General medicine - PASSMED Flashcards
1
Q
When giving units of packed red cells, what should be prescribed to prevent fluid overload
A
Furosemide
2
Q
Right bells palsy = what side of lesion
A
Right - same side
3
Q
Treatment for autoimmune hepatitis
A
STEROIDS
4
Q
Inferior myocardial infarction plus aortic regurgitation =
A
Proximal aortic dissection
5
Q
First line renal replacement therapy for pts. w/ good daily function of living
A
Peritoneal dialysis
6
Q
Renal replacement therapy in patient w/ Crohn’s
A
Haemodialysis - insertion of peritoneal catheter dangerous as well as the infusion/drainage of fluid
7
Q
Severe headache which may be worse when bending neck but with normal temperature/no signs of infection
A
Subarachnoid haemorrhage
8
Q
Traction injury: nerve implicated:
Px:
A
Ulnar
Weakness of intrinsic hand muscles (thumb adduction and finger abduction)
Loss of sensation over the medial epicondyle (T1)
9
Q
Upper zone fibrosis mnemonic: CHARTS
A
C - coal workers lung H - histiocytosis/hypersensitivity A - ankylosing spondylitis R - Radiation T - tuberculosis S - silicosis/sarcoidosis
10
Q
New back pain in pt. w/ history of cancer should be investigated by:
A
URGENT MRI
11
Q
Patients who have had an episode of SBP should receive what prophylaxis
A
Infection prophylaxis in the form of CIPROFLOXACIN
12
Q
Ix. of choice in genital herpes:
A
NAAT
13
Q
Sudden anaemia in sickle-cell pt. w/ low reticulocyte count indicates:
A
Parvovirus infection - Aplastic crisis
Acute sequestration and haemolysis would all cause a high reticulocyte count
14
Q
Pseudoseizures vs true seizures onset
A
Pseudoseizures have a gradual on-set
True seizures have acute on-set
15
Q
Anti-biotics causing torsades de pointes
A
MACROLIDES
16
Q
Acute heart failure w/ hypotension - what should be conisdered:
A
Inotropes
17
Q
Most common thyroid cancer
A
Papillary
18
Q
S3 - diastolic filling of the ventricle considered normal if:
A
<30 years old
19
Q
What is Eisenmenger’s syndrome/complex:
A
Reversal of a LEFT to RIGHT shunt
20
Q
What can be tried after intransal steroids in chronic rhinosinusitis
A
Nasal irrigation
21
Q
Smear cells (smudge cells) present in which cancer’s blood film:
A
Chronic lymphocytic leukaemia
22
Q
MODY is inherited via which mode of inheritance?
A
Autosomal dominant
23
Q
First-line management of pts. w/ hypercalcaemia
A
Fluid therapy
24
Q
Most sensitive blood test for liver cirrhosis: in routine bloods
A
THROMBOCYTOPENIA
25
Broca's aphasia vs conduction aphasia
Broca's -> comprehension remains largely intact whereas output is dyarthric and agrammatic. Unlike conduction aphasia the broca's aphasic speech is not at all fluent.
speech fluency
26
Restrictive lung function testing
FEV1- reduced FEV1/FVC ratio normal or increased
27
NSTEMI anti-platelet choice: aspirin plus:
Ticagrelor if not high bleeding risk
| Clopidogrel if high bleeding risk
28
What stage of syphilis are 'GUMMA' associated with:
Tertiary syphilis
29
TB diagnosis active disease:
CXR
Sputum CULTURE = GOLD STANDARD
Sputum smear
NAAT
30
Digoxin toxicity symptoms:
```
GI disturbance (nausea, vomiting, abdominal pain)
dizziness confusion, blurry or YELLOW vision
```
31
Obesity w/ derranged LFTs ->
NAFLD
32
Oral mucositis therapy in palliative care:
Benzydamine hydrochloride mouthwash
33
When is the HbA1C target <53 mmol/l as opposed to <48mmol/l
If patient is on more than 1 oral diabetic medication
| If the patient is on any oral diabetes medication which may cause hypoglycaemia (Gliclazide)
34
Patients taking warfarin should avoid which kinds of food:
Foods containing vitmain K - Sprouts, spinach, kale and broccoli
35
If urine osmolality is > 500 mOsm/kg what renal disease does this indicate
PRE-renal disease - dehydration etc.
