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GP / Acute management Flashcards

1
Q

what blood test results would you see in osteoporosis

A

Normal ALP, Normal calcium, normal phosphate, normal PTH

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2
Q

what can be used to reduce blood pressure during induced labour

A

Epidural anaesthesia

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3
Q

causative organism for pyelonephritis

A

e. coli

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4
Q

what should be used in the diagnosis of UTI in women over 65, men and catheterised patients

A

urine culture

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5
Q

what are the important risk factors for the development of osteoporosis

A

steroids
RA
Alcohol
history of hip fracture
Low BMI
smoking currently

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6
Q

give an example of a medication that should be stopped for 48h after a CT with contrast

A

Metformin

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7
Q

is the forehead affected in bells palsy

A

yes

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8
Q

from when to when should women with risk factors take aspirin in pregnancy

A

aspirin 75-150 mg daily from 12 weeks until birth

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9
Q

what is the triad of symptoms seen in pre-eclampsia ?

A

New onset HTN
proteinuria
oedema

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10
Q

when can Lyme disease be diagnosed clinically and how is it managed

A

if erythema migrans is present - prescribe doxycycline

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11
Q

what are the red flags presenting with trigeminal neuralgia

A

sensory changes
deafness
history of skin or oral lesions
pain only in ophthalmic division
optic neuritis
fhx of MS
age of onset < 40

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12
Q

what is the first line investigation to diagnose Lyme disease

A

ELISA

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13
Q

are antibiotics recommended for tick bite

A

no - only if lyme disease

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14
Q

how is disseminated Lyme disease managed

A

ceftriaxone

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15
Q

what pain makes lateral epicondylitis worse

A

resisted wrist extension with elbow extended

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16
Q

what 8is the first line investigation for chlamydia and gonorrhoea

A

vulvovaginal swab in women
urine is first line in men

NAAT

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17
Q

what is the first line management of chlamydia ? does this change if the woman is pregnant

A

doxycycline - 7 day course
if pregnant - azithromycin, erythromycin, amoxicillin

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18
Q

what are they key features of parkinson’s

A

assymetrical features

bradykinesia
tremor - improves with voluntary movement
rigidity

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19
Q

what is the most common psychiatric feature of Parkinson’s

A

depression

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20
Q

what are the features of drug induced parkinsonism

A

more symptoms, rapid onset and bilateral
rigidity and rest tremor uncomonnon

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21
Q

how can u distinguish between essential tremor and parkinsons

A

single photon emission computed tomography

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22
Q

what medication slows disease progression in ADPKPD

A

tolvaptan

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23
Q

what are the features of Lewy Body dementia ?

A

progressive cognitive impairment
parkinsonism
visual hallucinations

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24
Q

fluctuating cognition?

A

Lewy Body dementia

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25
Q

what risks to the mother does chicken pox come with

A

pneumonitis

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26
Q

what is the management of chicken pox exposure in pregnancy

A

check varicella antibodies
oral aciclovir for PEP = given at day 7 to day 14 after exposure

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27
Q

what is the management of chicken pox in pregnancy

A

specialist advice
oral aciclovir if women is >20 weeks and presents within 24h of onset
< 20 weeks : consider aciclovir with caution

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28
Q

guidelines for checking urine sample in child

A

symptoms suggesting UTI
Unexplained fever of 38 or higher
alternative site of infection but remain unwell

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29
Q

what is the urine collection method for uti in child

A

clean catch is preferable
if not possible then urine collection pads should be used
cotton wool balls, gauze and sanitary towels are not suitable
invasive methods such as suprapubic aspiration should only be used if non-invasive methods are not possible

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30
Q

management of UTI in child

A

< 3m = refer immediately to paeds
>3 or more w Upper UTI = refer for admission/ oral abx ( cephalosporin and co-amoxiclav)
> 3 m with lower UTI = oral abx for 3 days

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31
Q

what should be corrected before giving alendronic acid

A

correct hypocalcaemia/ vit d deficiency

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32
Q

what are the primary , secondary and tertiary features of syphilis

A

primary - chancre ( painless ulcer at site of sexual contact)
local non tender lymphadenopathy
secondary = systemic , rash, buccal snail track ulcers, condylomata lata ( warty lesions on genitals)

tertiary : gummas,, aneurysms, argyll robinson pupil

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33
Q

what is cubital tunnel syndrome caused by? what are its features

A

compression of ulnar nerve leading to intermittent tingling in the 4th and 5th finger

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34
Q

what is the management of pertusssis

A

oral macrolide indicated if onset of the cough is within the previous 21 days - clarithromycin, azithromycin, erythromycin

