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1
Q

Name three changes to the structure of the airways after asthma remodelling?

A

Goblet cell metaplasia
Thickened basement membrane
Smooth muscle hyperplasia

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2
Q

Name 4 health conditions you would look for during the 8 week baby check?

A
  1. Congenital heart defects
  2. Spina bifida
  3. Cleft lip or palate
  4. Cryptochordism
  5. Ortalani Test - developmental dysplasia of the hip
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3
Q

Name 5 red flag signs in a patient with a chronic cough?

A
  1. Haemoptysis
  2. Recurrent chest infections
  3. Night sweats
  4. Weight loss
  5. Pleuritic chest pain
  6. Hoarse voice
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4
Q

Name 4 acute causes of cough and chest pain?

A

Asthma and COPD exacerbations
Pulmonary embolism
Pneumothorax
Pulmonary oedema

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5
Q

Name 3 symptoms of asthma?

A

Wheeze
Intermittent dyspnoea
Cough (nocturnal)

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6
Q

Name 5 precipitants of asthma?

A 
Exercise 
Allergen (dust mites, fur) 
Cold Air 
Drugs eg BB or Aspirin 
Infection 
Smoking
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7
Q

Name 4 signs of asthma?

A
  1. Tachypnoea
  2. Audible wheeze
  3. Hyperinflated chest
  4. Hyper-resonant percussion note
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8
Q

How do you assess diurnal variation in asthma?

A

Peak flow meter, shows diurnal variation of >20% on ≥3 days a week for 2 weeks

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9
Q

What are the results of spirometry in a patient with asthma?

A

Obstructive defect FEV1/FVC <0.7 and ≥15% increase post bronchodilator

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10
Q

What are the RCP3 questions in assessing asthma?

A

Recent nocturnal wakening
Usual asthma symptoms in a day
Has your asthma interfered with usual activity

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11
Q

What are the first 3 lines of drugs you would use in an asthma patient?

A
  1. SABA - salbutamol
  2. Inhaled corticosteroid - beclamethasone
  3. LABA - eg formeterol
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12
Q

In step 4 of asthma medication management what would you consider?

A

Increased beclamethasone dose
Oral theophylline
Leukotriene receptor agonist rg monteleukast

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13
Q

What would you use in step 5 of asthma management?

A

Oral prednisilone

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14
Q

What are the risk factors for breast cancer?

A

Alcoholic drinks, oestrogren progesterone contraceptive , HRT< radiation, smoking

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15
Q

Name 5 changes you would see in the breast in suspected breast cancer?

A
  1. Lump - fixed, rocky
  2. Skin changes - peau de orange
  3. Nipple inversion
  4. Nipple discharge
  5. Redness or rash
  6. Breast asymmetry
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16
Q

Name 4 differential diagnosis of a breast lump?

A
  1. Fibroadenoma
  2. Breast cyst
  3. Breast abscess
  4. Duct ectasia
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17
Q

What is the triple assessment for a breast lump?

A
  1. Clinical presentation
  2. Radiology, ultrasound >35, mammography <35
  3. Histology/cyology - ultrasound guided core biopsy is best
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18
Q

When would you consider urgent referral (within 2 weeks) for breast lump?

A

> 30 with unexplained breast lump

>50 with either discharge or retraction in one nipple only

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19
Q

What circumstance would you consider a referral in suspected breast cancer?

A

> 30 with unexplained axillary lump OR skin changes that suggest breast cancer

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20
Q

What is a non-urgent referral for breast cancer?

A

<30 with unexplained breast lump

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21
Q

In a patient who is BRCA1 or 2 positive (not got breast cancer) what are the three management options?

A
  1. Chemo-prevention or pre-prophylactic eg tamoxifen
  2. Surgical management - mastectomy
  3. Enhanced screening- MRI and mammography
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22
Q

Which two drugs used in breast cancer management hormone therapy and how do they work?

A
  1. Tamoxifen - decrease oestrogen binding

2. Aromatase inhibitors eg Anastrozole to block oestrogen synthesis - usually used in post-menopausal women

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23
Q

If a patient is HER2 positive which biological agent would you give them?

A

Herceptin

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24
Q

Name 3 signs of heart failure?

A

Raised JVP, 3rd heart sounds, basal crepitation

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25
Q

Name 3 signs of acute coronary syndrome?

A

Pallor, 4th heart sound, tacypnoea, sweatiness

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26
Q

What are the ECG changes in an MI?

