?
Forceful atrial contraction against a stiff hypertrophic left ventricle - this is seen in p wave
What is the ggram staining of clostridium perfringens?
gram positive
What is most likely causing organisms of gas gangrene
clostridium pefringens
which scar indicates a renal transplant?
Rutherford morrison scar
Which scar indicates liver transplant?
Mercedes benz scar
Which drug can cause gingival hyperplasia?
Ciclosporin - immunsuppressant
What is wellen’s syndrome?
biphasic or deeply inverted T waves in V2-3, plus a history of recent chest pain now resolved.
What are the asthma guidelines?
- ICS/ Formoterol
- MART low dose
- Moderate dose MART
FeNO testing - if eosinophils raised - refer to asthma clinic, if not then start a LTRA or LAMA
What fluids are important to give a pregnant woman with hypermesis gravidarum?
Thiamine
If pelvic floor and duoloxetine fails for stress incontinence then what can be trialled?
Colposuspension
In patients with simple anal fistulas what is management?
Surgical fistulotomy
In patients with complex multiple tract fistulas esp crohns disease patients what is important step?
MRI of pelvis to look for and abscess or secondary tracts
Which muscle issue causes scapula winging?
Serratus anterior
Which nerve innervates the serratus anterior?
Long thoracic nerve
Which nerve innervates the supraspinatus muscle?
Suprascapular
What is the meaning of leukocoria?
White pupillary reflex
What are the features of retinoblastoma?
Leukocoria
Strabismus
Decreased vision
Which gene is indicated in retinoblastoma?
RB1 gene
What indicates an XRAY is needed for foot/ankle injuries?
Pain in malleolar area + one of the following:
Bone tenderness at posterior edge or tip of lateral malleolus
Same on medial malleolus
Inability to bare weight for 4 steps immediate after injury and during examination
What is first line management for haemostasis in rectal bleeding caused by angiodysplasia?
Colonscopy
Which nerve damage would cause weakness in plantar flexion?
S1
What is the sensory loss with deep peroneal nerve injury?
first web space loss
Foot drop due to weakness with dorsi flexion
Which antiemetic can cause an acute dystonic reaction?
Metroclopromide becasue of it’s anti-dopinaminergic activity
Which diuretic can cause hypercalcaemia?
Thiazide
What is best prognostic marker for live failure?
Prothrombin time - gives an indication of clotting ability
What drugs cause QT prolongation?
THE MASC
Terfenidine
Haloperidol
Erythromycin
Methadone
Amiodarone
Soltalol
Chloroquine
What are LH levels like in meopausal/perimenopausal women?
Basal LH levels are increased.
What morphology is seen in glomerunephritis?
epithelial crescents in bowman s capsule
What is seen on morphology in minimal change c=disease?
Podocyte effusion and effacement of podocyte process
What is seen on histology in lewy body dementia?
Alpha synuclein cytoplasmic inclusions
Where is hippocampus located?
Temporal lobe
What gene is implicated in reactive arthritis ? (reiter’s) syndrome?
HLA-B27
What is perthes disease?
Avascular necrosis of femoral head in kids
What risk factors in SLE for avascular necrosis?
The long term steroid use
In what age range is a temp of 38 or higher a red flag?
3 months or less
Which antibiotic can cause pancreatitis?
Co-trimoxazole
When should vitamin K be given to newborn?
IM on first day of life, if orally then 3 times in first few weeks of life
What is the pathology behind succinylcholine apnoea?
Defect in plasma cholinesterase - leading to enzyme reduced activity slowing down break down of the muscle relaxant leading to paralyisis
What are features o fat ebolism?
Tachy
Tachypneoa
Hypoxia
Petechial rash
Confusion
Retinal haemorrhage
Esp caused by fracture of long bones
What is the xray finding in rickets?
Bowed femurs and widened epiphyseal plates
What drug can be given in severe reduced LV systolic function?
IV dobutamine or mirinone - they are positive inotropes so increase cardiac contractility - maintaining perfusion to end organs
If axillary nerve is damaged where will sensation be impaired?
lower half of right deltoid muscle
Which nerve supplies dorsal webspace between 1st and second digit?
radial
Which test can elicit de quervains tenosynovitis?
