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Difficult Passmed- MLA > General > Flashcards

General Flashcards

1
Q

Fever, diarrhoea (non bloody, yellow green) , abdo pain, constipation, rose spots (small pink spots on abdomen) - organism

A

Salmonella typhi - typhoid

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2
Q

2 types systemic sclerosis, symptoms and Abs associated with each

A

Limited cutaneous = raynauds, scleroderma affects face + distal limbs first. Anti-centrometer abs. CREST Syndrome

Diffuse cutaneous systemic sclerosis = scleroderma affects trunk and proximal limbs. Anti-scl-70 Abs. Most common cause death is respiratory involvement

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3
Q

In the context of tachyarrhythmia and SBP<90 what is the immediate management

A

DC cardio version

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4
Q

Acute HF not responding to treatment - what might be useful to use when severe dyspnea

A

CPAP

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5
Q

Flashes and floaters with no redness or pain - dx

A

Vitreous/retinal detachment

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6
Q

Acute vs prophylaxis migraines

A

acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol

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7
Q

Inguinal hernia in infants vs umbilical hernia mx

A

Inguinl hernia in infants = urgent surgery
Umbilical - can be left up to a year as can resolve

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8
Q

Mx of symptomatic bradycardia if atropine fails

A

External pacing

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9
Q

Raised ICP causing third nerve palsy - how?

A

Trans-tentorial herniation

The combination of a fixed and dilated pupil with an eye deviated inferiorly and laterally (‘down and out’) is indicative of a third nerve palsy. In the context of a decreasing conscious level and an intracranial mass (the haematoma) this is indicative of a trans-tentorial, or uncal, herniation.

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10
Q

What is cerebellar tonsillar herniation

A

Cerebellar tonsillar herniation affects the medulla oblongata and is often a terminal event in an unconscious patient resulting in asystolic cardio-respiratory arrest. Although a classical cause of a third nerve palsy, a posterior communicating artery aneurysm is not the most likely cause here given the history of trauma and an intracranial mass. Frontal eye field injury would cause a functional ocular paralysis and the eye would tend to the neutral position in a state of reduced consciousness. Optic nerve compression would not cause deviation of the eye.

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11
Q

Scoring system for acute pancreatitis

A

There are several scoring systems used to identify cases of severe pancreatitis which may require intensive care management. These include the Ranson score, Glasgow score and APACHE II.

The specifics of each scoring system will not be repeated here. However, some common factors indicating severe pancreatitis include:
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

Note that the actual amylase level is not of prognostic value.

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12
Q

IgA nephropathy vs Post-strep glomerulonephritis

A

IgA nephropathy - visible haematuria after recent URTI

Post strep glomerulonephritis 1-2 weeks after URTI and ass with proteinuria. From bacteria (strep)

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13
Q

Rapidly enlarging aneurysm or over 5.5cm needs surgery - which type surgery (not blown)

A

Elective end-vascular aneurysm repair

I blown (unstable) need urgent and that has to be open

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14
Q

What type of stoma is used to defunciton colon to protect anastomosis

A

Loop ileostomy

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15
Q

Episcleritis vs scleritis

A

Scleritis is painful

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16
Q

Caput Succedaneum vs cephalhaematoma

A

Caput succedaneum is a puffy swelling that usually occurs over the presenting part and crosses suture lines
(Starts with s so spreads)

Cephalhaematoma - haemorrhage between skull and peritoneum and limited by boundaries of cranial bones.
(starts with h so halts at suture lines)

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17
Q

At what age do you refer women with unexplained breast lump for cancer referral

A

Refer women aged >30 with an unexplained breast lump using a suspected cancer pathway referral

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18
Q

First line treatment delirium tremens

A

Chlordiazepoxide

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19
Q

Acute reactive arthritis (eg with urination prob, itchy eyes etc after stomach bug) management

A

nsaid- ibUPROFEN IF NO ci

(can’t see can’t see can’t climb a tree with reactive arthritis)

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20
Q

Miscarriage mx

A

NICE guidelines recommend expectant management as first line in the treatment of miscarriage, unless one of the following factors is present: there is an increased risk of bleeding, there are previous adverse experiences associated with pregnancy, there is increased risk from the effects of haemorrhage or there is evidence of infection. The most appropriate option in the above case, which represents an infected miscarriage with the patient progressing to septic shock, is to evacuate the pregnancy as soon as possible through surgical management.

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21
Q

Symptoms hypomania in primary care - mx

A

Routine referral to CHMT

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22
Q

If neoplastic spinal cord compression is suspected, what is Mx

A

High dose oral dexamethasone

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23
Q

Hypercalcaemia vs hyperkalaemia on ecg

A

Hypercalcaemia = shortening QT interval but
Hyperkalaemia is tall tented t waves

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24
Q

In step down treatment asthma what to do with ICS

A

In the step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids
ie, half ICS dose and review in 6m

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25
Q

Confirmed miscarriage vs threatened

A

A transvaginal ultrasound demonstrating a crown-rump length greater than 7mm with no cardiac activity is diagnostic of a confirmed miscarriage

Threatened = get pains etc but stilll have signs life

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26
Q

Sinusitis prophylaxis if recurrent episodes is…

A

Intransala corticosteroids

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27
Q

Myxoedemic coma treatment

A

Thryoxine and hydrocortisone

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28
Q

Thyrotoxic storm tx

A

Beta blockers,
Propylthiourical
Hydrocortisone

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29
Q

Ectopic pre first surgery

A

Salpingectomy is first line for women with no other RFs for infertility

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30
Q

Intrahepatic cholestasis mx

A

Increases risk still birth so elective induction of el from 37 weeks
Tx of the condition is ursodeoxycholic acid

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31
Q

Common drugs for causes of urinary retention

A

Opioid analgesia (tramadol) and anticholinergic drugs

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32
Q

DKA - what insulin do you have and continue vs stop

A

In the acute management of DKA, insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin

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33
Q

what is the status

A

Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-HBc in the presence of HBsAg implies chronic HBV infection

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34
Q

Initial bloods/tests for screening when erectile dysfunction

A

HbA1C
Lipids
Testosterone

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35
Q

When to add a second drug in T2DM

A

A second drug should be added in type 2 diabetes mellitus if the HbA1c is > 58 mmol/mol

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36
Q

Anterior uveitis treatment

A

Steroid eye drops with mydriatic eye drops

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37
Q

Vestibular neuronitis vs viral labyrinthitis

A

VN + layrinthtis = Dizziness, off balance, sickness, tinnitus

But unaffected hearing points more to vestibular neuritis and in viral labyrinthitis you would expect a preceding viral infection

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38
Q

Correcting sodium levels rapidly - the complications (hypo correction vs hyper correction)

A

Correcting sodium levels rapidly is dangerous:
Hyponatraemia correction - osmotic demyelination syndrome
Low to high- brain will die

Hypernatreamia correction - cerebral oedema
High to low brain will blow
Because if you have high sodium then u must be dehydrated so if you correct you pump loads of water and it swells

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39
Q

Acute dystonia secondary to antipsychotics - management

A

Procyclidine

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40
Q

Psoriasis - which medication can worsen it???

