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Last Ditch Attempt > GG > Flashcards

GG Flashcards

1
Q

Rate control and Rhythm control Rx in AF

A

Rate: metoprolol - diltiazem/verapamil - digoxin
Rhythm: flecanide - sotalol - amiodarone

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2
Q

AF: anti-coag/anti-plt, and which Rx?

A

Anti-coag (anti-plt arterial blood); warfarin or NOACs (not in valvular AF)

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3
Q

Rx you’re concerned with in renal failure

A
  • Abx: vancomyin, gentamicin

- NOACs

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4
Q

Signs indicating retroperitoneal bleeding and DDx of it

A
  • DDx: AAA and pancreatitis
  • Grey-Turner’s (flank bruising)
  • Cullen’s (peri-umbilical bruising)
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5
Q

how to calculate ECG axis

A 
Quadrant approach: 
	○ If I and aVF positive = normal 
	○ I negative aVF positive = RAD 
	○ I positive aVF negative ->: 
		○ II +ve = normal
II -ve = true LAD
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6
Q

Typical march of appendicitis Sx

A
  1. prodromal bowel upset
  2. abdo pain -> worsens
  3. anorexia, N/V
  4. mod fever
  5. signs of peritonitis
  • normal T/WCC early on is normal!
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7
Q

what is agoraphobia

A

Fear of places and situations that might cause panic, helplessness or embarrassment.

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8
Q

Most specific cancer markers for following Ca:

  • HCC
  • ovarian
  • bowel
  • testicular/germ cell
A
  • HCC: alpha feto-protein
  • ovarian: CA-125
  • bowel: CEA
  • testicular/germ cell: hCG
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9
Q

Female puberty development

A

Female:

  1. breast bud enlargement
  2. growth spurt
  3. axillary hair
  4. pubic hair
  5. menstruation
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10
Q

Male puberty development

A

Male:

  1. Scrotal and testicular growth
  2. Deepening of voice
  3. Pubic hair
  4. Penile enlargement
  5. Growth spurt
  6. Facial + axillary hair
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11
Q

Erb’s palsy - signs and nerve roots affected

A
  • Asymmetric moro

- Arm: adducted, shoulder internal rotation, elbow extension and pronation, flexed wrist

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12
Q

side effects of steroids

A 
C – Cataracts
U – Ulcers
S – Striae, Skin thinning
H – Hypertension, Hirsutism
I – Immunosuppression, Infections
N – Necrosis of femoral heads
G – Glucose elevation
O – Osteoporosis, Obesity
I – Impaired wound healing
D – Depression/mood changes
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13
Q

right lung lobar changes on CXR - which lobe?

A

middle = R heart border obscured, lower = costophrenic angle obscured

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14
Q

Rx pneumonia

A

CAP - typical/atypical:

  1. Amoxycillin (oral) / OR doxycycline (oral)
  2. Benpen (IV) / AND doxy (oral)
  3. Ceftriazone (IV) /AND azithromycin (IV) - legionella

HAP:
- Low risk MDR (e.g. just admitted) = ABCDDA
High risk MDR (i.e. long hospital stay) = tazocin

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15
Q

COPD exacerbation

A

ASOSS:

  • Abx: amoxy/doxy 5 days
  • salbutamol
  • O2
  • steroids: pred/hydrocort
  • support - ventilatory
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16
Q

ddx high troponin

A
  • MI
  • PE
  • HF
  • pericarditis
  • strenuous exercise
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17
Q

transudate vs exudate

A

Transudate

  • = fluid pushed through capillary due to high capillary pressure
  • Low protein, low LDH, low cell count
  • Usually bilateral
  1. RHF (inc venous pressure)
  2. Liver failure (inc venous pressure, dec oncotic pressure, hypoalbuminaemia)
  3. Nephrotic syndrome (dec oncotic pressure)

Exudate

  • = fluid leaking through capillaries due to inflammation
  • High protein, high LDH, high cell count
  • Usually unilateral
  1. Pneumonia
  2. Malignancy
  3. TB
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18
Q

diuretics - K sparing and non-sparing

A

K sparing:
- spironolactone + amiloride (CD)

K non-sparing:

  • loop diuretic e.g. frusemide
  • thiazides e.g. hydrochlorothiazide (DCT)
  • mannitol - osmotic agent
  • CA inhibitor e.g. acetazolamide (PT)
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19
Q

Symptoms/signs of pre-eclampsia

A
  • headaches
  • high BP
  • RUQ pain
  • peripheral oedema
  • proteinuria
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20
Q

early vs late schizophrenia

A

late schizophrenia:

  • less negative symptoms/disorganisation
  • high rates florid delusions/hallucinations
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21
Q

Sx/signs of pulmonary atelectasis

A
  • tachy
  • mild fever
  • mucoid sputum
  • <24h post-op
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22
Q

pre-menopausal irregular ovulatory cycles: most likely dx?

