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General Internal Medicine > GIM exam Easter 2018 > Flashcards

GIM exam Easter 2018 Flashcards

1
Q

Cellulitis - antibiotic

A

Flucloxacillin

  • clarithromycin for penicillin allergy
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2
Q

Dermatome to dorsum of foot

A
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3
Q

What does ART stand for (with HIV topic)

and associated problems?

A

anti-retroviral therapy

  • resistance to drugs
  • side effects, drug intolerance
  • adherence problems from complex regime
  • drug interactions
  • cost
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4
Q

What’s a cause of loud borborygmi?

(movement of fluid and gas)

A

small-bowel obstruction/ dysmotility if associated with colicky discomfort.

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5
Q

What conditions can cause upper motor neurone symptoms?

A
  • stroke
  • MS
  • traumatic brain injury
  • cerebral palsy
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6
Q

Important things that affect vit D absorption (except for the obvious)

A
  • age
  • absorption is in first part of SI, therefore digestive disorders
  • condition of the Kidneys
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7
Q

Reasons to do a lumbar puncture

A
  • investigating bacterial meningitis
    *
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8
Q

what is a cardinal feature of bronchitis?

A

a productive cough.

(usually self resolving and viral)

  • an infection of the main airways (bronchi)

Chronic bronchitis features in COPD

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9
Q

What is the ROME III criteria?

A

Criteria for diagnosing IBS

Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with two or more of the following:

  • Improvement with defecation
  • Onset associated with a change in frequency of stool
  • Onset associated with a change in appearance of stool.
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10
Q

What type of headache is common first thing in the morning?

A

migraine

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11
Q
A

The hallux dorsiflexes, and the other toes fan out; this is Babinski’s sign;

damage to the central nervous system.

Stimulate from heel upwards.

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12
Q

ACNE - antibiotic

A

doxycycline - tetracyclines

if not responding; erythromycin

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13
Q

Dermatome to Upper inner arm

A
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14
Q

Suspected subarachnoid haemorrhage headache diagnosis

A

CT scan (reliability 95-98% only)

If CT negative, LP > 12 hours following onset of symptoms.

LP: uniform RBC in bottles suggests SAH

Presence of bilirubin suggests bleed. Bilirubin will give the csf a yellowish colour and is due to the breakdown of RBCs. Called xanthochromia.

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15
Q

What is bioavailability?

A

Bioavailability :

A subcategory of absorption and is the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs.

By definition, when a medication is administered intravenously, its bioavailability is 100%.

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16
Q

UTI - antibiotic

A

nitrofurantoin

trimethoprim

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17
Q

Characteristics of cluster headaches

A

severe, unilateral, retro-orbital

clustered over time

variable duration (10-60 mins)

autonomic symptoms; tearing (>> lacrimation), red eye, nasal congestion (rhinorrhoea)

attacks often at night

much more commen in MEN (9:1)

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18
Q

Pathophysiology of pleural effusion due to LVF

A

back up of fluids increases pulmonary pressure resulting in pulmonary oedema in the alveoli, fluid in the interstitial fluid, and finally into the pleural cavity.

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19
Q

What’s the common cause of esophageal varices?

A

cirrhosis and consequences of portal hypertension

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20
Q

What is cor pulmonale?

A

Pulmonary heart disease.

Occurs in 25% of patients with COPD.

Caused by pulmonary hypertension causing enlargement of the right ventricle.

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21
Q

Buerger’s disease

(thomboangiitis obliterans)

A

Occurs in young men who smoke

This pain may occur when you use your hands or feet and eases when you stop that activity (claudication), or when you’re at rest

Inflammation along a vein just below the skin’s surface (due to a blood clot in the vein)

Gangrene

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22
Q

Possible antibiotics for meningitis

A

Cefolaxime

Benzylpenicillin

Chloramphenicol

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23
Q

How is HIV infection diagnosed?

A

Detection of anti-HIV antibodies by ELISA (enyme-linked immunosorbent assay).

