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FLASH FINALS > General medicine - PASSMED > Flashcards

General medicine - PASSMED Flashcards

1
Q

When giving units of packed red cells, what should be prescribed to prevent fluid overload

A

Furosemide

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2
Q

Right bells palsy = what side of lesion

A

Right - same side

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3
Q

Treatment for autoimmune hepatitis

A

STEROIDS

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4
Q

Inferior myocardial infarction plus aortic regurgitation =

A

Proximal aortic dissection

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5
Q

First line renal replacement therapy for pts. w/ good daily function of living

A

Peritoneal dialysis

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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

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7
Q

Severe headache which may be worse when bending neck but with normal temperature/no signs of infection

A

Subarachnoid haemorrhage

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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)

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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
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10
Q

New back pain in pt. w/ history of cancer should be investigated by:

A

URGENT MRI

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11
Q

Patients who have had an episode of SBP should receive what prophylaxis

A

Infection prophylaxis in the form of CIPROFLOXACIN

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12
Q

Ix. of choice in genital herpes:

A

NAAT

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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

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14
Q

Pseudoseizures vs true seizures onset

A

Pseudoseizures have a gradual on-set

True seizures have acute on-set

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15
Q

Anti-biotics causing torsades de pointes

A

MACROLIDES

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16
Q

Acute heart failure w/ hypotension - what should be conisdered:

A

Inotropes

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17
Q

Most common thyroid cancer

A

Papillary

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18
Q

S3 - diastolic filling of the ventricle considered normal if:

A

<30 years old

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19
Q

What is Eisenmenger’s syndrome/complex:

A

Reversal of a LEFT to RIGHT shunt

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20
Q

What can be tried after intransal steroids in chronic rhinosinusitis

A

Nasal irrigation

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21
Q

Smear cells (smudge cells) present in which cancer’s blood film:

A

Chronic lymphocytic leukaemia

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22
Q

MODY is inherited via which mode of inheritance?

A

Autosomal dominant

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23
Q

First-line management of pts. w/ hypercalcaemia

A

Fluid therapy

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24
Q

Most sensitive blood test for liver cirrhosis: in routine bloods

A

THROMBOCYTOPENIA

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25
Q

Broca’s aphasia vs conduction aphasia

A

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

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26
Q

Restrictive lung function testing

A

FEV1- reduced FEV1/FVC ratio normal or increased

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27
Q

NSTEMI anti-platelet choice: aspirin plus:

A

Ticagrelor if not high bleeding risk

Clopidogrel if high bleeding risk

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28
Q

What stage of syphilis are ‘GUMMA’ associated with:

A

Tertiary syphilis

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29
Q

TB diagnosis active disease:

A

CXR
Sputum CULTURE = GOLD STANDARD
Sputum smear
NAAT

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30
Q

Digoxin toxicity symptoms:

A 
GI disturbance (nausea, vomiting, abdominal pain) 
dizziness confusion, blurry or YELLOW vision
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31
Q

Obesity w/ derranged LFTs ->

A

NAFLD

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32
Q

Oral mucositis therapy in palliative care:

A

Benzydamine hydrochloride mouthwash

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33
Q

When is the HbA1C target <53 mmol/l as opposed to <48mmol/l

A

If patient is on more than 1 oral diabetic medication

If the patient is on any oral diabetes medication which may cause hypoglycaemia (Gliclazide)

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34
Q

Patients taking warfarin should avoid which kinds of food:

A

Foods containing vitmain K - Sprouts, spinach, kale and broccoli

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35
Q

If urine osmolality is > 500 mOsm/kg what renal disease does this indicate

A

PRE-renal disease - dehydration etc.

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36
Q

Causes of raised TLCO:

A 
Asthma
Pulmonary haemorrhage
Left-to-right cardiac shunts 
Polycythaemia 
hyperkinetic states
Male gender
Exercise
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37
Q

Causes of lowered TLCO:

A 
Pulmonary fibrosis 
Pneumonia 
Pulmonary emboli 
pulmonary oedema 
Emphysema 
Anaemia 
Low cardiac output
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38
Q

RIPE (TB) side effects:

A

Rifampicin - red/orange secretions

Isoniazid - peripheral neuropathy (prevent with pyridoxine)

Pyrazinamide - Hyperuricaemia, gout

Ethambutol - Optic neuritis: check visual acuity

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39
Q

Treatment for herpes simplex keratitis:

A

TOPICAL Aciclovir

NOTE - Herpes zoster ophthalmicus cannot be treated w/ topical antivirals

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40
Q

Test to confirm menopause

A

Follicle stimulating hormone (FSH)

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41
Q

Which blood cancer are coeliac pts. at an increased risk of:

A

T-cell lymphoma

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42
Q

Chronic lymphoblastic leukaemia are at risk of what type haemolytic anaemia

A

Warm-type

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43
Q

Platelet threshold for transfusion in:
Normal but significant bleeding
Bleeding at high-risk site (CNS)

