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5th (Final year) > Gen Med 3 > Flashcards

Gen Med 3 Flashcards

1
Q

How does duodenal atresia present?

A

Non projectile bilious vomiting in the first few days of life

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2
Q

What condition is duodenal atresia associated with?

A

Downs

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3
Q

In a patient with longstanding diabetes (T1) what is most likely to cause decreased hypothyroidism awareness?

A

Autonomic neuropathy

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4
Q

What can you use to treat tardive dyskinesia?

A

Tetrabenazine

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5
Q

What can you use to treat tremor in drug induced parkinsons?

A

Procyclidine

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6
Q

What is coarctation of the aorta associated with?

A

Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis

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7
Q

How do you differentiate a prerenal AKI from an intra renal one?

A

Pre-renal will result in:
- High urine osmolality
- Low urine sodium

Renal (most common is acute tubular necrosis)
- High urine sodium
- Low urine osmolality

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8
Q

What bacteria is commonly associated with acne?

A

Propionibacterium acnes

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9
Q

How might a myxoedema coma present? What is it a complication of?

A

A complication of hypothyroidism

Presents with:
- Bradycardia
- Hypothermia
- Hypotensive

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10
Q

How do you treat myxoedema coma?

A

Hydrocortisone and levothyroxine

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11
Q

What electrolyte abnormalities can lead to a long QT?

A

Hypomagnesaemia
Hypokalaemia
Hypoclacaemia

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12
Q

Management of otitis externa?

A

If non severe
- Topical acetic acid

If more severe
- Topical antibiotic and steroid

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13
Q

ACE inhibitors and statins in pregnancy?

A

Not good

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14
Q

Major and Minor criteria for rheumatic fever?

A

Major:
- Erythema marginatum (pink, ring shaped)
- Sydenham’s chorea
- Polyarthritis
- Carditis and valvulitis (eg, pancarditis)*
- Subcutaneous nodules

Minor:
- Raised ESR or CRP
- Pyrexia
- Arthralgia (not if arthritis a major criteria)
- Prolonged PR interval

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15
Q

Persistent sterile pyuria and negative culture is suspicious of what?

A

Renal TB

Also look for recent travel history

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16
Q

Warfarin in breastfeeding?

A

Okay

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17
Q

Two main rashes in pregnancy? How do you tell them apart?

A

Polymorphic eruption of pregnancy
- Last trimester often
- Pruritic
- Small erythematous maculopapular

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18
Q

HTN treatment for diabetics?

A

ACEI first line regardless of age

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19
Q

What hormones change in a stress response?

A

Increased
- GH
- Cortisol
- Renin

Decreased
- Insulin
- Testosterone
- Oestrogen

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20
Q

What is Samters triad?

A

Association between asthma, nasal polyps and aspirin

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21
Q

Sick day rules for diabetes?

A
  1. Increase frequency of blood glucose monitoring to four hourly or more frequently
  2. Encourage fluid intake aiming for at least 3 litres in 24hrs
    If unable to take struggling to eat may need sugary drinks to maintain carbohydrate intake
  3. It is useful to educate patients so that they have a box of ‘sick day supplies’ that they can access if they become unwell
  4. Access to a mobile phone has been shown to reduce progression of ketosis to diabetic ketoacidosis

Insulin:
- Normal regime, with correcting doses (one sixth of normal, max 15 units)

Oral:
- Continue all, apart from metformin which you can consider taking off.

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22
Q

How do you manage diabetes post MI?

A

Stop oral drugs, start IV insulin infusion

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23
Q

What is the mechanism of nephrogenic diabetes insipidus, how do you treat?

A

Inability of the kidneys to respond to ADH, treated with thiazides

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24
Q

At what INR do you need to cover someone being treated for PE with immediate cover LMWH?

A

INR <2

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25
Q

First line management for mild acne?

A

Topical benzyl peroxide

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26
Q

Loop and Thiazide diuretics effects on electrolytes?

A

Loop - less (looss?) of everything
- Hyponatraemia
- Hypocalcaemia
- Hypokalaemia
- Hypomagnesaemia

Thiazide
- Hypokalaemia
- Hyponatraemia
- Hypercalcaemia

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27
Q

Special investigation for reflux nephropathy?

A

Micturating cystography

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28
Q

What is kussmauls sign?

A

Raised JVP that DOESN’T fall with inspiration

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29
Q

What bugs are most likely to cause endocarditis?

A

Gram positive cocci

Staph aureus
Staph viridans
Staph epidermidis

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30
Q

What is used to calculate the volume of IV fluid required post burn over the first 24hrs?

A

Parkland formula

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31
Q

What diuretic should be prescribed to patients after Beta blocker and Calcium channel antagonist? examples?

A

Thiazide-like (NOT thiazide)

e.g. Indapamide, chlortalidone

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32
Q

How can you differentiate spider naevi from telangiectasia?

A

If pressed naevi fill from the middle

Telangiectasia fill from the outside

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33
Q

What are the two GLP-1 mimics?

A

Exenatide

Liraglutide

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34
Q

What criteria for continuing GLP-1 mimic therapy do NICE have?

A

NICE like patients to have achieved a 11 mmol/mol (1%) reduction in HbA1c and 3% weight loss after 6 months to justify the ongoing prescription of GLP-1 mimetics.

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35
Q

How long do you watch and wait a perforated eardrum?

A

6 weeks

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36
Q

What medications can falsely lower BNP?

A

ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics can all falsely lower BNP levels, as can obesity.