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35
Q

what are the school exclusion rules regarding pertussis

A

48 h after commencing antibiotics - or 21 days from onset of symptoms if no antibiotics

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36
Q

what is the z score adjusted for

A

age, gender and ethnic factors

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37
Q

what is the management of catheterised patients who are asymptomatic

A

no treatment needed

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38
Q

how to check if uti has resolved in pregnant women

A

urine culture

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39
Q

what is the first line management of syphilis

A

IM benzathine penicillin

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40
Q

how do the following present -

active syphilis
negative syphilis
false negative syphilis
false positive syphilis
successfully treated syphilis

A

active = positive treponemal and non-treponemal test
negative = both tests negative
false negative = both tests being negative but patient has disease
false positive = positive non-treponemal test, negative treponemal ( due to pregnancy, SLE,APL,TB)
Successfully treated = treponemal positive, non treponemal negative

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41
Q

most commonly diagnosed STI in the UK

A

chlamydia

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42
Q

which nerve root compression produces with reduced ankle reflex

A

S1 nerve root compression

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43
Q

how to distinguish L3 and L4 nerve root compression

A

L3 - anterior thigh
L4 - anterior knee and medial malleolus

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44
Q

L5 root compression

A

no loss of reflexes
sensory loss on the dorsum of the foot

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45
Q

What is the management of uti in pregnancy close to term ?

A

amoxicillin

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46
Q

what is the management of primary genital herpes during 3rd semester

A

oral aciclovir and delivery by c section

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47
Q

what is the adult dose of adrenaline

A

500 mcg ( 0.5 ml of 1 in 1000)

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48
Q

what is the management of trichomonas vaginalis ?

A

metronidazole for 5-7 days

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49
Q

what are the key signs of trichomonas vaginalis

A

vaginal discharge
vulvovaginitis
strawberry cervix
pH > 4.5
urethritis in men if symptomatic

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50
Q

which antibiotic can cause achilles tendon disorders

A

ciprofloxacin

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51
Q

what dose of adrenaline is prescribed in anaphylaxis depending on age band

A

< 6m 100-150
6m-6y 150
6-12y 300
adult and child > 12 500

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52
Q

what stage of prostate cancer is ass,. with a histologically aggressive form of cancer

A

gleason score of 10

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53
Q

at what bp do you admit women w htn in pregnancyy

A

160/110

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54
Q

how is jarisch herxheimer reaction managed

A

antipyretics

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55
Q

what is the second line management of gonorrhoea if patient refuses IM Ceftriaxone

A

cefixime and azithromycin

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56
Q

which diabetic drug causes -

fractures
pancreatitis

A

glitazones
gliptins

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57
Q

what is the complication of using SSRI in the
1st trimester
third trimester

A

small increase of congenital heart defects, paroxetine can cause congenital malformations
Persistent pulmonary HTN

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58
Q

what values does the Modification of diet in renal disease use?

A

Creatinine, age, gender, ethnicity- CAGE

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59
Q

what is the first line laxative prescribed for constipation in children? what is added next ?

A

Osmotic laxative
Stimulant laxative

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60
Q

what is the management of bells palsy

A

prednisolone and lubricating eye drops

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61
Q

how does gonorrhoea present under the microscope? what is the treatment of choice?

A

gram negative diplococci
IM ceftriaxone

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62
Q

what does Simmonds triad include

A

Calf squeeze test
observation of the angle of declination
palpation of the tendiin

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63
Q

what is finkelsteins test? what condition does it diagnose

A

forced adduction and flexion of thumb is elicited- de quervains tenosynovitis

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64
Q

how is a severe polyarthritis managed

A

systemic steroids

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65
Q

Osgood-Schlatter disease

A

Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle

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66
Q

what is the presentation of Panic attack on ABG

A

normal pO2
low CO2
raised ph
bicarb on the higher side

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67
Q

what is flash pulmonary oedema and what does it present after?

A

occurs with acute mitral regurgitation due to an MI - early to mid diastolic murmur is heard

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68
Q

what are the features of Mycoplasma pneumoniae ( abbreviation)

A

multiforme ( erythema)
IgM haemolytic anaemia
Myocarditis
meningo-encephalitis and other immune mediate disease
macrolide treatment : erythromycin

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69
Q

what are the features of legionella ( abbrvt))

A

Lymphocytosis
Low sodium
look at the pee to diagnose
LFT’s deranged

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70
Q

what is the oxford stroke classification

A
  1. unilateral hemiparesis and / or hemisensory loss of face arm and leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction ( dysphasia)
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71
Q

Pneumonia, peripheral blood smear showing red blood cell agglutination →

A

Mycoplasma pneumoniae

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72
Q

how can MI present in diabetic patients

A

without chest pain

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73
Q

what ABG picture is typical in a COPD patient who has received too much Oxygen

A

low pH and raised bicarb

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74
Q

what are the components of the ORBIT score?