A. Lithium
B. Amoxicillin
C. Clindamycin
D. Methotrexate
E. Amlodipine

A

Lithium

Also BBlockers

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41
Q

Resus fluids for paeds

A

10ml/kg over <10

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42
Q

What Ix to do before starting biologics fro RA

A

CXR- to check for TB as biological can cause reactivation

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43
Q

If metformin is not tolerated due to GI side effects, what do you do

A

If metformin is not tolerated due to GI side-effects, try a modified-release formulation before switching to a second-line agent

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44
Q

Most common secondary cause of hypertension and the Ix

A

Primary hyperaldosteronism (Conns syndrome)
Renin aldosterone ratio

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45
Q

Whilst a patient is receiving PCA opioids then what drugs to stop in normal meds

A

Stop all other opioid to avoid toxicity

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46
Q

When babies are suspected cows milk protein intolerance, what might you prescribe for mum when she is cutting out cows milk from diet

A

Calcium and vitamin D

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47
Q

Investigating a PE: If the CTPA is negative then what Ix is next steps

A

Proximal leg vein doppler US

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48
Q

Bonocular vision post facial trauma - what type of fracture and which bone does this suggest

A

Bonocular vision post facial trauma is suggestive of depressed fracture of zygoma

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49
Q

Interpretation of pupillary findings in head injuries

A
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50
Q

where should IV amiodarone be given and why?

A

Into central vein as it is a common cause of thrombophlebitis

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51
Q

Confidentiality regarding HIV diagnoses to partner

A

You may disclose information to a known sexual contact with a patient with a sexually transmitted serious communicable disease if you have reason to think that they are at risk of infection and that the patient has not informed them and cannot be persuaded to do so.

(Give pt opportunity to tell them and inform them that if they don’t you will have to)

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52
Q

Pt presents with bones, stones, abdomen groans and psychic moans. Their bloods show raised calcium, low phosphate and PTH may be raised (or inappropriately normal due to raised calcium)
Pepperpot skull

Diagnosis

A

Primary hyperparathyroidism

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53
Q

Features of heparin induced thrombocytopeniaa and what Abs are presents

A
  • Abs form against completes of platelet factor 4 and heparin
    • These abs binds and indie platelet activation
  • Usually doesn’t develop until after 5-10 days of treatment
  • Despite low platelets association it is prothombrotic
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54
Q

Sudden painless loss vision, severe retinal haemorrhages on fundoscopy - diagnosis

A

Central retinal vein occlusion

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55
Q

A 49-year-old man is brought into ED after he was found on the side of the road unconscious. The paramedics give a history of alcohol abuse. You ask the nurse to perform a set of basic observations, capillary blood glucose (CBG) and an ECG.

His basic observations are: a temperature of 35.9ºC, blood pressure 190/110 mmHg, heart rate 51 beats/min, respiratory rate is 24 breaths/min (Cheyne-Stokes breathing), oxygen saturations 95% on air. His Glasgow coma scale is 4/15 (E1V1M2).

Capillary blood glucose comes back as 10.1.

The ECG shows T wave inversion in all leads and QT prolongation.

What is the most likely diagnosis?

A

Head injury
(Global T wave inversion - think non cardiac cause of abnormal egg)

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56
Q

T2DM initial therapy - if metformin is contraindicated and patient has a risk of CVD, established CVD or chronic HF then what medication to start

A

SGLT-2 mono therapy

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57
Q

A 57-year-old man presents to the emergency department with a 2-day history of right upper quadrant abdominal pain. His past medical history is remarkable for type 2 diabetes mellitus and alcohol excess.

There are no clinical signs of jaundice, and the patient denies pale stools or dark urine.

An ultrasound of the biliary tree shows no gallstones, demonstrating some regional lymphadenopathy. Further imaging is suggestive of extramural compression of a branch of the biliary tree.

Given this information, where is the most likely location of the lesion?

Ampulla Vater, common bile duct, common hepatic duct, cystic duct, sphincter odd

A

Cystic duct - blockage of cystic duct or gallbladder doesn’tcause jaundice

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58
Q

Pt presents with petechia, pupa, bleeding and isolated thrombocytopenia - what is dx and mx

A

ITP
Orla prednisolone

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59
Q

In compartment syndrome - what biochemical abnormality is most likely seen and why

Alkalosis, hypercalcaemia, hypocalcaemia, hyperkalaemi, hyponatraemia

A

Hyperkalaemia - muscle death causes release potassium and probably degree of renal impairment

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60
Q

Headaches, amenorrhoea, visual field defects- dx

A

Prolactinoma

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61
Q

What is useful for helping prevent attacks of Menderes disease vs acute attacks

A

Betahistine and vestibular rehab for prevention

Acute - buck or IM prochlorperazine

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62
Q

What Abs has a side effect of rash with infectious mononucleosis

A

Amoxicillin

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63
Q

What Abs have side effect cholestasis

A

Co-amox
Flucloxiicllin

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64
Q

Side effects trimethoprim

A

Rashes - photosensitivity
Prutitis
oppression haeamtopeisis

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65
Q

Most common organism causing cholangitis

A

E.COLI

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66
Q

Question 44 of 50

An 83-year-old male is referred to the ophthalmology clinic by his general practitioner with a new-onset inability to see objects near to him, especially at night. On fundoscopy, the doctor notices well-demarcated red patches. He has a past medical history of hypertension and he is a life-long smoker.

Given the most likely diagnosis, which one of the following is the most appropriate treatment?

A

AMD - Anti VEGF

This patient has the characteristic signs and symptoms: a reduction in visual acuity, particularly for near field objects, worse at night and red patches representing intra-retinal or sub-retinal fluid leakage or haemorrhage visible on fundoscopy.

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67
Q

What monitoring is needed on methotrexate

A

FBC U&E LFT

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68
Q

Monitoring needed on levetiracetam

A

No routine monitoring needed

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69
Q

monitoring needed on amiodarone

A

TFT LFT

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70
Q

Pacenta accrete, increta, percreta

A

Accrete = chorionic villi attach to myometrium, rather than being restricted within decide basalts
Increate = chorionic villi invade into myometrium
Percreta = chorionic villi invade through perimetruym

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71
Q

A 48-year-old man presents to his GP with a number of symptoms that have come on over the past few days. His vision is blurred and his right eye is painful, as well as having a generalised headache.