36
Causes of raised TLCO:
```
Asthma
Pulmonary haemorrhage
Left-to-right cardiac shunts
Polycythaemia
hyperkinetic states
Male gender
Exercise
```
37
Causes of lowered TLCO:
```
Pulmonary fibrosis
Pneumonia
Pulmonary emboli
pulmonary oedema
Emphysema
Anaemia
Low cardiac output
```
38
RIPE (TB) side effects:
Rifampicin - red/orange secretions
Isoniazid - peripheral neuropathy (prevent with pyridoxine)
Pyrazinamide - Hyperuricaemia, gout
Ethambutol - Optic neuritis: check visual acuity
39
Treatment for herpes simplex keratitis:
TOPICAL Aciclovir
| NOTE - Herpes zoster ophthalmicus cannot be treated w/ topical antivirals
40
Test to confirm menopause
Follicle stimulating hormone (FSH)
41
Which blood cancer are coeliac pts. at an increased risk of:
T-cell lymphoma
42
Chronic lymphoblastic leukaemia are at risk of what type haemolytic anaemia
Warm-type
43
Platelet threshold for transfusion in:
Normal but significant bleeding
Bleeding at high-risk site (CNS)
<30
<100
44
Initial radiological investigation in suspected Budd-Chiari syndrome
Ultrasound
Hepatic venography after
45
Commonest cause of primary hyperaldosteronism:
Bilateral idiopathic adrenal hyperplasia
46
Steroids may cause which kind of myopathy:
Proximal myopathy
47
If AF secondary to other acute condition (e.g pneumonia) what should be given:
IV fluids - or correct that particular disturbance rather than starting anti-arrhythmic drugs
48
Recurrent gout - pt. already established on Allopurinol, how should their acute flare be managed:
Continue Allopurinol
| Commence Colchicine
49
Features of mitral stenosis
```
AF
Malar flush
Dyspnoea
Haemoptysis
Loud S1 - opening snap
Malar flush
Atrial fibrillation
```
50
AF treatment if coexistent heart failure, reversible cause
Rhythm control
51
Difference between labyrinthitis and vestibular neuronitis
Hearing is normal in vestibular neuronitis
52
Lithium toxicity may be precipitated by:
Dehydration
Renal failure
Drugs - diuretics (thiazides) ACEis, BB
NSAIDS
53
Lithium may exacerbate which skin condition:
Psoriasis
54
Type of eczema exacerbated particularly by humidity: sweating and high temperatures
Pompholyx eczema
55
Cystic fibrosis/sickle cell are inherited via which type of inheritance
Autosomal recessive
56
If neutropenic with cancer and NOT septic tx:
FILGRASTIM (G-CSF)
57
Hypothenar wasting w/ reduction in thumb ADDUCTION nerve injury:
Ulnar nerve
58
Hyperkalaemia ECG features:
small P waves
Widened QRS complexes
sinusoidal pattern
Tall tented T waves
59
Man returns from trip abroad w/ maculopapular rash and flu-like illness ->
HIV seroconversion
60
GI malabsorption is common feature for which cause of gastroenteritis
Giardiasis
61
Causes of reduced reticulocytes in sickle cell:
Parvovirus B19 _>
| Aplastic anaemia
62
Treatment for acute haemolytic transfusion reaction
Terminate transfusion
Generous fluid resuscitation
No need for IM adrenaline
63
IBD associated w/ gallstones
Crohn's disease
64
MUST score: (3)
BMI < 18.5 kg/m
BMI < 20 and >5% weight loss in 6 months
Unintentional weight loss > 10% of body weight in 6 months at any weight
65
Derranged LFTs and neurological disease:
Wilson's disease
66
Previous splenectomy will have which effect on HbA1C
Over-estimates due to increased RBC life
67
Causes of HbA1C under-estimation:
Sickle-cell anaemia
G6PD deficiency
Hereditary spherocytosis
68
Aside from metformin which other oral diabetic drug works by reducing peripheral insulin resistance
Glitazones
69
Signs of right heart failure:
Ankle oedema
Hepatomegaly
Raised JVP
70
Aortic stenosis tx: if symptomatic:
Valve replacement
71
Options for Aortic valve replacement:
| incl. asymptomatic pts. w/ valvular gradient > 40 mmHg
Surgical AVR = for young, low operative risk patients
| TAVR (transcatheter AVR is used for pts. w/ high operative risk
72
Aortic stenosis: when may balloon valvuloplasty be considered:
In children w/ no aortic valve calcification or adults not fit for valve replacement
73
Pneumonia which causes cavitation in the upper lobes
Klebsiella
| Assoc. w/ alcoholism
74
Pain relief if GFR < 10ml/min
Fentanyl
75
Pain relief if GFR 10-50 ml/min
Oxycodone
76
Levodopa side-effects:
```
Dyskinesia
On-off effect
Postural hypotension
Cardiac arrhythmias
Nausea and vomiting
psychosis
```
77