A

<30

<100

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44
Q

Initial radiological investigation in suspected Budd-Chiari syndrome

A

Ultrasound

Hepatic venography after

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45
Q

Commonest cause of primary hyperaldosteronism:

A

Bilateral idiopathic adrenal hyperplasia

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46
Q

Steroids may cause which kind of myopathy:

A

Proximal myopathy

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47
Q

If AF secondary to other acute condition (e.g pneumonia) what should be given:

A

IV fluids - or correct that particular disturbance rather than starting anti-arrhythmic drugs

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48
Q

Recurrent gout - pt. already established on Allopurinol, how should their acute flare be managed:

A

Continue Allopurinol

Commence Colchicine

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49
Q

Features of mitral stenosis

A 
AF 
Malar flush 
Dyspnoea 
Haemoptysis 
Loud S1 - opening snap 
Malar flush 
Atrial fibrillation
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50
Q

AF treatment if coexistent heart failure, reversible cause

A

Rhythm control

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51
Q

Difference between labyrinthitis and vestibular neuronitis

A

Hearing is normal in vestibular neuronitis

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52
Q

Lithium toxicity may be precipitated by:

A

Dehydration
Renal failure
Drugs - diuretics (thiazides) ACEis, BB
NSAIDS

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53
Q

Lithium may exacerbate which skin condition:

A

Psoriasis

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54
Q

Type of eczema exacerbated particularly by humidity: sweating and high temperatures

A

Pompholyx eczema

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55
Q

Cystic fibrosis/sickle cell are inherited via which type of inheritance

A

Autosomal recessive

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56
Q

If neutropenic with cancer and NOT septic tx:

A

FILGRASTIM (G-CSF)

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57
Q

Hypothenar wasting w/ reduction in thumb ADDUCTION nerve injury:

A

Ulnar nerve

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58
Q

Hyperkalaemia ECG features:

A

small P waves
Widened QRS complexes
sinusoidal pattern
Tall tented T waves

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59
Q

Man returns from trip abroad w/ maculopapular rash and flu-like illness ->

A

HIV seroconversion

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60
Q

GI malabsorption is common feature for which cause of gastroenteritis

A

Giardiasis

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61
Q

Causes of reduced reticulocytes in sickle cell:

A

Parvovirus B19 _>

Aplastic anaemia

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62
Q

Treatment for acute haemolytic transfusion reaction

A

Terminate transfusion
Generous fluid resuscitation
No need for IM adrenaline

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63
Q

IBD associated w/ gallstones

A

Crohn’s disease

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64
Q

MUST score: (3)

A

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

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65
Q

Derranged LFTs and neurological disease:

A

Wilson’s disease

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66
Q

Previous splenectomy will have which effect on HbA1C

A

Over-estimates due to increased RBC life

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67
Q

Causes of HbA1C under-estimation:

A

Sickle-cell anaemia
G6PD deficiency
Hereditary spherocytosis

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68
Q

Aside from metformin which other oral diabetic drug works by reducing peripheral insulin resistance

A

Glitazones

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69
Q

Signs of right heart failure:

A

Ankle oedema
Hepatomegaly
Raised JVP

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70
Q

Aortic stenosis tx: if symptomatic:

A

Valve replacement

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71
Q

Options for Aortic valve replacement:

incl. asymptomatic pts. w/ valvular gradient > 40 mmHg

A

Surgical AVR = for young, low operative risk patients

TAVR (transcatheter AVR is used for pts. w/ high operative risk

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72
Q

Aortic stenosis: when may balloon valvuloplasty be considered:

A

In children w/ no aortic valve calcification or adults not fit for valve replacement

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73
Q

Pneumonia which causes cavitation in the upper lobes

A

Klebsiella

Assoc. w/ alcoholism

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74
Q

Pain relief if GFR < 10ml/min

A

Fentanyl

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75
Q

Pain relief if GFR 10-50 ml/min

A

Oxycodone

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76
Q

Levodopa side-effects:

A 
Dyskinesia
On-off effect
Postural hypotension 
Cardiac arrhythmias 
Nausea and vomiting 
psychosis
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77
Q

High-stepping gait indicates:

A

Peripheral neuropathy - foot drop compensation

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78
Q

Weakened dorsiflexion, inversion and eversion of the ankle, paraesthesia in first web space of big toe indicates nerve lesion where:

A

L5

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79
Q

Medications which can delay bone healing:

A

NSAIDS
Steroids
Immunosuppressants

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80
Q

Most common cause of ambiguous genitalia

A

Congenital adrenal hyperplasia

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81
Q

What is Prehn’s sign:

A

Easing of pain upon lifting of the scrotum - occurs with Epididymitis but NOT with torsion

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82
Q

Components of the Glasgow pancreas score:

A 
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
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83
Q