On examination, the right eye has deviated inferiorly and laterally. There is visible ptosis of the upper right lid, and the pupil is dilated. It does not respond to light. This eye does not follow movements well, but the left eye appears unaffected and is normal upon testing.

Where is the most likely location of the lesion?

A

Posterior communication artery (aneurysm) - painful third nerve palsy

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72
Q

Loss of vibration sense, ataxia and absent ankle reflexes with recent gastrectomy - dx

A

Subacute degeneration of cord

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73
Q

2nd most common ass cancer in HNPCC after CRC

A

Endometrial cancer

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74
Q

Mechanism of controlled hyperventilation as a management in raised ICP

A

Hyperventilation -> reduce co2 -> vaoconstrict cerebral arteries -> reduce ICP

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75
Q

Hypokalaemia EGC findings

A

small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

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76
Q

A baby is noted to have micrognathia (post displacement of tongue) and a cleft palate. He is placed prone due to upper airway obstruction. There is no family history of similar problems

Diagnosis

A

Pierre robin syndrome

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77
Q

If a mild-mod flare of UC doesn’t respond to topical OR oral aminosalicylates then what to add

A

Oral corticosteroids

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78
Q

Acriomioclavicular joint injury - grades and mx

A

Injury to the AC joint is relatively common and typically occurs during collision sports such as rugby following a fall on to the shoulder or a FOOSH (falls on outstretched hand).

AC joint injuries are graded I to VI depending on the degree of separation.

Grade I and II injuries are very common and are typically managed conservatively including resting the joint using a sling.

Grade IV, V and VI are rare and require surgical intervention.

The management of grade III injuries is a matter of debate and often depends on individual circumstances.

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79
Q

Young females with suspected appendicitisis - next step in iX

A

US abdomen - helps rule out ovarian pathology and/or increase suspicion of appendicitis

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80
Q

Young females with suspected appendicitisis - next step in iX

A

US abdomen - helps rule out ovarian pathology and/or increase suspicion of appendicitis

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81
Q

Young females with suspected appendicitisis - next step in iX

A

US abdomen - helps rule out ovarian pathology and/or increase suspicion of appendicitis

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82
Q

MRCG grading for muscle weakness

A
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83
Q

In tx anaphylaxis - how often can you repeat adrenaline and salbutamol inhalers?

A

Every 5 mins

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84
Q

In people with achalasia and the dysphagia has worsened with a mass on oesophagus - what type of cancer

A

Squamous cell carcinoma - this is increased risk in achalasia

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85
Q

NYHA Classification of CHF

A

NYHA Class I
no symptoms
no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations

NYHA Class II
mild symptoms
slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea

NYHA Class III
moderate symptoms
marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms

NYHA Class IV
severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity

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86
Q

Contact lens wearers with red painful eye - mx

A

refer to eye casualty to exclude microbial keratitis

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87
Q

Confusion, pink mucosa - dx

A

CO poisoning

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88
Q

A 42-year-old male presents to her general practitioner with a 2-week history of asymmetrical oligoarthritis predominantly affecting his lower extremities, associated with dysuria and conjunctivitis. He is usually well apart from suffering from a diarrhoeal illness 1 month ago.

What is the most appropriate first-line management of this patient?

A

NSAIDs - acute reactive arthritis

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89
Q

Scleritis vs episcleritis

A

Scleritis = Red eye, classically painful, watering and photophobia are common, gradual decrease in vision

Episcleritis is classically not painful

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90
Q

Hypertensive retinopathy on fundosocpy - grading system

A

I - arteriolar narroing and tortuosity, increased light reflex (silver wiring)
II - AV nipping
III - cotton wool exudates, flame and blot haemorrhages
IV - Papilloedema

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91
Q

Cholangiocarcinoma vs pancreatic cancer

A

Cholangio - may present with persist symptoms of biliary colic and very rare ass with IBD

Pancreatic - lost weight, onset fatigue, Rfs liek DM, jaundice, enlarged gallbladder (may feel mass). No pain

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92
Q

Tx diabetic maculopathy (if proliferative retinopathy also)

A

Panretinal photocoagulation and intravitreal VEGF.
VEGF - maculopathy
Panretinal photocoagulation for proliferative retinoopathy

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93
Q

rules for weight bearing after hip fracture surgery

A

immediate unrestricted weight bearing in all

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94
Q

Mx HUS

A

supportive - fluids + dialysis as example

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95
Q

Mx ACS when o2 >94% and hypotensive and going PCI

A

Aspirin + ticagrelor + fondaparinux
no nitrates as hypotensive

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96
Q

clubfoot - position of foot

A

Inverted + plantar flexed foot which is not passively correctable

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97
Q

Women with suspected PCOS should have which Ix….

A

Pelvic US, FSH, LH, Prolactin, TSH, Testosterone, sex hormone binding globulin

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98
Q

Factors fvaoruign rhythm control in AF

A

Age <65
First presentation
Symptomatic

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99
Q

BMI >50 first line mx

A

Bariatric surgery

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100
Q

When is a missed pOP - desogestrel vs traditional

A

Traditional <3hrs

Desogstrol <12hrs

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101
Q

Wells score and cut off for CTPA

A

PE likely = >4 points - CTPA
PE unlikely = <4 points - D dimer (if neg then stop anticoagulant)

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102
Q

Treatment for salicylate overdose

A

Urinary alkalisation with iV bicarb, haemodialysis

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103
Q

Opioid overdose Tx

A

Naloxone

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104
Q

Benzodiazepine overdose tx

A

Flumazenil

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105
Q

Tricyclic antidepressant overdose tx?

A

No specific antidote but IV bicarb can help educe risk seizures etc
Might need dialysis to help remove

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106
Q

Heparin overdose mx

A

Protamine sulphate

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107
Q

Ethylene glycol and methanol poisoning antidote

A

Ethanol (now fomepizole mosltyly)

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108
Q

Organophosphate insecticide overdose mx

A

Atropin

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109
Q

Digoxin overdose mx

A

Digoxin specific antibody fragments

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110
Q

Mx PPH order

A

RCOG guidelines then suggest to initially use Syntocinon 5 Units by slow IV injection.
This should then be followed by ergometrine (contraindicated in hypertension) and
then a Syntocinon infusion.
Carboprost (contraindicated in asthma) and then misoprostol 1000 micrograms rectally are then recommended. If pharmacological management fails then surgical haemostasis should be initiated.

