flash cards for wrong questions
1
Q
When should amiodarone 300mg be administered for shockable rhythms?
A
After delivery of 3rd shock
2
Q
What is seen on the ECG in wolf parkinson white?
A
Delta wave
3
Q
What causes wolf Parkinson white?
A
Pre-excitation of an accessory pathway between atria and ventricles
4
Q
What is first-line medication for rhythm control?
A
Bisoprolol or CCB - diltiazem
5
Q
What is first line for papulopustular rosacea?
A
Topical ivermectin
6
Q
What is first line for rosacea without the pustules?
A
Topical brimonidine
7
Q
What are the obvious features of dermatomyositis?
A
Heliotrope rash and gottron’s papules
8
Q
What is the most sensitive indicator for dermatomyositis?
A
Creatinine kinase
9
Q
What is the muscle weakness conditions caused by Small cell cancer?
A
Lambert eaton syndrome
10
Q
What is pathophysiology of labert eaton syndrome?
A
Anti VGCC antibodies
11
Q
What is first-line drug for bed wetting in kids and what is the mechanism of action?
A
Desmopressin - it’s an AVP analogue
12
Q
What measure is enough for diagnosing diabetes?
A
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
13
Q
Which brain tumour shows psamomma bodies?
A
Meningioma
14
Q
What do meningiomas look like on T1 MRI?
A
Hypointense
15
Q
In patients where adenosine is contraindicated - eg. asthmatics what drug should be used?
A
Verapamil
16
Q
What are 3 side effects of bisoprolol?
A
Tiredness
Peripheral coldness
Bronchospasm
17
Q
What are 4 side effects of CCB’s?
A
Ankle swelling
Headache
Flushing
In patients with reflux - can increase it as it relaxes the lower oesophageal sphincter
18
Q
What is definitive treatment for brugada syndrome?
A
Implanatable cardiac defib
19
Q
What UTI drug is okay in 1st and second trimester?
A
Nitrofurantoin
20
Q
What drug is okay for third trimester UTI?
A
Trimethoprim
21
Q
Why can’t nitrofurantoin be used in third trimester?
A
Risk of neonatal haemolytic anaemia
22
Q
Which UTI drug is contraindicated with methotrexate?
A
Trimethoprim
23
Q
Which UTI drug is contraindicated with G6PD deficiency?
A
Nitrofurantoin
24
Q
Which pathogens are culture negative?
A
Kingella, cardiobacterium, Eikenella
25
For non sexual epididymo-orchitis what is first line?
Oral ofloxacin - as they cover e.coli
26
What is treatment for severe malaria?
IV artesunate
27
When should liraglutide be discontinued?
If within 12 weeks the patient has not lost 5% or more of their body weight
28
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
29
What are the symptoms of systemic sclerosis (scleroderma)
CREST
Calcinosis
Raynauds
Eosophageal dysfunction
Sclerodactyl
Telengiectasia
30
What antibodies are found in dermatomyosists?
Anti-m2
31
Which pathogen is involved in food poisoning within 1-2 hours esp after eating dairy products?
Staph aureus
32
Can campylobacter cause bloody diarrhea?
Yes - 2-5 days after exposure
33
Which pathogen is involved in diarrhea for HIV and immunocompromised patients?
Cryptosporidium parvum
34
When is a CABG more advantageous than a PCI?
Over 65
T2DM
Complex 3 vessel disease
35
What is a serious side effect of azathioprine?
Neutropenia due to bone marrow suppression
36
What is a relative contraindication to thrombolytic therapy?
Systolic BP over 180 , diastolic over 110
37
What is the function of alpha 1 trypsin?
Protease inhibitor - it inhibits neutrophil elastase in lung
38
What is the pathophysiology of alpha 1 trypsin deficiency?
Deficiency of alpha 1 trypsin which is a protease inhibitor
39
What is the treatment for PBC?
Ursodeoxycholic acid and supplementation of fat soluble vitamins - A,D, E and K
40
Which heart defects are associated with carcinoid syndrome?
Pulmonary stenosis
Tricuspid regurg
41
Which drug is used to treat influenza in high risk people?
Oseltamivir
42
Which tumours are present in MEN1?
Pancreas
Parathyroid
Pituitary adenoma
43
Which gene is implicated in MEN1 vs MEN2?
Men 1 - men 1 gene
Men 2- RET-proto-oncogene
44
Which tumours are associated with MEN2?
Parathyroid
Medullary thyroid
Phaechromacytoma
45
What drug is long term prophylaxis against further leeds in variceal patients?
Propranalol
46
Which drug is used in acute treatment of variceal bleeds?
Terlipressin
47
Which antibodies are positive in patient with autoimmune hepatitis type 1?
Anti smooth muscle antibodies
48
What are the symptoms of pellagra and which vitamin deficiency causes it?
DDD
Diarrhea
Dementia
Dermatitis - photosensitive rash
Lack of vitamin B3- niacin
49
If P waves are inverted in V2 - what is most likely cause of this ECG abnormality?
Rarm and LA electrodes have been reversed
50
What is treatment for children with cradle cap - seborrhaeic dermatitis that doesn't go away with cleaning?
Topical clomitrazole 1%
51
Which wall is affected in wellen's syndrome?
Anterior wall
52
Where is fibrosis usually caused in TB?
Upper lobes
53
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
54
What does 5-alpha reductase actually mean?
Block the conversion of testosterone to dihydrotestosterone and therefore slow progression of BPH
55
Which medication can be used for reducing secretions from tumour sites?
Glycopyrronium
56
What is treatment for torsades de point?
IV magnesium sulfate
57
What are the symptoms of bacterial prostitis?
Boggy prostate
Fever
Tender prostate
Urgency
Fever
Dysuria
58
What is first line management of bacterial prostitis?
Ciprofloxacin 500mg BD
59
What is the mechanism of action of sulfonyurea?
Increased insulin secretion from beta cells
60
What is mechanism of thiazolidinediones?
Increased peripheral glucose uptake
61
What time definition is QT elongation in men and women?
Over 460ms i women
over 440 in men
62
What are the symptoms of whipple's disease?
Large joint arthropathy
Gi features - malabsorption
Diarrhea
Weight loss
Hyperpigmentation
63
What is gold standard diagnosis for whipples disease?
Jejunal biopsy shows deposition of macrophages in lamina propria staining positive for acid-schiff
64
Treatment for whipple's?
Co-trimoxazole
65
What drugs cause steven johnson syndrome?
Co-trimoxazole
Beta lactams like penicillin
Anti-convulsants
66
What is pattern of inheritance of charcot marie tooth?
Autosomal dominant
67
What are symptoms of charcot marie tooth?
Genetic peripheral neuropathy - distal motor and sensory deficits
68
Which pathogen causes rice water like stool?
Cholera
69
What are symptoms of giardia lamblia?
Contaminated water access, uncooked fruit , 1-3 week incubation
70
Treatment for giardia lamblia?
Metronidazole
71
Which diabetes drug cause lactic acidosis?
Metformin
72
What's the genotype of androgen insensitivity
46XY - so resistance to testosterone - so phenotypically female - regression of mullerian duct structures
73
What is ovulatory dysfunctional uterine bleeding?
Excessive production of vasoconstrictive prostaglandins in endometrium during menstrual period leading to painful uterine contractions and prolonged bleeding.
74
What is management of genital herpes in expectant mothers?
Treat primary infection then oral aciclovir from 36 weeks and expectant delivery
75
What is the dose mother with HSV from 1st or second trimester should be offered?