Basically all the HTN drugs apart from Calcium channel antagonists

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37
Q

CXR findings for constrictive pericarditis?

A

Pericardial calcification

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38
Q

Bilateral and unilateral high stepping gait causes?

A

Bilateral
- peripheral neuropathy

Unilateral
- Common peroneal nerve injury

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39
Q

What is autonomic dysreflexia?

A

This clinical syndrome occurs in patients who have had a spinal cord injury at, or above T6 spinal level

The features are due to excessive sympathetic response below the level of injury without a coordinated parasympathetic counter-response resulting in excessive hypertension with flushing and sweating above the level of injury.

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40
Q

Features of inflammatory arthropathy?

A

Early morning stiffness (>20mins)
Stiffness that is worse after resting, eased by movement
Raised ESR CRP

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41
Q

Which of the hand joints are classically affected in RA and OA?

A

RA the more proximal MCP

OA the More distal Interphalangeal joints

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42
Q

What is the boutonniere deformity in RA?

A

Tendon splits like a button-hole

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43
Q

What is the swan neck deformity in RA?

A

Proximal interphalangeal joint is extended

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44
Q

Investigations for RA?

A

BOXES

Bloods
- FBC, CRP
- Renal and LFT
- Rheumatoid factor, Anti-CCP

O
- nil

XRAY
- Hands
- Feet

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45
Q

What is the treatment in Rheumatoid Arthritis?

A

DMARDS
- Methotrexate
- Leflunomide
- Sulfasalazine

In first presentation episode add in oral pred.

CRP and DAS 28 each visit

Biological
- Adalimumab

If not winning:

  • First increase dose
  • If not winning after 6 months DUAL DMARD
  • High level of disease activity - biological
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46
Q

Prior to prescribing a biological what tests do you need to run?

A

Check for TB
- Tuberculin skin test
- OR IGRA

(treat latent TB first)

CXR

Hep B, C and HIV serology

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47
Q

What condition is atlanto-axial subluxation associated with?

What are the risks?

A

RA

Sudden compression can cause cardiac arrest
- e.g. in theatre

Chronic
- cervical compression - resulting in spastic quadraplegia

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48
Q

Main differentials with RA?

A

RA
Psoriatic arthropathy
SLE
Osteoarthritis with inflammatory component

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49
Q

What is the series of colour changes in raynauds?

A

White, blue, then brick red.

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50
Q

What is the spectrum of disease in systemic sclerosis?

A

CREST is mild
- Calcinosis
- Raynauds
- Esophageal involvement
- Sclerodactyly (hands)
- Telangiectasia

Diffuse cutaneous scleroderma - more extensive
- Includes internal organs
- Microstomia
- Tethering of skin over nose
- Interstitial pulmonary fibrosis
- Renal involvement
- Atonic oesophagus

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51
Q

Three questions to ask in a possible systemic sclerosis history?

A

Do your hands change colour in the cold
Do you get breathless
Do you get indigestion or heartburn

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52
Q

Management of systemic sclerosis?

A

Nifedipine for raynauds

Methotrexate for skin

PPI for GI

ACEI for renal crisis

Bosentan or sildenafil for pulmonary hypertension

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53
Q

What are the different seronegative arthritis’?

A

Psoriatic
Reactive
Ankylosing spondylitis

Behcets and Juvenile idiopathic
Post dysenteric and enteropathic

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54
Q

What is HLA B27 associated with?

A

Ank spond

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55
Q

treatment for Pagets?

A

Bisphosphonate

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56
Q

What is the aetiology of polyarteritis nodosa?

A

Polyarteritis nodosa (PAN) is a vasculitis affecting medium-sized arteries with necrotizing inflammation leading to aneurysm formation.

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57
Q

What HLA is associated with RA?

A

HLA-DR4

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58
Q

What HLA is associated with ank spond and reiters syndrome?

A

HLA-B27

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59
Q

What is the most common join gout affects?

A

The most common joint that gout affects is the first metatarsophalangeal joint.

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60
Q

Classic clinical examination signs associated with ankylosing spondylitis?

A

Reduced lateral flexion
Reduced chest expansion
Reduced forward flexion (Schobers test)

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61
Q

What medication is predisposed to toxicity in Thiopurine methyltransferase (TPMT) deficiency?

A

Azathioprine

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62
Q

Genetic inheritance of marphans?

A

Autosomal dominant

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63
Q

What is osteogenesis imperfecta?

A

Brittle Bone Disease.

Autosomal dominant

Abnormality in type 1 collagen due to decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides

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64
Q

Neuroleptic malignant syndrome treatment?

A

Dantrolene

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65
Q

What is the main immunoglobulin in breast milk?

A

IgA

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66
Q

What is the advice for taking bisphosphonates?

A

30 mins before brekkie with lots of water and sit upright 30 mins after

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67
Q

Management steps for osteoarthritis?

A

Education, weight loss, muscle strengthening and aerobic fitness

Paracetamol or topical NSAIDS (hand or knee)

Oral NSAIDS/COX-2 inhibitors (with PPI)

Supports, braces, TENS and shock absorbing soles/insoles

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68
Q

Periarticular erosions in psoriatic arthritis are given what name?

A

Pencil-in-cup

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69
Q

What is dermatomyositis? Antibody? Presentation?

A

An inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions.

May be idiopathic or associated with connective tissue disorders or underlying malignancy

Anti-Jo1 antibody, also ANA

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70
Q

Advice for women wanting to conceive who are on methotrexate?