Ulnar deviation of hand with thumb clasped in palm
Which type of brain bleed has a lucid period after incident?
Extradural haematoma
What nerve is affected in cubital tunnel syndrome?
Ulnar - ring finger and little finger issue
What difference btween hypothenar eminence vs thenar eminence ?
Thenar - fleshy bit below thumb. hypothenar is below little finger
which fracture in hand would elicit tenderness in anatomical snuffbox?
Scaphoid
If there is tenderness over hypothenar eminence which fracture indicated?
Hook of hamate
Do children with HFAMD need to be excluded?
No as long as they feel well enough
What is the garden classification?
1+2 (1 = partical fracture, no displacement 2= full fracture, no displacement)
3+4 (3 = full fracture, partially displaced 4= full fracture , fully displaced)
Which infection can cause post infectious glomerulonephritis?
Strep
What is histopathology of post infectious glomerulonephritis?
subepithelial humps
What hair related side effect is associated with ciclosporin?
hypertrichosis
What zones are usually fibrosed in sarcoidosis?
Upper
Which zones are usually fibrosed in SLE?
Lower
Prior to PCI when is supplemental oxygen given?
Below 90% saturations
What is the mechanism of action of anti-platelts?
P2Y-12 receptor inhibitor
What characterises a severe UC flare?
6 or more bowel motions plus:
1. temp above 37.8
tachy over 90
anaemia under 105
ESR over 30
What is management principles of UC flare?
IV fluids + IV hydrocortisone + LMWH
What is surgical management of bleeding oesophageal varices?
Band ligation
What drug is given to prevent rebleeds of varices?
Propranalol
where is iron and calcium absorbed
duodenum
Which organ is b12 absorbed in?
Terminal ileum
What is a long term risk of sulfasalzine use?
pancreatitis
What is management of critical limb ischaemia?
Urgent referral to vascular surgeons
What level of carboxyhaemoglobin level is poisoning?
Over 10%
Which blood test should be used to test for haemochromatosis?
Serum transferrin
Does thiazide diretics cause hypo or hyper natraemia?
Hyponatraemia
Where can the pain be felt in ruptured aortic anyeurysm
illiac fossa pain, and if person is obese may not feel pulsatile mass
What are the characteristic features of whipple’s disease?
And what is seen on staining
Diarrhea
Polyarthropathy
Acid Schiff positive on duodenal biopsy
What medication should a person with heart failure less than 40% be started on?
ACE inhibitor and aldosterone antagonist (spirnalactone)
What is treatment for tension pneumothorax vs spontaneous?
Tension - needle decompression
Spontaneous - chest drain
Which antibodies are found with PSC?
C-anca and smooth muscle antibodies
Which anti emetic is contraindicated in heart failure?
Domperidone
In cardiac arrest if adrenaline can’t be given IV then how should it be given?
Intraosseous access via proximal humerus or distal tibia
When is terlipressin stopped after given for a variceal bleed?
once definitive haemostasis has been achieved or after five days
Which murmur would be present in a carcinoid tumour?
Holosystolic murmur - tricuspid regurg
What is mechanism of action of amiodarone?
Blockage of voltage gated potassium channels
What do thiazide diuretics do to lithium conc?
Keep it in circulation for longer as it reduces lithium clearance
Which medication can be given to reduce meniere episodes?
Betahistine - histamine analoge
Which medication can be used to manage acute vertigo symptoms?
Prochloperazine
Which vaccine is recommended with people with sickle?
Annual influenza
What are the features of henoch schonlein purpura?
Joint pain
Abdo
Rash
Kidney impairment
What is compression rate for paed life cpr?
15:2
Which gene is indicated in malignant hyperthermia?
ryr1 due to uncontrolled release of calcium for sarcoplasmic reticulum leading to sustained muscle contraction
What is the antidote for malignant hyperthermia?
IV dantrolene
Cooling fluids
What can trigger malignant hyperthermia?
Suxamethonium
Other volatile anaesthetic agents: sevoflurane, isoflurane
Which nerve is paralysed if ulnar nerve is damaged?
Adductor pollicis muscle - positive froments signs
What is the most common subtype of lung cancer?