400mg three times a day from 36 weeks onwards
76
If a pathogen is methicillin sensitive which antibiotic should be given?
Flucloxacillin
77
What is a positive Mc-Murrays test and what does it indicate?
Clunk when flexing knee up to chest - indicates a meniscal tear
78
Which line is safest to administer adrenaline through?
Central venous line
79
When does uterine rupture usually occur?
During labour more common in women with previous uterine surgery
80
What is management of uterine rupture?
Emergency exploratory laparotomy with C section and fluid recuss
81
Which disorder contains Barr bodies on histopathology?
Klienfelter's syndrome
82
What is the genotype of klinefelter's?
47 XXY
83
What is a barr body?
In activated and condensed X chromosome
84
Which drugs causes erythema nodusm?
COCP
Penicillin
Sulfonamides
85
What pathogen causes a chancroid?
Haemophilus ducreyi
86
What is antidote to lidocaine toxicity?
Intralipid
87
When is it abnormal for kids to develop a hand preference?
Before 12 months
88
What is a red flag when it comes to walking age for kids?
Not walking by 18 months
89
Where does the origin of the tear in lateral epicondylitis begin?
Extensor carpi radialis brevis - ERCB
90
Which fractures is the radial nerve more likely to be injured?
Mid shaft fractures
91
Which artery is in danger in supracondylar fractures?
Brachial artery
92
Which drug can be used for trigeminal neuralgia?
Carbamezapine
93
Which function tests do you need to do before beginning carbamezapine?
Liver function tests
94
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
95
What is mechanism of action of spironolactone?
Aldosterone antagonist
96
What is mechanism of action of loop diuretics?
Inhibits co-transport of Na , potassium and chloride
97
What is the most common side effect of ondansteron?
Constipation
98
What can ondansteron do to the QT ?
Prolong it
99
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.
100
When can BP meds be stopped in women who had pre-eclampsia?
When BP drops below 130/80
101
Which rare congenital malformation is associated with primary ciliary dyskinesia?
Kartagener's syndrome
102
What are the features of kartagener's syndrome?
Subfertility
Recurrent sinus infection
Situs inversus - heart on right side of chest
103
What is the level of bifurcation of carina?
t4-t5
104
What is bartter syndrome?
Metabolic hypokalaemia
Alkalosis
Hypercalcueria
Normal BP
105
Which gene mutation causes achondroplasia - dwarfism?
Activation of fibroblast growth factor 3 receptor
106
Which genetic mutation causes marfan syndrome?
Fibrillin mutation
107
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
108
If BP is not increasing in sepsis despite fluid bolus what should be given?
IV noradrenaline/ norepinephrine infusion - vasopressor support
109
Which biochemical marker is super raised in tumour lysis syndrome?
Urate - uric acid
110
What are the characteristics of perthes disease?
Insidious onset of limp with or without pain
In boys 4-6
111
What is diagnostic test for myeloma?
Serum light chains - look for bence jone sproteins
112
What drug is used to oppose a neuromuscular blockade?
Neostigmine
113
What hormone surges just before ovulation
LH
114
Which virus is indicated in SCC of oropharynx?
HPV
115
What is the meaning of continuous data?
On a scale eg. numbers
116
What is a nominal variable?
No ranking order - categories like hair colour, occupation
117
Which two drugs are okay with renal impairement?
Oxycodone and fentanyl
118
Why is warfarin used in valular heart failure for anticoagulation instead of DOACs?
DOACs are contraindicated in valvular heart disease
119
Where is broca's area ?
Frontal lobe - left hemisphere
120
Where is wernicke's area?
Left hemisphere temporal lobe
121
What is medical management for toxoplasmosis?
Administer sulfadiazine and pyrimethamine
122
Which anti-depressant is okay in children?
Fluoxetine
123
What is treatment for scarlet fever?
Phenoxymethylpenicillin
124
What is treatment for kawasaki?
IVIG and aspirin
125
What are the symptoms of Kawasaki?
CRASH
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hands and feet burn
126
When nitrofurantoin and trimethoprim is contraindicated for UTI was is given?
Pivmecillinam 400mg initial dose then 200mg TDS for three days
127
Which drug is common to cause drug induced lupus?
Isonizaid
Minocylcine
Phenytoin
Hydralazine
128
Which markers should be tested for in anti-phospholipid
Anti-cardiolipin
Lupus anticoagulant
Beta-2-glycoprotein
129
What is the most common viral cause of croup?
Parainfluenza
130
Which vaccine should be given to children who are at risk of RSV and bad RSV?
Palivizumab
131
Which function tests do you have to do before starting lithium therapy?
Renal and thyroid function tests
132
What is acceptable limit for sperm morphology?
4% or more
133
What non pharma therapies can be used to treat palliative care?
CBT
134
Which mutation are associated with a poorer outcomes in AML ?
FLT3 internal tandem duplication.
135
Which mutation is associated with better outcomes in AML?
NPM1 mutation without concurrent FLT3 internal tnadem duplication
136
What is the best initial management for autism?
Applied behaviour analysis
137
What is appropriate treatment for complex facial fractures?
Open reduction and internal fixation
138
Is cervical os closed in threatened miscarriage?
Yes
139
What age can HPV vaccine be given till?
45 years old
140
When is chronic villus sampling done?
10-13 weeks - used for high risk pregnancies when NIV tests shown a high risk
141
When is quadrouple test done?
15-20 weeks
142
When is amniocentisis done?
15-20 weeks gestation
143
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
144
What colour is discharge with trichomonas?
Yellow-green frothy
145
At which mmol is giving biscuits okay to a diabetic with low blood sugar?
Over 4mmol
146
What is 1st line management of hypoglycaemic conscious patient?
Oral glucose gel
147
What is treatment for hypoglycaemia if oral glucose gel fails after 3 treatment cycles?
IM glucagon
148
What is the management of oral hairy leukoplakia
Refer to secondary care
149
How many days of treatment is recommended in men for UTI vs woman?
7 days in men and 3 days in women
150
In a near term pregnant woman with UTI what can yougive her?
Amoxcillin or cefalexin
151
Medication for bacterial meningitis?
Ceftriaxone
152
What is prophylactic for meningitis for contacts?
Ciprofloxacin single oral dose
153
What medication is used in pen allergic patients for meningitis?
Chloramphenicol is second line in patients with severe penicillin allergy
154
Which BP drug is contraindicated in heart failure?
CCB except amlodipine
155
Why is beta blockers and verapamil an issue together ?
Can cause severe brady
156
What type of CCB is amlodopine?
Dihydropyridine
157
Give an example of non dihydropyridine CCB?
Ditiazem
Verampamil
158
What is target INR for aortic valve replacement vs mitral?
Aortic - 3
Mitral 3.5
159
What is the dose of adrenaline to be used in cardiac arrest?
1mg-10ml 1:10000 IV or 1ml
160
What reaction is commonly known about for metronidazole?
Reaction with alcohol
161
Which antibiotic lowers seizure threshold?
Ciprofloxacin
162
Which collagen is affected in osteogenesis imperfecta?
Type 1 collagen
163
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
164
What is surgery for tumours located more than 8cm away from anal margin?
anterior resection
165
What is surgery for tumour located less than 8cm away from anal margin?
Abdomino-perineal resection
166
What is management for traumatic tension pneumothorax?
Wide bore cannula into 5th intercoastal space in mid axillary line
167
If there is dorsal displacementof distal fragment of radius what fracture is this?
Colles
168
What is bolam test?
Standard of care should be judged based on that of ordinary doctor not specialist
169
Who mainly gets chondrosarcoma's?