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111
Q

High uric acid and renal impairment following chemo - what s the diagnosis and how to prevent

A

tumour lysis syndrome
If high risk then IV Allopurinolc or IV rasburicase prior and during first days of she,o

(high potassium and high phosphate in presence low calcium_

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112
Q

Bets induction agent for haemodynamically unstable patients in anaesthesia

A

Ketamine

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113
Q

Downs syndrome on combined screening test

A

Increased HCG, Decreased PAPP-A, thickened nuchal translucency

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114
Q

Pt develops acute heart failure 5 days after MI. New pan-systolic murmur is noted on exam -dx

A

VSD

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115
Q

Carpal tunne syndrome - what happens in nerve conduction evlauation (to action potential in sensory and motor axons)

A

Prolongs

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116
Q

Renal failure, sensorineural hearing loss and ocular abnormalities in a child - dx

A

Alport syndrome

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117
Q

Suspected DVT and raised D dimer but scan negative - what to do (already on anticoagulant)

A

Stop anticoagulant and repeat scan in 1 week

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118
Q

Pain on radial side wrist/ tenderness over radial styled process - dx

A

De Quervains tenosynovitis

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119
Q

Trnsvers myelitis vs GBS on reflexes

A

GBS = hyporflexia
Transverse myelitis= hyperreflexia

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120
Q

What score is useful to assess hypemrobility

A

Beighton score - positive if at least 5/9 in adults or least 6/9 in children

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121
Q

S/E Isoniazid

A

Peripheral neuropathy, hepatitis, agranulocytosis

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122
Q

S/E pyrazinamide

A

Hyperuricaemia causing gout
Arthralgia, myalgia, hepatitis

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123
Q

S/E ethambutol

A

Optic neuritis - check visual acuity before and during

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124
Q

S/E Rifampicin

A

Hepatitis, orange secretions, flu-like symptoms

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125
Q

Signs digoxin toxicity

A

Generally unwell - lethargy, N&V, anorexia, confusion, yellow-green vision, arrhythmias (av BLOCK), GYNAECOMASTIA

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126
Q

Inferior mI and aortic regurgitation murmur with taring chest pain - dx

A

proximal aortic dissection

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127
Q

A 78-year-old man presents to emergency department with sudden onset, severe, diffuse abdominal pain at 7:30pm after finishing his evening meal. It is intermittent and severe in nature. However the abdomen is soft on examination. While in hospital he suffers from 1 episode of non-bloody emesis. Initial imaging does not yield any diagnosis. He has a history of GORD, hernia repair, hypertension, myocardial infarction and atrial fibrillation. What is the most likely diagnosis?

A

ischaemia colitis - pain after meal, with predisposing factors

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128
Q

What might be one of the earliest symptoms in aspirin overdose

A

Tinnitus

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129
Q

Reversal agent for dabigatran/ bleeding on dabigatran

A

Idarucizumab

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130
Q

A 65-year-old man presents with difficulty swallowing which has been present for 6 months and has been getting worse over the past few weeks. The dysphagia occurs to both solids and fluids equally. He has also noticed some chest pains recently, especially after eating. A barium swallow shows a dilated oesophagus that tapers at the lower oesophageal sphincter.

What is the most likely diagnosis?

A

Achalasia

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131
Q

What ECG abnormality ub Subarachnoid space

A

Polymorphic ventricular tachycardia

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132
Q

Which gene translation is bursitis lymphoma ass with

A

C-Myc gene translocation

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133
Q

What is the risk of SSRI + NSAID and how to treat this

A

Increased risk gI bleeding when aspirin/ NSAIDs are combine with SSRIs so offer PPI like lansoprazole (as in IHD you can’t just stop aspirin)

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134
Q

Red facial rash which looks greasy and fine scale over affecting cheeks, nasolabial folds, eye brows, nasal bridge and scalp

Dx

A

Seborrheic dermatitis

135
Q

if the Bishop score is </= 6 then management

A

vaginal PGE2 or oral misoprool for induction labour
score 5 or less suggests labour unlikely o start without induction

136
Q

If Angie is not controlled with a Beta blocker - what do we use

A

Longer acting dihydropyridine CCB like amlodipine

137
Q
A

lentigo maligna

138
Q

Addisons with intercurrent illness - does glucocorticoids and fludrocortisone dose stay same

A

No
Double hydrocortisone, same fludrocortisone

139
Q
A

Small bowel obstruction

140
Q

Bone pain, tenderness, proximal myopathy (waddling gait) and low calcium, low phosphate, high ALP, low Vit D, high PTH

A

osteomalacia

141
Q

Prolactinoma Tx

A

Mostly treated with dopamine agonist (bromocriptine) which inhibit release prolactin from pituitary gland.
Surgery si for those who can’t tolerate or fail to respond to medical therapy (transphenoidal)

142
Q

A 65-year-old lady has recently had a colonoscopy and been found to have a malignant tumour in the most distal portion of the rectum, involving the anal sphincter.

which surgical procedure

A

Abdominoperineal (AP) resection
Rectal cancer on anal verge - abdomino-perineal excision of rectum

143
Q

Blood stained nipple discharge

A

Duct papilloma

144
Q

Grene brown discharge of the nipple + red, swollen

A

Duct ectasia

145
Q

Upper rurinary tract obstruction causing hydronehrosis - primary mx

A

nephrostomy

146
Q

A 35-year-old woman presents with a one week history of progressive leg swelling. Her past medical history includes type 2 diabetes which is diet-controlled. On examination, there is bilateral pitting oedema up to her knees and periorbital oedema. Her observations are heart rate 88/min, blood pressure 151/91mmHg, oxygen saturations 97%, temperature 37.1ºC, and respiratory rate 14/min. Urine dipstick shows protein +++. Two days later, she complains of left-sided flank pain and haematuria.

What complication has occurred?

A.	Haemorrhage into renal cyst
B.	Splenic infarction
C.	Renal vein thrombosis	
D.	Haemolytic crisis	
E.	Ureteric stone
A

Nephrotic syndrome Is ass with hyper coagulable state due to loss of antithrombin III via kidneys and therefore here - renal vein thr0ombpsis has occurred

147
Q

Stooping of vol movement or staying still in unusual position with schizophrenia

A

= Catalonia

148
Q

A 21-year-old male presents to the emergency department with a cough, fever and dyspnoea. On examination he is hypoxic. Pulmonary infiltrates are seen on chest x-ray. He has suffered with anaemia, jaundice and general weakness since the age of 3 months, as well as severe pain when exposed to cold conditions.

A

sickle cell disease

Acute chest syndrome is a complication of sickle-cell disease and presents with dyspnoea, chest pain, cough, hypoxia and new pulmonary infiltrates seen on chest x-ray

149
Q

What would you see on synovial fluid for reactive arthritis

A

Cloudy yellow colour, Culture negative, No crystals, White cell count: 20,000/mm

150
Q

What is the threshold for platelet transfusion

A

Platelet transfusion is appropriate for patients with a platelet count < 30 x 109 and clinically significant bleeding

151
Q

Which cancer can CLL transofrm into and what is this called

A

Richeters transformation - high grade lymphoma (non Hodgkins)

152
Q

Bilious vom in kids

A
153
Q

All breech babies at, or after 36 weeks gestation - what do they need

A

DDH screening at 6 weeks regardless mode del

154
Q

What is the main benefit of prescribing albumin when treating large volume ascites’?