Adenocarcinoma
What are the risk factors for pseudogout?
Osteoarthritis
Trauma
Hyperparathyroidism
Haemochromatosis
Electrolyte imbalances
What tumour is associated with Sjorgens?
Marginal cell lymphoma - MALT
What is the ABG outcome in Anorexia?
Metabolic alkalosis
In babies over 32 weeks what medium should rescue breaths be delivered with?
Air
If baby is 28 - 31 weeks what oxygen percentage should rescue breaths be given with? then what about under 28 weeks?
21-30%
under 28 weeks - 30% oxygen
What is the barlow sign?
Hip displacement - evil gary barlow - in and down on joint
What is ortanli sign?
Realigning hip - out and out
What is first line management for atelecstasis?
Chest physiotherapy
What are features of atelectasis?
Bilateral dullness and mild pyrexia
In which patients is flecainide contraindicated for AF?
Structural heart disease
Which antibiotic is associated with achilles tendinopathy? and tendon rupture
Ciprofloxacin
Which nerves are affected in thoracic outlet syndrome?
brachial plexus is compressed or the subclavian vessels.
What is a common symptoms of thoracic outlet syndrome?
Trapezius pain
Where can pain occur in plantar fasciitis?
Heelp pain worse in morning - better throughout day . Limited dorsiflexion due to tight achilles tendon Also might have some tenderness on medial side of heel
Which imaging is used for meckels diverticulum?
Technetium scan
What is imaging for malrotation in babies?
Upper GI contrast study
What are features of malrotation in babies?
Bilious green vomiting a few days after birth
What is the rate of chest compression to breaths in neonates?
3:1 - reassess heart rate every 30 secs
For a women who wants to be pregnant with fibroids what is treatment?
Myomectomy
In woman with fibroids who doesn’t care about pregnancy what is treatment?
GnRH analogues to shrink the fibroids
What is medical management of PID?
PO doxy, Im ceftriaxone, PO metronidazole for 14 days
What is management of anyone over 50 with blood in poo? and what is criteria for referral?
FIT - 10 or more nanograms of blood present refer for colonscopy
What is the danger of back to back on the heart ?
Can cause tachycardia
If back to back nebs are given what electrolyte abnormality does that cause?
Hypokalaemia
What is drug treatment of anterior uveitis?
Topical steroids - atropine/cyclopentalone
What is offered after metformin not working great?
SGLT-2 like flozin
What is the most common type of renal stone made from?
Calcium oxalate
Which cells are high in acute intersitial nephritis?
Eosinophils
Which antibiotics can cause acute interstitial nephritis?
Beta lactams - cephalosporins
What can be used as a treatment for colicky pain due to peristalsis against a malignancy?
Hyoscine butylbromide as it’s an antispasmodic and antimuscurinic
Which antibodies are most likely to be found in a lupus patient?
Anti-nuclear antibodies - this is the most sensitive
What is most specific antibody for lupus ?
Anti-smith and anti ds-dna
What is found with genitals with congenital adrenal hyperplasia?
Fused labia and urogenital sinus
If you hear tinkling bowel sounds in thoracic cavity what is most likely diagnosis?
Diaphragmatic hernia
What’s a specific signs in neonates of opiod withdrawal?
Yawning
What is chorioamnionitis?
Placental infection can occur following invasive testing and presents with fever and foul smelling discharge
If NSAIDs dont work for ankylosing spondylitis what is then offered?
Infliximab - anti TNF
Which chemo drug is likely to cause cardiomyopathy?
Doxorubicin
What is management of retinoblastoma that is confined to the eye?
Enucleation - removal of the eye
What is koebner phenomenon?
Polygonal plaques with white striae at sties of injury
How is koebner phenomenon managed?
Topical corticosteroids
What is treatment for c.diff including route?
Oral Vanc
What is first line management for pseudomonas?
Ciprofloxacin
Which TB drugs are inducers vs inhibitors?
Rifampicin - p450 inducer
Isoniazid - inhibitor
Which epilepsy drugs are p450 inducers vs inhibitors?
Carbamezapine - inducer
Na valproate - inhibitor
Which fruit is a p450 inhibitor?