High-stepping gait indicates:
Peripheral neuropathy - foot drop compensation
78
Weakened dorsiflexion, inversion and eversion of the ankle, paraesthesia in first web space of big toe indicates nerve lesion where:
L5
79
Medications which can delay bone healing:
NSAIDS
Steroids
Immunosuppressants
80
Most common cause of ambiguous genitalia
Congenital adrenal hyperplasia
81
What is Prehn's sign:
Easing of pain upon lifting of the scrotum - occurs with Epididymitis but NOT with torsion
82
Components of the Glasgow pancreas score:
```
P - PaO2 <8
A - Age >55
N - Neutrophilia >15X109
C - Calcium <2 mmol
R - Renal function (Urea) >16
E - Enzymes - LDH > 600 AST > 200
A - Albumin < 32 g/l
S - Sugar > 10 mmol/l
```
83
Post ORIF breathlessness w. retinal haemorrhages and intra arterial fat globules assoc. w/
Fat embolism
84
Long term usage of which drug may result hyperparathyroidism and hypercalcaemia:
Lithium
85
Murmurs are graded by the __ scale
Levine scale
| Grades 1-6
86
Upper GI bleeding score to assess which pts. can be discharged:
Glasgow-Blatchford score ->
Not to be confused w. Rockall score which is used AFTER endoscopy to identify those at risk of repeat bleed
87
Suspected PE - clear CTPA -> investigation
Leg ultrasound
88
ABC features of irritable bowel syndrome:
Abdominal pain
Bloating
Change in bowel habit
89
What electrolyte indicates whether a kidney injury is acute or chronic
Calcium
90
Bronchodilator reversibility percentage indicative of Asthma
Reversibility >12%
91
Which pneumonia bug can cause neurological disturbances via immune complexes
Mycoplasma
92
Aortic stenosis most common cause in:
<65
>65
Bicuspid aortic valve
Calcification
93
What should be given before endoscopy in a variceal bleed:
Terlipressin and antibiotics
94
Autoimmune hepatitis antibodies
Anti-nuclear antibodies
Anti-smooth muscle antibodies (ASMA)
NOT Anti-mitochondrial antibodies as seen in PBC
95
3 features of trichomonas vaginalis
Offensive yellow/green discharge
Vulvovaginitis
Strawberry cervix
96
SCALP psoriasis - first line-Tx
Potent topical steroids
97
When is the anomaly scan:
18-20+6 weeks
98
Gingival hyperplasia causes:
Phenytoin
CICLOSPORIN
CCB
AML
99
What diabetes drug should be stopped during myocardial infarction
Metformin
| Risk of lactic acidosis
100
Prior to administering flecainide, what should be performed and why:
Echocardigram
To look for signs of structural heart disease as flecainide contraindicated in structural heart failure
101
Pupil size in anterior uveitis vs. acute closed angle glaucoma:
Anterior uveitis = normal or small pupil
Acute angle closure glaucoma = fixed semi-dilated pupil
102
Direct vs indirect Coombs test:
Direct: haemolytic anaemias
Indirect: Rhesus haemolytic disease of the newborn
103
Cancer assoc. w/ Hashimoto's
Thyroid lymphoma (which may be felt as a hard nodule)
104
Healthcare workers w/out immunity to chickenpox should receive ->
Varicella-Zoster vaccination
105
Antibiotics which lower seizure threshold and should be avoided in epilepsy:
Quinolones
106
Hypertension is more commonly associated w/ Nephroblastoma or Neuroblastoma
Nephroblastoma (Wilm's)
107
Incontinence study indicated where there is diagnostic uncertainty:
Urondynamic studies
108
Normal examination finding in polymyalgia rheumatica:
No reduced POWER
109
Urine osmolarity < 350 mOsm/kg
Acute tubular necrosis
110
Antihypertensive to stop prior to initiating sacubitril-valsartan therapy
ACEIs or ARBS
111
If there's an inferior MI, what may also happen as a result of the occluded artery
Right coronary artery
Supplies SA node
Atrioventricular block (AV block)
112
Indications for dialysis in AKI
```
AEIOU
Acidosis (ph <7.1)
Electrolytes - refractory
Intoxication
Overload (refractory to diuresis)
Uraemic pericarditis, encephalopathy
```
113
How long after clinical resolution of pneumonia should an X-ray be taken
CXR taken 6 weeks after resolution
114
Treatment for SIADH:
Fluid restriction
115
Chronic diarrhoea, abdominal bloating and failure to thrive in a child:
Coeliac disease
116
How can you tell if an AKI is caused by dehydration
Urea - proportionally higher rise than that of creatinine
In dehydration, ADH causes reabsorption of the urea from loop of Henle and collecting duct
117
Small bowel bacterial overgrowth syndrome tx.