A

A. Reduce postparacentesis circulatory dysfunction

155
Q

Patients who have had an episode of SBP require antibiotic prophylaxis
which one

A

ciprofloxacin

156
Q

Primary hgyperaldosteronism (conn syndrome) treatment

A

Spironolactone

157
Q

Acut edelirium tx when Parkinson’s disease

A

lorazepam

158
Q

A 55-year-old woman presents to the emergency department with a sudden onset of central chest pain while she was at rest. The pain was not relieved by her glyceryl trinitrate spray. She has a past history of angina and hypertension. ECG and cardiac biomarkers were positive for an ST-elevation myocardial infarction (STEMI).

A few minutes later, she complained of worsening shortness of breath. On examination, her pulse was weak and thready. Her jugular venous pressure is increased. On chest auscultation, there was a new systolic murmur. Her pulse rate was 130 beats per minute and blood pressure was 80/55 mmHg. There were no new acute changes to the ECG.

A

mitral regurgitation

159
Q

Next course of action after WLE with sentinel LN biopsy Neg

A

radiotherapy

160
Q

first line for stroke

A

non contrast ct head

161
Q

How do BB work in open angle glaucoma

A

Reduced aqueous section by ciliary body

162
Q

PANCREAS severity scoring system for pancreatitis

A

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

163
Q

preferred anti platelet for secondary prevention after stroke

A

clopidogrel

164
Q

otitis externa mx

A

Topical gentamicin + hydrocortisone drops

165
Q

A 55-year-old woman presents to the emergency department with progressive weakness of the arms and legs bilaterally that started today. She has also been getting progressively more tired, with some episodes of sweating. Her past medical history includes hypertension, diabetes and a transient ischaemic attack (TIA) 6 months ago. She is taking clopidogrel, metformin, gliclazide and ramipril. On examination, she appears confused and drowsy. She has 4/5 power on both arms and legs.

most appropriate next ix in this patient

A

capillary blood glucose

166
Q

Widened QRS or arrhythmia in tricyclic overdose mx

A

iv bicarb

167
Q

acute flare mx ra

A

methylprednisolone iM

168
Q

in palliative patients - what is the pain relief choice when renal impairment

A

Oxycodone

169
Q

when is clinical jaundice on bilirubin level

A

when it hits 50

170
Q

props in household contacts meningitis

A

ciprofloxacin

171
Q

In a patient with suspected anaemia of chronic disease secondary to CKD, what should be checked before commencing EPO

A

Iron status

172
Q

A 72-year-old patient presents to her general practitioner complaining of a 6-month history of unexplained weight loss. She reports that she has also noted yellowing of her eyes and skin over the same time period, but denies any abdominal pain or fever. Her past medical history is significant for ulcerative colitis (UC) and primary sclerosing cholangitis (PSC), both of which presented in her 30’s.

On examination, the woman is cachectic and jaundice. Her abdomen is soft and non-tender, with palpable peri-umbilical lymph nodes. The gallbladder is non-palpable.

dx

A

cholangiocarcinoma

173
Q

> = 75 years following a fragility fracture
mx

A

Start alendronate in patients >= 75 years following a fragility fracture, without waiting for a DEXA scan

174
Q

dose adrenaline in ALS

A

Recommend Adult Life Support (ALS) adrenaline doses
anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

175
Q

Which is a depolarising muscle relaxant

A

Suxamethonium

176
Q

MOA flumenazil

A

GABA antagonist

177
Q

Sudden onset vertigo and vomiting, dysphagia, ipsilateral facial pain + temp loss, contralateral limb pain and temp loss and ataxia

Which artery is the stroke in

A

Posterior inferior cerebellar artery

178
Q

Mx status epilepticus

A
  1. ABC
  2. IV benzos or in pre hospital rectal (diazepam/lorazepam).
  3. In hospital IV lorazepam mostly used and can be repeated once after 10-20mins
  4. If ongoing then phenytoin/phenobarbitl infusion
  5. If no response in 45mins from onset then induction general anaesthesia
179
Q

What can GBS be triggered by

A

surgery involving GI or respiratory tract, infection

180
Q

Symptoms GBS

A

Weakness ascending
Reflexes reduced or absent
Sensory symptoms tend to be mild
Hx gastroenteritis poss
May have Resp muscle weakness, CN involvement, autonomic involvement…

181
Q

Ix in GBS

A

Lumbar puncture - rise in protein, normal WBC
Nerve conduction studies - decreased motor nerve conduction velocity, prolonged distal motor latency, increased F wave latency

182
Q

Defintion malnutrition

A

unintentional weight loss greater than 10% in last 3-6months

183
Q

Breast cancer referral - urgent vs non urgent

A

Cance pathway =
30 + with UE lump or without pain OR
50+ with any: changes in one nipple (discharge/retraction/othe changes of concern)

Non urgent if <30 with UE breaks lump with or without pain

184
Q

Initial mx od open fractures

A

IV ABS, photography of wound, application of sterile soaked gauze and impermeable film

185
Q

Women aged >30 with dysmenorrhoea, menorrhagia, enlarged boggy uterus = dx

A

Adenomyosis - endometrial tissue grows in myometrium. More common in older females approaching menopause

186
Q
A

normal as all above green line

187
Q

Horners syndrome - how does anihydrosis determine lesion

A

Horner’s syndrome - anhydrosis determines site of lesion:
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery

188
Q

When ACEi aren’t tolerated - which medication next

A

ARB

189
Q
  1. A 28-year-old man is playing tennis when he suddenly collapses and has a GCS of 4 when examined.

which type haemorrhage

A

Subarachnoid - sudden collapse and loss consciousness

190
Q

A 78-year-old man is brought to the emergency department by the police. He is found wandering around the town centre and is confused. His family report that he is usually well apart from a simple mechanical fall 3 weeks previously from which he sustained no obvious injuries.

which type haemorrhage and acute vs chronic

A

Chronic sub dural haematoma

191
Q

Hepatic encephalopathy mx

A

Lactulose

192
Q

Diagnosis:

Younger females, Asian
Systemic features - malaise, headache
Unequal bloo depressor ein upper limbs
CAROTI BRUIT + TENDERNESS
absent or weak peripheral pulses
Upper and lower limb claudication one exertion
Aortic regurgitation in some