Post ORIF breathlessness w. retinal haemorrhages and intra arterial fat globules assoc. w/

A

Fat embolism

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84
Q

Long term usage of which drug may result hyperparathyroidism and hypercalcaemia:

A

Lithium

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85
Q

Murmurs are graded by the __ scale

A

Levine scale

Grades 1-6

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86
Q

Upper GI bleeding score to assess which pts. can be discharged:

A

Glasgow-Blatchford score ->

Not to be confused w. Rockall score which is used AFTER endoscopy to identify those at risk of repeat bleed

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87
Q

Suspected PE - clear CTPA -> investigation

A

Leg ultrasound

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88
Q

ABC features of irritable bowel syndrome:

A

Abdominal pain
Bloating
Change in bowel habit

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89
Q

What electrolyte indicates whether a kidney injury is acute or chronic

A

Calcium

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90
Q

Bronchodilator reversibility percentage indicative of Asthma

A

Reversibility >12%

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91
Q

Which pneumonia bug can cause neurological disturbances via immune complexes

A

Mycoplasma

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92
Q

Aortic stenosis most common cause in:
<65
>65

A

Bicuspid aortic valve

Calcification

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93
Q

What should be given before endoscopy in a variceal bleed:

A

Terlipressin and antibiotics

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94
Q

Autoimmune hepatitis antibodies

A

Anti-nuclear antibodies
Anti-smooth muscle antibodies (ASMA)

NOT Anti-mitochondrial antibodies as seen in PBC

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95
Q

3 features of trichomonas vaginalis

A

Offensive yellow/green discharge
Vulvovaginitis
Strawberry cervix

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96
Q

SCALP psoriasis - first line-Tx

A

Potent topical steroids

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97
Q

When is the anomaly scan:

A

18-20+6 weeks

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98
Q

Gingival hyperplasia causes:

A

Phenytoin
CICLOSPORIN
CCB
AML

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99
Q

What diabetes drug should be stopped during myocardial infarction

A

Metformin

Risk of lactic acidosis

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100
Q

Prior to administering flecainide, what should be performed and why:

A

Echocardigram

To look for signs of structural heart disease as flecainide contraindicated in structural heart failure

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101
Q

Pupil size in anterior uveitis vs. acute closed angle glaucoma:

A

Anterior uveitis = normal or small pupil

Acute angle closure glaucoma = fixed semi-dilated pupil

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102
Q

Direct vs indirect Coombs test:

A

Direct: haemolytic anaemias
Indirect: Rhesus haemolytic disease of the newborn

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103
Q

Cancer assoc. w/ Hashimoto’s

A

Thyroid lymphoma (which may be felt as a hard nodule)

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104
Q

Healthcare workers w/out immunity to chickenpox should receive ->

A

Varicella-Zoster vaccination

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105
Q

Antibiotics which lower seizure threshold and should be avoided in epilepsy:

A

Quinolones

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106
Q

Hypertension is more commonly associated w/ Nephroblastoma or Neuroblastoma

A

Nephroblastoma (Wilm’s)

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107
Q

Incontinence study indicated where there is diagnostic uncertainty:

A

Urondynamic studies

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108
Q

Normal examination finding in polymyalgia rheumatica:

A

No reduced POWER

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109
Q

Urine osmolarity < 350 mOsm/kg

A

Acute tubular necrosis

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110
Q

Antihypertensive to stop prior to initiating sacubitril-valsartan therapy

A

ACEIs or ARBS

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111
Q

If there’s an inferior MI, what may also happen as a result of the occluded artery

A

Right coronary artery
Supplies SA node
Atrioventricular block (AV block)

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112
Q

Indications for dialysis in AKI

A 
AEIOU
Acidosis (ph <7.1) 
Electrolytes - refractory 
Intoxication
Overload (refractory to diuresis) 
Uraemic pericarditis, encephalopathy
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113
Q

How long after clinical resolution of pneumonia should an X-ray be taken

A

CXR taken 6 weeks after resolution

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114
Q

Treatment for SIADH:

A

Fluid restriction

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115
Q

Chronic diarrhoea, abdominal bloating and failure to thrive in a child:

A

Coeliac disease

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116
Q

How can you tell if an AKI is caused by dehydration

A

Urea - proportionally higher rise than that of creatinine

In dehydration, ADH causes reabsorption of the urea from loop of Henle and collecting duct

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117
Q

Small bowel bacterial overgrowth syndrome tx.