Over 40 with pain and lump
170
What does ewing sarcoma look like on x-ray?
Onion peel
171
What does osteosarcoma look like on xray?
Sunburst
172
Where does ewing sarcoma usually occur?
Along long bone diaphysis
173
If fluffy popcorn appearance is seen on Xray which bone pathology is that?
Chondrosarcoma
174
Which pole (distal or proximal) is avascular necrosis due to scaphoid fracture associated with?
Proximal pole
175
What is most common type of carpal bone fracture?
Scaphoid
176
If ABG in COPD patient shows normal co2 what are the oxygen saturation targets?
94-98%
177
What is the antidote to benzo overdose?
Flumazenil
178
How can a benzo overdose present?
Slurred speech
Ataxia
Drowsy
179
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
180
What is first line management for a symptomatic large (more than 2cm ) pneumothorax?
Aspiration
181
What is diagnostic test for hirshprung disease?
Rectal biopsy at least 1.5cm above the pectinate line
182
What pH after paracetamol ingestion is grounds for a transplant?
pH less than 7.3 24 hours after overdose
183
What are 4 grounds for liver transplant except pH after paracetamol overdose?
1. Prothrombin time over 100 secs
2. Creatinine over 300 umol
3. grade 3 or 4 encephalopathy
184
On blood test what is serum copper like in Wilson's?
It's low - because all copper is in tissues rather then blood
185
What side effect does amitriptyline have when it comes to urine?
Urinary retention
186
For a person with a AA 3-4.4 cm what is management?
12 monthly US
187
For a person with 4.5- 5.4 cm AA what is management?
3 Monthly US
188
What is first line medication for giardiasis?
Metronidazole
189
What is characteristic findings of giardisis?
Rose petals on stool microscopy
diarhhea and cramps
190
What are the signs and symptoms of boerhaave syndrome?
Subcut emphysema
Pleural effusion - usually left sided
Severe chest pain and vomiting
Hamman sign
191
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
192
What milk should be used in baby with potential cow milk intolerance?
Hydrolysed milk
193
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
194
What is most appropriate diagnostic test for neuroleptic malignant syndrome?
Creatinine kinase
195
When is abortion allowed in the uk for normal baby vs defect baby?
Normal - under 24 weeks
Defect - anytime
196
What feature of c. diff makes it hard to destroy?
Spore formation
197
What is management of someone with MS who has neuropathic bladder?
Intermittent self catheter
198
Which anti hypertensive is known to cause ankle swelling?
Amlodipine
199
Which anti hypertensive is known to cause a cough?
ACE inhibitors
200
What is most common nephrotic syndrome?
Membranous nephropathy
201
What would biopsy show with membranous nephropathy?
Subepithelial immune complex deposits
202
What is the most common nephrotic syndrome in children?
Minimal change disease
203
What indicates pseudohypoparathyroidism?
High parathyroid
Low calcium
With no renal issues
204
What classification system is used to stage cellulitis?
Erons classification
205
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
206
Other than urine output dropping below 0.5 ml/kg an hour what else is a sign of AKI?
Creatinine rise 1.5x baseline
207
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
208
What causes waterhouse-friderichson syndrome
Neisseria meningitidis (usually) cause disseminated intravascular coagulation (DIC), leading to widespread clotting and bleeding, including in the adrenal glands.
209
which levels are elevated in sarcoidosis?
Serum ACE and hypercalcaemia
210
What is genotype of turner syndrome?
45XO
211
What is virchows triad?
Hypercoagulability
stasis
vessel wall injury
212
Can topical chloramphenicol be used in pregnant women?
No - can cause neonatal grey baby syndrome
213
Which nerve is implicated in carpal tunnel?
Median nerve
214
If median nerve implicated what area of body sensation is altered?
lateral 3.5 digits
215
What is the most common cause of viral myocarditis?
Coxackie B virus
216
What is gold standard test for CF?
Sweat test
217
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
218
Which nerve supplies the superior oblique?
Fourth nerve - trochlear
219
Which nerve supplies the lateral rectus?
6th nerve - abducens
220
Which tumour markers are elevated in testicular teratoma?
AFP
HCG
221
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
222
What is the most effective way to reduce contrast induced nephropathy?
Saline before and after the surgery
223
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.
224
What is hallmark on cytology of brachial cyst?
Presence of cholesterol crystals
225
Difference in location of thyroglossal vs bracial cyst?
Brachial:lateral
Thyroglossal : midline
226
What is correct site for epidural?
L2-L3 or L3-4
227
What is treatment of hypotension due to epidural?
1L hartmanns over 20 mins
228
When is fibrinolysis indicated in MI patients?
If PCI over 120 mins
229
What is vitamin B3?
Niacin
230
What is deficiency of niacin called?
Pellagra
231
What are symptoms of pellagra?
4 D's :
Diarrhea
Dementia
Dermatitis
Death
232
If a patient comes in with hyperpigmented band around neck what is it called and indicates?
Casals necklace: chronic alcohol excess
233
What creatinine kinase is used for MI?
CK-MB - myocardium one
234
What Creatinine kinaseis for skeletal muscle?
CK-MM
235
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
236
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
237
What is first line treatment for focal seziure?
Lamotrigine
Leviteractam
238
Which is the main lymphatic drainage of the ovary?
Para aortic nodes
239
What is the most common pathogen involved in cellulitis?
Streptococcus
240
In someone with cardiac disease what is fluid maintence rules?
20-25ML/kg
241
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
242
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
243
What action of trazadone means it causes priapism
a adrenergic blocking activity
244
What is peri op advice for aspirin and clopidogrel?
Stop 7 days before surgery
245
What is peri op advice for bisoprolol?
Take even on day of surgery
246
What score is used to calculate risk of major bleeds in patient with anticoag?
ORBIT
247
What is hasbled score?
assess the risk of major bleeding in patients with atrial fibrillation (AF) who are being considered for anticoagulation therapy
248
What is cullens sign?
Bruising in perumbilical region
249
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
250
If a patient takes more than 20mg of pred a day what is operative strategy?
IV hydrocortisone during induction and usual morning dose
251
When is Electrocardioversion used in AF management?
If the AF onset is within 48 hours.
252
Following electrocardioversion for AF how long should person be on anticoag?
3 weeks prior and 4 weeks after
253
What is first line medication for acute prostatitis?
Oral ciprofloxacin
254
Which BP medication can cause hyperkalaemia and why?
ACEs as they block action of aldosterone
255
What is gold standard for diagnosing coeliac?
Endoscopy with duodenal biopsy
256
What is treatment for staph scalded skin syndrome?
IV flucloxacillin and topical fusidic acid
257
What is medical treatment for toxic shock syndrome?
IV clindamycin and meropenem
258
What is management of a patient with Angina still experiencing angina after beta blocker or CCB?
Switch to the other vice versa
259
Which ECG sign is most specific for pericarditis?
PR depression
260
What mustthe serum osmolality be in HHS?
Greater than 320/kg
261
What is diagnostic test for carcinoid tumour?
Urinary 5-HIAA
262
Diagnostic test of phaeochromacytoma?
Urinary VMA - VMA is breakdown of catecholamines
263
What is treatment of severe crohns?
Infliximab
264
What is treatment for severe UC?
Ciclosporin
265
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
266
What is diagnostic test for hereditary spherocytosis?
Eosin - 5 - maleimide binding test
267
What are fibrinogen levels like in DIC?
Low
268
What is the treatment for oculogyric crisis?
Procyclidine
269
What is first line management for achlasia then second line if surgery not okay?