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24
Q

Felty’s syndrome (important)

A

Rare autoimmune disease

Splenomegaly

neutropenia

RhA

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25
Q

C. diff - antibiotic

A

metronidazole

or vancomycin (glycopeptide) . Nephrotoxic

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26
Q

Characteristics of tension headaches

A
  • mild to moderate (fuzzy head); dull generalized headache
  • bilateral
  • non-pulsatile
  • exert bandlike pressure
  • no nausea

poor response to over the counter analgesia

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27
Q
A
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28
Q

What is the TIMI score?

A

Estimates mortality for patients with unstable angina and non-ST elevation MI.

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29
Q

What is Boerhaave syndrome?

A

10% of esophageal perforations which occur due to vomiting.

full-thickness tear in the esophageal wall

high morbidity and mortality and is fatal without treatment

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30
Q

What are the clinical features of a PE?

A
  • sudden and unexplained dyspnoea. This maybe the only symptom, especially in the elderly.
  • IMP> pleuritic chest pain and haemoptyosis are present only when infarction has occured. PE can be silent!
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31
Q
A
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32
Q

What is Proctitis?

A

Proctitis is an inflammation of the lining of the rectum.

Proctitis can cause rectal pain and the continuous sensation that you need to have a bowel movement

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33
Q

RhA diagnostic criteria

A

morning stiffness >> 60 mins

stiffness after rest

>> six weeks duration

DIP joints spared

Volar subluxation

Swan neck/ boutonniere, guttering between bones

RhA attacks connective tissue (therefore tendinous sheaths); fingers stay in flexion/ extension

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34
Q

Dermatome to Toes 1-3

A
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35
Q

Central upper abdominal radiating through to the back and partially relieved by sitting forwards is…

A

pancreatitis

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36
Q

What is found here?

A
  • SOLID:
  • lymph nodes, cervical rib
    • CYSTIC:
  • cystic hygroma (lymphangioma)
  • Pharyngeal pouch
  • Subclavian aneurysm
    *
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37
Q

What is achalasia?

What is a dange of this?

A
  1. Oesophageal aperistalsis
  2. Impaired relaxation of the lower oesophageal sphincter.

Progressive overflow of secretions and food, esp. at night and can cause aspiratory pneumonia.

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38
Q

Upper motor neurone signs

A

Increase in muscular tone (spasticity)

Increase in reflexes (hyperflexia)

++ Babinski sign

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39
Q

Takayasu’s disease (rare)

A

Takayasu arteritis is a rare, systemic, inflammatory large-vessel vasculitis of unknown etiology; affects women of childbearing age.

Gradual stenosis of arteries dues to inflammatory attacks.

  • Pain with use of an arm or leg (called “claudication”),
  • high BP

distinguish between narrowing due to vasculitis and due to atherosclerosis

Diagnosis; angiogram (X-ray with dye), CT angiography

Tx: steroids, immune suppresants

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40
Q

Upper motor neurone lesion, upper….

A

face sparing.

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41
Q

What are the two types of leukaemia?

A

acute lymphoblastic leukaemia (ALL) - lymphoid cell line

myeloid cell line - Acute Myeloid Leukaemia (AML)

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42
Q

What happens to Functional Residual Capacity with emphysema?

A

Increased because

REDUCED elastic recoil, and therefore less resistance to the elastic recoil of the chest.

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43
Q

Which part of the GI tract is Crohn’s disease?

A

anywhere

(abdominal cramping + diarrhoea)

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44
Q

Sudden onset headache could be:

A

meningitis

subarachnoid haemorrhage

migraine

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45
Q

Typically symptoms of intestinal obstruction

A
  • abdominal colic
  • vomiting
  • constipation WITHOUT the passing of wind
  • distension
  • increased bowel sounds
  • Marked tenderness
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46
Q

What is bacterial vaginosis?

A
  • Commonest cause of vaginal discharge (often recurrent)
  • Overgrowth of commensals - anaerobes, mycoplasmas & Gardnerella vaginalis
  • NOT sexually transmitted though may exacerbate

METRONIDAZOLE

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47
Q

What is a common cause of melaena.