A

Takayasus arteritis -
Ix - MRA/CTA
mx is steroids

193
Q

Flush to the skin stoma - which type

A

Colostomy

194
Q

What is the most common cause primary headache in children

A

Migraine - unilateral, pulsating, 4-72hrs, exacerbation by routine activity

195
Q

Cluster headache mx

A

Acute = 100% o2, submit triptan
Trophy = verapamil

196
Q

Mx of abdominal wound dehiscence

A

Coverage of wound with saline impregnated gauze + iV broad-spectrum Abxs

197
Q

Which type pneumonia is as with eryisipelas

A

Streptococcus pyogenes

198
Q

dysentery, liver abscesses, colonic abscesses, or inflammatory masses in the colon

which organism

A

Entamoeba histolytica

199
Q

cause of recurrent watery or sticky eye in neonates and usually, self-resolves by 1 year of age

A

Congenital tear (lacrimal) duct obstruction

200
Q

Primary VS Secondary vs Tertiary Hyperparathyroidism

A

Primary = hypercalcaemia with raised o inappropriately normal PTH. PTH levels are generally elevated. Renal impairment commonly seen in it as a consequence of dehydration

Secondary hyperparathyroidism is incorrect. This occurs as the physiological response to hypocalcemia. Kidney failure and vitamin D deficiency are the most common causes of secondary hyperparathyroidism. The key biochemical features are hypocalcemia and a raised PTH. A raised ALP also occurs due to excessive bone resorption. Phosphate levels will vary with aetiology e.g. raised in kidney failure and decreased in vitamin D deficiency.

Tertiary hyperparathyroidism is incorrect. This occurs when an excess of PTH is secreted by the parathyroid glands, usually after longstanding secondary hyperparathyroidism results in hyperplasia of the parathyroid glands. It biochemically presents the same as primary hyperparathyroidism with raised calcium and elevated PTH. Although this remains a possibility, the patient only has mild renal impairment making this a less likely diagnosis. Furthermore, the phosphate level would generally be high in tertiary hyperparathyroidism (due to reduced renal clearance).

201
Q

For moderate/severe OCD + SSRI is contraindicated - what is the drug to use

A

Clomipramine

202
Q

Clustered erythematous papule around the mouth (perioral) but also perinatal and pericoular. Skin immediately adjacent to vermillion border of lip is often spared. What is the dx and mx

A

Perioral dermatitis
Topical and oral antibiotics
Steroids can worsen symptoms

203
Q

Obese T2 diabetic is on metformin but HbA1C is 64. What second line meds may be helpful

A

DPP-4 inhibitors

204
Q

What are the grades of hepatic encephalopathy

A

Grade I - irritability
Grade II - confusion, inappropriate behaviour
Grade III - incoherence, restless
Grade IV - coma

205
Q

In SIADH what happens to Sodium

A

Low

206
Q

Ulcerative colitis and cholestasis - diagnosis

A

PSC

207
Q

Brigade syndrome vs arrhythmogenic right ventricular cardiomyopathy (ARVC)

A

ARVC = T wave inversion V1-3

Brigade - ST elevation V1-3

208
Q

Patient with AF and acute stroke - when to start anticoagulant therapy after event

A

2 weeks

209
Q

Which class is liraglutide and how it is given

A

GLP-1 receptor - protons weight loss - injections

210
Q

Class of meds that empagliflozin is and s.e

A

SGLT-2 inhibitor - weight loss.

211
Q

Less severe vs more severe depression on the pHQ-9 score

A

Score <16 = less severe

More severe s >/16

212
Q

What level do you need a platelet transfusion

A

90 x 10^9/L

213
Q

ECG changes in hyperkalaemia

A

Tall tented t waves
Small p waves
Widened QRS - sinusoidal pattern and asystole

214
Q

Plummer vinson syndrome

A

Dysphagia, glossiis, IDA

215
Q

First line treatment for lichen plants

A

Topical steroids

216
Q

Greek boy develops pallor and jaundice after having a lower respiratory tract infection. He has a history of neonatal jaundice. The blood film shows Heinz bodies

A

G6PD Def

217
Q

Tx of choice for Toxic multi nodular goitre

A

Radioactive iodine

218
Q

Tx uveitis

A

Steroid and cycloplegia (mydratic) drops

219
Q

,Mx pts with acute ischaemic stroke presenting in 4.5hrs

A

Thrombolysis AND thrombectomy

220
Q

Acute dystonia - what is this

A

Sustained muscle contraction like torticollis or uculogyric crisis

221
Q

Which type of stoma is spouted

A

Ileostomy - prevent skin coming into contact with enzymes in small intestine

222
Q

Aspirin overdose mx

A

Activated charcoal if <1hr ingestion
IV bicarb - can be used later down the lie

223
Q

Pruritis (worst after taking showers or hot baths).
Tingling, burning, and numbness in arms, hands, and feet.
Headaches and lethargy.
Splenomegaly.
Elevated haemoglobin on full blood

dx and mx.

A

Polycythaemia vera

Venesection first line

224
Q

How to decide which surgery needed for ectopic

A

Sapingectomy first line for women with no other RFs for infertility

225
Q

Dyspepsia (indigestion) and nausea and elevated platelet count - next step mx

A

Urget upper gastro endoscopy

Thrombocytosis can occur in context malignancy as reaction to inflammation

226
Q

cAPUT SUCCEDANEUM VS Cephalohaematoma

A

Succedanum = cross suture lines

Haematoma - H for halt os doesn’t cross suture lines

227
Q

Which Abx for brain abscess

A

Ceftriaxone and metronidazole

228
Q

Reverse agent rivaroxaban

A

Andexanet alfa

229
Q

Cerebellar signs, contralteral sensory loss and ipsilateral Horners

A

Lateral medullary syndrome - Posterior inferior cerebellar artery
(App side artery to the leg/arm problems)

230
Q

Crown rump length greater than 7mm with no cardiac activity - what is this

A

Diagnostic of miscarriage

231
Q

High reticulocyte count - what can this suggest

A

Increased destruction (eg haemolytic) or increased los (bleeding) of red cells

232
Q

A/E of aromatase inhibitors (anastrozole)

A

Osteoporosis, hot flushes, arthralgia, myalgia, insomnia

233
Q

First and second line meds for GAD

A
  1. SSRI
  2. SSRI or SNRI
234
Q

Communicating hydrocele mx in newborn males

A

Uuslaly resolv
Reassurance, surgical repair if doesn’t resolve in 1-2 years

235
Q

Lights criteria for transudative vs exudative

A

Exudates - protein >30g/l
Transudates <30

If 25-35 then lights criteria…
Exudative likely if at leats one met…
- Pleural fluid protein divided by serum protein >0.5
Pleural fluid LDH divided by serum LDH >0.6
Pleural fluid LDH more than 2/3 the upper limits of normal serum LDH

236
Q

A 25-year-old man attends with a 3-month history of numbness in his right hand. On examination, you note the loss of sensation to the palmar and dorsal aspect of the 5th digit. Sensation of the forearm is preserved.

What is the most likely diagnosis?