A

Must wait for 3 months after stopping methotrexate to conceive

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71
Q

Anticentromere antibodies positive in which condition?

A

CREST

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72
Q

Erythema marginatum associated most strongly with?

A

Rheumatic fever

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73
Q

CXR signs in late Ankylosing Spondylitis?

A

Apical fibrosis

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74
Q

Azathioprine would interact with what to produce severe bone marrow suppression?

A

Allopurinol
- Both inhibit xanthine oxidase

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75
Q

Scleroderma antibody?

A

Anticentromere

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76
Q

What is liddles syndrome?

A

Autosomal Dominant

hypertension and hypokalaemic alkalosis

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77
Q

Anyone who’s started on long term steroids osteoporosis risk management?

A

If >65 or previous fragility fracture:
- Offer alendronate and adcal

If <65 then offer DEXA
- Less than -1.5 then offer bone protection

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78
Q

Management of hepatic encephalopathy?

A

NICE recommend lactulose first-line, with the addition of rifaximin for the secondary prophylaxis of hepatic encephalopathy.

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79
Q

Glasgow scale of pancreatitis severity?

A

PaO2< 7.9kPa
Age > 55 years
Neutrophils (WBC > 15)
Calcium < 2 mmol/L
Renal function: Urea > 16 mmol/L
Enzymes LDH > 600IU/L
Albumin < 32g/L (serum)
Sugar (blood glucose) > 10 mmol/L

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80
Q

Antibody associated with drug induced lupus?

A

Antihistone

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81
Q

What is pellagra?

A

Pellagra is a caused by nicotinic acid (niacin) deficiency. The classical features are the 3 D’s - dermatitis, diarrhoea and dementia.

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82
Q

Key features of Multiple systems atrophy to distinguish it/

A

Autonomic dysfunction

Unilateral symptoms

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83
Q

Distinguishing feature between secondary and tertiary hyperparathyroidism?

A

High calcium and extremely high PTH in Tertiary. (hyperplasia of all glands following secondary hyperparathyroidism)

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84
Q

Classic presentation of NF2? (neurofibromatosis)

A

Bilateral acoustic schwannoma

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85
Q

What is Stills disease? (adults)

A

Typically affects 16-35 year olds

Arthralgia
Classic salmon pink rash
Fluctuating pyrexia (late afternoon/evening)

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86
Q

Causes of Gout?

A

Causes of Gout= DART
D- iuretics
A- lcohol
R- enal disease
T- rauma

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87
Q

What is Felty’s syndrome?

A

Felty’s syndrome is a condition characterized by splenomegaly and neutropenia in a patient with rheumatoid arthritis.

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88
Q

DKA classic triad of signs?

A

Acidosis
Ketosis
Hyperglycaemia

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89
Q

Clinical features of DKA?

A

Dehydration - Tachycardia and Hypotension
Kussmaul breathing
Smell of ketones
Vomiting and abdo pain
Some precipitating causes e.g. MI, Infection

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90
Q

Priniciples of DKA treatment?

A

Rehydration
Gastric aspiration (if vomiting or reduced GCS)
Insulin replacement
Potassium replacement

PANICS:
Potassium - measure hourly (omit if >5.5 or anuria)
Acidosis: check venous pH and Ketones
Normal saline - 500ml over 15mins if systolic <90, otherwise 1L in first hour
Insulin by infusion
Catheter and cultures, urine, blood etc.
Stomach aspiration if drowsy

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91
Q

What are the stages of diabetic retinopathy?

A

Background
- Maculopathy (location rather than severity)
Pre-proliferative
Proliferative
End-stage

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92
Q

What are the features of Background retinopathy?

A
  • Microaneurysms (dot haemorrhages)
  • Hard exudates (lipid leaking from microaneurysms)
    Blot haemorrhages

<3 Blot haemorrhages (like thumbprints)

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93
Q

Features of Pre-proliferative retinopathy?

A

Cotton wool spots (infarcts)

> 3 blot haemorrhages

Venous bleeding and looping

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94
Q

Features of proliferative retinopathy?

A

New vessels round disc

Peripheral new vessels

New vessels on iris

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95
Q

Features of end-stage proliferative retinopathy?

A

Vitreous haemorrhage (from fragile vessels)

Scarring

Retinal detachment

Blindness

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96
Q

What are the different Neurological manifestations of diabetic damage?

A

Peripheral neuropathy

Mononeuropathy (e.g III nerve palsy)

Mononeuropathy multiplex (more than one individual nerve trunk affected)

Diabetic femoral neuropathy - sudden onset wasting of quads

Autonomic neuropathy

Cerebrovascular disease

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97
Q

Peripheral thyroid status examination?

A

Lid retraction/Lid Lag

Clubbing and onycholysis

Fine tremor, moist palms

Tachycardia, AF

Biceps reflex - slow relaxation (hypo)

Proximal myopathy (stand from sitting)

Pretibial myxoedema

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98
Q

Graves disease Triad?

A

Goitre

Eye disease

Thyrotoxicosis

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99
Q

Graves disease treatment options?

A

Carbimazole low dose for 18 months then recheck

Block and replace

Surgery

Radioiodine

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100
Q

SWEDISH mnemonic for Cushings features?

A

Spinal tenderness
Weighty central obesity
Easy bruising
Diabetes
Interscapular fat pad
Striae
Hypertension

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101
Q

Hypothyroidism examination findings?