NB> melaena is due to an upper GI bleed

A

peptic ulceration

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48
Q

Testing the median nerve

NB. Thumb opposition; C8, T1 nerve roots

A
  • test; altered sensation over thumb, index, middle fingers
  • any thenar eminence wasting?
  • hand palm up on flat surface. Px moves thumb vertically against resistance (abductor pollicis brevis)
  • opponens pollicis; try and pull thumb and ring finger apart
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49
Q

Common AIDS-defining illnesses in the West

A
  • Pneumocystis jirovecii
  • oesophageal candidiasis
  • tuberculosis
  • herpes simplex/ zoster - repeated infections
    • others

ALONG WITH; systemic features weight loss, persistent fever or persistent diarrhoea.

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50
Q

What is the GRACE score?

A

A scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality

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51
Q

CAP - antibiotic

A

amoxicillin

or doxycycline/ clarithromycin

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52
Q

How does PCP present? - pneumocystis carinii (jirovecii) pneumonia

A
  • non-productive cough
  • fever
  • dyspnoea
  • subacute, symptoms last 3-4 weeks.

CXR normal in 90% of cases.

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53
Q

Name some lower motor neurone conditions

A

Guillain-Barre syndrome

C. botulism

polio

cauda equina syndrome

amyotrophic lateral sclerosis

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54
Q

Epigastric pain that is not tender on palpation and has autonomic symptoms could be….

A

MI

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55
Q

Syphilis - antibiotic

A

Benzylpenicillin

or

Doxycycline

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56
Q

Dermatome to medial malleolus

A
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57
Q

Diagram of Lung Volumes

A
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58
Q

Dermatome to the thumb

A
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59
Q

Dermatome to Toes 4 and 5; lateral malleolus

A
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60
Q

Dermatome to Inner Forearm

A
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61
Q

Small bony nodules (osteophytes) at the DIP and PIP joints are characteristic of what?

A

OA

DIP - Herberden’s nodes

PIP - Bouchard’s nodes

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62
Q

Characteristics of migraines

A
  • often unilateral. Recurrent
  • usually pulsatile
  • builds up over minutes to hours
  • occurs with or with aura
  • associations include; nausea & vomiting, photophobia, sound sensitivity, family history
  • exacerbation with physical activity
  • triggers; cheese, chocolate, etc.

NB. neurological exam should be negative

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63
Q

What are the signs and symptoms of peritonitis?

A

severe abdominal pain, tenderness and guarding.

(rigidity - invol contraction of abdo muscles)

Worse for movement as the inflammed peritoneum moves.

REBOUND pain (Blumberg sign) as the peritoneum snaps back into place after palpation.

fever, weight loss

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64
Q

Endocarditis - antibiotic

A

Gentamicin and Penicillin G

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65
Q

Another name for Broca’s aphasia?

A

Expressive aphasia

66
Q

Acute asthma attack

A

Salbutamol nebs

add ipratropium bromide if not working well.

Give steroids (orally, IM, IV)

67
Q

Name some cystic lumps

A
  • Branchial cyst
  • Cystic degeneration of tumour
  • Larynogocoele
68
Q

NYHA

A
69
Q
A
70
Q

What are typical signs and symptoms of acute leukaemia?

A
  1. Bone marrow failure symptoms; anemia, leukopenia, thrombocytopenia. Therefore; SOB, fatigue, bacterial infections, bleeding, bruises. Possibly DIC.
  2. Systemic; malaise, weight loss, sweats are common
71
Q

What is pseudomembranous colitis?

A

Also called antibiotic-associated colitis or C. difficile colitis, is inflammation of the colon associated with an overgrowth Clostridium difficile.

This overgrowth of C. difficile is most often related to recent antibiotic use.

72
Q

What’s the story?

A

Zollinger–Ellison syndrome (ZES) is a disease in which tumors cause the stomach to produce too much acid, resulting in peptic ulcers.

Symptoms include abdominal pain and diarrhea.

The syndrome is caused by a neuroendocrine tumor that secretes a gastrin. The tumor causes excessive production of gastric acid.

73
Q

Dermatome to knee

A
74
Q

What symptoms could indicate a median nerve pathology?

A

the thumb and lateral two and a half fingers affected (numbness)

wasting of thenar eminence

weakness of thumb abduction

75
Q

Immediate management of acute leukaemia

A
  • often very ill px vulnerable to infections and/or bleeding.
  • IV antibiotics
  • platelets and fresh frozen plasma for bleeding
  • blood transfusion for anaemia

* even if fever is caused by disease and not infection, treat with antibiotics because b.