A

Cystic glandular hyperplasia (CGH) - predominance of oestrogen, no progesterone

  • atypical hyperplasia/endometrial polyp less likely
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23
Q

partial facial nerve palsy pathognomonic of…

A

infiltrative malignant parotid tumour (NB: benign parotid tumours displace, not paralyse, the facial nerve)

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24
Q

Addison’s: signs/symptoms and Ix findings

A
  • vomiting -> hypotension
  • hyperpigmentation
  • weight loss, fatigue
  • hair loss, hypoglycaemia
  • hyponatraemia
  • high ACTH and CRH
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25
Q

ear test: Rinne and Webber findings, and conductive vs sensorineural

A

Rinne = middle ear function (not cochlear):

  • Rinne +ve: AC > BC = normal
  • Rinner -ve: BC > AC = defective middle ear (mostly conductive issues)

Weber:

  • conductive: sound louder in worse ear - the conductive issue blocks ambient sound and the sound is conducted through bone instead
  • sensorineural: sound louder in better ear
  • Conductive: BC>AC, lateralisation to worse ear
  • SN: AC>BC, lateralisation to better ear
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26
Q

aniline + work in dye industry -> ??

A

bladder + urinary tract Ca

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27
Q

cocaine intox vs heroin withdrawal - differentiating factor

A

fever in cocaine intox

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28
Q

highest populations at risk of Fe deficiency

A

In order:

  1. weaned toddlers
  2. adolescents
  3. women of child-bearing years
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29
Q

what is the triple test negative we look for when Ix a benign breast lump?

A
  1. -ve clinical findings
  2. -ve imaging (US for young, mamm for old)
  3. cytology/histology -ve (FNAC/percutaneous core biopsy)
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30
Q

what is cyclothymic disorder

A

2 years minimum of numerous hypomanic and depressive episodes, but not bipolar

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31
Q

myopia vs hypermetropia

A

1) myopia = short-sighted = eyeball long so image comes up short -> concave to spread out light rays
2) hypermetropia = long-sighted = eyeball short so image comes up long -> convex to focus light rays

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32
Q

what lens for astigmatism

A

cylindrical

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33
Q

conn syndrome v renal artery stenosis

A

1) conn syndrome = primary hyperaldosteronism
- AngII independent: kidneys secrete aldosterone -> Na/H2O retention -> inc. BF + HTN -> reduced renin

2) renal artery stenosis = secondary hyperaldosteronism
- AngII dependent: reduced renal BF -> high renin -> HTN

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34
Q

CT appearance of:

  • hemangioma
  • hydatid cyst
  • liver cyst
  • liver mets
A
  • hemangioma: dense in arterial, less dense in portal venous phase
  • hydatid cyst: well-defined lining, septate/locular due to daughter cysts
  • liver cyst: low density, homogenous
  • liver mets: hypovascular cf surrounding parenchyma
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35
Q

stye vs chalazion

A

stye/hordeolum:

  • infection of eyelid gland - on eyelid margin
  • red, acutely tender

chalazion:
- infection of blocked mebomian gland -> subsides to small fibrosis, hard nodule - non-tender

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36
Q

digitalis leads to…

A

… AV block/dissociation (slows down conduction through AV junction)

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37
Q

classic hx of reflux nephropathy

A
  • childhood recurrent UTIs, enuresis, fevers

- hypertension

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38
Q

Ix of choice for reflux nephropathy or renal stones

A
  • now US for reflux nephropathy, non-contrast helical CT for renal stones
  • previously IVP (but, contrast!)
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39
Q

nerve root supply of:

  1. quads
  2. knee jerk reflex
  3. bladder
  4. ankle jerk
A
  1. quads: L2,3, (mainly) 4
  2. knee jerk reflex: L4
  3. bladder: lower sacral
  4. ankle jerk: S1
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40
Q

foot drop:

  1. weakness of which muscles
  2. which nerve root
  3. type of gait
A
  1. tib anterior + ankle and toe extensors
  2. L5 (through common peroneal)
  3. high-stepping gait with slapping down
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41
Q

unilateral nasal discharge…

A

= foreign body

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42
Q

scc vs bcc

A

scc: keratotic crusty ulcerous lesion, more invasive and quicker growing, precursor lesion (Bowens in situ)
bcc: pearly nodule, telangiectasia, umbilicated centre, more indolent, more common (2/3) and locally invasive

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43
Q

free subdiaphragmatic gas on XR

A

perforated peptic ulcer

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44
Q

risks of tamoxifen therapy

A
  1. endometrial polyp formation (more likely)
  2. subendometrial oedema
  3. endometrial Ca (less likely)

(NB: not endometrial atrophy)

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45
Q

red currant jelly stool =

A

intussusception

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46
Q

pregnant lady with CIN3 on pap smear. what do you do?

A

colposcopy; only if lesion extends up canal would you need cone biopsy or LLETZ biopsy

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47
Q

sleep disturbances and associated dx:

  • difficulty falling asleep
  • middle insomnia
A
  • difficulty falling asleep: anxiety/stimulants

- middle insomnia: depression

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48
Q

giardia story

A
  • diarrhoea, cramps, bloating, nausea, fatigue, weight loss
  • loose, pale greasy stool
  • contaminated food/water
  • illness ~7 days after infection
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49
Q

vesiculo-colic fistula from which disease?

A

diverticulitis

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50
Q

glioblastoma multiforme: fast or slow growing

A

fast - faster than months!