Surgical myotomy
Botulinum toxin
270
What scan is used to detect meckels diverticulum ?
Technetium scan 99
271
What is the symptoms of meckels diverticulum?
Abdo pain + rectal bleeding
272
Which chromosome is involved in digeorge?
22q11.2 deletion
273
Is electrocution a recognised cause of posterior shoulder dislocation?
Yes
274
What is staining for amyloidosis?
Apple green birefringence when stained with congo red under polarised light
275
What collagen is affected in ALport syndrome?
Type 4
276
What is symptoms of alport syndrome?
Kidney disease
Visual issues
Hearing loss
277
Which drug overdose presents with resp alkalosis ?
Aspirin
278
Where is there a swelling is osgood schlatter disease?
Tibial tuberosity
279
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
280
What pathogen causes hand foot and mouth?
Coxackie virus 16
281
Which pathogen causes scarlet fever?
Strep pyogenes
282
What are the symptoms of intussusception?
Severe colick pain
Vomit
Passage of blood stained mucus
Target sign on ultrasound
Palpable mass on abdomen
283
What is management of intussussepsion?
Rectail air or contrast enema
284
What does thiazide diuretics do to sodium and chloride?
Reduce active reabsorption in distal tubules
285
What is diagnostic investigation for thalassaemia?
Haemoglobin electrophoresis
286
What haemoglobin is found to be increased in thalassaemia?
HbF or HbA2
287
What genetic mutation is involved in fragile X syndrome?
CGG trinucleotide repeat expansion in FMR1 gene
288
What can a mass superiour to ischium on rectal exam indicate?
Obturator hernia
289
What abnormality in pregnancy is created with lithium use?
Ebstein anomaly
290
How long does it take for transient tachypnoea of newborn to dissapear?
72 hours
291
What can help prevent air emboli whe inserting a central line?
Trendelenburg position - lie 15 degrees down
292
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
293
What is investigation of hydrocephalus?
MRI or CT head
294
If there is a young patient with paroxysmal AF what is treatment?
Oral flecainide or sotalol
295
When is a carotid endarterectomy needed?
If carotid artery stenosis is 70-99% with symptoms such as stroke or TIA in corresponding areas
296
What is the most common cause of HAP?
Pseudomonas aerginosa
297
In patients with sjorgens disease which tubuar acidosis is common?
Renal tubular acidosis type 1 : hypokalaemic, hyperchloraemic, with a normal anion gap
298
How often should patients with low grade dysplasia due to barrett's have endoscopy?
Every 6 months
299
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
300
Which cancer is increased if you have PBC?
Hepatocellular carcinoma
301
Which antibodies are present in PBC?
Anti-mitochondrial
302
What cancer is increased risk of having if you have PSC?
Cholangiocarcinoma
303
What antibodies are seen in PSC?
Anti nuclear - ANA
304
What is the most common cause of renal cell cancer?
Renal clear cell carcinoma
305
Which renal cell cancer is usually seen in young men with sickle cell?
Renal medullary carcinoma
306
Which scoring system is used to assess patients risk of developing a pressure ulcer?
Waterlow score
307
Which mental health medication can cause SIADH?
Citalopram - SSRI's!!!
308
What is first line pharma treatment for idiopathic intracranial hypertension?
Acetazolamide it reduces the CSF
309
What is phosphate, calcium and ALP like in paget?
ALP is raised. everything else is normal
310
In osteomalacia what is calcium, alp and phosphate like?
High ALP, low calcium, low phosphate
311
In osteoporosis what is the bone profile?
Normal
312
What metabolic disorder does vomiting and diarrhea cause?
Vomiting - alkalosis
Diarrhea - acidosis
313
What is first line treatment of atrial flutter?
Bisoprolol
314
First line medication for toxoplasmosis?
IV pyrimethamine and sulphadiazine
314
If HIV patient has single ring enhancing lesion what is this ?
Brain abscess
315
What is treatment for brain abscess?
IV ceftriaxone and metronidazole
316
What sign is most apparent for babies to know they have congestive heart failure?
Hepatomegaly
317
Which antibody test is first line in coeliac then second line?
First line anti-ttg -IGA then the IGG ones
318
What is treatment of guttate psoriasis?
Topical emollient and reassurance
319
What is mechanism of action of tamsulosin?
Alpha blocker - relaxes protastatic smooth muscle
320
What is mechanism of action of finasteride?
5-alpha reductase inhibitor that shrinks prostate
321
What are symptoms of potter's syndrome?
Twisted posture baby
Dysplastic kidneys
Bbay is squashed due to oligohydramnios
322
What measure is used to confirm that tube for anaesthetics is in right place?
End tital CO2
323
Is allopurinol an inducer or inhibitor of CYP450?
Inhibitor
324
Does hyper or hypokalaemia increase risk of digoxin toxicity?
Hypokalaemia
325
What is definitive imaging of chronic pancreatitis?
MRCP
326
What is faecal elastase levels in pancreatitis?
Low levels due exocrine pancreatic dysfunction
327
What is mechanism of action dipyridamole?
Anti-platelet - PDE3 enzyme inhibitor
328
What is mechanism of action of warfarin?
Vitamin K inhibitor
329
Which area is McBurney sign felt in?
RLQ - 1/4 from asis to umbilicus
330
What is Rovsing's sign?
When LLQ palpated RUQ feels pain
331
What does WHO recommend for breastfeeding?
Exclusive breast fed for 6 months then combo of breast food and food for 2 years or beyond
332
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
333
When does progesterone peak in a womans cycle?
7 days after ovulation
334
What BP is needed to start labetalol in pregnant woman?
150/100 - 159/109 and above
335
If pregnant woman BP is 140/90 -149/99 what is management?
Admit to hospital and monitor
336
What are the risk factors for endometrial cancer?
Obesity
Diabetes
Hypertension
337
Where does a cervical carcinoma metastases to in terms of lymph nodes?
Pelvic lymph nodes along iliac arteries
338
What is the features of felty syndrome?
Rheumatoid arthritis
Swollen spleen
Decreased white cell count
Repeated infections
339
At what age in a upper GI endoscopy urgently required if patient has weight loss and new reflux?
Over 55
340
When is percutaneous nephrolithotomy done?
Renal calculi in renal pelvis
341
Which cells in which organ produce intrinsic factor?
Parietal cell in the stomach
342
What is the increase in amylase required for pancreatitis to beexpected?
3x UPPER LIMIT OF NORMAL
343
What is genotype in kleinfleters?
47 XXY
344
What is diagnostic markers for kleinfelters?
FSH> LH
345
Which conditions is argyll robertson pupils seen in?
nEUROSYPHILLIS and diabetes
346
What is the cushing's triad?
Increased blood pressure
Bradycardia
Irregular breathing
347
Which diabetes drug class is associated with hypoglycaemia?
sulfonylurea
348
Which diabetes drug class is associated with euglycaemic DKA
SGLT2
349
What are features of an anastamotic leak?
Rigid abdomen
Purulent abdominal drain
Tachycardia
Fever
350
What is imaging for anastamotic leak?
CT abdo pelvis with contrast
351
How is pancreas pseudocyst diagnosed?
Ultrasound or CT -
352
What size pseudocyst of pancreas needs drainage?
more than 6cm
353
What medication can be used to prevent calcium stones?
Thiazide diuretic
354
What does a fourth heart sound suggest?
Forceful atrial contraction against a stiff hypertrophic left ventricle - this is seen in p wave
355
What is the ggram staining of clostridium perfringens?
gram positive
356
What is most likely causing organisms of gas gangrene
clostridium pefringens
357
which scar indicates a renal transplant?