Grapefruit
On a forest plot what does the diamond touching solid vertical line mean?
Overall outcome is not statistically significant
What is haptoglobin and what does a low amount mean?
Specific marker for haemolysis, low level - suggest haemolysis - this occurs in HELLP syndrome
What is the fluid amount for DKA?
10-20ml/kg 0.9% saline over 30 mins . If patient is not shocked minus the original fluid bolus from maintenance fluids
In children aged 6-12 what is IM adrenaline dose for anaphylaxis? then what aboutchildren 6 months to 6 years, then under 6 months?
1:1000 300microgram
6months - 6 years: 150 micrograms
Under months: 100 micrograms
Which pathogen looks like a bunches of grapes on histology and is gram positive diplococci?
Staph aureus
What investigation must be done before a patient starts on trastuzumab?
ECHO and cardiomyopathy may occur
When is a valve replacement warranted?
If left ventricular ejection fraction is less than 55%
What is the most likely pathogen causing diarrhoea in a HIV patient?
Cryptosporidium parvum
What is an example of a sedative antihistamine?
Chlorphenamine - give loratidine instead if they can’t have a sedating effect
What is treatment for bowen’s disease - SCC?
5 fluoruracil
What drug should be stopped before contrast CT and why?
Metformin because it can react with the contrast to cause contrast induced nephropathy
What is most effective medication to treat albuminurea?
ACE inhibitors
What eGFR would stop duoloxetine being used?
Below 30
What is first line treatment for diabetic neuropathy pain?
Duloxetine - if contraindicated then use amitryptiline
What is diagnostic investigation for painless haematuria in a smoker?
Flexible cystoscopy
What is management steps for a patient with b12 deficiency?
Im hydroxocobalamin 1mg on alternate days then once no further improvement - maintainence dose every 2 months
What is the gold standard vessel for a CABG?
Internal thoracic artery
What can be used for acute moderate mountain sickness?
Acetazolamide
What gene mutation is polycythaemia vera associated with?
JAK2
Which antipsychotic is recommended for Parkinson patients?
Quetiapine
When does breast milk jaundice appear compared to physiological jaundice?
Physiological: first 2-4 days of life and resolves within first week
Breast milk jaundice: presents within first week of life, characterised by presence of increased unconjugated bilirubin levels
What is found on ECHO in takotsubo cardiomyopathy?
Apical ballooning with preserved basal function
What can cause hypomagnesium?
Chronic alcohol use
PPI
What characterises toxic epidermal necrolyis? and what is difference between steven johnson
more than 30% blistering, steven johnson less than 10%
What is first line investigation for salivary gland lithiasis?
Ultrasound of neck
What is treatment for a localised pancreatic cancer?
Whipple procedure
Out of bromocriptine and cabergoline which one is used for prolactinomas?
Cabergoline - cos u get a cab to bro’s house so cab first
Which chromosome abnormality is seen with AML?
t8:21, tq22:q22
What is first line management for acute otitis externa?
Topical ciprofloxacin and hydrocortisone
What are the two key tests for brain death determination?
Neuro exam and apnoea test
What is most causative bacterial pathogen for meningitis?
Strep pneumoniae and neisseria meningitidis
What is hallmark of parkinson’s in brain?
Degeneration of substantia nigra
What is first line test for TB?
Sputum fast acid bacilli smear
Which medication is best to shrink fibroids and keep them shrunk?
Selective progesterone receptor modulators (e.g. ulipristal acetate) , cos GNRH agonists once stopped fibroids go back to original size
What is treatment for mycoplasma pneumoniae?
Azithromycin
What is another word for transitional cell carcinoma?
Urothelial carcinoma
If you see ragged red fibres, T2 hyperintensities in basal ganglia MRI what is likely diagnosis?
Mitochondrial encephalopamyopathy , lactic acidosis and stroke like episodes
For malignant bowel obstruction what can be a useful anti emetic?
Dexamethasone 4mg PO twice daily
What is an imporatn consideration to optimise ventilation and intubation ?
Pre-oxygenate with 100% oxygen
What is capgras syndrome?
Person thinks someone close to them has been replaced by an imposter
What is De clarebeut syndrome?