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51
Q

mullerian agenesis

A

= no formation of endometrial tissue

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52
Q

symptoms of H.pylori peptic ulcer

A
  • dyspepsia
  • haematemesis
  • weight loss
  • dysphagia
  • anaemia Sx
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53
Q

MS symptoms and signs, UMN/LMN

A
  • visual: optic neuritis, diplopia
  • UMN weakness
  • paraesthesia
  • autonomic dysfunction
  • cerebellar
  • fatigue, dysarthria
  • <60yo onset, more women
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54
Q

MND symptoms and signs, UMN/LMN

A
  • progressive LMN AND UMN, asymmetrical weakness

- bulbar involvement

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55
Q

alcoholic peripheral neuropathy

A
  • mixed motor and sensory symmetrical peripheral neuropathy

- other alcohol signs

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56
Q

SLE vs ITP

A

SLE has splenomegaly, not ITP

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57
Q

SLE findings

A

A RASH POIN MD:

  • arthritis
  • renal disease
  • ANA =+ve
  • serositis
  • haem disorder
  • photosensitivity
  • oral ulcers
  • immunological - anti-dsDNA, anti-phospholipid
  • neurological
  • malar rash
  • discoid rash

+ Raynauds, alopecia, spelnomegaly

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58
Q

elevated JVP + cardiomegaly =

A

mitral regurgitation

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59
Q

JVP loss of a waves =

A

AF

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60
Q

what is an endometrial thickness assessment performed for?

A
  • which pts should have D&C, esp younger post-menopausal (>4mm)
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61
Q

most consistent finding of obstructed labour needing C/S?

A

brow presentation in nulliparous woman

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62
Q

what would have greatest effect on reducing perinatal mortality in the developed world?

A

reducing premature births 20-26 weeks

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63
Q

side effects of opioids

A
  • constipation
  • drowsiness
  • resp depression
  • hypotension
  • nausea
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64
Q

no foetal movements 24h after normal CTG - what to do?

A

induction of labour (immediate C/S not req unless cervix not fully dilated)

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65
Q

normal clinical picture of infective mononucleosis

A
  • malaise, fever
  • pharyngitis
  • maculopapular rash
  • lymphadenopathy
  • splenomegaly
  • lymphocytosis on film
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66
Q

bilirubin patterns:

1) high unconjugated: conjugated
2) high conjugated + transaminases
3) conjugated + urine bilirubin, no urobilinogen

A

1) high unconjugated: conjugated = haemolytic jaundice
2) high conjugated + transaminases = hepatocellular
3) conjugated + urine bilirubin, no urobilinogen = post-hepatic obstructive jaundice

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67
Q

orbital vs periorbital cellulitis

A

orbital: proptosis, eye paralysis, URGENT CT needed
periorbital: full eye movement, eyelid swelling

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68
Q

urinary injuries in setting of pelvic trauma: Ix of choice, and what Ix not to do

A

ascending urethrogram, don’t catheterise - may cause more trauma

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69
Q

onset of NICU gut issues:

duodenal atresia v hirschprung’s v mec plug syndrome v volvulus v small bowel obstruction v intuss

A
  1. duodenal atresia/volvulus/sbo: first few hours
  2. intuss - more hours
  3. mec plug - 2-3 days
  4. hischprung’s - usually 4-5 days
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70
Q

obstetric cholestasis vs acute fatty liver in pregnancy

A

obstetric: milder LFT derangement, no severe vomiting

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71
Q

GCA (temporal arteritis) clinical picture, diagnostic test, how to treat

A
  • temporal headache
  • jaw claudication
  • irreversible monocular vision loss
  • scalp tenderness
  • MSK + systemic e.g. weight loss
  • 50yo female
  • girdle pain = PMR
  • temporal artery biopsy
  • steroids (pred) + aspirin
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72
Q

chance of recurrence of psychosis postpartum?

A

15-20%

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73
Q

Horner syndrome

A

damage to sympathetic trunk, triad of 1) miosis 2) partial ptosis 3) loss of hemifacial sweating

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74
Q

how soon after acute gout attacks do we introduce allopurinol?

A

after 4 weeks

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75
Q

RFs for ischaemic stroke: rank them - HTN, smoking, obesity, T2DM, hyperchol

A
  1. HTN
  2. T2DM
  3. obesity
  4. smoking
  5. hyperchol - u shaped
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76
Q

shingles: what Rx and when?

A

first 24-48h after rash = famcyclovir - oral or IV

rash 10 days or more = amitryptiline for post-herpatic neuralgia

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77
Q 
levonorgestrel - which is true: 
A) vaginal spotting in 1st 3 days
B) menstruation within 7 days
C) N/V in 50% women 
D) virilisation of fetus 
E) fails in 2-3%
A

E) fails in 2-3%

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78
Q

alcoholic hallucinosis vs delirium tremens

A

sensorium remains clear despite auditory hallucinations in alcoholic hallucinosis

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79
Q

which more common - duodenal or gastric ulcers

A

duodenal ulcers

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80
Q

transient episodes of monocular blindness = what medical term, and indicates what pathology?

A

=amaurosis fugax, carotid artery plaque causing ophthalmic artery platelet embolisation

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81
Q

typical picture of oesophageal rupture (boerhaave)

A
  • forceful vomiting, pt tries to hold it in - sudden onset chest pain after
  • subsequent shock, hypotension, cyanosis
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82
Q

what is testamentary capacity?