Rutherford morrison scar
358
Which scar indicates liver transplant?
Mercedes benz scar
359
Which drug can cause gingival hyperplasia?
Ciclosporin - immunsuppressant
360
What is wellen's syndrome?
biphasic or deeply inverted T waves in V2-3, plus a history of recent chest pain now resolved.
361
What are the asthma guidelines?
1. ICS/ Formoterol
2. MART low dose
3. Moderate dose MART
FeNO testing - if eosinophils raised - refer to asthma clinic, if not then start a LTRA or LAMA
362
What fluids are important to give a pregnant woman with hypermesis gravidarum?
Thiamine
363
If pelvic floor and duoloxetine fails for stress incontinence then what can be trialled?
Colposuspension
364
In patients with simple anal fistulas what is management?
Surgical fistulotomy
365
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
366
Which muscle issue causes scapula winging?
Serratus anterior
367
Which nerve innervates the serratus anterior?
Long thoracic nerve
368
Which nerve innervates the supraspinatus muscle?
Suprascapular
369
What is the meaning of leukocoria?
White pupillary reflex
370
What are the features of retinoblastoma?
Leukocoria
Strabismus
Decreased vision
371
Which gene is indicated in retinoblastoma?
RB1 gene
372
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
373
What is first line management for haemostasis in rectal bleeding caused by angiodysplasia?
Colonscopy
374
Which nerve damage would cause weakness in plantar flexion?
S1
375
What is the sensory loss with deep peroneal nerve injury?
first web space loss
Foot drop due to weakness with dorsi flexion
376
Which antiemetic can cause an acute dystonic reaction?
Metroclopromide becasue of it's anti-dopinaminergic activity
377
Which diuretic can cause hypercalcaemia?
Thiazide
378
What is best prognostic marker for live failure?
Prothrombin time - gives an indication of clotting ability
379
What drugs cause QT prolongation?
THE MASC
Terfenidine
Haloperidol
Erythromycin
Methadone
Amiodarone
Soltalol
Chloroquine
380
What are LH levels like in meopausal/perimenopausal women?
Basal LH levels are increased.
381
What morphology is seen in glomerunephritis?
epithelial crescents in bowman s capsule
382
What is seen on morphology in minimal change c=disease?
Podocyte effusion and effacement of podocyte process
383
What is seen on histology in lewy body dementia?
Alpha synuclein cytoplasmic inclusions
384
Where is hippocampus located?
Temporal lobe
385
What gene is implicated in reactive arthritis ? (reiter's) syndrome?
HLA-B27
386
What is perthes disease?
Avascular necrosis of femoral head in kids
387
What risk factors in SLE for avascular necrosis?
The long term steroid use
388
In what age range is a temp of 38 or higher a red flag?
3 months or less
389
Which antibiotic can cause pancreatitis?
Co-trimoxazole
390
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
391
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
392
What are features o fat ebolism?
Tachy
Tachypneoa
Hypoxia
Petechial rash
Confusion
Retinal haemorrhage
Esp caused by fracture of long bones
393
What is the xray finding in rickets?
Bowed femurs and widened epiphyseal plates
394
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
395
If axillary nerve is damaged where will sensation be impaired?
lower half of right deltoid muscle
396
Which nerve supplies dorsal webspace between 1st and second digit?
radial
397
Which test can elicit de quervains tenosynovitis?
Ulnar deviation of hand with thumb clasped in palm
398
Which type of brain bleed has a lucid period after incident?
Extradural haematoma
399
What nerve is affected in cubital tunnel syndrome?
Ulnar - ring finger and little finger issue
400
What difference btween hypothenar eminence vs thenar eminence ?
Thenar - fleshy bit below thumb. hypothenar is below little finger
401
which fracture in hand would elicit tenderness in anatomical snuffbox?
Scaphoid
402
If there is tenderness over hypothenar eminence which fracture indicated?
Hook of hamate
403
Do children with HFAMD need to be excluded?
No as long as they feel well enough
404
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)
405
Which infection can cause post infectious glomerulonephritis?
Strep
406
What is histopathology of post infectious glomerulonephritis?
subepithelial humps
407
What hair related side effect is associated with ciclosporin?
hypertrichosis
408
What zones are usually fibrosed in sarcoidosis?
Upper
409
Which zones are usually fibrosed in SLE?
Lower
410
Prior to PCI when is supplemental oxygen given?
Below 90% saturations
411
What is the mechanism of action of anti-platelts?
P2Y-12 receptor inhibitor
412
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
413
What is management principles of UC flare?
IV fluids + IV hydrocortisone + LMWH
414
What is surgical management of bleeding oesophageal varices?
Band ligation
415
What drug is given to prevent rebleeds of varices?
Propranalol
416
where is iron and calcium absorbed
duodenum
417
Which organ is b12 absorbed in?
Terminal ileum
418
What is a long term risk of sulfasalzine use?
pancreatitis
419
What is management of critical limb ischaemia?
Urgent referral to vascular surgeons
420
What level of carboxyhaemoglobin level is poisoning?
Over 10%
421
Which blood test should be used to test for haemochromatosis?
Serum transferrin
422
Does thiazide diretics cause hypo or hyper natraemia?
Hyponatraemia
423
Where can the pain be felt in ruptured aortic anyeurysm
illiac fossa pain, and if person is obese may not feel pulsatile mass
424
What are the characteristic features of whipple's disease?
And what is seen on staining
Diarrhea
Polyarthropathy
Acid Schiff positive on duodenal biopsy
425
What medication should a person with heart failure less than 40% be started on?
ACE inhibitor and aldosterone antagonist (spirnalactone)
426
What is treatment for tension pneumothorax vs spontaneous?
Tension - needle decompression
Spontaneous - chest drain
427
Which antibodies are found with PSC?
C-anca and smooth muscle antibodies
428
Which anti emetic is contraindicated in heart failure?
Domperidone
429
In cardiac arrest if adrenaline can't be given IV then how should it be given?
Intraosseous access via proximal humerus or distal tibia
430
When is terlipressin stopped after given for a variceal bleed?
once definitive haemostasis has been achieved or after five days
431
Which murmur would be present in a carcinoid tumour?
Holosystolic murmur - tricuspid regurg
432
What is mechanism of action of amiodarone?
Blockage of voltage gated potassium channels
433
What do thiazide diuretics do to lithium conc?
Keep it in circulation for longer as it reduces lithium clearance
434
Which medication can be given to reduce meniere episodes?
Betahistine - histamine analoge
435
Which medication can be used to manage acute vertigo symptoms?
Prochloperazine
436
Which vaccine is recommended with people with sickle?
Annual influenza
437
What are the features of henoch schonlein purpura?
Joint pain
Abdo
Rash
Kidney impairment
438
What is compression rate for paed life cpr?
15:2
439
Which gene is indicated in malignant hyperthermia?
ryr1 due to uncontrolled release of calcium for sarcoplasmic reticulum leading to sustained muscle contraction
440
What is the antidote for malignant hyperthermia?
IV dantrolene
Cooling fluids
441
What can trigger malignant hyperthermia?
Suxamethonium
Other volatile anaesthetic agents: sevoflurane, isoflurane
442
Which nerve is paralysed if ulnar nerve is damaged?
Adductor pollicis muscle - positive froments signs
443
What is the most common subtype of lung cancer?
Adenocarcinoma
444
What are the risk factors for pseudogout?
Osteoarthritis
Trauma
Hyperparathyroidism
Haemochromatosis
Electrolyte imbalances
445
What tumour is associated with Sjorgens?