A

Gruff voice, slow cerebration

Coarse facial features

Dry, cold, scaly skin

Slow pulse and slow relaxation

Goitre in hashimoto’s

Myxoedema - hands, swelling of subcutaneous tissue

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102
Q

Special tests for diagnosis of cushing’s?

A
  1. 24hr urinary free cortisol
  2. Dexamethasone test
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103
Q

Causes of cushings syndrome?

A

Exogenous steroids

Pituitary adenoma (cushings disease)

Adrenal adenoma or carcinoma

Ectopic ACTH syndrome (paraneoplastic)

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104
Q

What type of tumours cause cushings and what type cause acromegaly?

A

Microadenoma - Cushings

Macroadenoma - Acromegaly

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105
Q

Hand examination findings in acromegaly?

A

Increased size of hands

Thenar eminence wasting in carpal tunnel syndrome
- Check median nerve distribution sensation

Sweating increased

Bogginess of palms

Skin fold increased in active disease

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106
Q

Face examination findings in acromegaly?

A

Prominent supraorbital ridges, big ears, nose and lips

Tongue may be big on protrusion

Prognathism - Protrusion of jaw (look from the side)

Wide separation of teeth - ‘show me your gums’

107
Q

Features of Acromegaly acronym?

A

ABDCEF

Arthropathy
BP high
Carpal tunnel syndrome
Diabetes
Enlarged tongue, heart, thyroid
Fields (bitemporal hemianopia)

108
Q

What is the medical treatment for Acromegaly (in prep for surgery)

A

Octreatide/Lanreotide

109
Q

Features of addisons (chronic)?

A

Non specific
- Fatigue
- Nausea
- Abdo pain
- Diarrhoea

Dizziness (postural hypotension)

Hyperpigmentation
- Buccal
- Hand creases

Hypoglycaemia

110
Q

Questions to ask in acromegaly history?

A

Headaches

Vision problems

Tingling in hands, at night

Tingling in feet (diabetic nephropathy)

Sweat easily?

Difficulty with sex - erectile dysfunction

Any increase in shoe, hat or glove size

111
Q

Pancoasts tumour features?

A

Horners syndrome
Upper lobe carcinoma
Wasting of small muscles of the hand
Pain felt in the axilla

112
Q

Pleural effusion findings on examination?

A

Reduced expansion on the side of the lesion

Stony dull percussion

Trachea normal

Air entry and tactile vocal fremitus reduces

113
Q

Common causes of pleural exudates?

A

Carcinoma of the bronchus

Infection: lobar pneumonia and TB

Pulmonary emboli

Rheumatoid arthritis

114
Q

Common causes of pleural transudates

A

HF

Nephrotic syndrome

Liver failure

115
Q

Main differences between an effusion and a collapse on examination?

A

Collapse
- Loss of lung volume
- Trachea deviated

Effusion
- Stony dullness
- Trachea central

116
Q

What can cause loss of lung volume?

A

(trachea is deviated towards affected side)

Pneumonectomy
TB and old treatments for TB
Unilateral fibrosis
Collapse of a lobe

117
Q

4 signs of severe asthma?

A

Unable to complete sentences in one breath
RR > 25
HR > 110
Peak Flow <50% predicted (or best)

118
Q

7 signs of life threatening asthma?

A

33-92 CHEST

  1. Less than 33% Peak flow
  2. <92% sats

CHEST

Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia (or brady)

119
Q

What are the findings of FEV1/FVC and transfer factor in restrictive lung disease?

A

FEV1 and FVC reduced, the ration is normal or increased

Transfer factor reduced in a pulmonary cause

Transfer factor normal if extra-pulmonary

120
Q

Extrapulmonary causes of restrictive lung disease?

A

Guillain barre

Respiratory depression

Flail chest

Kyphoscoliosis

Scleroderma of chest wall

121
Q

Causes of pulmonary fibrosis?

A

Upper causes: TB SPACE
- TB
- Sarcoid
- Pneumoconiosis
- Ank spond
- CF
- Extrinsic allergic alveolitis

Lower causes: Acid
- Asbestosis
- Connective tissue disease
- Idiopathic pulmonary fibrosis
- Drugs

Drugs: AMEN
- Amiodarone
- Methotrexate
- Ergot derivatives (cabergoline)
- Nitrofurantoin

122
Q

Drug causes of pulmonary fibrosis?

A

Drugs: AMEN
- Amiodarone
- Methotrexate
- Ergot derivatives (cabergoline)
- Nitrofurantoin

123
Q

Causes of clubbing and basal crackles?

A

Idiopathic pulmonary fibrosis
Bronchiectasis
Asbestosis

124
Q

Common organisms causing CAP?

A

Most common is strep pneumoniae

Haemophilus influenzae

Atypicals
- Mycoplasma
- Chlamydia
- Legionella (rare)

125
Q

Signs and symptoms of pneumonia?

A

Symptoms
- Fever
- Cough - may be productive
- Breathlessness
- Pleuritic pain
- In elderly may be confused

Signs (of consolidation)
- Reduced expansion
- Increased vocal resonance (fremitus)
- Dullness to percussion
- Reduced air entry
- Bronchial breathing
- Coarse crackles

126
Q

CURB 65 score made up of?

A

Confusion
Urea (>7)
RR >30
BP low

> 65 y/o

127
Q

Management of infective exacerbation of COPD?