Rifaximin
118
Tumour lysis syndrome electrolyte disturbances
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
119
Prophylaxis tumour lysis syndrome:
IV allopurinol
120
As well as WPW, which condition can cause slurring of QRS on ECG
RBBB
121
ES Murmurs which are louder on inspiration:
ASD
| Pulmonary stenosis
122
ES Murmurs which are louder on expiration
Aortic stenosis
| HOCM
123
AF stroke secondary prevention
Aspirin 300 mg for 2 weeks
| Life-long anticoagulant
124
Thyrotoxicosis may lead to which cardiac complication:
High-output cardiac failure
125
Over-replacement of thyroxine may cause what:
OSTEOPOROSIS
126
Side-effects of thyroxine:
Hyperthyroidism
Reduced bone mineral density
Worsening of angina
Atrial fibrillation
127
Flashers and floaters in vision:
Posterior vitreous detachment
128
Achalasia puts pts. at greater risk of which cancer:
Squamous cell carcinoma
129
Which CCB may cause constipation
Verapamil
130
Should pts. be made nil by mouth in acute pancreatitis:
Not routine - unless there is a clear reason. Pt. is vomiting
131
Physical direct complication of thymomas
IVC obstruction causing neck vein distension and facial flushing
132
When to give Vit K orally:
if NO bleeding and INR > 8
If INR 5-8 but there is bleeding, it goes back to IV VIT K
133
Food product which usually harbours E.coli 0157 -> HUS
Contaminated beef
134
Hoffman's sign assoc w/
DCM
135
Petrosal sampling used in Cushing's to:
differentiate between pituitary and ectopic ACTH production
136
Renal transplant plus infection =
CYTOMEGALOVIRUS
137
Antibiotics of choice in bronchitis:
DOXYCYCLINE
138
First-line investigation in thyroid nodules:
Ultrasound
139
Most common site affected in UC
Rectum
140
Key component of blood test in assessing severity of C.difficile
WCC
| >15 = severe
141
Investigation of choice in genital herpes:
NAAT
142
Drug most likely to prevent motion sickness:
CYCLIZINE
143
Antibiotic contraindicated in G6PD deficiency:
Ciprofloxacin
144
Paracetamol overdose - which factors are high risk for adverse outcomes
Chronic alcohol intake
HIV
Anorexia
P450 inhibitors
145
Intoxication/overdose w/ hallucinations:
LSD
146
Methotrexate monitoring tests:
FBC. LFT, U&E
147
If women taking HRT for premature menopause, when should they stop:
Age 50
148
Hydatidiform mole: Blood tests: HCG, TSH, Thyroxine
High
Low
High
HCG stimulates the thyroid gland directly
149
In a patient w/ cardiac arrest caused by hypothermia: what temperature should they be warmed to before restarting compressions
30 degrees
150
Anaphylaxis reaction to blood transfusion management:
```
Permanent transfusion termination
IM adrenaline
Antihistamines
Corticosteroids
Bronchodilators
Supportive care
```
151
Tetralogy of Fallot murmur:
Ejection systolic
152
which diuretics cause ototoxicity
Loop diuretics
153
Papilloedema will show what kind of change on fundoscopy
```
Blurred of the optic disc margin
Venous engorgement (usually first sign)
```
154
Cupping of the optic disc occurs due to
Glaucoma - Increased ocular pressure
155
Fracture of upper limb which causes pain and inability to pronate/supinate
Radial head
156
How many units of insulin are in 1 ml
100 units
157
IDA vs anaemia of chronic disease
TIBC high in IDA
| TIBC low or normal in anaemia of chronic disease
158
Two cardio medications which, if taken together will cause bradycardia and/or complete heart block:
Bblocker and Rate-limiting CCB
159
Anti-epileptic drug with peripheral neuropathy as a side effect:
Phenytoin
160
Ankle dorsiflexor nerve roots:
L4, L5
161
Tx. lichen planus:
Potent TOPICAL steroids
162
GBM = deposits of which immunoglobulin:
IgG
163
Side effects of bisphosphonates:
Oesophageal reactions - oesophagitis
Osteonecrosis of jaw
Atypical stress fractures
hypocalcaemia
164
Giving aspirin (NSAIDS) increases the risk of which dermatological complication when given to pts. w/ chickenpox
Necrotising fasciitis
165
Scarlet fever school exclusion:
24 hours from time of antibiotic commencement
166
Hypo/Hypercalcaemia causes cataracts ->
HYPOcalcaemia
167
AACG - what is given as initial tx.
```
Direct parasympathomimetic (constricts pupil to widen the iridocorneal angle) - pilocarpine
and BB eye drops
```
168
How long must a pt. have been in hospital for before their pneumonia can be classed and treated as HAP
48 hours - 2 days
169
Restless legs syndrome tx.