A

Cubital tunnel syndrome
Ulnar nerve supplies sensory to palmar and dorsal aspects 1 and 1/2 fingers medially

237
Q

A 17-year-old girl presents with a sore throat. On examination she has inflamed tonsils covered in white patches. Tender cervical lymphadenopathy and a low grade pyrexia are also present. Which one of the following organisms is most likely to be responsible?

Streptococcus viridans

Streptococcus agalactiae

Streptococcus pneumoniae

Staphylococcus aureus

Streptococcus pyogenes

A

Streptococcus pyogenes

238
Q

Typical distribution eczema in 10month old child

A

Face and trunk

239
Q

Which medication ahs been overdosed on and mx…

GIT: nausea, vomiting, anorexia, diarrhoea
Visual: blurred vision, yellow/green discolouration, haloes
CVS: palpitations, syncope, dyspnoea
CNS: confusion, dizziness, delirium, fatigue

A

Digoxin (toxicity) - yellow/green discolouration
Administer digoxin specific antibody fab fragments (digibind iV)

240
Q

Absestosis vs pleural plaques on CXR

A

Pleural plaques = all over (image) - benign, do not go malignant

Asbestosis is more lower lung fibrosis

241
Q

What medications can treat orthostatic hypotension

A

Fludrocortisone and midodrine

242
Q

Medication to treat bowl colic in palliation

A

Hyoscine hydromromide

243
Q

Most common S/E isotretinoin

A

Dry skin

244
Q
A

chronic infection with hep b

hbsag if >6m can be chronic!!

245
Q

mx pre menstrual syndrome

A

mild symptoms can be managed with lifestyle advice
apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates

moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP)
examples include Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg)

severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI)
this may be taken continuously or just during the luteal phase (for example days 15–28 of the menstrual cycle, depending on its length)

246
Q

Which medication for glaucoma causes increased eyelash length

A

Prostaglandin analogues alongside iris pigmentation an dperiocular pigmentation

247
Q

WHta is best for motion sickness

A

Hyoscine then cyclizine/cinnarizine if not good

248
Q

High serum PTH with moderately raised serum calcium and CKD - type hypoparathyroidism

A

Tertiary hyperparathryoidism

249
Q

Chlamydia in pregnancy - mx

A

Azithromycin, erythromycin, or amoxicillin may be used

250
Q

Most common cause PPH

A

Uterine atony

251
Q

First line test acromegaly

A

Serum IGF-1 levels

252
Q

Recurrent episodes natal cleft pain with discharge - mx

A

pilonoidal cystectomy

253
Q

GCS

A
254
Q

Antifreeze antidote

A

Fomepizole

255
Q

A 45-year-old man presents to the emergency department with pain in his lower back, buttocks, and legs over the last 5 days that persists at rest. Today he has noticed weakness and pins and needles. He has a history of ischaemic heart disease, type 2 diabetes, and an episode of gastroenteritis 2 weeks ago. He has a family history of ankylosing spondylitis. The patient works as a builder.

He is afebrile, his pulse is 85 bpm, and his blood pressure is 135/75 mmHg. Despite having paraesthesia, lower limb sensation is intact. There is bilateral lower limb weakness and hyporeflexia.

What is the most likely diagnosis?

A

Gullain barre syndrome - back/ leg pain is seen in majority pts with GBS

256
Q

Blue vision - which drug is this a S/E of

A

Sildenafil

257
Q

Yellow - green vision = which is this a S/E of

A

Digoxin

258
Q

What positioning can help in Acute respiratory distress syndrome

A

Prone position - improves oxygenation and decreases mortality rates

259
Q

Hernias that are superior and medial to pubic tubercle

A

Inguinal hernias

260
Q

Baby blues mx

A

Reassurance and follow up

261
Q

Speech non fluent, comprehension normal, repetition impaired

A

Brocas dysphasia, frontal lobe

262
Q

which type fracture
A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.

A

Potts

263
Q

which type fracture
A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.

A

Potts

263
Q

which type fracture
A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.

A

Potts

264
Q

Which type fracture
A 22-year-old drunk man is involved in a fight. He hurts his thumb when he punches his opponent.

A

Bennetts

265
Q
  1. A 73-year-old woman presents with pain in her wrist after falling on to an outstretched hand. On examination there is dorsal displacement and angulation. An x-ray shows a transverse fracture of the radius around 2 cm proximal to the radio-carpal joint.
A

Colles fracture

266
Q

Visual field defect in glaucoma

A

Common in peripheries

267
Q

Low grade MALT lymphoma management

A

Eradicate H.Pylori

268
Q

A 45-year-old woman attends the ear, nose and throat clinic with a 3-month history of left-sided hearing loss. She describes an occasional ringing in her left ear and feels off-balance. Her past medical history includes type 1 diabetes which is well-controlled and she denies any recent infective symptoms.

On examination, Rinne’s test is positive in both ears with Weber’s test lateralising to her right ear. There is no evidence of nystagmus and her coordination remains intact. Aside from an absent left-sided corneal reflex, the remainder of her cranial nerve examination is unremarkable.

What is the most likely diagnosis?

A

acoustic neuroma - always think of this with loss of corneal reflex

269
Q

If 2 level PE wells score is 4 or less and D dimer is negative then what to do

A

Stop anticoagulant and consider alternative dx

270
Q

First line treatment of heart failure

A

ACE inhibitor and B Blocker

(2nd line is aldosterone antagonist like spironolactone and third line is things like ivabradine by specialist)

271
Q

Furosemide - MOA and location

A

Inhibits Na-K-Cl co transporte rin thick ascending limb of loop of hence

272
Q

HTN in diabetes - which is the first line medication

A

ACEP/ARB (regardless age)

273
Q

S/E of calrithromycin which can cause ECG changes

A

Torsades de Pointes

274
Q

Diastolic murmur + AF -> which murmur

A

mitral stenosis

275
Q

How to differentiate cardiac tamponade and constrictive pericarditis

A

Kussmauls sign (raised JVP that doesn’t fall in insporation) with constrictive pericarditis

276
Q

Mx symptomatic bradycardia

A

Atropine 500mcg IV first line
If not good enough then atropine up to 3mg. Transcutaneous pacing. Isporenaline/adrenaline infusion titrated to response

277
Q

Pericarditis vs myocarditis

A

Myocarditis = <50, recent viral illness, inflammatory markers and torpnonin raised, ECG shows non specific ST segment and T wave changes. Can manifest as new onset CHF

Pericarditis = similar but doesn’t cause symptoms left ventricular dysfunction and troponin less likely to be raised with more global ST elevation rather than focal