Person think celebrity or someone is infatuated with them
What is Ekbom syndrome?
Person thinks they are infested with parasites
What imaging is used for osteomyelitis?
MRI imaging
What bone issue is common in diabetic non healing ulcers?
Osteomyelitis
If breast feeding mum has a fissure vs no fissure what is treatment?
No fissure keep breastfeeding. Fissure - flucloxacillin
What is the treatment for ringworm?
Topical terbinafine
Which zone in protstate is exclusive for BPH?
Transition zone
What is the difference between incarcerated hernia vs strangulated?
Incarcerated: contents are stuck and can’t be reduced: if acutely incarcerated need surgical immediate repair, if chronically strangulated then elective repair
Strangulated hernia: blood supply is compromised causing ischaemia and maybe necrosis - need emergency surgery
What is first line treatment for MG?
Pyridostigmine
Is weight loss or gain seen in duodenal ulcers?
Weight gain as pain is made better by eating
In abdominal surgery which pain relief should be avoided an why?
Opiods as it can cause respiratory disease
Which marker is low in osteomalacia?
Serum 25 OH cholecalciferol
Which is the only tube that can seal trachea off and protect against aspiration?
Tracheal tube
What is best screening test for haemochromatosis?
Transferrin saturation
Which pathogenic infection would be a bad prognosis with people with CF?
Pseudomonas aerginosa
What is management of suspected wernicke’s encephalopathy?
Parenteral thiamine
First line management of Impetigo?
Hydrogen peroxide. if not that then fusidic acid
What scale is used for pancreatitis severity?
Glasgow imrie
Which is score system for liver cirrohsis?
Child pugh
What is pathogenic cause of whooping cough?
Bordetella pertussis
How long is school exclusion for mumps?
Five days
What medication is used in subarachnoid haemorrhage?
Nimodipine
Which diabtetic medication is associated with vaginal thrush?
SGLT2 - they suppress glucose reabsorption
What is gold standard investigation for bowel obstruction?
CT with contrast
Difference between quinsy and acute tonsillitis?
Quinsy - potato voice - the uvula deviates away from affected side and the anterior arch of soft palatte is pushed medially . Acute tonsillitis is less severe does not present with anterior arch movement
Which pathogen causes epiglotitis?
H influenzae type B
What is common cause of non -gonococchal urethritis?
Chlamidya and mycoplasma
What is a massive risk factor for transient tachypnoea of newborn?
C section
If pencil in a cup appearance is seen on radiograph what is likely diagnosis?
Psoriasis
Which joints are involved in psoariatic vs rheumatoid arthritis?
Psoariatic: DIP and asymmetrical
Rheumatoid: PIP and symmetrical
What is the law regading FGM under 18?
Doctor must report it to police within 28 days of discovery
What is treatment for CML?
imatinib and JAK inhibitor
When is amniocentitis done?
After 15 weeks
When is chronic villous sampling done?
11-14 weeks
When can COCP be restarted in breastfeeders?
After 6 weeks
Is contraception needed in first 3 weeks of birth?
NO
Which anti psychoticis least likely to cause galactorhea?
Ariprazole
At what GFR is metformin contraindicated?
Below 30
What is the diagnositc investigation of motor neurones disease?
Electromyography
At what week is sympheseal fundal height measured?
From 20 weeks gestation
What is management of breast abscess?
Urgent referral to hospital
What is is medication option for croup causing breathlessness and cough?
Oral dexamethasone
What are warfarin guidelines pre-op?
If it’s a surgery that can be delayed by 6-12 hours then 5mg iv VITAMIN k AND OMIt evening dose of warfarin. If surgery cant be delayed for 6-12 hours then prothrombin complex
What type of brain cancer is an AIDS defining illness?
Primary CNS lymphoma
What does glioblastoma look like on radiology/?
Butterfly
What does meningioma look like on radiology?
Tail sign
If pregnant woman is more than 20 weeks gestation and exposed to chicken pox plus is symptomatic whats treatment, vs if she was under 20 weeks?
Under 20 weeks: Oral aciclovir immediate
Over 20 weeks: oral aciclovir 7 days post exposure
If a pregnant woman under 20 weeks is asymptomatic to chicken pox what is treatment?