Ropinirole - dopamine agonist
170
First line mx. in dementia
dopamine agonist (Donepezil etc.)
Memantine is second line
171
Tx. for severe HYPOkalaemia
Cardiac monitoring
3X1 L bags of 0.9% saline
40 mmol KCL per bag over 24 hours
172
Ectopic pregnancy with heartbeat tx.
Salpingotomy/ectomy
Medical/conservative management not enough
173
Reactive arthritis tx. to try after NSAIDs if no response:
Oral steroids
174
Cardiac arrest w/ suspected PE treatment in addition to ALS:
Thrombolysis w/ alteplase
175
PE with renal impairment investigation:
V/Q scan
176
Describe the effect of long term steroids on the aldosterone system and subsequent metabolic disturbance
1. Steroids suppress adrenal function over time, this includes aldosterone synthesis
2. Aldosterone acts at the kidney to cause retention of sodium and excretion of potassium
3. Reduced aldosterone means less potassium excretion
4. Potassium is equivalent to hydrogen ions, so acidity increases (essentially)
5. Acidosis - via a metabolic mechanism and with hyperkalemia
177
Subarachnoid haemorrhage may cause what on ECG
Torsades de pointes
178
If patients treated with PCI for MI are experiencing pain or haemodynamic instability post-procedure ->
CABG
179
T1DM targets for blood glucose:
On waking
Before meals or other times of the day
5-7 mmol/l on waking and
| 4-7 mmol/l before meals at other times of the day
180
Warfarin: target INR =
2. 5
| 3. 5 if recurrent VTEs
181
Diabetic foot - ulcer that goes to bone Ix.
MRI to rule out/in osteomyelitis
182
Wernicke's and Broca's area are supplied by which cerebral artery:
Middle cerebral artery
183
Common trigger for cluster headaches:
Alcohol
184
Heart failure 3rd line for afro-carribean patients:
Hydralazine with nitrate
185
Endometriosis treatment ladder:
1) NSAIDs and Paracetamol
2) COCP or POP
If this fails:
3) GnRH analogues
186
AF pharmacological control if first episode:
Flecainide or other rate limiting anti-arrhythmic drug
187
INR 5.0-8.0 (no bleeding)
Withhold 1 or 2 doses of warfarin, reduce subsequent maintenance dose
188
In a non-urgent scenario: how long are RBCs infused over:
90-120 minutes
189
Idiopathic thrombocytopaenic purpura type of hypersensitivity:
Type II
190
Osteomyelitis in pt. w/ sickle cell disease organism:
Salmonella
191
Cardio drug which can cause ulceration of the GI tract
Nicorandil
192
Hyperlipidaemia: causes of primary hypertriglyceridaemia
```
diabetes mellitus (types 1 and 2)
obesity
alcohol
chronic renal failure
drugs: thiazides, non-selective beta-blockers, unopposed oestrogen
liver disease
```
193
Causes of predominantly hypercholesterolaemia
nephrotic syndrome
cholestasis
hypothyroidism
194
Pin-point pupils stroke:
Pontine stroke
195
Factor V Ledien deficiency =
Activated protein C resistance
196
Weber's syndrome - midbrain stroke
CN palsy on ___ side
Weakness on ___ side
Ipsilateral
Contralateral
197
Global T wave inversion and prolonged QT on ECG:
Head injury - cerebral T waves
198
Hepatitis likely to be contracted via ano-oral sex
Hepatitis A
199
Aortic dissection ix.
CT aortic angiogram
200
Status epilepticus: Which two metabolic states should be ruled out:
Hypoglycaemia
| Hypoxia
201
Ramsay hunt syndrome tx.
Oral aciclovir and corticosteroid
202
Salicylate overdose: first symptom:
Tinnitus
Starts with respiratory alkalosis due to hyperventilation then goes to metabolic acidosis
203
Heparin electrolyte disturbance:
May cause HYPERKALAEMIA
204
AF cardioversion what should be given first:
Heparin - anticoagulation
205
What does homonomyous hemianopia mean with regards to visual field defects:
same side (L-L/R-R) of visual field on both eyes affected
206
Erysipelas causative organism:
Streptococcus pyogenes
207
Erysipelas vs. cellulitis appearance
Erysipelas has raised and well defined border
208
Nose bleed if fail to stop with conventional methods:
Silver nitrate cautery if bleed can be visualised
| Anterior packing if bleed cannot be visualised
209
Antibiotic class which causes: Metallic taste in mouth and black hairy tongue
Tetracycline
210
Switching from PoP to COCP -> how many days of condom cover:
7 days
211
DVLA: single TIA protocol
No need to inform DVLA, 1 month off driving
212
Hypersegmented neutrophils on blood film indicate:
Macrocytic anaemia
213
First move in orbital cellullitis:
IV antibiotics
214
Red melanoma which oozes/bleeds and metastasises early:
Nodular melanoma
215
Polycythaemia vera tx.