A

Rifaximin

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118
Q

Tumour lysis syndrome electrolyte disturbances

A

Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia

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119
Q

Prophylaxis tumour lysis syndrome:

A

IV allopurinol

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120
Q

As well as WPW, which condition can cause slurring of QRS on ECG

A

RBBB

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121
Q

ES Murmurs which are louder on inspiration:

A

ASD

Pulmonary stenosis

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122
Q

ES Murmurs which are louder on expiration

A

Aortic stenosis

HOCM

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123
Q

AF stroke secondary prevention

A

Aspirin 300 mg for 2 weeks

Life-long anticoagulant

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124
Q

Thyrotoxicosis may lead to which cardiac complication:

A

High-output cardiac failure

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125
Q

Over-replacement of thyroxine may cause what:

A

OSTEOPOROSIS

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126
Q

Side-effects of thyroxine:

A

Hyperthyroidism
Reduced bone mineral density
Worsening of angina
Atrial fibrillation

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127
Q

Flashers and floaters in vision:

A

Posterior vitreous detachment

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128
Q

Achalasia puts pts. at greater risk of which cancer:

A

Squamous cell carcinoma

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129
Q

Which CCB may cause constipation

A

Verapamil

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130
Q

Should pts. be made nil by mouth in acute pancreatitis:

A

Not routine - unless there is a clear reason. Pt. is vomiting

131
Q

Physical direct complication of thymomas

A

IVC obstruction causing neck vein distension and facial flushing

132
Q

When to give Vit K orally:

A

if NO bleeding and INR > 8

If INR 5-8 but there is bleeding, it goes back to IV VIT K

133
Q

Food product which usually harbours E.coli 0157 -> HUS

A

Contaminated beef

134
Q

Hoffman’s sign assoc w/

A

DCM

135
Q

Petrosal sampling used in Cushing’s to:

A

differentiate between pituitary and ectopic ACTH production

136
Q

Renal transplant plus infection =

A

CYTOMEGALOVIRUS

137
Q

Antibiotics of choice in bronchitis:

A

DOXYCYCLINE

138
Q

First-line investigation in thyroid nodules:

A

Ultrasound

139
Q

Most common site affected in UC

A

Rectum

140
Q

Key component of blood test in assessing severity of C.difficile

A

WCC

>15 = severe

141
Q

Investigation of choice in genital herpes:

A

NAAT

142
Q

Drug most likely to prevent motion sickness:

A

CYCLIZINE

143
Q

Antibiotic contraindicated in G6PD deficiency:

A

Ciprofloxacin

144
Q

Paracetamol overdose - which factors are high risk for adverse outcomes

A

Chronic alcohol intake
HIV
Anorexia
P450 inhibitors

145
Q

Intoxication/overdose w/ hallucinations:

A

LSD

146
Q

Methotrexate monitoring tests:

A

FBC. LFT, U&E

147
Q

If women taking HRT for premature menopause, when should they stop:

A

Age 50

148
Q

Hydatidiform mole: Blood tests: HCG, TSH, Thyroxine

A

High
Low
High

HCG stimulates the thyroid gland directly

149
Q

In a patient w/ cardiac arrest caused by hypothermia: what temperature should they be warmed to before restarting compressions

A

30 degrees

150
Q

Anaphylaxis reaction to blood transfusion management:

A 
Permanent transfusion termination
IM adrenaline
Antihistamines
Corticosteroids 
Bronchodilators 
Supportive care
151
Q

Tetralogy of Fallot murmur:

A

Ejection systolic

152
Q

which diuretics cause ototoxicity

A

Loop diuretics

153
Q

Papilloedema will show what kind of change on fundoscopy

A 
Blurred of the optic disc margin 
Venous engorgement (usually first sign)
154
Q

Cupping of the optic disc occurs due to

A

Glaucoma - Increased ocular pressure

155
Q

Fracture of upper limb which causes pain and inability to pronate/supinate

A

Radial head

156
Q

How many units of insulin are in 1 ml

A

100 units

157
Q

IDA vs anaemia of chronic disease

A

TIBC high in IDA

TIBC low or normal in anaemia of chronic disease

158
Q

Two cardio medications which, if taken together will cause bradycardia and/or complete heart block:

A

Bblocker and Rate-limiting CCB

159
Q

Anti-epileptic drug with peripheral neuropathy as a side effect:

A

Phenytoin

160
Q

Ankle dorsiflexor nerve roots:

A

L4, L5

161
Q

Tx. lichen planus:

A

Potent TOPICAL steroids

162
Q

GBM = deposits of which immunoglobulin:

A

IgG

163
Q

Side effects of bisphosphonates:

A

Oesophageal reactions - oesophagitis
Osteonecrosis of jaw
Atypical stress fractures
hypocalcaemia

164
Q

Giving aspirin (NSAIDS) increases the risk of which dermatological complication when given to pts. w/ chickenpox

A

Necrotising fasciitis

165
Q

Scarlet fever school exclusion:

A

24 hours from time of antibiotic commencement

166
Q

Hypo/Hypercalcaemia causes cataracts ->

A

HYPOcalcaemia

167
Q

AACG - what is given as initial tx.

A 
Direct parasympathomimetic (constricts pupil to widen the iridocorneal angle) - pilocarpine
and BB eye drops
168
Q

How long must a pt. have been in hospital for before their pneumonia can be classed and treated as HAP

A

48 hours - 2 days

169
Q

Restless legs syndrome tx.