VZV immunoglobulins
What genetic mutation is affected in CF?
Delta F508
wHAT IS FIRST LINE MEDICATION FOR NEUROpathic pain in palliative care?
Gabapentinoid
What features characterise disseminated intravascular coagulation?
Low platelets
Elevated PT
Elevated APTT
Elevated D dimer
What is investigation for suspected cerebral oedema - can be caused by DKA?
CT head
What is Lemeirre syndrome
Infective thrombophlebitis can develop due to untreated bacterial throat infection
What is Lemeirre syndrome
Infective thrombophlebitis can develop due to untreated bacterial throat infection
What does the direct coombs test test for?
Autoimmune haemolytic anaemia
What is first line treatment for hip dysplasia?
Hip bracing
What is the mainstay of treatment for lithium toxicity ?
IV fluids
What do eyes look like in opiod withdrawal vs opioid overdose?
Over dose - pinpoints
Withdrawal - dilation
What is medical management of raynauds
Nifedipine
Is calcium high or low in tumour lysis syndrome?
Calcium is low
Which electrolytes are high in tumour lysis syndrome?
Potassium
Urea
Phosphate
What is most common tumour in parotid gland and is it benign ?
Pleomorphic Adenoma - benign
When is a G6PD enzyme assay taken?
3 months following an episode of acute haemolysis
What is an immediate test to do to work out if patient has immune mediated haemolytic anaemia ?
Direct anti globulin test - direct Coombs
In terms of giving anti d immunoglobulin. If the woman is pregnant between 12-20 weeks if they have a miscarriage do you give it?
Yes because the miscarriage over 12 weeks is the sensitisation event
What is first line medication for uterine stony causing post partum haemorrhage?
IV syntocinon - oxytocin
What is the management for conduct disorder ?
Child focussed programmes - available for children 9-14
When is the onset of jaundice in criggler najjar?
Less than 24 hours due to error in bilirubin metabolism
Which joints do pseudo gout more commonly present in?
Knees and wrists
What’s conversion rate of oral morphine to oral oxycodone
Divide by 2
What is most specific marker for in translating choldstasis of pregnancy ?
Bile acids
What is the medical management of acute limb ischaemia?
Unfractionated heparin and high flow oxygen
What is the starting dose of ramipril?
1.25mg then it’s gradually increased at two week intervals
Which dementia medication can cause third degree heart block?
Donepezil - complete dissociation of p waves and qrs complex
What is treatment for post herpatic neuralgia ?
Amittiptyline
What is medical management for leprosy
Rifampicin monthly and dapsone daily
If patient has AKI and present with a new pericarditis what is treatment?
Haemodialysis
What is treatment of COPD if patient does not have asthmatic features
LABA + LAMA
What is treatment of COPD if there is Asma this features e.d diurnal variation?
LABA + ICS
What is diagnostic test for necrotising facitis
Abdo Xray
What is diagnostic test for necrotising facitis
Abdo Xray
When is zoledronic acid used?
Manage hyper cal anemia caused by malignancy or pagets
What is additional management if head lice treatment is unsuccessful
Detection combing for entire household
What drug is used to treat head lice?
Malathion
What is the mechanism of action of ezetimibe?
Prevents intestinal absorption of cholesterol
What is mechanism of fibrates?
Increase triglyceride clearance
What test can be used to test for chronic kidney disease ?
Urine albumin to creatinine ratio
What is surgical management of a hiatus hernia?
Nissan fundoplication - gastric funded is wrapped around inferior oesophageal to prevent herniation of stomach
What is surgical management of a hiatus hernia?
Nissan fundoplication - gastric funded is wrapped around inferior oesophageal to prevent herniation of stomach
What is first line for acute limb ischaemia ?
IV heparin
What can be done if carbedopa and levodopa aren’t working as well anymore?
Add entacapone
Which IBD has skip lesions and cobble stone appearance ?
Crohns
How should acute relapses of MS be managed ?
Oral methyprednisolone for 5 days
When is beta interferon used in MS
If needing long-term treatment, if the patient has had two or more relapses in two years
What is the treatment for Guillian Barr syndrome?