A

capacity to make a valid will

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83
Q

nipple discharge:

  • yellow/green + worm-like
  • single duct bloody, no ass. lump
A
  • yellow/green + worm-like: mammary duct ectasia

- single duct bloody, no ass. lump: benign duct papilloma

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84
Q

DCIS (intraductal carcinoma in-situ) usually presents as…

A

… focal/generalised microcalcification seen on mammography

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85
Q

pneumothorax mx options

A
  1. <15% = obs, supplemental o2,
  2. > 15% = needle aspiration is Mx of choice (previously intercostal tube insertion + underwater seal drainage), thoracotomy
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86
Q

branchial cyst findings

A
  • fluctuant
  • anterior chain
  • partially covered by sternocleidomastoid
  • painless
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87
Q

normal location of branchial cyst v salivary gland tumour v neck lymphoma

A
  • branchial cyst = anterior chain, partially covered by sternomastoid
  • salivary gland = higher in neck, closer to mandibular angle
  • neck lymphoma = deep cervical chain
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88
Q

reversing agent for warfarin and heparin

A

warfarin = vit K, heparin = protamine

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89
Q

pt needs urgent surgery but on warfarin with INR 2.5, what do you do?

A

give FFP (has coag factors), vit K takes too long to work

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4
5
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90
Q

breech presentation: c/s or vaginal, induction/spontaneous?

A

c/s optimal but woman can choose vaginal if aware of risks, spontaneous as induction has risk of cord prolapse

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91
Q

why can hypertrophic pyloric stenosis vomitus present with coffee ground appearance?

A

due to tearing of gastric mucosa + associated bleeding, but not bile stained

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92
Q

L4, L5, S1 radioculopathy signs

A

L4 impaired: knee jerk, quads, inner lower leg sensation
L5…: no reflex impaired, foot drop + toe ext -> high stepping gait, outer lower leg sensation
S1…: ankle jerk + plantar reflex, ankle PF, sole

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93
Q

risk of arm abduction during surgery

A

nerve injury - ulnar nerve at elbow or lower trunk of brachial plexus

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94
Q

pathognomonic joint feature of acute rheumatic fever

A

migratory polyarthritis

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95
Q

definitive mx of acute cholangitis v cholecystitis v choledocolithiasis v cholelithiasis v biliary colic

A
  • biliary colic = analgesia, elective lap chole
  • acute cholangitis: abx, ERCP + lap chole
  • acute cholecystitis = abx + lap chole
  • choledocolithiasis/lithiasis = ERCP/MRCP
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96
Q

common risk of central venous catheter insertion

A

pneumothorax

97
Q

duration of acute gout flare treatment with NSAIDs

A

3-5 days

98
Q

abdo mass in young child ddx

A
  • Wilms tumour (most common): haematuria, HTN, hemi-hypertrophy ass from Beckwith-Wiedermann
  • faecal loading 2’ constipation
  • PCKD/hydronephrosis
  • neuroblastoma
99
Q

pain/limp in child ddx and classic picture

A
  • transient synovitis: post-viral, <4yo
  • perthes (osteochondritis of femoral head): 4-8 yrs
  • slipped capital femoral epiphyses: tubby adolescent
  • septic arthritis: intense pain, can’t WB
  • osteogenic sarcoma: chronic pain + swelling
100
Q

CVB vs amniocentesis risk of miscarriage

A

CVS = 1:100, amniocentesis = 1:200

101
Q

types of paediatric congenital cardia lesions

A
  1. cyanotic right-left: ToF, TGV
  2. left right: VSD, ASD, PDA
  3. obstructive: AS, PS, aortic coarctation
102
Q

asd vs vsd murmur in kids

A 
ASD = soft mid-systolic, LUSE
VSD = systolic, LSE, radiates to left axilla and back
103
Q

myasthenia gravis

A
  • muscle fatiguability (prox -> distal) esp. ocular, facial
104
Q

acute red eye NTBM and their findings

A

1) iritis: light sensitivity, non-reactive pupil
2) ACA glaucoma: halos, corneal and scleral injection, corneal oedema, hard globe, inc. IOP, non-reactive pupil
2) scleritis: pain +++
3) microbial keratitis: contact lens wear, compromised corneal surface

105
Q

signs of third nerve palsy

A
  • ptosis
  • eye paralysis -> down and out eye
  • loss of direct + consensual reflexes
106
Q

diff types of ulcers: neuropathic / venous / arterial

A

neuropathic: metatarsal heads bc highest pressure; deep, painless.
arterial: toes + dorsum of foot, v painful
venous: over malleoli, ass. haemosiderin staining

107
Q

binocular vs monocular vertical diplopia

A

binocular = EOM involvement, monocular = refractive error

108
Q

isolated fourth CN lesion most likely due to? describe the fourth CN lesion findings.

A

DM; superior oblique affected (rotates eye down and in) - pt tilts to remove diplopia

109
Q

difference between bell’s palsy and stroke, and why?

A

bells = peripheral lesion -> no forehead sparing; stroke = central lesion -> innervation from other side of brain -> forehead sparing

110
Q

dissociated vs complete sensory loss in all modalities: where is the lesion in the brain?

A

dissociated = pons or below, bc DCML and anterolateral fibres cross there

111
Q

spotaneous rupture of EPL =

A

rheumatoid arthritis

112
Q

posterior dislocation of hip findings

A

hip flexion + IR, shortened leg

113
Q

femoral neck fracture at particular risk of…?