A

anaemia -2
age > 74-1
bleeding history - 2
renal impairment -1
treatment with anti-platelet agents -1

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75
Q

bilateral pleural effusions
patchy infiltrates
new systolic murmur loudest at the apex radiating to the axilla

A

mi —> flash pulmonary oedema –> acute mitral regurgitation

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76
Q

how does a chronic subdural haematoma appear on CT

A

hypodense, crescentic collection around convexity of the brain

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77
Q

what describes the appearance of a large acute subdural haematoma

A

Hyperdense, crescentic collection with evidence of mass effect

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78
Q

Metabolic alkalosis + hypokalaemia → ?

A

prolonged vomiting

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79
Q

which seizures are managed first line by sodium valproate ?

A

Tonic clonic , Tonic
Atonic
Myoclonic

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80
Q

what is the first line management of absence seizures ?

A

ethosuximide

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81
Q

what is the management of myoclonic seizures in women

A

levetiracetam

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82
Q

Tonic or atonic seizures: first line for females

A

Lamotrigine

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83
Q

what are the signs of right sided heart failure

A

raised JVP
ankle oedema
hepatomegaly

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84
Q

first-line investigation for a suspected osteoporotic vertebral fracture.

A

X-ray spine

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85
Q

how does DKA present on ABG

A

metabolic acidosis with increased anion gap.

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86
Q

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

A

coronary artery bypass graft (CABG)

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87
Q

what is the management of raised ICP

A

head elevation to 30º

controlled hyperventilation
aim is to reduce pCO2 → vasoconstriction of the cerebral arteries → reduced ICP
leads to rapid, temporary lowering of ICP. However, caution needed as may reduce blood flow to already ischaemic parts of the brain

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88
Q

Causes of raised SAAG

A

liver disorders ( cirrhosis, failure, mets)
cardiac ( RHF, Constrictive pericarditis)
budd chiari
portal vein thrombosis

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89
Q

causes of low SAAG

A

hypolbuminaemia
malignancy
infection
pancreatitis
obstruction
ascites
lymphatic leak

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90
Q

severe pancreatitis signs

A

age > 55
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
increased LDH, AST

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91
Q

which scoring system is most specific for acute pancreatitis

A

glascow

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92
Q

examples of other features of aortic dissection depending upon location

A

coronary arteries → angina
spinal arteries → paraplegia
distal aorta → limb ischaemia

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93
Q

mx of nutrition in moderate-severe pancreatitis

A

oral nutrition and do not keep nil by mouth unless moderate to severe in which case enteral nutrition

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94
Q

how does a fibroadenoma present ? when is surgical excision recommended?

A

mobile, firm, smooth breast lump
if > 3 cm = surgical excision

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95
Q

most common cause of pelvic inflammatory disease in the UK

A

chlamydia trachomatis

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96
Q

what is the management of PID

A

Oral ofloxacin + oral metronidazole / IM ceftriaxone, oral doxy and oral metronidazole

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97
Q

what is fitzhughcurtis syndrome

A

peri-hepatitis characterised by RUQ and may be confused with cholecystitis - seen in PID

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98
Q

what investigations are performed in PID

A

pregnancy test
high vaginal swab - negative
screen for chlamydia and gonorrhoea

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99
Q

mx of testicular torsion

A

emergency bilateral orchidopexy

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100
Q

what is the surgical management of breast cancer

A

depends on axillary lymphadenopathy :

if palpable - axillary node clearance at primary surgery

not palpable - ultrasound and biopsy

radiotherapy for anyone who has had wide-local excision

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101
Q

when is trastuzumab useful

A

HER2 +ve

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102
Q

what is a systemic complication of acute pancreatitis

A

ARDS

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103
Q

What are the features of testicular torsion

A

tender testis retracted upwards
cremasteric reflex lost
elevation of the testis does not ease the pain ( Prehn’s sign)

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104
Q

when are prosthetic valves the choice vs when are mechanical valves the right choice ?

A

old ppl - prosthetic ( > 65 for aortic , > 70 for mitral)
mechanical - younger ( thrombosis needed)

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105
Q

how does mastitis present ?