Marginal cell lymphoma - MALT
446
What is the ABG outcome in Anorexia?
Metabolic alkalosis
447
In babies over 32 weeks what medium should rescue breaths be delivered with?
Air
448
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
449
What is the barlow sign?
Hip displacement - evil gary barlow - in and down on joint
450
What is ortanli sign?
Realigning hip - out and out
451
What is first line management for atelecstasis?
Chest physiotherapy
452
What are features of atelectasis?
Bilateral dullness and mild pyrexia
453
In which patients is flecainide contraindicated for AF?
Structural heart disease
454
Which antibiotic is associated with achilles tendinopathy? and tendon rupture
Ciprofloxacin
455
Which nerves are affected in thoracic outlet syndrome?
brachial plexus is compressed or the subclavian vessels.
456
What is a common symptoms of thoracic outlet syndrome?
Trapezius pain
457
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
458
Which imaging is used for meckels diverticulum?
Technetium scan
459
What is imaging for malrotation in babies?
Upper GI contrast study
460
What are features of malrotation in babies?
Bilious green vomiting a few days after birth
461
What is the rate of chest compression to breaths in neonates?
3:1 - reassess heart rate every 30 secs
462
For a women who wants to be pregnant with fibroids what is treatment?
Myomectomy
463
In woman with fibroids who doesn't care about pregnancy what is treatment?
GnRH analogues to shrink the fibroids
464
What is medical management of PID?
PO doxy, Im ceftriaxone, PO metronidazole for 14 days
465
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
466
What is the danger of back to back on the heart ?
Can cause tachycardia
467
If back to back nebs are given what electrolyte abnormality does that cause?
Hypokalaemia
468
What is drug treatment of anterior uveitis?
Topical steroids - atropine/cyclopentalone
469
What is offered after metformin not working great?
SGLT-2 like flozin
470
What is the most common type of renal stone made from?
Calcium oxalate
471
Which cells are high in acute intersitial nephritis?
Eosinophils
472
Which antibiotics can cause acute interstitial nephritis?
Beta lactams - cephalosporins
473
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
474
Which antibodies are most likely to be found in a lupus patient?
Anti-nuclear antibodies - this is the most sensitive
475
What is most specific antibody for lupus ?
Anti-smith and anti ds-dna
476
What is found with genitals with congenital adrenal hyperplasia?
Fused labia and urogenital sinus
477
If you hear tinkling bowel sounds in thoracic cavity what is most likely diagnosis?
Diaphragmatic hernia
478
What's a specific signs in neonates of opiod withdrawal?
Yawning
479
What is chorioamnionitis?
Placental infection can occur following invasive testing and presents with fever and foul smelling discharge
480
If NSAIDs dont work for ankylosing spondylitis what is then offered?
Infliximab - anti TNF
481
Which chemo drug is likely to cause cardiomyopathy?
Doxorubicin
482
What is management of retinoblastoma that is confined to the eye?
Enucleation - removal of the eye
483
What is koebner phenomenon?
Polygonal plaques with white striae at sties of injury
484
How is koebner phenomenon managed?
Topical corticosteroids
485
What is treatment for c.diff including route?
Oral Vanc
486
What is first line management for pseudomonas?
Ciprofloxacin
487
Which TB drugs are inducers vs inhibitors?
Rifampicin - p450 inducer
Isoniazid - inhibitor
488
Which epilepsy drugs are p450 inducers vs inhibitors?
Carbamezapine - inducer
Na valproate - inhibitor
489
Which fruit is a p450 inhibitor?
Grapefruit
490
On a forest plot what does the diamond touching solid vertical line mean?
Overall outcome is not statistically significant
491
What is haptoglobin and what does a low amount mean?
Specific marker for haemolysis, low level - suggest haemolysis - this occurs in HELLP syndrome
492
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
493
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
494
Which pathogen looks like a bunches of grapes on histology and is gram positive diplococci?
Staph aureus
495
What investigation must be done before a patient starts on trastuzumab?
ECHO and cardiomyopathy may occur
496
When is a valve replacement warranted?
If left ventricular ejection fraction is less than 55%
497
What is the most likely pathogen causing diarrhoea in a HIV patient?
Cryptosporidium parvum
498
What is an example of a sedative antihistamine?
Chlorphenamine - give loratidine instead if they can't have a sedating effect
499
What is treatment for bowen's disease - SCC?
5 fluoruracil
500
What drug should be stopped before contrast CT and why?
Metformin because it can react with the contrast to cause contrast induced nephropathy
501
What is most effective medication to treat albuminurea?
ACE inhibitors
502
What eGFR would stop duoloxetine being used?
Below 30
503
What is first line treatment for diabetic neuropathy pain?
Duloxetine - if contraindicated then use amitryptiline
504
What is diagnostic investigation for painless haematuria in a smoker?
Flexible cystoscopy
505
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
506
What is the gold standard vessel for a CABG?
Internal thoracic artery
507
What can be used for acute moderate mountain sickness?
Acetazolamide
508
What gene mutation is polycythaemia vera associated with?
JAK2
509
Which antipsychotic is recommended for Parkinson patients?
Quetiapine
510
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
511
What is found on ECHO in takotsubo cardiomyopathy?
Apical ballooning with preserved basal function
512
What can cause hypomagnesium?
Chronic alcohol use
PPI
513
What characterises toxic epidermal necrolyis? and what is difference between steven johnson
more than 30% blistering, steven johnson less than 10%
514
What is first line investigation for salivary gland lithiasis?
Ultrasound of neck
515
What is treatment for a localised pancreatic cancer?
Whipple procedure
516
Out of bromocriptine and cabergoline which one is used for prolactinomas?
Cabergoline - cos u get a cab to bro's house so cab first
517
Which chromosome abnormality is seen with AML?
t8:21, tq22:q22
518
What is first line management for acute otitis externa?
Topical ciprofloxacin and hydrocortisone
519
What are the two key tests for brain death determination?
Neuro exam and apnoea test
520
What is most causative bacterial pathogen for meningitis?
Strep pneumoniae and neisseria meningitidis
521
What is hallmark of parkinson's in brain?
Degeneration of substantia nigra
522
What is first line test for TB?
Sputum fast acid bacilli smear
523
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
524
What is treatment for mycoplasma pneumoniae?
Azithromycin
525
What is another word for transitional cell carcinoma?
Urothelial carcinoma
526
If you see ragged red fibres, T2 hyperintensities in basal ganglia MRI what is likely diagnosis?
Mitochondrial encephalopamyopathy , lactic acidosis and stroke like episodes
527
For malignant bowel obstruction what can be a useful anti emetic?
Dexamethasone 4mg PO twice daily
528
What is an imporatn consideration to optimise ventilation and intubation ?
Pre-oxygenate with 100% oxygen
529
What is capgras syndrome?
Person thinks someone close to them has been replaced by an imposter
530
What is De clarebeut syndrome?
Person think celebrity or someone is infatuated with them
531
What is Ekbom syndrome?
Person thinks they are infested with parasites
532
What imaging is used for osteomyelitis?
MRI imaging
533
What bone issue is common in diabetic non healing ulcers?
Osteomyelitis
534
If breast feeding mum has a fissure vs no fissure what is treatment?
No fissure keep breastfeeding. Fissure - flucloxacillin
535
What is the treatment for ringworm?
Topical terbinafine
536
Which zone in protstate is exclusive for BPH?
Transition zone
537
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
538
What is first line treatment for MG?
Pyridostigmine
539
Is weight loss or gain seen in duodenal ulcers?