Aspirin - preven clots
Venesection - keep Hb in normal range
Hydroxyurea - reduce chance of secondary malignant transformation
216
Heparin induced thrombocytopenia mx.
Switch to direct thrombin inhibitor
| protamine sulphate can reverse heparin
217
Blue gum margin w/ abdominal pain
Lead poisoning
218
What are Triptans contraindicated in:
Triptans are contraindicated in ischaemic heart disease and cerebrovascular disease
219
Ascites managenent:
Antibiotic prophylaxis?
Reduce dietary sodium
Restrict fluid intake (if sodium less than 125)
Aldosterone
Ciprofloxacin - for people with cirrhosis
220
Chronic alcoholism electrolyte disturbance:
Hypomagnesaemia
221
HIV drugs that end in Navir belong to which class?
Protease inhibitors
'Navir tease a pro"
222
Chronic subdural bleed on CT
Hypodense crescenteric
223
Superinfection for IVDU w/ diagnosed Hepatitis B
Hepatitis D
224
Drugs to avoid in chronic renal failure:
NSAIDS
Lithium
Metformin
Antibiotics: tetracycines and nitrofurantoin
225
Antibiotics safe in CKD:
Erythromycin
| Rifampicin
226
Flexion of the 1st,2nd and 3rd fingers nerve:
Median
227
Antibiotic contraindicated in G6PD deficiency
CIPROFLOXACIN
228
Pigmented gallstones are assoc. w/ which condition
Sickle cell anaemia
229
Fanconi anaemia fx.:
Haematological
Skeletal
misc.
Aplastic anaemia
increased risk of AML
Short stature
Cafe au lait spots - multiple
230
Which cardio medication should be stopped in severe aortic stenosis:
ACE inhibitor
Theory is that due to vasodilatory effect of drug the coronary perfusion pressure will be reduced resulting in ischaemia
231
ERCP most common complication:
Acute pancreatitis
232
Investigations of choice in PSC
ERCP/MRCP
233
Multiloculated, heterogenous mass located above the hyoid bone
Dermoid cyst
234
When should Allopurinol be started in acute gout:
after 1st episode, when the inflammation has settled
| Bridge w/ colchicine
235
Antibiotic of choice in Erythrasma
Erythromycin
Erythra-erythro
236
Pancreatitis scoring systems: which is more specific
Glasgow and Apache II
| Glasgow
237
Side effects of Tamoxifen:
Irregular bleeding
Hot flushes,
Venous thromboembolism
Endometrial cancer
238
Can you use metronidazole in pregnancy:
YES
239
worst prognostic factor in MI:
Cardiogenic shock
As per Killip classses
Pulmonary oedema is second worst (Grade 3)
240
when should intranasal steroids be considered for sinusitis:
If symptoms have persisted for 10 DAYS.
241
```
Mode of action of
COCP
POP
Injectable
Implantable
IUD
IUS
```
COCP: inhibits ovulation
POP: thickens cervical mucous
Injectable: Inhibits ovulation
Implantable: Inhibits ovulation
IUD: Decreases sperm motility and survival
IUS: Prevents endometrial proliferation
242
IBS: tx.
Pain
Constipation
Diarrhoea
Pain: Anti-spasmodic agent
Constipation: laxative but NOT LACTULOSE
Diarrhoea: Loperamide
243
Antibiotic which may cause IIH:
Tetracyclines
244
Acanthosis nigricans is seen in T1 or T2 DM?
T2 - as due to insulin resistance
245
Pts. w/ haemochromatosis are at risk for which cancer:
Hepatocellular carcinoma
246
When should a social smile be seen in a baby:
6-8 weeks
Refer if not seen by 10 weeks
247
Risk factors for abruption mnemonic:
```
A for abruption
B for blood pressure
R for ruptured membranes
U for uterine injury
P for polyhydramnios
T for twins or multiple gestation
I for Infection
O for older age
N for narcotics - cocaine, amphetamines and smoking
```
248
Common activity which may cause increased iron without overload:
Alcoholism
249
High plasma osmolarity with low urine osmolality:
Diabetes insipidus
250
Plummer-Vinson triad:
Dysphagia
Glossitis
IDA
251
Respiratory tract infections:
| Who gets immediate antbiotic therapy
Child < 2 years w/ bilateral acute otitis media
Children w/ acute otitis media and otorrhoea
Pts. w/ sore throat/acute pharyngitis/acute tonsilitis w/ 3 or more CENTOR present
252
Management for pt. with sigmoid volvulus and peritonism:
Skip flexible sigmoidoscopy and treat with urgent midline laparotomy
253
When are steroids to be used in sarcoidosis:
```
If deteriorating CXR findings
Deteriorating pulmonary function tests
Neurological/cardiac/ocular/splenic/hepatorenal involvement
Hypercalcaemia
or Lupus pernio
```
254
Neoplastic spinal cord syndrome tx.