A

non-union (not avascular necrosis): bc of orientation of the # line, so internal fixation can cut soft bone and -> displacement of fracture

114
Q

typical picture dermatomyositis vs inclusion body myositis

A

dermatomyositis:

  1. progressive muscle weakness + raised CK
  2. maculopapular skin rash
  3. erythematous, scaly eruptions on back of hands

inclusion body - predom distal muscle weakness

115
Q

typical picture of muscular cramping vs ischaemic rest pain

A

Muscular cramping:

  • intense, acute pain at night often in calves
  • middle aged pt
  • have to get up to relieve

Ischaemic rest pain:

  • intense pain, burning/throbbing in feet/toes
  • have to hang foot off bed
116
Q

mx of ischaemic rest pain vs intermittent claudication

A
  • claudication - just stop smoking and more exercise

- rest pain - arteriogram

117
Q

mx options for SVT

A
  • face in cold water
  • carotid massage (caution), valsalva
  • adenosine/verapamil IV
118
Q

which valvular lesion most likely to cause issues in pregnancy and why?

A

mitral stenosis - pregnancy induced inc. BV + CO -> pul HTN and oedema with MS -> inc risk of AF and tachy

119
Q 
what structure is at risk in the following conditions: 
A) posterior knee dislocation
B) elbow dislocation
C) pos hip dislocation
D) anterior shoulder
A

A) posterior knee: popliteal artery (highest vascular risk)
B) elbow dislocation (brachial artery)
C) pos hip dislocation (sciatic nerve)
D) anterior shoulder (axillary nerve)

120
Q

Anastomotic leak following oesophagectomy:

  1. when
  2. clinical picture
  3. how often
  4. how to confirm?
A
  1. when: D7-10 post-surg
  2. clinical picture: sudden onset AF, pleural effusion, sepsis
  3. how often: 5% cases
  4. how to confirm: oral contrast study
121
Q

buttock pain relieved by rest: DDx

A
  • spinal canal stenosis

- large vessel atherosclerotic occlusion

122
Q

best initial tx for flail chest is?

A

controlled PPV (restores chest expansion on inspiration), intubation, and ICC - prevents tensio pneumothx while on PPV

123
Q

causes of haematemesis

A

oesophagus: varices (10-30%), oesophagitis, Ca, mallory weiss (10%, repeated wretching against closed glottis causing tear)
stomach: gastric ulcer (20%), Ca, erosive gastritis
duodenum: ulcer (25%)

124
Q

indicators of disease severity in liver disease

A

Child pugh score:

1) INR
2) albumin
3) bilirubin
4) confusion
5) ascites

125
Q

perforated peptic ulcer v pancreatitis presentation

A
  • perf ulcer: sudden onset, pain worse with pressure/movement
  • pancreatitis: gradual onset, radiates to back, often move to try and relieve
126
Q

causes of dysphagia and differentiating factors

A

oropharyngeal = hard to initiate swallow:

  • neuro
  • muscular e.g. MG, polio
  • structural

oesophageal = gets stuck:

A) solids only = mechanical

  • progressive -> Ca, peptic stricture: dysphagia improves as stricture worsens
  • variable -> oesophagitis

B) solids + liquids = neuromuscular disorder

  • intermittent -> spasms
  • progressive: achalasia, paraoesophageal hernia
127
Q

Crohn’s vs coeliac disease: risk of which GI Ca?

A
  • coeliac: primary jejunal lymphoma

- Crohn’s: ileal adenocarcinoma

128
Q

regurg in pharyngeal pouch vs achalasia

A

pouch = regurg after eating, achalasia = noctural regurg

129
Q

abdo colic + vomiting + constipation + abdo distention =

A

abdo obstruction

130
Q

diverticulitis range of presentation and complications

A
  • asymptomatic, incidental finding
  • LLQ pain, constipation/diarrhoea, N/V, low grade fever
  • painless rectal bleeding
  • complications: abscess, fistula, obstruction, peritonitis
131
Q

what is most likely to cause deep wound dehiscence post abdo op?

A
  • paralytic ileus
132
Q

adult vs childhood intussusception- most likely cause

A
  • child: enlarged peyer’s patches

- adult: metastatic deposits (commonly melanoma)

133
Q

peptic ulcer: PPI vs triple therapy - when?

A

PPI for normal ulcer, triple therapy (PPI, Abx - clarithro + amoxy) for H.pylori

134
Q

explain mechanism of gallstone ileus + typical AXR picture

A

stone -> necrosis of gallbladder + duodenal wall -> fistula -> obstruction -> free air in RUQ on AXR

135
Q

why pale poo and dark pee in obstructive jaundice?

A
  • bilirubin gets redirected to blood stream and doesn’t go through rest of GIT -> poo has nothing in it = pale -> pee only gets bilirubin = dark
136
Q

fat necrosis of breast: usually follows what, physical signs

A
  • usually after trauma

- signs: firm stellate lump/parenchymal distortion/skin puckering/dimpling - DDx ca

137
Q

mammary duct ectasia: other name, and typical mammography appearance

A

= plasma cell mastitis; spilt milk appearance

138
Q

recurrent thyrotoxicosis and b/d partial thyroidectomy mx and what not to do

A
  • carbimazole -> radioactive iodine

- no surgery: likely scarred - more risk than benefit if there’s no indicator for surgery

139
Q

ITP: what and Mx options

A
  • sensitied IgG against plts (secondary e.g. SLE) or idiopathic
  • steroids then IgG if not working -> splenectomy
140
Q

Egyptian + UTI + haematuria =

A

urinary schistosomiasis

141
Q

what pathology is often associated with epididymo-orchitis?