A

24% O2 initially

(evidence of significant acidosis or rising CO2 level may indicate need for ventilation)

Salbutamol and ipratropium via air-driven nebuliser

Steroids - IV or orally

Repeat nebulisers

Consider IV aminophylline if still struggling and not on oral theophylline

IV fluids and Abx

128
Q

What is extrinsic allergic alveolitis?

A

Exposure to organic antigens in microbial spores. Presents acutely with fever SOB and crackles

Chronic exposure may lead to pulmonary fibrosis.

Either Framers lung (mouldy hay) or bird fanciers lung.

129
Q

Typical sequelae of asbestos exposure?

A

Pleural plaques, pleural thickening

Asbestosis (pulmonary fibrosis)

Carcinoma of bronchus (50x risk if also smoker)

Mesothelioma

130
Q

Presentation of Sarcoidosis?

A

Either acute (self-limiting) or chronic

Acute:
- Erythema nodosum
- Arthralgia
- Fever
- Hilar lymphadenopathy

Chronic
- Hilar lymphadenopathy
- Pulmonary fibrosis
- Tender swellings of fingers
- Facial rash
- Hypercalcaemia
- Facial nerve palsy, parotitis
- Anterior uveitis

131
Q

Causes of erythema nodosum?

A

Sarcoidosis
Strep infection
TB
IBD
Drugs - Sulphonamides. OCP

132
Q

Suspected lung cancer, CXR or similar investigations?

A

NICE recommends that patients with known or suspected lung cancer are offered a contrast-enhanced CT scan of the chest, liver and adrenals.

Biopsy after CT scan

133
Q

Features of Kartagener’s syndrome?

A

Primary ciliary dyskinesia

Dextrocardia
Quiet heart sounds
Bronchiectasis
Sinusitis
Subfertility

134
Q

What is Varenicline, what is it used for?

A

Nicotinic receptor partial agonist

Used to help stop smoking

135
Q

Why do you use inhaled corticosteroids in COPD?

A

Reduce the frequency of exacerbations

136
Q

Factors for Long term oxygen therapy?

A
  • Very severe airflow obstruction (FEV1 < 30% predicted).
  • Cyanosis
  • Polycythaemia
  • Peripheral oedema
  • Raised jugular venous pressure
  • Oxygen saturations less than or equal to 92% on room air
137
Q

Factors that determine whether chest drain should be placed in pulmonary effusion?

A

Frankly purulent/cloudy aspirate

Organisms identified

pH <7.2

138
Q

First things to rule out in status epilepticus?

A

Hypoxia and hypoglycaemia

139
Q

Most common complication following meningitis?

A

Sensorineural hearing loss

140
Q

Antiemetic for parkinson’s disease?

A

Domperidone - doesn’t cross BBB

141
Q

Can you take inhaled asthma drugs in pregnancy?

A

Yes, no problem

142
Q

Non-small cell cancer contraindications for surgery?

A

SVC obstruction

FEV < 1.5

MALIGNANT pleural effusion

Vocal cord paralysis

Mets

143
Q

Features of Wernicke’s encephalopathy?

A

CAN OPEN

Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy

144
Q

Cannonball lung tumours are mets from what cancer?

A

Renal Cell Carcinoma

145
Q

Symptom control in non-CF bronchiectasis?

A

Inspiratory muscle training + postural drainage

146
Q

What three interventions may improve survival in COPD patients?

A

Smoking cessation - the single most important intervention in patients who are still smoking

Long term oxygen therapy in patients who fit criteria

Lung volume reduction surgery in selected patients

147
Q

COPD criteria for LTOT on ABG?

A

LTOT if 2 measurements of pO2 < 7.3 kPa

148
Q

How do you classify the severity of COPD?

A

Done on the FEV1 freading, mild is normal (>80% with symptoms)

Moderate is FEV1 50-79%

Severe is 30-49%

Very severe is <30%

149
Q

How do you diagnose asthma in de=ifferent age groups?

A

Patients >= 17 years:

  1. Patients should be asked if their symptoms are better on days away from work/during holidays. If so, patients should be referred to a specialist as possible occupational asthma.
  2. All patients should have spirometry with a bronchodilator reversibility (BDR) test
  3. All patients should have a FeNO test.

Patients 5-16 years;

  1. All patients should have spirometry with a bronchodilator reversibility (BDR) test.
  2. A FeNO test should be requested if there is normal spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test.

Patients < 5 years:

  1. Diagnosis should be made on clinical judgement
150
Q

When should you use BIPAP and CPAP roughly speaking?

A

CPAP in Type One resp failue

BiPAP in Type two

151
Q

One way to differentiate microscopic polyangiitis and Churg-Strauss syndrome/Polyangiitis with granulomatosis?

A

Churg/Wegeners have sinusitis

152
Q

What is pott’s disease? How does it present?

A

TB in the bone

Back pain
Night sweats
Kyphosis
Weight loss

153
Q

Signs and symptoms of asthma?

A

Symptoms
cough: often worse at night
dyspnoea
‘wheeze’, ‘chest tightness’

Signs
expiratory wheeze on auscultation
reduced peak expiratory flow rate (PEFR)

154
Q

All patients with suspected/confirmed TB must also be tested for what?

A

HIV

155
Q

What COPD patients with exacerbations require abx?

A

Purulent sputum or signs of pneumonia

156
Q

What percentage increase in FEV1 is indicative of asthma?

A

An increase in the FEV1 of 12% or more after inhalation of a short-acting bronchodilator is indicative of asthma.

157
Q

Prescription and course length to settle an acute exacerbation of asthma (non severe, in community)?