A

ST elevation, tall T waves or new LBBB in hours

T wave inversion and pathological Q waves follow over hours to days

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27
Q

Name the acute MI management steps ?

A

MONA

  1. Morphine eg diamorphine + anti-emetic
  2. Oxygen- only if hypoxic (<94%)
  3. Nitrates - GTN spray
  4. Aspirin ( + ticagrelor/clopidogrel - P2Y12 inhibitors)
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28
Q

Which two drugs would you use in thrombolysis?

A

Streptokinase

Tissue plasminogen activator ( tenectaplase)

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29
Q

When should you offer PCI?

A

Within <12 hour onset of symptoms and ST elevation on ECG

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30
Q

Which two drugs should a patient use for at least 12 months after vascular event?

A

Aspirin and a second anti-platlet eg clopidogrel

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31
Q

In a patient with chronic diarrhoea associated with weight loss, nocturnal diarrhoea or anaemia suggests what?

A

IBD

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32
Q

Give the 3 routes of administration for paracetamol?

A

Oral, intravenous and rectal

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33
Q

Which diseases would you find frank pus in the stool?

A

IBD, diverticulitis, abscess

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34
Q

Name 3 causes of explosive diarrhoea?

A

Giardia, cholera, rotavirus

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35
Q

Name 3 diseases you would find mucus in the stools?

A

IBS, colorectal cancer, polyps

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36
Q

How would you diagnose someone with IBS?

A

If recurrent abdominal pain associated with at least 2 of:

  1. Relief by defecation
  2. Altered stool form
  3. Altered bowel frequency
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37
Q

Name 3 drugs you could use in the management of IBS?

A

Loperamide - for diarrhoea
Meberverine - antispasmodics
Tri-cyclic antidepressants for abdominal pain

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38
Q

Which drug is useful in UC but not Chron’s?

A

5-ASA - eg mesalamine

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39
Q

In Moderate Chron’s what drug would you use in a patient who is refractory to steroids?

A

Azathioprine

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40
Q

What is the name of the skin complication that arises as a result of coeliac?

A

Dermatatitis hepatiformis

treat with dapsone

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41
Q

What are the voiding symptoms of LUTS (DDH SHIP)?

A

Dysuria, Dribbling, Hesitancy

Straining, Haematuria, Incomplete emptying, Poor stream

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42
Q

What are the storage symptoms of LUTS? (FUUN)

A

Frequency, Urgency, Urgency incontinence, nocturne

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43
Q

What are the indications for surgery in LUTS? (RUSHES)

A 
Retention
UTI 
Stones 
Haematuria 
Elevated creatinine 
Symptom deterioration
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44
Q

Give 5 causes of LUTS?

A

BPH, hydronephrosis, UTI, prostatitis, prostate cancer, bladder outflow obstruction

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45
Q

What is the first line drug treatment for BPH and how does it work?

A

Tamulosin - alpha blocker. Relax smooth muscle in bladder and prostate

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46
Q

What is the second line drug treatment for BPH and how does it work?

A

Finestaride. 5-alpha reductase inhibitor. Inhibits conversion of testosterone to dihydrotestosterone. Decreases prostate growth

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47
Q

What are the side effects of tamulosin?

A

Dizziness, drowsiness, hypotension and ejaculatory failure

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48
Q

What are the side effects of finestaride?

A

Impotence and decreased libido

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49
Q

Name 3 surgical methods to treat BPH?

A

TURP

TUIP and retropubic prostatectomy

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50
Q

What is the name of the screening criteria?

A

Wilsons Criteria

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51
Q

Name 5 causes of a raised PSA?

A 
Prostate cancer 
Prostatitis 
UTI 
Surgery 
Some drugs eg finesteride 
Tall men, <25 BMI
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52
Q

Name 2 limitations of using PSA results?

A
  1. Overtreatment - risk with invasive diagnosis and risk of radiation
  2. False positives and false negatives - cause anxiety
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53
Q

Give 3 reasons why PSA is not used as in NHS screening?

A
  1. Uncertain natural history
  2. Morbidity of treatment
  3. Risk of over treatment /overdiagnosis
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54
Q

What PSA level is generally regarded as abnormal?

A

> 4mg/ml

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55
Q

What are the benefits of using PSA results?

A

Can detect early disease and early treatment

56
Q

What is the Mayo prognostic score used to predict survival for?

A

Renal cell carcinoma

57
Q

What is the GFR in stage 2 CKD?