Weight gain as pain is made better by eating
540
In abdominal surgery which pain relief should be avoided an why?
Opiods as it can cause respiratory disease
541
Which marker is low in osteomalacia?
Serum 25 OH cholecalciferol
542
Which is the only tube that can seal trachea off and protect against aspiration?
Tracheal tube
543
What is best screening test for haemochromatosis?
Transferrin saturation
544
Which pathogenic infection would be a bad prognosis with people with CF?
Pseudomonas aerginosa
545
What is management of suspected wernicke's encephalopathy?
Parenteral thiamine
546
First line management of Impetigo?
Hydrogen peroxide. if not that then fusidic acid
547
What scale is used for pancreatitis severity?
Glasgow imrie
548
Which is score system for liver cirrohsis?
Child pugh
549
What is pathogenic cause of whooping cough?
Bordetella pertussis
550
How long is school exclusion for mumps?
Five days
551
What medication is used in subarachnoid haemorrhage?
Nimodipine
552
Which diabtetic medication is associated with vaginal thrush?
SGLT2 - they suppress glucose reabsorption
553
What is gold standard investigation for bowel obstruction?
CT with contrast
554
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
555
Which pathogen causes epiglotitis?
H influenzae type B
556
What is common cause of non -gonococchal urethritis?
Chlamidya and mycoplasma
557
What is a massive risk factor for transient tachypnoea of newborn?
C section
558
If pencil in a cup appearance is seen on radiograph what is likely diagnosis?
Psoriasis
559
Which joints are involved in psoariatic vs rheumatoid arthritis?
Psoariatic: DIP and asymmetrical
Rheumatoid: PIP and symmetrical
560
What is the law regading FGM under 18?
Doctor must report it to police within 28 days of discovery
561
What is treatment for CML?
imatinib and JAK inhibitor
562
When is amniocentitis done?
After 15 weeks
563
When is chronic villous sampling done?
11-14 weeks
564
When can COCP be restarted in breastfeeders?
After 6 weeks
565
Is contraception needed in first 3 weeks of birth?
NO
566
Which anti psychoticis least likely to cause galactorhea?
Ariprazole
567
At what GFR is metformin contraindicated?
Below 30
568
What is the diagnositc investigation of motor neurones disease?
Electromyography
569
At what week is sympheseal fundal height measured?
From 20 weeks gestation
570
What is management of breast abscess?
Urgent referral to hospital
571
What is is medication option for croup causing breathlessness and cough?
Oral dexamethasone
572
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
573
What type of brain cancer is an AIDS defining illness?
Primary CNS lymphoma
574
What does glioblastoma look like on radiology/?
Butterfly
575
What does meningioma look like on radiology?
Tail sign
576
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
577
If a pregnant woman under 20 weeks is asymptomatic to chicken pox what is treatment?
VZV immunoglobulins
578
What genetic mutation is affected in CF?
Delta F508
579
wHAT IS FIRST LINE MEDICATION FOR NEUROpathic pain in palliative care?
Gabapentinoid
580
What features characterise disseminated intravascular coagulation?
Low platelets
Elevated PT
Elevated APTT
Elevated D dimer
581
What is investigation for suspected cerebral oedema - can be caused by DKA?
CT head
582
583
What is Lemeirre syndrome
Infective thrombophlebitis can develop due to untreated bacterial throat infection
584
What is Lemeirre syndrome
Infective thrombophlebitis can develop due to untreated bacterial throat infection
585
What does the direct coombs test test for?
Autoimmune haemolytic anaemia
586
What is first line treatment for hip dysplasia?
Hip bracing
587
What is the mainstay of treatment for lithium toxicity ?
IV fluids
588
What do eyes look like in opiod withdrawal vs opioid overdose?
Over dose - pinpoints
Withdrawal - dilation
589
What is medical management of raynauds
Nifedipine
590
Is calcium high or low in tumour lysis syndrome?
Calcium is low
591
Which electrolytes are high in tumour lysis syndrome?
Potassium
Urea
Phosphate
592
What is most common tumour in parotid gland and is it benign ?
Pleomorphic Adenoma - benign
593
When is a G6PD enzyme assay taken?
3 months following an episode of acute haemolysis
594
What is an immediate test to do to work out if patient has immune mediated haemolytic anaemia ?
Direct anti globulin test - direct Coombs
595
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
596
What is first line medication for uterine stony causing post partum haemorrhage?
IV syntocinon - oxytocin
597
What is the management for conduct disorder ?
Child focussed programmes - available for children 9-14
598
When is the onset of jaundice in criggler najjar?
Less than 24 hours due to error in bilirubin metabolism
599
Which joints do pseudo gout more commonly present in?
Knees and wrists
600
What’s conversion rate of oral morphine to oral oxycodone
Divide by 2
601
What is most specific marker for in translating choldstasis of pregnancy ?
Bile acids
602
What is the medical management of acute limb ischaemia?
Unfractionated heparin and high flow oxygen
603
What is the starting dose of ramipril?
1.25mg then it’s gradually increased at two week intervals
604
Which dementia medication can cause third degree heart block?
Donepezil - complete dissociation of p waves and qrs complex
605
What is treatment for post herpatic neuralgia ?
Amittiptyline
606
What is medical management for leprosy
Rifampicin monthly and dapsone daily
607
If patient has AKI and present with a new pericarditis what is treatment?
Haemodialysis
608
What is treatment of COPD if patient does not have asthmatic features
LABA + LAMA
609
What is treatment of COPD if there is Asma this features e.d diurnal variation?
LABA + ICS
610
What is diagnostic test for necrotising facitis
Abdo Xray
611
What is diagnostic test for necrotising facitis
Abdo Xray
612
When is zoledronic acid used?
Manage hyper cal anemia caused by malignancy or pagets
613
What is additional management if head lice treatment is unsuccessful
Detection combing for entire household
614
What drug is used to treat head lice?
Malathion
615
What is the mechanism of action of ezetimibe?
Prevents intestinal absorption of cholesterol
616
What is mechanism of fibrates?
Increase triglyceride clearance
617
What test can be used to test for chronic kidney disease ?
Urine albumin to creatinine ratio
618
What is surgical management of a hiatus hernia?
Nissan fundoplication - gastric funded is wrapped around inferior oesophageal to prevent herniation of stomach
619
What is surgical management of a hiatus hernia?
Nissan fundoplication - gastric funded is wrapped around inferior oesophageal to prevent herniation of stomach
620
What is first line for acute limb ischaemia ?
IV heparin
621
What can be done if carbedopa and levodopa aren’t working as well anymore?
Add entacapone
622
Which IBD has skip lesions and cobble stone appearance ?
Crohns
623
How should acute relapses of MS be managed ?
Oral methyprednisolone for 5 days
624
When is beta interferon used in MS
If needing long-term treatment, if the patient has had two or more relapses in two years
625
What is the treatment for Guillian Barr syndrome?
Plasmapheresis and IVIG
626
What is the screening for hepatocellular carcinoma?
Six. Monthly liver, ultrasound and alpha-fetoprotein.
627
What is the first line treatment for idiopathic, pulmonary fibrosis if it is mild
Pulmonary rehab
628
What drug can be used in pulmonary fibrosis if severe : FVC 50-80%
Ninntedanib
629
Which patients should not be given flecainide?
Patients with ischaemic or structural heart disease
630
Which patients should not be given flecainide?
Patients with ischaemia or structural heart disease
631
If a beta blocker has not worked for atrial fibrillation, what is the next medication step?
Amiodarone for rhythm control
632
When is a lumbar puncture contra indicated in meningitis ?