A

painful, tender and hot breast
fever + general malaise

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106
Q

1st line management of mastitis

A

keep breastfeeding, warm compress and analgesia etc

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107
Q

abx for mastitits - when and what

A

if after 12-24 h symptoms dont improve give oral flucloxacillin

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108
Q

what is the investigation of choice for chronic venous disease

A

venous doppler ultrasound- demonstrating retrograde venous flow

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109
Q

management of varicose veins

A

Leg elevation
weight loss
regular exercise
graduated compression stockings

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110
Q

what investigation is suggested for persons with suspected aortic dissection who are too unstable for CT scanning

A

TOE

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111
Q

When is a referral to secondary recommended in a patient with a varicose vein / chronic venous insufficiency

A

troublesome lower limb symptoms
bleeding
skin changes like pigmentation and eczema
superficial thrombophlebitis
active / healed venous ulcer

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112
Q

epigastric hernia

A

: lump in the midline between umbilicus and the xiphisternum

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113
Q

umbilical vs paraumbilical hernia

A

umbilical : under umbilicus
para-umbilical : above or below umbilicus

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114
Q

Periductal mastitis

A

recurrent episodes of infection
smoking

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115
Q

s/e of colchicine

A

diarrhoea

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116
Q

common side effect of verapamil

A

constipation

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117
Q

management of bell’s palsy

A

eye care
oral pred

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118
Q

In type 1 diabetics, blood glucose targets:

A

5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day

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119
Q

who should have a frax assessment

A

They advise that all women aged >= 65 years and all men aged >= 75 years should be assessed.

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120
Q

when should younger patients be considered for frax assessment

A

previous fragility fracture
current use or frequent recent use of oral or systemic glucocorticoid
history of falls
family history of hip fracture
other causes of secondary osteoporosis
low body mass index (BMI) (less than 18.5 kg/m²)
smoking
alcohol intake of more than 14 units per week for women and more than 14 units per week for men.

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121
Q

investigation of choice for ectopic pregnancy

A

TV USS

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122
Q

what is the criteria for expectant management of an ectopic pregnancy

A

Size < 35 mm
Unruptured
asymptomatic
no foetal Heartbeat
hCG < 1,000 IU/ L

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123
Q

what is expectant management of an ectopic

A

Expectant management involves closely monitoring the patient over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed.

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124
Q

what is the criteria for medical management of ectopic pregnancy

A

Size < 35 mm
Unruptured
minimal pain
no foetal Heartbeat
hCG < 1,500 IU/ L

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125
Q

what is the medical management of an ectopic

A

methotrexate + patient available for follow up

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126
Q

criteria for surgical mx of ectopic

A

size > 35 mm
can be ruptured
foetal heartbeat
hcg > 5000

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127
Q

what is the management of cardiogenic shock

A

1) inotropic agents such as dobutamine should be considered for patients with severe ventricular dysfunction who have potentially reversible cardiogenic shock

2) vasopressor agents : norepinephrine , only if insufficient response to inotropes and evidence of end organ hypoperfusion.

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128
Q

causes of metabolic acidosis with raised anion gap

A

lactate : shock, sepsis, hypoxia
ketosis
renal failure
poisoning

129
Q

causes of metabolic acidosis with normal anion gap

A

diarrhoea
renal tubular acidosis
addisons

130
Q

what vessels are damaged in an epidural haemorrhage

A

middle meningeal artery

131
Q

what vessels are damaged in SAH

A

circle of Willis - such as basilar and anterior circulating arteries

132
Q

what is the management of chronic symptomatic subdural

A

surgical decompression with burr holes

133
Q

how is TCA overdose investigated

A

ECG - shows widening of the QRS complex

134
Q

mx of TCA overdose

A

IV Bicarbonate

135
Q

what is the pattern of acid base disturbance seen in salicylate overdose

A

resp acidosis followed by met acidosis

136
Q

how does seretonin syndrome present and how is it managed

A

hyperreflexia, myoclonus , rigidity
hyperthermia + sweating
confusion

137
Q

what is the mx of seretonin syndrome

A

iv fluids and benzos

138
Q

how to differentiate between serotonin syndrome and neuroleptic malignant syndrome

A

neuroleptic malignant syndrome has a slower onset and presents with reduced reflexes and rigidity and normal pupils whereas serotonin syndrome presents with dilated pupils and increased reflexes