A

Salbutamol nebs initially

Then Oral Pred for 5 days plus beclometasone inhaler.

158
Q

Two most common causes of bilateral hilar lymphadenopathy?

A

sarcoidosis and tuberculosis

159
Q

COPD patients with frequent exacerbations should be given what?

A

Home prednisolone and abx

160
Q

Causes of Acute Pancreatitis?

A

GET SMASHED

Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

161
Q

What is Whipple’s disease?

A

Whipple’s disease is a rare multi-system disorder caused by Tropheryma whippelii infection.

162
Q

Causes of metabolic alkalosis?

A

Diuretics
Vomiting / aspiration
Hypokalaemia
Cushing’s syndrome
Primary hyperaldosteronism
Bartter’s syndrome

163
Q

What is Peutz Jeghers syndrome?

A

Peutz-Jeghers syndrome is an autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract. It is also associated with pigmented freckles on the lips, face, palms and soles. Around 50% of patients will have died from a gastrointestinal tract cancer by the age of 60 years.

164
Q

What is FAP and gardners syndrome?

A

FAP is a rare autosomal dominant condition which leads to the formation of hundreds of polyps by the age of 30-40 years. gardeners syndrome is a variant that can lead to osteomas, thyroid cancers, retinal pigmentation and epidermoid cysts.

165
Q

How does BUdd-Chiari syndrome present, what is the pathophysiology?

A

Abdominal pain: sudden onset, severe
Ascites
Tender hepatomegaly

Hepatic vein thrombosis

166
Q

Metabolic consequences of refeeding syndrome?

A

Hypophosphataemia
Hypokalaemia§
Hypomagnesaemia
Abnormal fluid balance

167
Q

What do you need to give to patients prior to large-volume paracentesis for the treatment of ascites? Why?

A

Albumin infusion to prevent circulatory dysfunction

168
Q

Typical carcinoid presentation?

A

Flushing, diarrhoea, bronchospasm, hypotension, and weight loss

169
Q

What is the main investigation for carcinoid syndrome?

A

Urinary 5-HIAA

170
Q

What antibiotic do you give to cover for spontaneous bacterial peritonitis?

A

Ciprofloxacin

171
Q

What would lead you to want to give cover for spontaneous bacterial peritonitis with a patient with ascites?

A

Protein concentration <15g/L

172
Q

Most prominent symptom of Crohn’s disease in children and in adults?

A

Children - Abdominal pain

Adults - Diarrhoea

173
Q

Diagnostic requirements for Wilson’s disease?

A

Reduced serum caeruloplasmin

Reduced serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)

Increased 24hr urinary copper excretion

174
Q

Three notable foods that are gluten free?

A

rice
potatoes
corn (maize)

175
Q

Notable foods with gluten in it?

A

wheat: bread, pasta, pastry
barley*: beer
rye
oats**

176
Q

Antibodies in autoimmune hepatitis?

A

Anti-nuclear and/or anti-smooth muscle antibodies.

177
Q

What is a serum-ascites albumin gradient (SAAG) used to determine?

A

If the ascites is caused by portal hypertension or not

If it is above 11g/L then it is portal hypertension

178
Q

What is the iron study profile in haemochromatosis?

A

Raised transferrin saturation and ferritin, with low TIBC.

179
Q

In iron studies what do transferring, ferritin and TIBC represent?

A

Transferrin binds iron in the blood. If there is more iron in the body the saturation (of iron bound to transferrin) increases, and vice versa.

Ferritin is the iron store intracellularly. If there is more iron then there will be more ferritin.

TIBC (total iron binding capacity) the available binding sites on transferrin, this will decrease in iron overload.

180
Q

What are the factors that contribute to the Modified glasgow score (for severity of pancreatitis)?

A

PANCREAS

paO2
Age (55)
Neutrophilia
Calcium
Renal function
Enzymes
Albumin
Sugar

181
Q

Treatment for C.Diff?

A

first line - Metronidazole

Second - Oral Vanc

If life-threatening then oral vanc and iv Metronidazole

182
Q

What investigations do you need before fundoplication surgery?

A

Endoscopy

Barium swallow

pH monitoring

Manometry studies

183
Q

What is the surgical management of GORD?

A

Fundoplication - when medical management has failed

184
Q

How do you classify the severity of Ulcerative colitis flare ups?

A

Mild
- fewer than four stools a day (with or without blood)

Moderate
- 4-6 stools a day
- Minimal systemic disturbance

Severe
- >6 stools a day
- Evidence of systemic disturbance

185
Q

Why are coeliac disease patients given immunisations?

A

Functional hyposplenism

186
Q

What are the common types of oesophageal cancer?

A

Most common is now adenocarcinoma
- Commonly have history of Barretts

Squamous
- Achalasia

187
Q

Time in which patients with UGIB need an endoscopy?

A

If unstable then immediate

If stable then within 24 hours

188
Q

Triad of symptoms in intestinal angina (chronic mesenteric ischaemia)?

A

Severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit.

189
Q

Pseudomembranous colitis is associated with what bug?

A

C.Diff

190
Q

What cancers are patients at risk of developing with HNPCC?

A

Colorectal most common

Endometrial second most common

191
Q

What is the investigation of choice to detect liver cirrhosis?

A

Transient elastography

192
Q

What are the extra-intestinal manifestations of IBD?

A

Iritis

Arthritis

Erythema nodosum

Pyoderma gangrenosum

193
Q

Classic features of Crohn’s disease?