76
Q

Deformities of the finger in RhA

(diagram)

A
77
Q

Dermatome to middle finger

A
78
Q

Symptoms of meningitis

A
  • high temperature of 38C or more
  • headache
  • blotchy rash that doesn’t fade when a glass is rolled over - septicaemia (
  • often not present)
  • stiff neck
  • photophobia, drowsiness, seizures, confusion,
  • aching muscles & joints,
  • cold hands & feet, tachypnoea
79
Q

Name opportunistic HIV infections

A
  • PCP - pneumocystis jirovecii
  • cytomegalovirus (CMV) in late-stage infection (CD4 <50) - main problem progressive retinitis (85%)
  • toxoplasmosis - protozoa infection. Causes encephalitis (80%) in late HIV
  • Kaposi’s sarcoma (herpes virus 8)
    • others
80
Q

What are the tests for Coeliac disease?

A

Total immunoglobulin A (IgA)

IgA Tissue transglutaminase antibody (shortened to tTG)

+ eat gluten in more than one meal every day for six weeks prior to testing.

GOLD standard; duodenal biopsies with IEL ( increased number of intraepithelial lymphocytes is typical of active celiac disease)

81
Q

Parotid tail lump - Solid

What other solid lumps are there?

A
  • lymph node
  • tumours
  • vagal schwannoma
82
Q

What is seroconversion?

A
  • Period of time during which HIV antibodies develop and become detectable.
  • takes place within a few weeks of initial infection.
  • It is often accompanied by flu-like symptoms including fever, rash, muscle aches and swollen lymph nodes. These symptoms are not a reliable way to identify seroconversion or to diagnose HIV infection.
83
Q

Lung volumes diagram

A
84
Q

What is a pharyneal pouch?

A

A diverticulum of the mucosa of the pharynx.

Dysphagia, and sense of a lump in the throat

Trapped food:

Regurgitation, r_eappearance of ingested food in the mouth_

Cough, due to food regurgitated into the airway

Halitosis, smelly breath, as stagnant food is digested by microorganisms

Infection

85
Q

Neisseria Gonorrhoea - antibiotic

A

Ceftriaxone

86
Q

What is the important of lactate in ABG?

A

by-product of anaerobic respiration.

Good indicator of poor tissue perfusion.

87
Q

What could CTS be associated with?

A

pregnancy

diabetes

hypothyroidism

88
Q

What does raised PSA indicate?

A

Prostate cancer/ benign hypertrophy

other examination; PR, biopsy

89
Q

Name for rectal bleeding

A

haematochezia

90
Q

Investigations for acute leukaemia

A

FBC; anaemia and thrombocytopenia, << WBCs (or normal , or raised). If raised then cells are mainly primitive white cells (blasts).

Coagulation profile; prolonged clotting times

Blood cultures; infection risk

CXR; mediastinal mass on ALL of T-cell lineage.

+ others

GOLD standards to differentiate ALL from AML; bone marrow aspirations, trephine biopsy.

91
Q

protozoan parasite that causes malaria

A

Plasmodium falciparum

92
Q

Coeliac disease and gluten… what’s the story?

A

gluten > villous atrophy > malabsorption

  • Familial component
  • T Cell mediated autoimmune inflammation of the small bowel.
93
Q

What is the definitive examination for a PE?

A

CT pulmonary angiogram (CTPA) computed tomography using a contrast dye to obtain an image of the pulmonary arteries.

94
Q

Lower motor neurone signs

A
  • absence of reflexes
  • muscle fasciculations
  • atrophy of muscles
  • decrease muscular tone
95
Q

HIV is caused by what type of virus?

A

blood-borne RNA retrovirus

  • intercourse, drug use
  • maternal-child transmission
  • transfusion of blood products
96
Q

What’s this? And info

A

BCC is a non-melanoma skin cancer, and is the most common type (> 80%) of all skin cancer.

BCC are sometimes referred to as ‘rodent ulcers’.

Common on areas that are exposed to the sun, such as your face, head, neck and ears

97
Q

Kussmaul breathing is a deep sighing pattern to decrease CO2 levels and is commonly seen with….