A

89-60

58
Q

What is the GFR in stage 4 CKD?

A

30-15

59
Q

Give 6 causes of CKD?

A
  1. Hypertension
  2. Diabetes
  3. High cholesterol
  4. SLE
  5. Lupus
  6. NSAID use
  7. Rheumatoid Arthritis
60
Q

In CKD what do you aim to get the BP under?

A

<140/90

<130/80 in diabetes

61
Q

What 3 levels would you monitor in a patient with CKD?

A

Serum creatinine levels
Urine creatinine levels
Haematuria
Proteinuria

62
Q

Name 4 complications of CKD and their treatment?

A

Anaemia - give erythropoietin
Acidosis - bicarbonate supplements
Oedema - furosemide
Bone mineral disorders - calcitriol of vit D supplements

63
Q

What are the 2 types of asymmetrical polyarthritis (≥5 joints involved)?

A

Reactive and psoriatic

64
Q

What do chondrocytes produce?

A

Proteoglycans and type 1 and 2 collagen

65
Q

Name three differences between osteoarthritis and Rheumatoid?

A
  1. OA- worsens on use, RA- better on use
  2. OA- <30 min stiffness, RA >60mins stiffness
  3. X-ray OA -LOSS , X-ray RA- LESS
66
Q

Which examination is used in an MSK examination?

A

GALS - Gait, Arm, Legs, Spine

67
Q

What two types of bony swellings do you see in OA and where are they located?

A

Bouchards - PIP

Heberdens - DIP

68
Q

Name 5 red flags of back pain?

A
  1. Neurological disturbance
  2. Bilateral or alternating leg pain
  3. Worse pain on being supine
  4. Nocturnal pain
  5. Fever, sweats, weight loss
  6. History of malignancy
69
Q

Which antibody is highly specific for RA?

A

Anti-cyclic cirtullinated peptide

70
Q

Name 3 hand deformities that occur as a result of RA?

A

Boutinnaires and swan neck deformity, ulnar deviation

71
Q

Name 3 side effects of methotrexate?

A

Pneumonitis, oral ulcers, hepatotoxity

72
Q

Which 3 DMARDS are used to treat RA?

A

Methotrexate, sulphalazine, hydroxychloroquine

73
Q

What is the main side effect of DMARDS?

A

Immunosuppression - result in pancytopenia, increased likelihood of infections

74
Q

Give 3 examples of biological agents used in RA?

A

Infliximab - TNF-alpha inhibitor
Rituximab- B cell depletion
Tociluzimab - IL1 and IL6 inhibition

75
Q

Which drug is first line if methotrexate contraindicated in RA?

A

Infliximab - TNF alpha inhibitor

76
Q

Name 3 drugs in step 1 of the analgesic ladder?

A
  1. Paracetemol
  2. NSAIDS
  3. Aspirin
77
Q

Name 3 drugs in step 2 of the analgesic ladder?

A
  1. Codeine
  2. Tramadol
  3. Dihydrocodeine
78
Q

Name 3 drugs in step 3 of the analgesic ladder?

A
  1. Morphine
  2. Fentanyl
  3. Methadone
79
Q

Name 3 adjuvants used in the analgesic ladder?

A
  1. Carmazepine - neuropathic pain
  2. Dexamethasone - bone pain
  3. Zolendronic acid - bisphosphonate
  4. Amiltryptaline - antidepressant used in neuropathic pain
80
Q

How to NSAIDS cause renal impairment?

A

They stop production of prostaglandin which causes vasodilation and you need vasodilation for adequate renal perfusion

81
Q

What are the 5 guiding principles when using the analgesic ladder?

A
  1. By Mouth – oral forms of analgesics is preferred
  2. By the Clock – analgesic should be given at regular intervals
  3. By the Ladder – principles of the ladder
  4. For the individual-Therapy based around the level of the patients pain
  5. Attention to details - close monitoring of patients
82
Q

Which 3 scales are used to assess activities of daily life?

A
  1. Katz ADL
  2. Barthel ADL
  3. IADL
83
Q

Name 3 components of Katz ADL?

A

Bathing, toilet use, dressing, transferring, urine and bowel continence, eating

84
Q

Name 3 components of Barthel ADL?

A

Walking on flat, going up stairs, feeding, grooming, move wheelchair to bed, move to and from toilet, dressing, continence of bowel, continence of bladder, bathing

85
Q

Name 3 components of IADL?