A

Both crohns and UC:
- Extra intestinal manifestations
- Diarrhoea

Crohns:
- Non-bloody diarrhoea
- Weight loss
- Abdo pain
- Skip lesions
- Inflammation all the way to the muscularis layer
- Granulomas
- Goblet cells
- Rose thorn ulcers

194
Q

Classic features of UC?

A

Both crohns and UC:
- Extra intestinal manifestations
- Diarrhoea

UC:
- Bloody Diarrhoea
- PSC
- Uveitis
- Colorectal cancer
- Continuous disease, starts at rectum
- Tenesmus
- Tumbprinting
- Leadpipe
Pseudopolyps

195
Q

Dr Clarke Mnemonic for Crohns disease presentation?

A

CAMPERS

Clubbing and cobblestone mucosa
Apthous ulceration
Mass in RIF
Perianal disease
Erythema nodosum
Rose thorn ulcers
Skip lesions

196
Q

Findings that suggest a fatty liver?

A

Raised LFTs, especially GGT

Highly echogenic liver on USS

197
Q

SIgns of Chronic liver disease and Liver cell failure?

A

Chronic Liver disease:
- Clubbing
- Palmar erythema
- Dupuytrens contracture
- Spider naevi
- Gynaecomastia
- Testicular atrophy

Liver cell failure
- Jaundice
- Leuconychia
- Bruising
- Ascites
- Encephalopathy

198
Q

Signs of Portal hypertension?

A

VASC

Varices
Ascites
Splenomegaly
Caput medusae

199
Q

How do you tell the difference between caput medusae and Vena cava obstruction?

A

In Caput medusae the veins flow outwards from the umbilicus

In Vena cava obstruction they all flow upwards

200
Q

Causes of ascites?

A

Cirrhosis
Hypoalbuminaemic states
Peritoneal secondaries
Constrictive pericarditis
Severe biventricular failure
Hepatic vein thrombosis
TB
Ovarian tumours

201
Q

Rule of M in primary biliary cholangitis?
Most common presenting feature?

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

Associated with lethargy and pruritis

202
Q

What is Courvoisier’s sign?

A

A palpable enlarged gallbladder is unlikely to be due to gallstones, likely to be cancer of biliary tree or pancreas.

203
Q

Cirrhosis changes seen in AST and ALT?

A

AST is >2.5 higher than ALT

204
Q

What is the most sensitive blood test to assess cirrhosis in chronic liver disease?

A

Thrombocytopenia

205
Q

Treatment for Wilsons?

A

Penicillamine

206
Q

What are the two triple therapy regimes associated with H.Pylori eradication?

A

PPI + amoxicillin + clarithromycin, or
PPI + metronidazole + clarithromycin

207
Q

Diagnostic test for PSC?

A

ERCP

208
Q

Features of vitamin C deficiency?

A

Gingivitis, loose teeth
Poor wound healing
Bleeding from gums, haematuria, epistaxis
General malaise

209
Q

What is the MAddrey discriminant function?

A

Used to determine whether alcoholic hepatitis needs steroids. >32 means it does.

210
Q

In wilsons what happened to the levels of serum copper and serum caeruloplasmin?

A

Both are reduced

211
Q

Most common causative bug in SBP?

A

E.Coli

212
Q

Risk associated with a too fast correction of a chronic hypernatraemia?

A

Correction of chronic hypernatraemia too fast predisposes to cerebral oedema

213
Q

What is the BRCA2 and BRCA1 mutation associated with asides from breast cancer?

A

BRCA2
- Ovarian in women
- Prostate Ca. in men

BRCA1
- Colorectal cancer

214
Q

Hiccups in Palliative care treatment?

A

Chlorpromazine or haloperidol

215
Q

Treatment of Nausea in chemotherapy?

A

Metoclopramide - First line

Ondansetron (5HT3) - second line, high risk

216
Q

What LFT is significantly altered in Pregnancy?

A

ALP is raised significantly

217
Q

WHich thyroid cancer causes a rise in Calcitonin

A

Medullary

218
Q

Haemophilia aetiology?

A

Haemophilia A is due to a deficiency of factor VIII whilst in haemophilia B (Christmas disease) there is a lack of factor IX.

219
Q

What is the key difference in gram negative and gram positive bacteria?

A

Gram-negative bacteria have a double membrane (outer membrane and cytoplasmic membrane).

220
Q

How do you remember the classification of bacteria?

A

Gram positive Cocci
- Staph and strep (inc enterococci)

Gram Negative cocci
- Neisseria meningitides and neisseria gonorrhoea
- Moraxella

Gram positive rods (ABCD L)
- Actinomyces
- Bacillus
- Clostridium
- Diptheria
- Listeria

221
Q

Ebola incubation period?

A

2-21 days

222
Q

How would you describe erythema multiforme?

A

Symmetrical target rash with central blister

223
Q

Scoring system specifically for sepsis?

A

qSOFA

224
Q

What are the CT findings for cerebral toxoplasmosis?

A

Ring enhancing lesions

225
Q

What are the Beta haemolytic streptococci responsible for causing?

A

Groups A, B and D are important in humans

group A
- Erysipelas, impetigo, cellulitis, type 2 necrotizing fasciitis and pharyngitis/tonsillitis
- Post strep GN
- Scarlet fever

Group B
- Neonatal meningitis and sepsis

Group D
- Enterococci

226
Q

Treatment of Hep C?

A

Protease inhibitors +/- ribavirin

227
Q

Treatment of Toxoplasmosis?