A

prostatomegaly + UTI -> secondary infection of epididymis via vas def

142
Q

chronic urinary retention - common aetiologies

A

obstructive/neuropathic/psychogenic

143
Q

cauda equina = LMN or UMN

A

LMN

144
Q

gold standard mx of prostate vs testicular ca

A

radical prostatectomy + orchidectomy

145
Q

worst prognosis draining nodes of testicular ca and why

A

cervical - drains into systemic venous circulation

146
Q

FNA in testicular Ca - what’s the use?

A

NONE - it’s contra-indicated bc could spread neoplasm

147
Q

prostate Ca mx options - local vs locally advanced

A
  • local = radical prostatectomy, locally advanced = external beam radiotherapy
148
Q

classic hyperkalaemia ECG findings

A

peaked T waves, wide QRS

149
Q

how to deal with hyperkalaemia in ED

A
  1. membrane stabiliser - calcium gluconate - works on toxic effects
  2. shift K into cell e.g. glucose + insulin, salbutamol
    3) K excretion e.g. NaHCO3, frusemide
150
Q

causes of hyponatraemia

A 
#Isotonic: hyperprotein/lipidaemia
#Hypertonic: hyperglycaemia/mannitol
#Hypotonic
1. hypovolaemic: A) extrarenal salt loss (diarrhoea/sweat/vomit) B) diuretics
2. euvolaemic: SIADH /hypothyroid/post-op/adrenocorticotropin deficiency
3. hypervolaemic = dilutional e.g. heart/renal/liver
151
Q

small vs squamous cell carcinoma hormone secretions

A
  • small cell = ACTH, SIADH

- squamous = PTHrP

152
Q

hyperglycaemia hyponaetraemia is also known as?

A

pseudohyponatraemia

153
Q

Q fever: how to Dx?

A

serum Ab testing; rickettsia doesn’t grow in standard media

154
Q

non-immused pt with tetanus prone wound, what does tetanus prophylaxis involve?

A
  • tetanus human Ig

- + active immunisation: 3 x ADT vaccines

155
Q

lung mets - where is the primary most likely to be from?

A

renal cell carcinoma

156
Q

renal tx patients are long-term most at risk of dying of…?

A

malignancy

157
Q

classic presentation wound dehiscence

A

copius haemoserous discharge from wound site

158
Q

HSP clinical picture

A
  • most common 2-8yo, takes weeks to develop and resolve - renal cx months later
  • arthralgia + joint swelling
  • normothrombocytopaenia purpura over bottom and legs - gravity dependent
  • colicky abdo pain + malaena
  • nephritis, oedema
159
Q

rash due to measles vs viral infection (kids)

A

measles rash isn’t urticarial, viral one is

160
Q

clubbing in paediatric cardiac disease: which conditions?

A

right-left shunt i.e.cyanotic e.g. ToF or TGA

161
Q

acute OM with intact eardrum vs chronic otitis media/externa: how to treat

A

AOM:
>12mo -> analgesia 24-48h -> if not resolving + amoxy
<12mo -> analgesia+amoxy 5 days

COM/E: + topical cipro

162
Q

autoimmune thyroiditis in kids: common presentation

A
  • often only swelling + tenderness in neck

- some have classic hypothryoid symptoms

163
Q

main screening Ix for secondary nocturnal enuresis

A

urine microscopy and culture

164
Q

non-specific vulvovaginitis in children: cause

A

low oestrogen -> thin epithelium -> (normal vaginal flora cultured)

165
Q

vaccination in pre-term infants - when?

A

at 2 months chronological age (not based on weight) according to normal schedule

166
Q

what are salaam spasms?

A

infantile spasms associated with:

  • clusters of seizure activity
  • falling off of developmental skills
  • T21
167
Q

XR appearance of:

  • Perthes’
  • Slipped femoral epiphyses
  • DDH
A
  • Perthes’: irregular fragmentation of head, enlocated, children
  • Slipped femoral epiphyses: normal femoral head, displaced
  • DDH: small femoral head, shallow hip joint angle, dislocated femoral head, younger children
168
Q

mouth ulcers in kids DDx

A
  • herpes: + fever, lymphadenopathy

- enterovirus: vesicular/maculopapular rash on hands/feet/butt/trunk i.e. HFMD

169
Q

petechial/purpural vs blanching rash DDx in children

A

Petechial + purpural = non-blanching:

  • meningitis
  • HSP
  • ITP
  • leukaemia
  • viral e.g. enterococcus or bacterial (strep. pneumoniae)

Blanching:
- roseola, kawasaki, scarlet fever, viral exanthem

170
Q

signs of significant cardiac murmur in children?