A

Use of telephone, travelling by car or public transport, food or clothes shopping, meal preparation, housework, medication use, management of money

86
Q

What is a common side effect of codeine?

A

Constipation - give with laxative

87
Q

What should you give when prescribing opioids?

A

Anti-emetic as cause nausea

88
Q

Which two screening questionnaire’s are used to assess the severity of depression/anxiety?

A

PHQ-9 and GAD-7

89
Q

What are the 4 sections of the red book?

A
  1. Child, family and birth information
    2, Immunisations
  2. Screening and routine reviews
  3. Growth charts and other information
90
Q

Give 4 different routes to administer drugs?

A

oral, rectal, subcutaneous, intra-muscular, rectal topical, sublingual, enteral feeding tubes

91
Q

What is the 8 week immunisation and how is it administered?

A

5 in 1 vaccine - diphtheria, tetanus, whooping cough, polio and haemophilia influenza B- administered as single injection into thigh

92
Q

What is meant by the term prophylaxis and which is used for asthma prophylaxis?

A

Treatment given or an action taken to prevent disease.

Beclamethasone

93
Q

How does breastfeeding work as a contraceptive?

A

Prolactin is released to stimulate lactation, which inhibits GnRH release and therefore the release of FSH and LH.

94
Q

How should a patient take aledronic acid?

A

Take with plenty of water whilst sitting or standing, take on empty stomach and sit upright for at least 30 mins after taking tablet

95
Q

What is the mechanism of alendronic acid?

A

oral Bisphosphonate and inhibits osteoclast mediated bone resorption

96
Q

Give an example of 4 questions you would ask in a patient with chest pain?

A
  1. What triggers the pain - worse on exercise?
  2. Character of pain?
  3. Where does it radiate t?
  4. Is it relieved by GTN?
  5. Associated symptoms?
97
Q

Name 3 non-modifiable risks for IHD?

A
  1. Increasing age
  2. Male gender
  3. Asian
  4. Family History
98
Q

Name 4 modifiable risks for IHD?

A
  1. Hypertension
  2. Smoking
  3. Hypercholesterolamia
  4. Type 2 diabetes
  5. Obesity
99
Q

Name 3 primary prevention steps for CVD?

A
  1. QRISK2 score for CVD
  2. Lifestyle changes - stop smoking, lose weight
  3. Drugs eg aspirin and statins
100
Q

Name 3 drugs you would prescribe post MI?

A
  1. ACE inhibitors
  2. Statins - control cholesterol
  3. Antiplatelts - aspirin
101
Q

What are the stages in the pathophysiology of MI?

A
  1. Rupture of fibrous cap of coronary artery plaque –> arterial thrombosis
  2. Thrombosis - formation of platelet rich clot
  3. Platelts release thromboxane A2–> inflammation and vasoconstriction
  4. Occludes coronary vessel - MI
102
Q

Why is GTN not used orally?

A

GTN is metabolised in liver by first pass metabolism which reduces its bioavailability - hence sublingual and transdermal prefered

103
Q

What are the non pharmacological management stages of IBS?

A 
Dietary and lifestyle advice 
Limit high fibre 
Lots of fluids 
Avoid caffeine 
Don't skip meals and do regular exercise
104
Q

In IBD which biologic drugs would you consider giving?

A

Infliximab

Adalimumab

105
Q

Name the dietary advice in a patient with coeliac?

A
  1. Info on what foods contain gluten
  2. Avoid cross contamination in home and accidental glucose
  3. Role of national and local coeliac groups
106
Q

How does the progesterone contraceptive pill prevent pregnancy?

A

Inhibits GnRH release
Thickens vaginal epithelium and cervical mucus
Inhibits ovulation

107
Q

How does loperamide work?

A

Opiod-receptor agonist which reduces GI motility, increases time material stays in intestine so more water absorbed from fecal matter

108
Q

Which 3 investigations would you do in a man with LUTS?

A
  1. Examination of abdomen and external genitalia
  2. Digital rectal examination
  3. urine dipstick test to detect blood, glucose, proteins, leukocytes and nitrates
109
Q

Give 3 treatment methods for localised prostate cancer?

A
  1. Watchful waiting
  2. Radical treatment - radical prostatectomy
  3. Bracytherapy
110
Q

Which receptor does doxazosin work on?

A

Alpha 1- adrenergic antagonist

111
Q

What is the main side effect of tamulosin?

A 
Postural hypotension 
Retrograde ejaculation (30%)
112
Q

What is the mechanism of action of cyclosporin?