Plasmapheresis and IVIG
What is the screening for hepatocellular carcinoma?
Six. Monthly liver, ultrasound and alpha-fetoprotein.
What is the first line treatment for idiopathic, pulmonary fibrosis if it is mild
Pulmonary rehab
What drug can be used in pulmonary fibrosis if severe : FVC 50-80%
Ninntedanib
Which patients should not be given flecainide?
Patients with ischaemic or structural heart disease
Which patients should not be given flecainide?
Patients with ischaemia or structural heart disease
If a beta blocker has not worked for atrial fibrillation, what is the next medication step?
Amiodarone for rhythm control
When is a lumbar puncture contra indicated in meningitis ?
Drop in GCS 3 or more showing raised ICP
What is the first line for preseptal cellulitis?
Oral Co amoxiclav
If osyient with pre septal cellulitis is pen allergic what is treatment
Oral clindamycin and metronidazole
Which side does uvula go in vagus lesion
Away from side of lesion
Which diabetic medication can cause fournier gangrene - it’s a type of necrotising fasciitis?
SGLT-2 - so the flozins
What is the mechanism of donepezil, gala at mine and rivastigmine ?
Acetylcholinesterase imhibitor
What is mechanism of action of memantine?
NDMA receptor antagonist
What is mechanism of action of memantine?
NDMA receptor antagonist
Which drug is used for motor neurones disease?
Riluzole
What drug class is riluzole
Benzothiazoles
What is seen on CT with bronchiectasis
Signet rings
What are the features of bronchiectasis?
Dyspnoea, fever, haemoptysis, purulent sputum production, recurrent pneumonia
What is first line treatment of psoriasis in young people?
Topical calcipotriol
What drug can be used to manage dermatitis herpetiformis?
Topical dapsone
Which lung cancer can cause, they raised calcium and why
SCC because these tumours can secrete PTH related peptide
What is the management of mastitis if there is fever nipple discharge
Oral fluixacillim
Which antibodies are involved in Hashimoto’s
Thyroid peroxidase antibodies
Which antibodies are involved in Graves’ disease?
TSH receptor antibodies
What is the most common cause of cellulitis?
Strep pyogenes
At what age does muscular dystrophy present, and what are the signs?
4-6 years old
Pseudocalf hypertrophy
Growers signs - using arms to stand up from squatting
At what age should a child be sitting?
Eight months
What is the management for acute dacryocystitis?
Oral amoxicillin and clavulanate
What is management for chronic dacrycystits?
Dacryycrocystorhinoetomy
What must be ruled out first in a patient with temporary neuro dysfunction
Glucose - hypoglycaemia
What type of bacteria are patients with splenectomy at risk of?
Encapsulated bacteria like strep pneumonia
What antibiotic is used in spontaneous bacterial peritonitis?
Cefitaxime
What is first lime drug to manage ascites?
Spironolactone
When is amphotericin B used ?
Fungal cerebral abscess
What is scabies treatment ?
Topical permthrin
What is the most aggressive type of melanoma?
Modular melanoma
Which melanoma is slow growing
Lentigo maligna
Which melanoma is under nail on sole and palms
Actual leniginous
Which brain area is affected in huntingtons?
Basal ganglia striatum
Which area is alpha synuclein deposited in?
Primary motor cortex
Which organisms cause post splenectomy sepsis
Strep pneumonia
Haemophilia influenza
Menungococci
What is the management of ischaemic stroke within 4.5 hours
Thrombolysis with alteplase
What is ischaemic stroke management after 4.5 hours
Aspirin 300 mg no thrombolysis
What is FEV1/FVC ratio in restrictive lung disease ?
Normal
What size does the trachea shift is there is lung collapse
Towards the lung collapse
If eosinophilia casts are seen what kidney condition is this?
Tubulointerestitial nephritis
What is a direct complication of nephrotic syndrome?
VTE
Which drug can cause hypokalaemia?
Thiazide like diuretic
When is dexamethasone vs mannitol use for increased ICP?
Dexamethasone - brain tumours / more chronic
Mannitol- acute management of raised ICP like brain injury
What drug is used to treat a PE
DOAC
Can PPI cause hyponatraemia?
Yes
How long should people wait between first and second puff of inhaler?