Drop in GCS 3 or more showing raised ICP
633
What is the first line for preseptal cellulitis?
Oral Co amoxiclav
634
If osyient with pre septal cellulitis is pen allergic what is treatment
Oral clindamycin and metronidazole
635
Which side does uvula go in vagus lesion
Away from side of lesion
636
Which diabetic medication can cause fournier gangrene - it’s a type of necrotising fasciitis?
SGLT-2 - so the flozins
637
What is the mechanism of donepezil, gala at mine and rivastigmine ?
Acetylcholinesterase imhibitor
638
What is mechanism of action of memantine?
NDMA receptor antagonist
639
What is mechanism of action of memantine?
NDMA receptor antagonist
640
Which drug is used for motor neurones disease?
Riluzole
641
What drug class is riluzole
Benzothiazoles
642
What is seen on CT with bronchiectasis
Signet rings
643
What are the features of bronchiectasis?
Dyspnoea, fever, haemoptysis, purulent sputum production, recurrent pneumonia
644
What is first line treatment of psoriasis in young people?
Topical calcipotriol
645
What drug can be used to manage dermatitis herpetiformis?
Topical dapsone
646
Which lung cancer can cause, they raised calcium and why
SCC because these tumours can secrete PTH related peptide
647
What is the management of mastitis if there is fever nipple discharge
Oral fluixacillim
648
Which antibodies are involved in Hashimoto’s
Thyroid peroxidase antibodies
649
Which antibodies are involved in Graves’ disease?
TSH receptor antibodies
650
What is the most common cause of cellulitis?
Strep pyogenes
651
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
652
At what age should a child be sitting?
Eight months
653
What is the management for acute dacryocystitis?
Oral amoxicillin and clavulanate
654
What is management for chronic dacrycystits?
Dacryycrocystorhinoetomy
655
What must be ruled out first in a patient with temporary neuro dysfunction
Glucose - hypoglycaemia
656
What type of bacteria are patients with splenectomy at risk of?
Encapsulated bacteria like strep pneumonia
657
What antibiotic is used in spontaneous bacterial peritonitis?
Cefitaxime
658
What is first lime drug to manage ascites?
Spironolactone
659
When is amphotericin B used ?
Fungal cerebral abscess
660
What is scabies treatment ?
Topical permthrin
661
What is the most aggressive type of melanoma?
Modular melanoma
662
Which melanoma is slow growing
Lentigo maligna
663
Which melanoma is under nail on sole and palms
Actual leniginous
664
Which brain area is affected in huntingtons?
Basal ganglia striatum
665
Which area is alpha synuclein deposited in?
Primary motor cortex
666
Which organisms cause post splenectomy sepsis
Strep pneumonia
Haemophilia influenza
Menungococci
667
What is the management of ischaemic stroke within 4.5 hours
Thrombolysis with alteplase
668
What is ischaemic stroke management after 4.5 hours
Aspirin 300 mg no thrombolysis
669
What is FEV1/FVC ratio in restrictive lung disease ?
Normal
670
What size does the trachea shift is there is lung collapse
Towards the lung collapse
671
If eosinophilia casts are seen what kidney condition is this?
Tubulointerestitial nephritis
672
What is a direct complication of nephrotic syndrome?
VTE
673
Which drug can cause hypokalaemia?
Thiazide like diuretic
674
When is dexamethasone vs mannitol use for increased ICP?
Dexamethasone - brain tumours / more chronic
Mannitol- acute management of raised ICP like brain injury
675
What drug is used to treat a PE
DOAC
676
Can PPI cause hyponatraemia?
Yes
677
How long should people wait between first and second puff of inhaler?
30 secs
678
Which vaccine should be offered to high risk groups like homosexuals
HEP A
679
Give me two examples of a cycloplegic?
Atropine
Cyclopentolate
680
Features of anterior uveitis
Photophobia
Small, irregularly shaped pupil
681
What is the treatment of anterior uveitis ?
Steroids and cycloplegic drops
682
What indicates a exude tube pleural fluid
Protein level in pleural fluid more than 30. Educative is cancerous
683
What test must all men with erectile dysfunction have done?
Morning testosterone
684
What’s the diagnostic investigation for pancreatic cancer?
Abdo CT
685
I’m patients with severe alcoholic hepatitis what is treatment ?
Prednisolone
686
If high fibre diet , gtn lubricant and laxatives don’t work for anal fissure what is management
Spincterotomy
687
When is a seton suture used?
For anal FISTULAE
688
When is rubber band ligation used?
Haemorrhoids
689
What is consistency of stool in colostomy vs ileostomy?
Colostomy - more solid and formed
Ileostommy - liquid to semi solid
690
Difference between end and loop colostomy
End usually more permanent
Loop usually temp - to be teversed
691
What illness causes glandular fever (infectious mononucleosis)
EBV
692
What is diagnostic test for glandular fever - infectious mononucleosis
Monospot
693
What drug is used for first like In raynauds?
Nifedipine
694
Which drug is used for sun arachnoid haemorrhage
Nimidipine
695
What are high risk bite areas
Face
Hands
Genitals
Skin overlying cartilage
Area of poor circulation
696
What is treatment for human bite if drawn blood or on high risk area?
Co amoxiclav
697
Where is a chest drain inserted?
Base of Scilla lateral pectoral is major , 5th inter coastal space anterior latissimus dorsi
698
Which medication are known to exacerbate plaque psoriasis
Beta blockers
699
What is management of smoker in pregnancy
Nicotine replacement as buproprion and varenciline is contraindicated
700
What are sick day rules for Addisons?
Double the hydrocortisone but keep the fludrocortisone the same
701
What combo of drug is used in acute angle closure glaucoma?
Direct parasympathathomemtic and beta block eye drops
E.g. pilocarpine and Timolol
702
What are goblet cells like in crohns
Increased goblet cells
703
Features in UC
Crypt abscesses
704
What are the features of coecliac
Villus atrophy
Crypt hypertrophy
705
What happens if you give a patient with MG a beta blocker?
Can worsen MG and cause a drop in vital capacity
706
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
707
What’s the combo of drugs for secondary care post MI
APLBA
Aspirin
Prasugrel
Lisonipril
Bisoprolol
Atorvastatin
708
Which areas are affected by alzhiemers?
Cortex and hippocampus
709
What do img and igg antibodies mean in hepatitis
Igm more acute gradually turn into igg in chronic infection
710
What does hbsag marker mean
Positive if there is acute infection
711
What does anti HBS mean
Positive means body has cleared the infectioj
712
If ccb or beta blockers are contraindicated in patient with angina what can be used
Isorbide mononitrate
713
If ccb or beta blockers are contraindicated in patient with angina what can be used
Isorbide mononitrate
714
What is first like for patient with rosacea and severe applies or pustules
Topical ivermectin and oral doxycycline
715
When can an asthmatic be discharged after acute asthma attack?
PEF should be more than 75% of expected
716
If uteric stone is presenting with infection and hydronephrosis what is management
Nephrostomy tube insertion and IV antibiotics
717
How long do people have to wait to drive after a stroke or a TIA?
One month
718
How long do people have to wait to drive after a unprovoked seizures with no activity on EEG or structural abnormalities?
Six months
719
How long do people have to wait to drive if they have multiple TIAs over a short period?
3 months
720
How long does finasteride treatment for BPH take to see affect
6 months
721
Which diabetic drug is good in chronic heart, failure or cardiovascular disease
Sgl2
722
How long must patient wait before eating gluten again, before being tested for coeliac
6 weeks
723
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%