A

Diabetic ketoacidosis

98
Q

Which part of the GI tract is ulcerative colitis?

A

colon and rectum only

(abdominal cramping + diarrhoea)

99
Q

What is FNAC?

A

Fine Needle Aspiration for Cytology

  • may be used for neck lumps
100
Q

Define acute leukaemia

A

Clonal haematopoietic stem cell/ progenitor disorder characterized by the rapid accumulation of immature progenitor cells (blasts) and impaired normal marrow function.

101
Q

Mallory-Weiss tears

  • when?
A

alcoholic ‘dry heaves’, retching, severe coughing.

tears at the oesophagogastric junction by a sudden increase in intra-abdominal pressure

102
Q

RhA nodules characteristics

A

Made from fibroblasts.

Pinky colour.

Blood supply on the outside only; can become necrotic.

Locations; extensor surfaces of elbows, forearms and hands

103
Q

What’s this? + info.

A

Thyroglossal cysts

asymptomatic midline neck mass at or below the level of the hyoid bone, above the thyroid cartilage.

Most often in the midline

They may present in childhood (less than 50%) or, usually as a young adult

Move up when the tongue is protruded & with swallowing- cysts attached to the base of the tongue by the thyroglossal tract.

104
Q

Symptoms of temporal arteritis

A

visual loss; blood supply to retina is affected.

One-sided headache, very tender scalp; tender brushing hair

Typically new and continuous headache with those over 50 yrs. Gradual onset (wks-mtns)

Pain in jaw with chewing; jaw claudication

Can cause clots leading to stroke.

  • ESR often raised (>100)
105
Q

What is respiratory acidosis?

A

Acidosis due to an inability of the lungs to excrete CO2 adequately.

106
Q

What is a pannus?

A

hypertrophied synovium,

containing inflammatory cells that release collagenolytic enzymes

causing loss of bone and cartilage (chronic RhA)

107
Q

What’s the common cause of this?

A

cirrhosis,

the consequences of portal hypertension.

Commonly these bleed.

lower 1/3 of the oesophagus

108
Q
A
109
Q

Which shoulder dislocation is most common?

A

Anterior - 95%

Usually caused by a direct blow to, or fall on, an outstretched arm.

The patient typically holds his/her arm externally rotated and slightly abducted.

110
Q

Management of Benign prostatic hypertrophy

A

alpha-adrenergic blockers; prazosin

alpha adrenoceptor antagonists; tamsulosin

or finasteride (inhibitor of testosterone, reduces prostatic hypertrophy)

TURP: TransUrethral Resection of the Prostate.

111
Q

POUND mneumonic

A
  • Pulsatile
  • 4-72 hOurs duration
  • Unilateral
  • Nausea or vomiting
  • Disabling intensity
112
Q

Some characteristics of CTS

A
  • more common in women
  • tingling in hand
  • symptoms often occur at night
  • px may hand hand and arm out of bed for relief
  • associated with…. (3)
  • thenar muscle wasting
113
Q

What is the ankle-brachial pressure index (ABPI)

A

The ratio of the blood pressure at the ankle to the blood pressure in the upper arm.

Lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease (PAD)

Unreliable with calcification of arteries (e.g. diabetes)

114
Q

Which type of leukaemia has a peak age of onset of four years?

A

ALL - acute lymphoblastic leukaemia

70-80% cure rate for children.

115
Q

Immediate Stroke/ TIA management

A
  • CT scan to rule out haemorrhagic cause
  • thrombolysis (3 hr window from onset of symptoms?)
  • antiplatelet therapy
116
Q

What is tenesmus?

A

Sensation of needing to defaecate although the rectum is empty.

(could be rectal inflammation of tumour)

117
Q

What is pharmacokinetics?

A

Pharmacokinetics is the study of how an organism affects a drug.

Absorption is part of pharmacokinetics.

IV - max bioavailability.

118
Q

infectious esophagitis.

Common cause?

A

Candida albicans

HIV/ cancer patients

119
Q

Characteristics of essential/ benign/ idiopathic tremor.