30 secs
Which vaccine should be offered to high risk groups like homosexuals
HEP A
Give me two examples of a cycloplegic?
Atropine
Cyclopentolate
Features of anterior uveitis
Photophobia
Small, irregularly shaped pupil
What is the treatment of anterior uveitis ?
Steroids and cycloplegic drops
What indicates a exude tube pleural fluid
Protein level in pleural fluid more than 30. Educative is cancerous
What test must all men with erectile dysfunction have done?
Morning testosterone
What’s the diagnostic investigation for pancreatic cancer?
Abdo CT
I’m patients with severe alcoholic hepatitis what is treatment ?
Prednisolone
If high fibre diet , gtn lubricant and laxatives don’t work for anal fissure what is management
Spincterotomy
When is a seton suture used?
For anal FISTULAE
When is rubber band ligation used?
Haemorrhoids
What is consistency of stool in colostomy vs ileostomy?
Colostomy - more solid and formed
Ileostommy - liquid to semi solid
Difference between end and loop colostomy
End usually more permanent
Loop usually temp - to be teversed
What illness causes glandular fever (infectious mononucleosis)
EBV
What is diagnostic test for glandular fever - infectious mononucleosis
Monospot
What drug is used for first like In raynauds?
Nifedipine
Which drug is used for sun arachnoid haemorrhage
Nimidipine
What are high risk bite areas
Face
Hands
Genitals
Skin overlying cartilage
Area of poor circulation
What is treatment for human bite if drawn blood or on high risk area?
Co amoxiclav
Where is a chest drain inserted?
Base of Scilla lateral pectoral is major , 5th inter coastal space anterior latissimus dorsi
Which medication are known to exacerbate plaque psoriasis
Beta blockers
What is management of smoker in pregnancy
Nicotine replacement as buproprion and varenciline is contraindicated
What are sick day rules for Addisons?
Double the hydrocortisone but keep the fludrocortisone the same
What combo of drug is used in acute angle closure glaucoma?
Direct parasympathathomemtic and beta block eye drops
E.g. pilocarpine and Timolol
What are goblet cells like in crohns
Increased goblet cells
Features in UC
Crypt abscesses
What are the features of coecliac
Villus atrophy
Crypt hypertrophy
What happens if you give a patient with MG a beta blocker?
Can worsen MG and cause a drop in vital capacity
What is rockfall score vs Glasgow blatchford?
Rockfall is used after Gi endoscopy to work out risk of rebleed
Glasgow is before procedure to calculate probability that patient will be needed to be admittted for medical intervention
What’s the combo of drugs for secondary care post MI
APLBA
Aspirin
Prasugrel
Lisonipril
Bisoprolol
Atorvastatin
Which areas are affected by alzhiemers?
Cortex and hippocampus
What do img and igg antibodies mean in hepatitis
Igm more acute gradually turn into igg in chronic infection
What does hbsag marker mean
Positive if there is acute infection
What does anti HBS mean
Positive means body has cleared the infectioj
If ccb or beta blockers are contraindicated in patient with angina what can be used
Isorbide mononitrate
If ccb or beta blockers are contraindicated in patient with angina what can be used
Isorbide mononitrate
What is first like for patient with rosacea and severe applies or pustules
Topical ivermectin and oral doxycycline
When can an asthmatic be discharged after acute asthma attack?
PEF should be more than 75% of expected
If uteric stone is presenting with infection and hydronephrosis what is management
Nephrostomy tube insertion and IV antibiotics
How long do people have to wait to drive after a stroke or a TIA?
One month
How long do people have to wait to drive after a unprovoked seizures with no activity on EEG or structural abnormalities?
Six months
How long do people have to wait to drive if they have multiple TIAs over a short period?
3 months
How long does finasteride treatment for BPH take to see affect
6 months
Which diabetic drug is good in chronic heart, failure or cardiovascular disease
Sgl2
How long must patient wait before eating gluten again, before being tested for coeliac
6 weeks
What FEV1 is moderate, severe and very severe COPD and normal and mild
Normal : over 80%
Mild : over 80% but symptomatic
Moderate : 50-79%
Severe 30-49%
Very severe : under 30%