A
  • thrills
  • diastolic murmur
  • loud >4/6
  • failure to thrive
171
Q

persistent cyanosis at birth DDx

A
  • asphyxia e.g. meconium aspiration
  • CDH
  • HMD
  • cyanotic heart disease: ABG is diagnostic (not ECG/CXR)
172
Q

group A strep vs strep aureus/pyogenes Abx of choice

A

phenoxymethylpenicillin = GAS, strep = fluclox

173
Q

howell jolly bodies =

A

asplenia

174
Q

absence seizure vs infantile spasms vs breath-holding attack

A
  • absence seizure: fluttering of eyelids, subtle
  • infantile spasms: not that subtle, 1st year of life, associated dev delay/regression
  • breath-holding: ass w collapse/cyanosis
175
Q

short duration fever + grunting + tachypnoea + cough + child =

A

sepsis, likely pneumonia

176
Q

major problem with petrol ingestion =

A

aspiration pneumonia

177
Q

bronch vs asthma vs croup

A 
asthma = expiratory wheeze
bronch = exp wheeze, fine inspiratory crackles 
croup = inspiratory stridor
178
Q

what is acanthosis nigricans

A

dark rash in axilla and around neck; indicative of DM

179
Q

seatbelt injuries cause what trauma?

A

abdo trauma

180
Q

fluid type and volume in kids: maintenance vs resusc

A
  • resusc = 10-20ml/kg normal saline

- maintenance: 4/2/1 (4ml per 1st 10kg, 2ml per next 10kg, 1ml for every kg after); and 2/3 of this if unwell

181
Q

stress fracture: typical position and how to Dx

A
  • shaft/neck of 2nd metatarsal

- nuclear bone scan with increased intensity at site

182
Q

baby dead at 39 weeks. what do you do?

A

amniotomy, treat shock via blood transfusion, treat any resulting coagulopathy

183
Q

obstructed vs inefficient/incoordinate labour

A

obstructed: fetal head moulding, caput formation, cervical oedema, fetal tachy ++ and progressive, usually >2cm head palpable above pelvic brim
incoordinate: no moudling +/- caput, no oedema, fetal tachy +, <1cm

184
Q

GBS +ve pregnancy, what to do?

A

parenteral penicillin 6hourly while in labour

185
Q

foetal distress in OP position during labour is most likely due to?

A

incoordinate uterine action

186
Q

grand multiparous woman with PPH =

A

uterine rupture

187
Q

most common cause of thrombocytopaenia in pregnancy, and numbers we worry about

A

incidental thrombocytopaenia of pregnancy, only worry if <50

188
Q

common causes of post-partum pyrexia

A
  • UTI
  • wound infection
  • breast engorgement
  • endometritis (less common)
  • DVT (least common)
189
Q

most common adverse effect of syntocinon

A

fetal distress

190
Q

most likely cause of dyspareunia post-partum breastfeeding + amenorrhoeic

A

atrophic vaginal epithelium

191
Q

what is the appropriate monitoring for a low lying pregnancy (18-20 weeks) with no bleeding?

A

US at 32-34 weeks

192
Q

causes of uterus smaller than expected size

A
  • reduced foetal growth
  • inadequate liquor
  • incorrect dates
  • PROM
193
Q

most appropriate way to recognise foetus with spina bifida

A

US of foetal spine at 16-18 weeks

194
Q

CTG vs intermittent auscultation in low risk pregnancy, which is better?

A

neither.

195
Q

long-term Mx for premature ejaculation

A

clomipramine

196
Q

what is a delusional perception?

A

sudden, urgent attribution of abnormal, irrational significance to an ordinary event

197
Q

delusion vs illusion vs hallucination vs overvalued idea

A
  • delusion = fixed, firm belief
  • illusion = misperception with stimulus
  • hallucination = perception without stimulus
  • overvalued idea = comprehensible pursued beyond bounds of reason
198
Q

what is passivity?

A

person believes someone/thing else is controlling their thoughts/actions etc.

199
Q

what does registration in the MMSE test?

A

anterograde working memory (i.e. ability to remember those three objects)

200
Q

schizoid vs schizotypal personality disorder

A

schizoid (Julian assange): lifetime of withdrawal, recluse, restricted affect, successful work, no FHx schiz

schizotypial: v eccentric, FHx schiz, rarely successful work, actually want to be part of society

201
Q

Diogenes syndrome

A

person who is dirty/lives in squalor/hoarder

202
Q

what is the point prevalence of schizophrenia in the population?

A

1%

203
Q

ECT is advantageous for what kinds of psych illness?

A
  • major depression + psychotic features/psychomotor retardation/previous suicidal ideation
204
Q

normal grief picture

A
  • tearfulness
  • auditory or visual hallucinations e.g. hearing deceased’s voice
  • disturbances in sleep
  • anxiety and chest pain
205
Q

most appropriate initial medication for breastfeeding mother with a) psychotic Sx b) bipolar

A

a) olanzapine b) sodium valproate (not lithium!)

206
Q

what is important in the workup for ADHD?

A
  • talk to both parents
  • behavioural rating scales
  • visual and hearing assessments
  • psychometric assessment
207
Q

anti-depressant of choice in adolescents

A

fluoxetine - not mirtaz (not approved for use)

208
Q

atypical anti-psychotics olanzapine and clozapine associated with what AEs

A
  • abnormal lipid profile
  • inc weight
  • T2DM
209
Q

classic restless legs syndrome picture

A
  • tingling/burning
  • involves thighs
  • sleep disturbance
  • have to wake up and walk to relieve
  • FHx
210
Q

Diazepam better IM or IV

A

never give diazepam IM - absorption too erratic, can cause tissue necrosis

211
Q

serotonin syndrome vs NMS

A

SS: due to SSRI, acute onset, agitation, tremor, hyperreflexia
NMS: due to DA-blockade e.g. haloperidol, ANS instability, CK rise, delirium, peaks in 3 days

212
Q

traveller’s diarrhoea + bloody stool + long incubation time =

A

entamobea histolytica

213
Q

where do testicular and rectal tumours drain

A

to para-aortic nodes

214
Q

appropriate chemoprophylaxis for malaria

A

doxy 2 days before arrival and 2 weeks after/chloroquine 1 week prior and 4 weeks post

215
Q

incubation period for falciparum malaria

A

2 weeks

216
Q

diphtheria toxoid vs immunoglobulin - when to give?