278
Q

Type murmur for aortic regurgitation

A

Early diastolic murmur

279
Q

When are you advised to take statins

A

Last thing in an evening

280
Q

New onset haemoptysis and mid late diastolic murmur = cause

A

Mitral stenosis

281
Q

MOA Fondaparinux

A

Activates antithrombin III

282
Q

Recent sore throat, rash, arthritis, murmur (systolic) - dx

A

Rheumatic fever

283
Q

What medication can cause torsades de pointes

A

Macrolides like clarithromycin

284
Q

Which murmur is turners syndrome ass with

A

Bicuspid aortic valve - systolic, loudest over aortic alve. Also prone to aortic valve stenosis and coarctation

285
Q

What 2 meds should be given with peripheral arterial disease

A

Antiplatelet and statin

286
Q

What do Q waves suggest on ECG

A

Prev MI

287
Q

Neutropenic sepsis Abx choice

A

IV Piperacillin with tazobactam (Tazocin)

288
Q

Large U waves - what can this suggest

A

Hypokalaemia

289
Q

Hydrogen breath test - what is it used for

A

Small bowel overgrowth syndrome, lactose eintolerance etc

290
Q

H.Pylori test

A

Urea breath test

291
Q

When to use anterior resection vs abdominoperineal resection

A

Anterior resection = rectal tumours (high ones)

APR = distal 8cm of rectum (low) and into sphincters

292
Q

Any unstable tacky needs

A

Synchronised cardio version

293
Q

What Ix in Kawasaki to screen cx

A

ECHO

294
Q

Mastoiditis in ear infeciton can lead to….

A

meningitis

295
Q

in preterm prelabour rupture of membranes what need to be given to reduce rsik resp distress syndrome

A

Dexamethasone

296
Q

In a miscarriage with missed or incomplete with closed os - what medicaiton to given

A

Vaginal misoprostol

297
Q

Which type of stoma is faeculant matter in bag with flush to skin

A

Colostomy

(ileosotmy is spouted)

298
Q

Symptoms of mania - what to do referral wise

A

urgently to community mental health team

299
Q

Bilious vomiting on first day life - what is it mostly likely to be

A

Duodenal atreesa (or intestinal atresia)

300
Q

n haemothoax when >1.5L blood initially lost or losses >200ml per hour for >2hrs then what is the mx

A

thoracotomy

301
Q

dx postural hypotension

A

drop systolic >20 or diastole >10

302
Q

in paeds BLS what is the ratio CPR to breaths

A

15:2

303
Q

serum amylase in pancreatitis

A

> 900 ish as normal is 300 so x3

304
Q

Stages of COPD

A
305
Q

osteoporosis bone labs

A

NORMAL all

306
Q

How often mammography for breast screening

A

every 3 years

307
Q

salicylate poisoning - what abg

A

resp alkalosis

308
Q

mx asymptomatic bacteriuria in pregnant women

A

Abx therapy asap

309
Q

what can recipitste digoxin toxicity

A

thiazides

310
Q

is statin allowed in pregnancy

A

NO

311
Q

what drugs can trigger G6PD def

A

Sulph containing drugs - sulphonamides, sulphasalazine, sulfonylureas - can trigger haemolytic

312
Q

if a pt is on anti-coag or bleeding disorder and they are suspected tIA what is immed mx

A

Exclude haemorrhage - CT!!!!! then maybe aspirin

313
Q

metabolic abnormality in bushings

A

hypokalaemic met alkalosis

314
Q

first line ix for preterm prelabour rupture of membranes

A

careful speculum exam

315
Q

Anaphylactoid reaction to IV NAC - mx (urticaria and facial flushing)

A

Anaphylactoid reactions to IV N-Acetylcysteine are generally treated by stopping the infusion, then restarting at a slower rate

316
Q

pts with cellulitis and penicillin allergy

A

erythromycin

317
Q

A 73-year-old man attends the emergency department with sudden-onset visual loss in the left eye. He reports no pain or headache, and there was no history of preceding trauma. There are no neurological symptoms.

He has a past medical history of poorly-controlled type 2 diabetes, and hypertension.

On examination, he his just about able to distinguish light from dark with the left eye. His red reflex is absent. You are unable to gain any view of the retina with fundoscopy. His neurological examination is otherwise normal.

A

vitreous haemorrhage

318
Q

what medication is lined to new fasciitis of genitalial or peirneum (fourniers gangrene)

A

dapagliflozin

319
Q

When Is the time out stage of Who checklist

A

before ski incision

320
Q

tx acute pancreatitis (even with bruising in flank- grey turnerss)

A

fluids and analgesia

321
Q

first-line for patients mild papules and/or pustules and rosacea

A

ivermectin

322
Q

pts with acute, severe, symptomatic hyponatraemia - mx

A

hypertonic saline

323
Q

if CBT or EDMR therapy ineffective in PTSD then what is first line drug tx

A

venlafaxine or ssri

324
Q

A 72-year-old man has been an inpatient on the elderly care ward for the last 2 weeks. He has a new diagnosis of metastatic lung cancer. On the morning ward round, he complains that his pain is not being adequately controlled. He currently takes oral morphine sulphate 20mg four times a day along with codeine 30mg four times a day and regular ibuprofen.

A

Breakthrough dose = 1/6th of daily morphine dose

Oral codeine to morphine (divide by 10). Therefore, oral codeine 10mg = oral morphine 1mg.

30mg x 4 = 120mg codeine. This equals 12mg morphine.

20mg x 4 = 80mg morphine.

Total morphine = 80mg + 12mg = 92mg.

The breakthrough dose of morphine is 1/6th of the total dose of morphine in 24 hours. This main takes 92mg of morphine in 24 hours. 1/6th of this is 15mg.

325
Q

Symptom control in non-CF bronchiectasi

A

inspiratory muscle training + postural drainage

326
Q

A 70-year-old man comes to the GP surgery with his wife because she is growing increasingly concerned about his health. Five years ago he began to suffer from periods of confusion and sleepiness that seemed to come and go at random. More recently he has also developed a unilateral tremor in his right hand.

Upon questioning, his wife tells you that she has slept in a separate bed for the last 30 years because her husband suffers from bad nightmares.

A

Lewy body

327
Q

Otitis externa in diabetics

A

treat with ciprofloxacin to cover Pseudomonas

328
Q

tx trichomonads vaginalis - trophozoites

A

mETRONIDAZOLE

329
Q

HOW to take hydrocortisone in Addisons

A

hydrocortisone split with majority given in first half day 9try mimic natural)

330
Q

IN statu sepilepticus, the stepwise mx

A
  1. Buccal midazolam/ IV lorazepam
  2. IV Lorazepam
  3. IV phenytoin
    Rapid sequence induction anaesthesia with thiopental sodium
331
Q

Neurogenic thoracic outlet syndrome

A

typical presents with muscle wasting of hands, numbness, and tingling and possiblyy autonomic symptoms

332
Q

aBS IN see

A

ANA positive - sensitive (good to rule ou)
some RF +
Anti-dsDNA highly specific
Anti smith specific…

Difficult Passmed- MLA (26 decks)

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