A

Ropinirole - dopamine agonist

170
Q

First line mx. in dementia

A

dopamine agonist (Donepezil etc.)

Memantine is second line

171
Q

Tx. for severe HYPOkalaemia

A

Cardiac monitoring
3X1 L bags of 0.9% saline
40 mmol KCL per bag over 24 hours

172
Q

Ectopic pregnancy with heartbeat tx.

A

Salpingotomy/ectomy

Medical/conservative management not enough

173
Q

Reactive arthritis tx. to try after NSAIDs if no response:

A

Oral steroids

174
Q

Cardiac arrest w/ suspected PE treatment in addition to ALS:

A

Thrombolysis w/ alteplase

175
Q

PE with renal impairment investigation:

A

V/Q scan

176
Q

Describe the effect of long term steroids on the aldosterone system and subsequent metabolic disturbance

A
  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
Q

Subarachnoid haemorrhage may cause what on ECG

A

Torsades de pointes

178
Q

If patients treated with PCI for MI are experiencing pain or haemodynamic instability post-procedure ->

A

CABG

179
Q

T1DM targets for blood glucose:
On waking
Before meals or other times of the day

A

5-7 mmol/l on waking and

4-7 mmol/l before meals at other times of the day

180
Q

Warfarin: target INR =

A
  1. 5

3. 5 if recurrent VTEs

181
Q

Diabetic foot - ulcer that goes to bone Ix.

A

MRI to rule out/in osteomyelitis

182
Q

Wernicke’s and Broca’s area are supplied by which cerebral artery:

A

Middle cerebral artery

183
Q

Common trigger for cluster headaches:

A

Alcohol

184
Q

Heart failure 3rd line for afro-carribean patients:

A

Hydralazine with nitrate

185
Q

Endometriosis treatment ladder:

A

1) NSAIDs and Paracetamol
2) COCP or POP

If this fails:
3) GnRH analogues

186
Q

AF pharmacological control if first episode:

A

Flecainide or other rate limiting anti-arrhythmic drug

187
Q

INR 5.0-8.0 (no bleeding)

A

Withhold 1 or 2 doses of warfarin, reduce subsequent maintenance dose

188
Q

In a non-urgent scenario: how long are RBCs infused over:

A

90-120 minutes

189
Q

Idiopathic thrombocytopaenic purpura type of hypersensitivity:

A

Type II

190
Q

Osteomyelitis in pt. w/ sickle cell disease organism:

A

Salmonella

191
Q

Cardio drug which can cause ulceration of the GI tract

A

Nicorandil

192
Q

Hyperlipidaemia: causes of primary hypertriglyceridaemia

A 
diabetes mellitus (types 1 and 2)
obesity
alcohol
chronic renal failure
drugs: thiazides, non-selective beta-blockers, unopposed oestrogen
liver disease
193
Q

Causes of predominantly hypercholesterolaemia

A

nephrotic syndrome
cholestasis
hypothyroidism

194
Q

Pin-point pupils stroke:

A

Pontine stroke

195
Q

Factor V Ledien deficiency =

A

Activated protein C resistance

196
Q

Weber’s syndrome - midbrain stroke
CN palsy on ___ side
Weakness on ___ side

A

Ipsilateral

Contralateral

197
Q

Global T wave inversion and prolonged QT on ECG:

A

Head injury - cerebral T waves

198
Q

Hepatitis likely to be contracted via ano-oral sex

A

Hepatitis A

199
Q

Aortic dissection ix.

A

CT aortic angiogram

200
Q

Status epilepticus: Which two metabolic states should be ruled out:

A

Hypoglycaemia

Hypoxia

201
Q

Ramsay hunt syndrome tx.

A

Oral aciclovir and corticosteroid

202
Q

Salicylate overdose: first symptom:

A

Tinnitus

Starts with respiratory alkalosis due to hyperventilation then goes to metabolic acidosis

203
Q

Heparin electrolyte disturbance:

A

May cause HYPERKALAEMIA

204
Q

AF cardioversion what should be given first:

A

Heparin - anticoagulation

205
Q

What does homonomyous hemianopia mean with regards to visual field defects:

A

same side (L-L/R-R) of visual field on both eyes affected

206
Q

Erysipelas causative organism:

A

Streptococcus pyogenes

207
Q

Erysipelas vs. cellulitis appearance

A

Erysipelas has raised and well defined border

208
Q

Nose bleed if fail to stop with conventional methods:

A

Silver nitrate cautery if bleed can be visualised

Anterior packing if bleed cannot be visualised

209
Q

Antibiotic class which causes: Metallic taste in mouth and black hairy tongue

A

Tetracycline

210
Q

Switching from PoP to COCP -> how many days of condom cover:

A

7 days

211
Q

DVLA: single TIA protocol

A

No need to inform DVLA, 1 month off driving

212
Q

Hypersegmented neutrophils on blood film indicate:

A

Macrocytic anaemia

213
Q

First move in orbital cellullitis:

A

IV antibiotics

214
Q

Red melanoma which oozes/bleeds and metastasises early:

A

Nodular melanoma

215
Q

Polycythaemia vera tx.