A

toxoid for active protection, ig when passive protection needed

217
Q

example of significant prognostic factor for reduced mortality in younger vs elderly populations

A
  • younger: marital status

- older: presence of living children

218
Q

Rx contraindicated in pregnancy

A
  • ACEI
  • NSAID
  • diuretics
  • beta-blockers
  • lithium
  • warfarin
219
Q

post-menopausal bleeding + adnexal mass NTBM

A

bleeding = endometrial carcinoma, adnexal mass = ovarian carcinoma

220
Q

rhythm method of contraception: cycles between 26-29 days. What is the correct abstinence period, and why?

A

day 6-17 of cycle.
A) ovulation occurs 14 days before period, luteal phase is 14 days regardless of follicular phase (D12-15)
B) sperm can survive 6 days - so cease 6 days prior (D6)
C) ovulated egg can be fertilised 2 days post - so D17

221
Q

beta-hcg can be measured using what in early pregnancy?

A

LH

222
Q

most common organisms for PID

A

chlamydia and gono

223
Q

cyst mid-menstrual cycle =

A

follicular cyst

224
Q

PCOS fertility tx 1st line

A

metformin

225
Q

FSH and E2 findings in the menopause

A

high FSH, low E2

226
Q

most likely primary site of ovarian ca in aus

A

colon

227
Q

GP screening: CRC

A
  • low risk: FOBT every 2y from 50
  • mod risk (1 relative <55 or 2 relatives): FOBT every 2y 40-49, colonoscopy every 5y from 50
  • high risk: FOBT every 2y from 35-44, colonoscopy every 5y from 45
228
Q

GP screening: breast Ca

A
  • low risk: mamm every 2y form 50
  • mod risk (1 relative <50): annual mammogram from 40
  • high risk: mamm/MRI/US

or 5-10 yrs prior to when dx was made in relative

229
Q

DDx vertigo

A

Migraine (Y) = migrainous vertigo
Migraine (N):

  • Hearing loss (Y)
    - Episodic vertigo Y -> Meniere’s (UNILAT fullness in ear, tinnitus, SN deafness, low-pitched rumbling)
    - Episodic vertigo N -> Labyrinthitis
  • Hearing loss (N)
    - Episodic vertigo Y -> BPPV
    - Episodic vertigo N -> vestibular neuronitis
230
Q

DDx otologic tinnitus

A

1) Meniere’s: excess endolymph, usually unilat tinnitus
2) acoustic neuroma: continuous usually unilat tinnitus from slow destruction of vestibular nerve, so slow that vertigo is minimal
3) otosclerosis: bilateral tinnitus, hearing loss, hyperacusis, pregnancy, FHx, femalel
4) presbycusis: progressive, old person, bila tinnitus, hearing loss
5) labyrinthitis

231
Q

Causes of conductive vs SN hearing loss

A

Conductive = outer/middle ear = OM/OE, trauma, cholesteatoma, TM perf, usually otosclerosis (but can be both)

SN = inner ear = infection/Rx/AI/presbycusis/meniere’s/acoustic neuroma

232
Q

sigmoid volvulus presentation and AXR findings

A
  • acute colicky pain
  • absolute constipation
  • inverted U gas rising from pelvis/coffee bean sign
233
Q

bowel obstruction AXR

A
  • dilated loops of bowel with air fluid levels, with no distal bowel gas
234
Q

GBS

A
  • symmetrical ascending paralysis

- distal starting paraesthesia

235
Q

roseola vs parvovirus vs measles vs kawasaki vs HFMD

A

roseola/6th: infants, sudden high fever -> febrile convulsions -> blanching rash after fever

parvo/5th: a bit older, fever + coryza, macular blanching rash on trunk + slapped check after fever, waxes and wanes

measles: prodrome (high fever + 3 C’s - cough, coryza, conjunctivitis, Koplic spots), cephalocaudal macpap rash
kawasaki: <5yo, CRASH (conjuncitivitis, polymorphous rash, adenopathy unilat, strawberry tongue, hand erythema -> desquamation) and burn 5 days

HMFD: mouth ulcers, vesicular lesions, high fever

236
Q

meningitis bacterial organisms

A

<2 mo = GEL: GBS, E.Coli, listeria

>2mo = NHS: neisseria meningitidis, HiB, strep pneumoniae

237
Q

earliest signs of chronic venous insufficiency

A
  • hyperpigmentation

- dilated tortuous veins

238
Q

anal fissure vs fistula vs colinic polyps vs 1st deg haemorrhoids

A

fissure = painful defecation + bleeding
distula = pain no bleeding
colonic polyps = bleeding no pain
1st deg haemorrhoids = bleeding no pain

239
Q

pulmonary HTN signs

A

right sided S4
loud P2
right ventricular heave

  • prominent v waves in JVP
  • TR
  • pulsatile liver

Last Ditch Attempt (1 decks)

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