A
  • cause unknown
  • symmetrical (Parkinson’s is asymmetric)
  • happens on movement or postural (due to sustained muscular tone). EG. Rattling of a teacup.
  • DOESN’T HAPPEN AT REST (unlike PARKINSON’S)
120
Q

Some possible red flags for neck lumps

A

Dark colour suggestive of malignant melanoma,

ulceration,

skin fixation,

bleeding, or

hard texture

121
Q

RhA on XR - characteristics

A

White sclerotic changes - spongy bone looks whiter.

Subluxation of MCP

Wrist/ hand displacement

Thumb - Z deformity

122
Q

Dermatome to little finger?

A
123
Q

meningitis - antibiotic

A

benzylpenicillin

124
Q

Headache; red flags

A
  • new onset or changes in headache in px over 50 years old
  • thunderclap
  • focal neurological symptoms
  • abnormal neurological examination
  • headache that changes with posture
  • wakes up px during night
  • worse for valsalva manoeuvre
  • thrombosis risks
  • jaw claudication
  • neck stiffness with fever
  • new onset with cancer/ HIV px
125
Q

Emphysema and Lung volumes - what’s the story

A

Emphysema, functional respiratory capacity is increased, because the lungs are more compliant. Total lung capacity also increases, largely as a result of increased functional residual capacity.

126
Q

Chlamydia - antibiotic

A

Azithromycin

127
Q

What lumps move with swallowing?

A

SOLID:

Goitre

lymph node

CYSTIC:

Thyroid cyst

128
Q

definitive tx of acute leukaemia and side effects?

A

cytotoxic drugs

  • hair loss, nausea & vomiting, sore mouth, bone marrow failure.
  • severe infection

radiotherapy, & some cases; stem cell transplantation. Destroy stem cells and reinfuse.

129
Q

What and where and how?

A

melanoma - cutaneous malignant melanoma is a cancer of the pigment cells of the skin

common backs (men), legs (women)

Usual skin type suspects. Sunbeds and sudden intense sun exposure BAD.

130
Q

What could cause wrist drop?

A

Radial nerve compression

131
Q

Where does pain radiate with acute cholecystitis?

A

from right hypochondrial region to shoulder/ interscapular region.

132
Q

Nerve involved with CTS?

A

median

133
Q

Which type of cells does HIV virus infect?

A

CD4-bearing T lymphocytes and monocytes/ macrophages

134
Q

What is the age group for AML (acute myeloid leukaemia)?

A

more common with increasing age, with peak age onset of 70 years.

135
Q

Causes of purpura

(pathophysiology)

A

Platelet disorders (thrombocytopenic purpura)

Vascular disorders (nonthrombocytopenic purpura)

Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged

Hypertensive states

Vasculitis, as in the case of Henoch–Schönlein purpura

Coagulation disorders

Disseminated intravascular coagulation (DIC)

Scurvy (vitamin C deficiency) - defect in collagen synthesis results in weakened capillary walls and cells

Meningococcemia

Cocaine use with concomitant use of the one-time chemotherapy drug and now veterinary deworming agent levamisole can cause purpura of the ears, face, trunk, or extremities. Levamisole is purportedly a common cutting agent.

136
Q

Referred pain (diagram)

A
137
Q

What condition can sometimes mimic cellulitis and is an medical emergency?

A

Necrotising Fasciitis

Important clues; pain, tenderness and systemic illness out of proportion to the localised physical signs.

Bullae and ecchymotic skin lesions also point to this condition (not normally found with cellulitis)

138
Q

Necrotising fasciitis of submandibular space is called….

A

Ludwig’s angina

139
Q

Smoking is protective for which condition?

A

ulcerative colitis

140
Q

What is a SAH (subarachnoid haemorrhage)?

A

Subarachnoid haemorrhage (SAH) is usually the result of bleeding from a berry aneurysm in the Circle of Willis.

141
Q

Subarachnoid haemorrhaging; can it present with meningeal irritation?

A

Yes

142
Q

What does the oculomotor nerve supply?

A

eye muscles

upper eyelid muscle (levator palpebrae superioris)

Muscles responsible for pupil contriction.

symtoms; strabismus, diplopia, ptosis, mydriasis

143
Q

What is aplastic anaemia?