Urgent high dose dexamethasone
| Urgent oncological assessment
255
Type I vs Type II bipolar
As well as psychotic symptoms, Bipolar I (mania) dx requires symptoms for at LEAST 7 days
Hypomania = at least 4 days w/ non psychotic symptoms
256
Pleural transduates (<30g/l)
Hypothyroidism
Hypoalbuminaemia
Heart failure
Meig's syndrome
257
Pleural exudates (>30g/l)
```
Pneumonia (m/c cause)
Connective tissue diseases (RA, SLE)
Malignancy - lung cancer, mesothelioma
Dressler's syndrome
Pericarditis
PULMONARY EMBOLISM (unexpected)
Pancreatitis
```
258
Pathological jaundice in neonate (<24 hours) investigation
Blood film
Think of the causes:
G6PD
Hereditary spherocytosis
Rhesus haemolytic disease
259
Neural tube defects: vitamin implicated
FOLIC ACID
260
Hip fracture fixation w/ DHS post op advise:
Immediate post-op full weight bearing
261
Barrett's: which is more alarming: Metaplasia or Dysplasia?
Dysplasia
Requires endoscopic resection
Metaplasia requires high-dose PPI plus SURVEILLANCE
262
Ocular trauma w/ hyphaema may put pt. at risk of which condition:
GLAUCOMA
263
Extra-dural vs. Subdural - which bleed crosses the suture lines
Subdural
264
Most common type of Hodgkin's lymphoma:
Nodular sclerosing
265
Non-keratinised warts vs. keratinised warts tx.
```
Keratinised = Cryotherapy
Non-keratinised = Topical Podophyllum
```
266
Dx. Lung cancer from CXR -> next investigation
Contrast enhanced CT scan
Tumours typically very vascular so will show increased uptake
267
Tumour lysis syndrome electrolytes:
```
Hyperkalaemia
Hyperphosphataemia
HYPOcalcaemia
Elevated Creatinine
Elevated Uric acid
```
268
CKD (eGFR<15) Anti-coagulant of choice:
If eGFR > 15:
Either LMWH or UFH
UFH has lower risk of bleeding (UFH recommended by NICE)
DOACs can be given between (15-50 eGFR)
269
N-acetyl cysteine reaction -> what type of reaction:
Anaphylactoid - Non-IgE mediated
NOTE: not 'anaphylacTIC'
270
Treatment of Theophylline toxicity:
HAEMODIALYSIS
271
Focal seizure w/ post-ictal weakness:
Todd's paresis
272
Drug causes of tinnitus/ototoxicity:
Aspirin/NSAIDs
Aminoglycosides
Loop diuretics - NOT THIAZIDES
QUININE
273
Longer duration of action - LMWH or UFH
LMWH
274
Diabetes insipidus visual field defect
LOWER bitemporal quadrantopia
Caused by craniopharyngioma
275
Maintaining remission in LEFT sided ulcerative colitis
low dose ORAL aminosalicylate or steroid
Otherwise, rectal aminosalicylate
276
UC mx. if > 2 exacerbations in the year:
Azathoprine or mercaptopurine
These two are first line in Crohn's remission maintenance treatment but are only used in this specific circumstance in UC
277
Marfan's murmur:
MITRAL REGURGITATION
278
Wells score 4 - which side do you air on: PE likely or unlikely
PE Unlikely
279
Coeliac disease: immunisations
Annual flu
| 5 yearly pneumococcal due to functional HYPOSPLENISM
280
Vasculitis with Hep B infection
Polyarteritis nodosa
px. w/ LIVEDO reticularis
281
Neuropathic drug which many cause/contribute to serotonin syndrome
Tramadol
282
Cystic fibrosis pneumonia organism:
Pseudomonas aeruginosa
283
Beta thalassaemia major vs trait:
Major = severe anaemia (<60) requiring frequent tranfusion
Trait - microcytosis out of proportion to minor anaemia
284
Blood product with highest infection risk:
Platelets - as they need to thaw out
285
Palliative care: if pain not controlled on morphine what may be changed:
Dose -> increase by 30-50% in effort to control pain
286
Antibiotic used for psittacosis
```
Doxycycline = 1st line
Macrolide = 2nd line
```
287
Obstructive lung diseases
ABC
Asthma
Bronchiolitis - bronchiolitis obliterans (RA)
COPD
288
Bupropion contraindications
EPILEPSY
Pregnancy
Breast feeding
Having an eating disorder is a relative contraindication
289
Varenicline contraindications:
Pregnancy
| Breast feeding
290
Low TLCO but increased KCO conditions:
Pneumonectomy
Kyphosis/scoliosis
Neuromuscular weakness
Ankylosing spondylitis
Mechanical issues
291
Bloody diarrhoea - more assoc w/ which IBD
Bloody diarrhoea is more associated with Ulcerative colitis
292
Post operative analgesia via epidural allows:
Faster return of normal bowel function after abdominal surgery
293
DMARDs considered safe in pregnancy:
Sulphasalazine and hydroxychoroquine
Women w/ RA should be referred to obstetric anaesthetis due to risk of atlanto-axial subluxation
294
Is rubella immunity screened for at booking
No
| Not since 2016
295
SFH should be within __ cm of weeks gestation
+/- 2 cm (24 weeks = 22-26 cm SFH)
296
Causes of hyperechogenic bowel on US
Cystic fibrosis
Down's syndrome
Cytomegalovirus
297
VTE prophylaxis in pregnancy:
Initiated from:
Till:
LMWH
28 weeks gestation
6 weeks PP (puerperal period duration - most likley time for VTE)
DOACs and Warfarin should be avoided in pregnancy
298
How is Exenatide (GLP-1) administered
S/C injection
299
Mouth ulcers persisting for > 3 weeks should be sent where under which referral
Oral surgery under 2WW referral
300
Ix. to check anastamotic function (not leaking) after abdominal surgery:
Gastograffin enema
Preferred over barium enema as less toxic
301
Pleural effusion fluid protein/serum protein ratio > __ indiactes an exudative infiltration?
Pleural effusion fluid protein:serum protein ratio of greater than 0.5 = Exudate
also pleural LDH:serum LDH > 0.6
302
Herpes zoster ophthalmicus assoc. w/ which ocular complication
Anterior uveitis
303
Breast cancer referral: 2WW
Women > 30 with unexplained breast lump - even if sounds benign
Women over 50 with UNILATERAL nipple changes
if < 30 refer via routine pathway
304
Young person with renal stones likely stone content:
Cysteine stones - inherited transmembrane disorder
305
Anaemia:
IDA effect on platelets:
B12 deficiency effect on platelets:
IDA may cause a reactive thrombocytosis
Lung cancer may also cause increased platelets
B12 def may cause thrombocytopenia
306
Commonest cancers to metastasise to bone (3)
Prostate
BREAST
Lung
PBL
307
Breast screening:
What
When
Who
Mammogram
every 3 years
women 50-70
308
Antibiotics not to be prescribed in G6PD
CIPROFLOXACIN
| SULF containing drugs (Sulphonamides, sulphasalazine, sulphonylurea)
309
In anaphylaxis, how often should adrenaline be administered:
Every 5 minutes
310
Chicken pox (Varicella zoster) rash progression
Macules and papules to vesicular lesions which crust over
311
Antibiotic of choice for bronchiectasis:
Amoxicillin
312
Differentiating between Parkinson's and Lewy body
```
Parkinson's = TREMOR before dementia
LBD = DEMENTIA before tremor
```
313
Addison's disease treatment: when should this be taken:
Hydrocortisone, fludrocortisone split with more taken earlier in the day to mimic natural release
314
Best imaging modality to confirm diagnosis of pancreatitis:
CT abdomen with contrast
Looking for pancreatic calcification
315
Which psych drug is associated with a large increase in mortality for pts. w/ dementia:
Anti-psychotics
316
If pt. w/ endometriosis has painful periods and has tried NSAIDs, COCP contraindicated what may be tried before GnRH
Progesterone only pill
317
IV adrenaline should be considered after how many bouts of IM adrenaline
2 (5 mins apart) as per resus council guidelines
318
Telogen effluvium: describe
hair loss after a stressful or traumatic experience
319
Acral lentingous melanoma: where does it affect
Arises in areas NOT related to sun-exposure
| Afro-carribeans
320
Endocarditis assoc. w/ poor dental hygiene:
STREPTOCOCCUS VIRIDANS
321
Treatment for APS in pregnancy
Aspirin and enoxaprin
322
Electrolyte disturbance caused by heparin
Hyperkalaemia
323
Reynold's pentad:
Charcot triad (jaundice, RUQ pain, fever) PLUS
Hypotension
Confusion
