General mix (3)

Question 1

management of ventricular tachycardia and fibrillation

Answer 1

unsynchronised cardioversion

10ml 1:10,000 adrenaline

then amiodarone

Question 2

torsades de pointes management

Answer 2

synchronised DC cardioversion

IV MgSO4

Question 3

management of AV node blo0ck

Answer 3

1st line: atropine

2nd : transcutaneous pacing

3rd: pacemaker

Question 4

bifascicular block

Answer 4

RBBB and LAD

Question 5

trifasicular block

Answer 5

RBBB, LAD and 1st degree AV block

Question 6

Answer 6

RBBB

Question 7

Answer 7

LBBB

william marrow

Question 8

initial management of someone with aortic stenosis who has collapsed

Answer 8

stope ACEi

Question 9

cause of aortic stenosis and presentation

Answer 9

• aortic stenosis
  
  • calcification- age
  • bicuspid- Turners
  • exertional chest pain and syncope if very severe

Question 10

aortic stenosis dinitive management

Answer 10

if large valve gradient / poor LVEF : valvuloplasty

• open if well
• TAVI if old
  
  • transcather aortic valve implantation

Question 10

aortic stenosis dinitive management

Answer 10

if large valve gradient / poor LVEF : valvuloplasty

• open if well
• TAVI if old
  
  • transcather aortic valve implantation

Question 11

mitral regurg causes

Answer 11

• calcification
• MI (<1 week)- papillary rupture→ flash pulmonary oedema
• Infective endocarditis

Question 12

Ankolysing spondylitis- As

Answer 12

• Anterior uveitis
• AV block
• Apical fibrosis
• Aortitis

Question 13

what medication are all T1DM on

Answer 13

insulin

statin

q

Question 14

Q75.) You are called to see an 83-year old patient on the ward as the nurses are concerned she has not opened her bowels in the past 5 days. The patient has a pmhx of Alzheimer’s dementia and is on the ward recovering from a recent pneumonia infection, but appears well. On abdominal examination you feel a palpable mass in the Lower left quadrant. You decide to perform a PR examination on the patient with a chaperone and you notice a relaxed anal spinter tone with some hard stool in the rectum. How would you manage this patient?

1. Stimulant laxative
2. Oral macrogol
3. Glycerol suppository
4. Enema
5. Oral lactulose

Answer 14

macrogol

Question 15

HHS

Answer 15

Immediate vigorous IV rehydration (0.9 saline)

HHS patients’ main problem is dehydration. It is not recommended to start insulin therapy until after the patient’s fluid balance is positive. Oftentimes, insulin isn’t even needed once the patient’s fluids are corrected.

Generally, even in DKA (where insulin is needed), potassium replacement is only started a little while into fluid therapy.

Question 16

neuropathic ulcers ulcers found

Answer 16

likely to be toes- rubbing for shoes

Question 17

in asthma if CO2 raised

Answer 17

life-threatening

Question 18

mitral stenosis causes

Answer 18

Mitral stenosis

• Rheumatic and scarlet fever
• Malar flush

Question 19

Pericarditis cause

Answer 19

• Post viral
• Post Mi
  *

Question 20

investigation for H.pylroi

Answer 20

• urea breath test- Carbon 13 ura
• stool antigen test
• rapid ureas test during endoscopy

all must be done 2 weeks without PPI

Question 21

management of H.pylori

Answer 21

PPI+

Amoxicillin + metronidazole

if pen allergic: clarithromycin and metronidazole

Question 22

barrets

Answer 22

metaplasia : squamous → columnar

management

• PPI
• endoscopic surveillance

if dysplasia identified during endoscopy: endoscopic mucosal resection

Question 23

endoscopic findings in coeliac

Answer 23

villous atrophy and crypt hypertrophy in small intestine

Question 24

presentation of coeliac

Answer 24

fatigue, ulcers, weigthlsos, bloating, farting * dermatitis herpiteformis

Question 25

investigation for coeliac

Answer 25

6 week gluten diet * IgA leveles - anti TTG * jejunum biopsy

Question 26

haematochromotosis symptoms

Answer 26

* bronzed skin * joint pain * fall in cog and memory can cause: liver cirrhosis and cancer

Question 27

haemochromotosis

Answer 27

autosomal recessive excess iron- free radicals- damage e.g. women after menopause (period removes iron)

Question 28

investigations for haematochromatosis

Answer 28

serum ferritin serum transferrin derranged LFTs

Question 29

wilsons presentation

Answer 29

autosomal recessive: excess copper absorptiona and decreased hepatic excretion * Copper * Confusion * Kayser-fleischer * Young

Question 30

investigations for wilsons

Answer 30

* reduced caeruloplasmin * reduced serum copper * increased urinary copper excretion can cause liver hepatitis and cirrhosis

Question 31

management of wilsons

Answer 31

pencillamine (chelates copper) can cause PF

Question 32

primary biliary cholangitis

Answer 32

M rule Middle age women anti-Mitochondrial antibodies IgM * associated with sjogrens, RA and system

Question 33

primary sclerosing cholangitis

Answer 33

UK, pANCA and cholangiocarcinoma, beaded bile duct

Question 34

which pathogens can cause hepatitis

Answer 34

Types A, B, C, D, E, cytomegalovirus, adenovirus

Question 35

LFT for hepatitis

Answer 35

ALT\>AST

Question 36

acute Hep

Answer 36

A (vaccine) and E (no vaccine) (RNA) foecal oral

Question 37

Hep D can only infect people if they have

Answer 37

HEP B

Question 38

alcoholic liver LFTS

Answer 38

AST x2\>2

Question 39

management of alcoholic liver disease

Answer 39

for hepatitis - prednisolone

Question 40

management of varcies

Answer 40

terlipress propanolol band ligation Abx

Question 41

hepatic encephalopathy

Answer 41

patient with infection and constipation * excess absorption of ammonia and glutamine from bacterial breakdown of protein in the gut→ **confusion** * **management** * laxative e.g. lactulose- wash out bacteria

Question 42

ascites can look at

Answer 42

SAAG * serum-ascites albumin gradient

Question 43

SAAG \<11g/l not much of a difference between albumin in the blood and ascitic fluid

Answer 43

cancer TB * lots of albumin

Question 44

SAAG \>11g/l

Answer 44

HF liver failure * not much albumin