A

Aspirin - preven clots
Venesection - keep Hb in normal range
Hydroxyurea - reduce chance of secondary malignant transformation

216
Q

Heparin induced thrombocytopenia mx.

A

Switch to direct thrombin inhibitor

protamine sulphate can reverse heparin

217
Q

Blue gum margin w/ abdominal pain

A

Lead poisoning

218
Q

What are Triptans contraindicated in:

A

Triptans are contraindicated in ischaemic heart disease and cerebrovascular disease

219
Q

Ascites managenent:

Antibiotic prophylaxis?

A

Reduce dietary sodium
Restrict fluid intake (if sodium less than 125)
Aldosterone

Ciprofloxacin - for people with cirrhosis

220
Q

Chronic alcoholism electrolyte disturbance:

A

Hypomagnesaemia

221
Q

HIV drugs that end in Navir belong to which class?

A

Protease inhibitors

‘Navir tease a pro”

222
Q

Chronic subdural bleed on CT

A

Hypodense crescenteric

223
Q

Superinfection for IVDU w/ diagnosed Hepatitis B

A

Hepatitis D

224
Q

Drugs to avoid in chronic renal failure:

A

NSAIDS
Lithium
Metformin
Antibiotics: tetracycines and nitrofurantoin

225
Q

Antibiotics safe in CKD:

A

Erythromycin

Rifampicin

226
Q

Flexion of the 1st,2nd and 3rd fingers nerve:

A

Median

227
Q

Antibiotic contraindicated in G6PD deficiency

A

CIPROFLOXACIN

228
Q

Pigmented gallstones are assoc. w/ which condition

A

Sickle cell anaemia

229
Q

Fanconi anaemia fx.:
Haematological
Skeletal
misc.

A

Aplastic anaemia
increased risk of AML

Short stature

Cafe au lait spots - multiple

230
Q

Which cardio medication should be stopped in severe aortic stenosis:

A

ACE inhibitor

Theory is that due to vasodilatory effect of drug the coronary perfusion pressure will be reduced resulting in ischaemia

231
Q

ERCP most common complication:

A

Acute pancreatitis

232
Q

Investigations of choice in PSC

A

ERCP/MRCP

233
Q

Multiloculated, heterogenous mass located above the hyoid bone

A

Dermoid cyst

234
Q

When should Allopurinol be started in acute gout:

A

after 1st episode, when the inflammation has settled

Bridge w/ colchicine

235
Q

Antibiotic of choice in Erythrasma

A

Erythromycin

Erythra-erythro

236
Q

Pancreatitis scoring systems: which is more specific

A

Glasgow and Apache II

Glasgow

237
Q

Side effects of Tamoxifen:

A

Irregular bleeding
Hot flushes,
Venous thromboembolism
Endometrial cancer

238
Q

Can you use metronidazole in pregnancy:

A

YES

239
Q

worst prognostic factor in MI:

A

Cardiogenic shock

As per Killip classses
Pulmonary oedema is second worst (Grade 3)

240
Q

when should intranasal steroids be considered for sinusitis:

A

If symptoms have persisted for 10 DAYS.

241
Q 
Mode of action of 
COCP 
POP 
Injectable 
Implantable 
IUD
IUS
A

COCP: inhibits ovulation

POP: thickens cervical mucous

Injectable: Inhibits ovulation

Implantable: Inhibits ovulation

IUD: Decreases sperm motility and survival

IUS: Prevents endometrial proliferation

242
Q

IBS: tx.
Pain
Constipation
Diarrhoea

A

Pain: Anti-spasmodic agent

Constipation: laxative but NOT LACTULOSE

Diarrhoea: Loperamide

243
Q

Antibiotic which may cause IIH:

A

Tetracyclines

244
Q

Acanthosis nigricans is seen in T1 or T2 DM?

A

T2 - as due to insulin resistance

245
Q

Pts. w/ haemochromatosis are at risk for which cancer:

A

Hepatocellular carcinoma

246
Q

When should a social smile be seen in a baby:

A

6-8 weeks

Refer if not seen by 10 weeks

247
Q

Risk factors for abruption mnemonic:

A 
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
Q

Common activity which may cause increased iron without overload:

A

Alcoholism

249
Q

High plasma osmolarity with low urine osmolality:

A

Diabetes insipidus

250
Q

Plummer-Vinson triad:

A

Dysphagia
Glossitis
IDA

251
Q

Respiratory tract infections:

Who gets immediate antbiotic therapy

A

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
Q

Management for pt. with sigmoid volvulus and peritonism:

A

Skip flexible sigmoidoscopy and treat with urgent midline laparotomy

253
Q

When are steroids to be used in sarcoidosis:

A 
If deteriorating CXR findings
Deteriorating pulmonary function tests 
Neurological/cardiac/ocular/splenic/hepatorenal involvement
Hypercalcaemia 
or Lupus pernio
254
Q

Neoplastic spinal cord syndrome tx.