A

Sulfadiazine and pyrimethamine

228
Q

PEP for Hep A, B and C?

A

Hep A
- Immunoglobulin

Hep B
- Booster vaccine if known responder
- immunoglobulin and booster if non-responder

Hep C
- PCR to monitor seroconversion
- If conversion then Inteferon +/- Ribavirin

229
Q

Treatment for Tetanus?

A

Tetanus immunoglobulin

Diazepam and ventilator if needed

230
Q

How to remember mechanism of Antiretrovirals?

A

Fusion inhibitors
- Rock and tide prevented from being fused
- MaraviROCK
- EnfuvirTIDE

Protease inhibitors
- Navir tease a pro
- drugs ending in Navir

Integrase inhibitors
- Grave to integrate
- Drugs ending in gravir

NNRTI (non-nucleoside reverse transcriptase inhibitors)
- vir in the middle

NRTI
- All the rest

231
Q

Who needs the Tuberculin skin test prior to BCG vaccination?

A

Any person being considered for the BCG vaccine must first be given a tuberculin skin test. The only exceptions are children < 6 years old who have had no contact with tuberculosis.

232
Q

What do you need to check before starting ethambutol?

A

Visual Acuity

233
Q

What are the vaccines offered to pregnant women?

A

Flu (during flu season) and pertussis (whooping cough)

234
Q

How many patients develop a chronic infection in Hep C?

A

55-85% become chronically infected

235
Q

Erythema infectiosum is caused by?

A

Parovirus

236
Q

Management of syphillis?

A

Intramuscular benzathine penicillin is the first-line management (e.g. penicilling G)

Alternatives: doxycycline

237
Q

Antibiotic for legionella?

A

Clarithromycin

238
Q

Second-line antibiotic for cellulitis?

A

Clarithromycin

239
Q

How does dengue fever present?

A

Causes headache (often retro-orbital)
Fever
Myalgia
Pleuritic pain
Facial flushing (dengue)
Maculopapular rash

Low platelets and raised ALT

240
Q

How does yellow fever present?

A

Often comes in phases:

  1. May cause mild flu-like illness lasting less than one week.
  2. Classic description involves sudden onset of high fever, rigors, nausea & vomiting. Bradycardia may develop.

A brief remission is followed by jaundice, haematemesis, oliguria.

241
Q

What conditions are spread by mosquito?

A

Japanese encephalitis

Yellow fever

Dengue fever

Malaria

242
Q

Most common pathogen causing pyelonephritis?

A

e.coli

243
Q

What is the post op management of splenectomy with regards to infectious diseases?

A

Vaccines (if elective should be done 2 weeks prior):
- Hib, meningitis A (and B?)
- Annual influenza vaccination
- Pneumococcal vaccine every 5 years

Abx
- Penicillin V, for 2 years or until 16 usually

244
Q

Overgrowth of what bacteria cause BV?

A

Gardnerella vaginalis

245
Q

Cholera presentation?

A

Profuse waery (‘rice water’) diarrhoea.

ALSO

Hypoglycaemia, dehydration.

246
Q

TB treatment drugs?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

247
Q

What tests do you need prior to TB treatment?

A

Visual acuity for ethambutol

LFTs and FBC for all of them as hepatotoxic

Us&Es for creatinine rise and electrolyte disturbance

248
Q

What is the normal presentation for aspergilloma?

A

Normally colonises an existing cavity and is usually asymptomatic, but may get cough and haemoptysis

249
Q

What pneumonias also cause erythema multiforme?

A

Mycoplasma and pneumococcus

250
Q

What bloods do you need before starting terbinafine?

A

LFTs

251
Q

What is red man syndrome, waht is the management?

A

vancomycin related transfusion reaction, redness over trunk and face due to vanc infusion at too high a rate.

Stop the transfusion then start again at a lower rate

252
Q

Causative organisms in meningitis?

A
  1. Streptococcus pneumoniae
  2. Neisseria meningitidis
  3. Mycobacterium tuberculosis
  4. Cryptococcus neoformans
253
Q

India ink staining picks up what bug?

A

Cryptococcus

254
Q

What is the Jarisch-Herxheimer reaction?

A

Reaction that sometimes occurs after initial treatment of syphillis. Fever. Rash and tachycardia.

255
Q

Which are the strains of HPV that cause cancer and which are the ones that cause warts?

A

16 & 18 are cancer

6 & 11 are warts

256
Q

What is the structure of a liver lobule?

A

Hexagon shape with central vein in the centre. Around it are hepatic triads made up of
- Bile duct
- Hepatic artery
- Portal vein

257
Q

What are the indications for stool microscopy (3)?

A

Immunocompromised

Blood/mucus

Suspect Sepsis

258
Q

What is the pneumonia that commonly presents with desaturations on exertion?

A

PCP

259
Q

Management of PCP?

A

Co-trimoxazole

260
Q

Abx for HAP?

A

Within 5 days of admission: co-amoxiclav or cefuroxime
More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

261
Q

What is the pneumonia most associated with hyponatraemia/

A

Legionella (could also be mycoplasma)

262
Q

Black hairy tongue associated with what class of antibiotics?

A

Tetracyclines

263
Q

Common organism to cause a chronic wound infection in a neuropathic ulcer (diabetic pt).

A

Pseudomonas

264
Q

In terms of non-response to Hep B vaccine what is the recommended management?

A

If 10-100 then one more dose

If <10 then repeat the whole course

5th (Final year) (34 decks)

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