A

a potentially life-threatening failure of haemopoisesis characterised by pancytopenia and hypcelullar bone marrow.

incidence; 2/1, 000, 000

Blood tests will show; normcytic anaemia, leukopenia and thrombocytopenia.

144
Q

What is normal pressure hydrocephalus?

A

>> csf in the brain’s ventricles. The brain ventricles enlarge and can cause symptoms related to surrounding tissue compression.

Age group; 60s and 70s.

‘wet, wobbly and whacky’ which represent urinary incontinence, gait ataxia, and dementia respectively.

145
Q

two main Causes of acute pancreatitis

A

Gall stones

Ethanol

146
Q

what is the Herxheimer’s reaction?

A

It is believed to be caused by the release of endotoxin-like substances when large numbers of Treponema pallidum are killed by antibiotics (treatment of syphilis)

147
Q

What’s the test for Quervain’s tenosynovitis?

A
148
Q

What is the most important treatment for prevention of neonatal respiratory distress syndrome?

A

Natural maternal glucocorticosteroids are very important for surfactant production in the foetus, and therefore synthetic steroids are the first line agents for preventing NRDS in pregnancies at risk of pre-term birth

149
Q

what is the best time of the day to take simvastatin?

(Statins inhibit the action of HMG-CoA reductase)

HMG-CoA reductase is the rate-limiting enzyme in hepatic cholesterol synthesis

A

Statins should be taken at night as this is when the majority of cholesterol synthesis takes place.

This is especially true for simvastatin which has a shorter half-life than other statins

150
Q

What are the symptoms of otosclerosis?

Otosclerosis (OTSC) is a condition in which there’s abnormal bone growth inside the ear. It’s a fairly common cause of hearing loss in young adults.

A

The main symptoms are progressive hearing loss and tinnitus. Hearing loss is bilateral in ~70% of cases.

Vestibular symptoms are usually absent.

151
Q

what is Glue ear?

A

otitis media with effusion

peaks at 2 years of age

hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)

secondary problems such as speech and language delay, behavioural or balance problems may also be seen

152
Q

What is Paget’s disease of the bones and how is it treated?

A

Paget’s disease is a condition of excessive bone remodelling by osteoclasts, followed by disordered formation of new bone. The mainstay of treatment for Paget’s disease is bisphosphonates as they inhibit osteoblastic activity.

153
Q

What’s the management of primary pneumothorax?

A
  • if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered ( consider other medical factors)

otherwise aspiration should be attempted

if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

patients should be advised to avoid smoking to reduce the risk of further episodes - the lifetime risk of developing a pneumothorax in healthy smoking men is around 10% compared with around 0.1% in non-smoking men

154
Q

What would affect the results of a urea breath test?

A

Urea breath test -

no antibiotics in past 4 weeks,

no antisecretory drugs (e.g. PPI) in past 2 weeks

155
Q

What type of urinary incontinence is the most associated with amitriptyline?

A

Overflow incontinence

Amitriptyline belongs to the drug class of tricyclic antidepressants (TCAs). TCAs have anticholinergic effects which may lead to urinary retention, leading to frequent leaking.

156
Q

What is urge incontinence?

A

Urge incontinence is due to detrusor over-activity and could be treated with an antimuscarinic drug

157
Q

What are the most common groups of groups that cause hyponatriaemia?

A

thiazide diuretics,

selective serotonin reuptake inhibitors (SSRIs),

proton pump inhibitors,

angiotensin-converting enzyme (ACE) inhibitors

and loop diuretics.

158
Q

What are some of the clinical characteristics of anorexia nerviosa?

A

hypokalaemia is the most common electrolyte abnormality.

They usually have high cholesterol levels in the blood.

bradycardia, hypotension, and cold-intolerance.

yellow tinge on the skin (hypercarotenaemia)

Possibly lanugo hair due to loss of body fat.

159
Q

What is Cushing’s disease?

A

Cushing’s disease which results from increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary, often caused as a result of a pituitary adenoma.

160
Q

How does Heparin work?

A

It activates (hyperpotentiates) antithrombin III

nat

161
Q

What is the most common cause of brain metastases?

A

Ca of Lungs

General Internal Medicine (3 decks)

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