A

Specific T-lymphocyte suppressor, acts in T-helper cells - inhibit IL-2

113
Q

What is meant by a narrow therapeutic index?

A

Range of doses at which a medication is effective without adverse events. Drugs with a narrow TI have a narrow window between their effective doses and those at which they produce adverse toxic effects eg Warfarin, lithium, digoxin

114
Q

Name 5 different investigations into joint swelling?

A
  1. Aspirate the joint
  2. X-Ray
  3. Ultrasound Scan
  4. Physical Inpecftion
  5. Serum inflammatory markers - CRP, ESR
  6. Blood cultures eg reactive arthritis
115
Q

Give 3 non-pharmacological advice of rheumatoid arthritis?

A

Exercise more, relaxation, stress management, cognitive coping skills

116
Q

What are the 3 steps in pharmacological management of rheumatoid arthritis?

A
  1. Symptoms control - analgesics
  2. DMARDS
  3. Biologics eg etanercept and infliximab
117
Q

Give 3 side effects of methotrexate?

A

Tetratogenic
Mouth ulcers
Diarrhoea
Hepatic and pulmonary fibrosis

118
Q

What is given weekly to patients on methotrexate?

A

Folic acid - reduces toxic effects

119
Q

What is the mechanism of Methotrexate?

A

Methotrexate prevents nucleic acid synthesis by causing cell death

120
Q

What is a controlled drug?

A

Drugs which are dangerous or otherwise harmful and have potential for abuse or misuse

121
Q

What is the definition of depression?

A

A state of persistent low mood, can affect thoughts, behaviours, feelings and physical health

122
Q

Give 5 risk factors for depression?

A
  1. Low socioeconomic status
  2. Bereavement
  3. Hypothyroidism
  4. Personality factors eg low self esteem
  5. Giving birth - post-natal
  6. Lonliness
123
Q

Give 4 psychological symptoms of depression?

A

Continuous low mood
Feeling guilty
Having no motivation or interest in things
Feeling anxious or worried

124
Q

Give 4 physical symptoms of depression?

A 
Change in apetite/weight 
Disturbed sleep 
Constipation 
Lack of energy 
Decreased libido 
Changes to menstrual cycle
125
Q

Give 3 social symptoms of depression?

A

Neglecting hobbies
Having difficulties at home
Not doing well at work

126
Q

How do SSRI (selective serotonin reuptake inhibitor) work?

A

Precent re-uptake of serotonin from synapses so there is increased serotonin

127
Q

How does amitryptilline work?

A

Raise levels of serotonin and noradrenaline in the brain by inhibiting reuptake

128
Q

What is the WHO criteria in diabetes diagnosis?

A

Symptoms of hyperglycaemia (e.g. polyuria, polydipsia, unexplained weight loss, visual blurring, genital thrush, lethargy) PLUS
Random >= 11.1mmol/L
Fasting >= 7mmol/L

Oral glucose tolerance test >11.1mmol/L

HbA1c >= 48mmol/L

129
Q

Give 5 risk factors of type 2 diabetes?

A

Obesity, smoking, intra-abdominal fat, hypertension, family history, history of MI,gestational diabetes

130
Q

How does metformin work?

A

Up-regulates GLUT4 receptors in the peripheries =increased insulin sensitivity

131
Q

Name 4 components of the diabetic review?

A
  1. Vascular risks under control
  2. Check eyes, feet and kidney function
  3. Check if had hospital admissions
  4. Check HbA1c
132
Q

How does haemodialysis work?

A

Two needles into AV fistula remove blood into dialyser dialysate through semi permeable membrane back into person

133
Q

Give examples of 5 drugs with a narrow therapeutic index?

A

Guys with large dicks make perfect inter- course

Gentamycin, warfarin, lithium, digoxin, methotrexate, phenytoin, insulin, cyclosporin

134
Q

Give 4 questions you would ask the mother during the 8-week baby check?

A
  1. Mental health and wellbeing
  2. Any vaginal discharge or period
  3. Stiches examined if C-section
  4. Enquire about contraception
135
Q

Which drug is used for the prophylaxis of asthma?

A

Beclamethasone

136
Q

Give 3 reasons as to why stage 4 CKD- elderly patient may object to having dialysis?

A
  1. Won’t have good QOL with treatment
  2. Don’t want inconvenience of having dialysis treatment
  3. Advised against treatment as have other serious illness

GP (1 decks)

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