A

Urgent high dose dexamethasone

Urgent oncological assessment

255
Q

Type I vs Type II bipolar

A

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
Q

Pleural transduates (<30g/l)

A

Hypothyroidism
Hypoalbuminaemia
Heart failure
Meig’s syndrome

257
Q

Pleural exudates (>30g/l)

A 
Pneumonia (m/c cause) 
Connective tissue diseases (RA, SLE)
Malignancy - lung cancer, mesothelioma 
Dressler's syndrome 
Pericarditis 
PULMONARY EMBOLISM (unexpected) 
Pancreatitis
258
Q

Pathological jaundice in neonate (<24 hours) investigation

A

Blood film

Think of the causes:
G6PD
Hereditary spherocytosis
Rhesus haemolytic disease

259
Q

Neural tube defects: vitamin implicated

A

FOLIC ACID

260
Q

Hip fracture fixation w/ DHS post op advise:

A

Immediate post-op full weight bearing

261
Q

Barrett’s: which is more alarming: Metaplasia or Dysplasia?

A

Dysplasia

Requires endoscopic resection
Metaplasia requires high-dose PPI plus SURVEILLANCE

262
Q

Ocular trauma w/ hyphaema may put pt. at risk of which condition:

A

GLAUCOMA

263
Q

Extra-dural vs. Subdural - which bleed crosses the suture lines

A

Subdural

264
Q

Most common type of Hodgkin’s lymphoma:

A

Nodular sclerosing

265
Q

Non-keratinised warts vs. keratinised warts tx.

A 
Keratinised = Cryotherapy 
Non-keratinised = Topical Podophyllum
266
Q

Dx. Lung cancer from CXR -> next investigation

A

Contrast enhanced CT scan

Tumours typically very vascular so will show increased uptake

267
Q

Tumour lysis syndrome electrolytes:

A 
Hyperkalaemia 
Hyperphosphataemia 
HYPOcalcaemia 
Elevated Creatinine 
Elevated Uric acid
268
Q

CKD (eGFR<15) Anti-coagulant of choice:

If eGFR > 15:

A

Either LMWH or UFH

UFH has lower risk of bleeding (UFH recommended by NICE)

DOACs can be given between (15-50 eGFR)

269
Q

N-acetyl cysteine reaction -> what type of reaction:

A

Anaphylactoid - Non-IgE mediated

NOTE: not ‘anaphylacTIC’

270
Q

Treatment of Theophylline toxicity:

A

HAEMODIALYSIS

271
Q

Focal seizure w/ post-ictal weakness:

A

Todd’s paresis

272
Q

Drug causes of tinnitus/ototoxicity:

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics - NOT THIAZIDES
QUININE

273
Q

Longer duration of action - LMWH or UFH

A

LMWH

274
Q

Diabetes insipidus visual field defect

A

LOWER bitemporal quadrantopia

Caused by craniopharyngioma

275
Q

Maintaining remission in LEFT sided ulcerative colitis

A

low dose ORAL aminosalicylate or steroid

Otherwise, rectal aminosalicylate

276
Q

UC mx. if > 2 exacerbations in the year:

A

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
Q

Marfan’s murmur:

A

MITRAL REGURGITATION

278
Q

Wells score 4 - which side do you air on: PE likely or unlikely

A

PE Unlikely

279
Q

Coeliac disease: immunisations

A

Annual flu

5 yearly pneumococcal due to functional HYPOSPLENISM

280
Q

Vasculitis with Hep B infection

A

Polyarteritis nodosa

px. w/ LIVEDO reticularis

281
Q

Neuropathic drug which many cause/contribute to serotonin syndrome

A

Tramadol

282
Q

Cystic fibrosis pneumonia organism:

A

Pseudomonas aeruginosa

283
Q

Beta thalassaemia major vs trait:

A

Major = severe anaemia (<60) requiring frequent tranfusion

Trait - microcytosis out of proportion to minor anaemia

284
Q

Blood product with highest infection risk:

A

Platelets - as they need to thaw out

285
Q

Palliative care: if pain not controlled on morphine what may be changed:

A

Dose -> increase by 30-50% in effort to control pain

286
Q

Antibiotic used for psittacosis

A 
Doxycycline = 1st line 
Macrolide = 2nd line
287
Q

Obstructive lung diseases

A

ABC
Asthma
Bronchiolitis - bronchiolitis obliterans (RA)
COPD

288
Q

Bupropion contraindications

A

EPILEPSY
Pregnancy
Breast feeding

Having an eating disorder is a relative contraindication

289
Q

Varenicline contraindications:

A

Pregnancy

Breast feeding

290
Q

Low TLCO but increased KCO conditions:

A

Pneumonectomy
Kyphosis/scoliosis
Neuromuscular weakness
Ankylosing spondylitis

Mechanical issues

291
Q

Bloody diarrhoea - more assoc w/ which IBD

A

Bloody diarrhoea is more associated with Ulcerative colitis

292
Q

Post operative analgesia via epidural allows:

A

Faster return of normal bowel function after abdominal surgery

293
Q

DMARDs considered safe in pregnancy:

A

Sulphasalazine and hydroxychoroquine

Women w/ RA should be referred to obstetric anaesthetis due to risk of atlanto-axial subluxation

294
Q

Is rubella immunity screened for at booking

A

No

Not since 2016

295
Q

SFH should be within __ cm of weeks gestation

A

+/- 2 cm (24 weeks = 22-26 cm SFH)

296
Q

Causes of hyperechogenic bowel on US

A

Cystic fibrosis
Down’s syndrome
Cytomegalovirus

297
Q

VTE prophylaxis in pregnancy:
Initiated from:
Till:

A

LMWH
28 weeks gestation
6 weeks PP (puerperal period duration - most likley time for VTE)

DOACs and Warfarin should be avoided in pregnancy

298
Q

How is Exenatide (GLP-1) administered

A

S/C injection

299
Q

Mouth ulcers persisting for > 3 weeks should be sent where under which referral

A

Oral surgery under 2WW referral

300
Q

Ix. to check anastamotic function (not leaking) after abdominal surgery:

A

Gastograffin enema

Preferred over barium enema as less toxic

301
Q

Pleural effusion fluid protein/serum protein ratio > __ indiactes an exudative infiltration?

A

Pleural effusion fluid protein:serum protein ratio of greater than 0.5 = Exudate

also pleural LDH:serum LDH > 0.6

302
Q

Herpes zoster ophthalmicus assoc. w/ which ocular complication

A

Anterior uveitis

303
Q

Breast cancer referral: 2WW

A

Women > 30 with unexplained breast lump - even if sounds benign
Women over 50 with UNILATERAL nipple changes

if < 30 refer via routine pathway

304
Q

Young person with renal stones likely stone content:

A

Cysteine stones - inherited transmembrane disorder

305
Q

Anaemia:
IDA effect on platelets:
B12 deficiency effect on platelets:

A

IDA may cause a reactive thrombocytosis
Lung cancer may also cause increased platelets

B12 def may cause thrombocytopenia

306
Q

Commonest cancers to metastasise to bone (3)

A

Prostate
BREAST
Lung

PBL

307
Q

Breast screening:
What
When
Who

A

Mammogram
every 3 years
women 50-70

308
Q

Antibiotics not to be prescribed in G6PD

A

CIPROFLOXACIN

SULF containing drugs (Sulphonamides, sulphasalazine, sulphonylurea)

309
Q

In anaphylaxis, how often should adrenaline be administered:

A

Every 5 minutes

310
Q

Chicken pox (Varicella zoster) rash progression

A

Macules and papules to vesicular lesions which crust over

311
Q

Antibiotic of choice for bronchiectasis:

A

Amoxicillin

312
Q

Differentiating between Parkinson’s and Lewy body

A 
Parkinson's = TREMOR before dementia 
LBD = DEMENTIA before tremor
313
Q

Addison’s disease treatment: when should this be taken:

A

Hydrocortisone, fludrocortisone split with more taken earlier in the day to mimic natural release

314
Q

Best imaging modality to confirm diagnosis of pancreatitis:

A

CT abdomen with contrast

Looking for pancreatic calcification

315
Q

Which psych drug is associated with a large increase in mortality for pts. w/ dementia:

A

Anti-psychotics

316
Q

If pt. w/ endometriosis has painful periods and has tried NSAIDs, COCP contraindicated what may be tried before GnRH

A

Progesterone only pill

317
Q

IV adrenaline should be considered after how many bouts of IM adrenaline

A

2 (5 mins apart) as per resus council guidelines

318
Q

Telogen effluvium: describe

A

hair loss after a stressful or traumatic experience

319
Q

Acral lentingous melanoma: where does it affect

A

Arises in areas NOT related to sun-exposure

Afro-carribeans

320
Q

Endocarditis assoc. w/ poor dental hygiene:

A

STREPTOCOCCUS VIRIDANS

321
Q

Treatment for APS in pregnancy

A

Aspirin and enoxaprin

322
Q

Electrolyte disturbance caused by heparin

A

Hyperkalaemia

323
Q

Reynold’s pentad:

A

Charcot triad (jaundice, RUQ pain, fever) PLUS
Hypotension
Confusion

FLASH FINALS (34 decks)

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