139
Q

mx of neuroleptic malignant syndrome

A

dantrolene

140
Q

what type of arrest rhythm does tension pneumo cause

A

PEA reversible

141
Q

what is the management of salicylate overdose

A

charcoal
urinary alkalinzation with iv sodium bicarb

142
Q

what is the acceptable daily amount of glucose

A

50-100 g

143
Q

how to tell prerenal aki

A

high urine to creatinine ratio

144
Q

If a patient with AF has a stroke or TIA, the anticoagulant of choice should be ____________

A

apixaban, warfarin or direct thrombin / factor Xa inhibitor

145
Q

what drugs should a patient be offered for secondary prevention of MI

A

dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin

146
Q

which patients are at risk of developing hepatotoxicity post paracetamol overdose

A

liver enzyme inducing drugs -
malnourished patients
chronic alcohol excess

147
Q

which meds interact with SSRI’s to cause seretonin syndrome

A

tramadol

148
Q

what is a normal anion gap?

A

8-14 mmol/L

149
Q

how to calculate anion gap

A

sodium + potassium - bicarb + chloride

150
Q

which ivx is most important when assessing a patient with bilateral UTI

A

u+e

151
Q

which type of stroke causes torsades de pointes

A

sah

152
Q

Idiopathic intracranial hypertension signs -

A

papilledema, 6th nerve palsy

153
Q

can u continue aspirin in aki

A

yes

154
Q

how does narcolepsy present

A

cataplexy in which patient suddenly loses muscle control , usually triggered by some form of +ve emotion

155
Q

what abg result does aspirin toxicity give

A

mixed primary respiratory alkalosis and metabolic acidosis

156
Q

which bridging veins does a subdural haemorrhage damage

A

between cortex and venous sinuses

157
Q

what are the signs of aspirin overdose

A

hyperventilation
tinnitus
lethargy
sweating
vomiting
seizures coma

158
Q

shortest time over which 40 mmol of potassium can be administered

A

4h

159
Q

what feature of COPD can mimic pneumothorax

A

large bullae

160
Q

what is the most common pulmonary manifestation of methotrexate use? how does it present

A

pneumonitis, presenting with hypersensitivity pneumonitis , non productive cough, dyspnoea malaise and fever

161
Q

which malaria is associated with nephrotic syndrome

A

plasmodium malariae

162
Q

what are the general features of malaria

A

fever headache splenomegaly
cyclical fever

163
Q

most common cause of non falciparum malaria

A

Plasmodium vivax

164
Q

management of malaria

A

ACT therapy or chloroquine followed by primaquine to prevent relapses

165
Q

how often should chest physiotherapy and postural drainage be conducted in the mx of cystic fibrosis

A

twice daily

166
Q

mirror image nuclei - what condition ?

A

hodgkins lymphoma

167
Q

at what t score would you start bisphosphonates with patients on steroids

A
  • 1.5
168
Q

where are struvite calculi normally formed

A

pelvis - stag horn

169
Q

action of tamoxifen

A

oestrogen receptor selective antagonism

170
Q

diagnostic investigation of ankylosing spondilytis

A

pelvic xray

171
Q

why do patients with coeliac disease need pneumococcal

A

due to functional hyposplenism

172
Q

contraindication to surgery for lung cancer

A

stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point*
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction

173
Q

how is colorectal cancer staged

A

CEA
CT CAP

174
Q

how is a cancer of the caecal, ascending or proximal transverse colon resected

A

Right hemicolectomy

175
Q

how is the cancer of distal, transverse or descending colon resected

A

left hemicolectomy

176
Q

how to exclude diabetes insipidus

A

urine osmolality of > 700 mOsm/kg

177
Q

what picture is seen on blood tests in polycythaemia vera

A

isolated rise in Hb

178
Q

define volvulus

A

Torsion of the colon around its mesenteric axis resulting in compromised blood flow and closed loop obstruction

179
Q

what is the management of volvulus

A

sigmoid : rigid sigmoidoscopy with rectal tube insertion
caecal : operative with right hemicolectomy

180
Q

how does sigmoid volvulus present

A

large bowel obstruction = large dilated loop of colon , often with air fluid levels and coffee bean sign

181
Q

how does caecal volvulus present

A

small bowel obstruction

182
Q

when would you refer to ENT - bells palsy

A

no sign of improvement after 3 weeks

183
Q

features associated with bell’’s palsy

A

post-auricular pain
altered taste
dry eyes
hyperacusis

184
Q

what feature can be used to differentiate between primary and secondary hypoadrenalism

A

skin hyperpigmentation

185
Q

diff between primary secondary and tertiary hypoadrenalism

A

Primary - Pigments (skin and mucosa)
Secondary - Spares (no pigmentation)
Tertiary - Treatment (iatrogenic, steroid use)

186
Q

what sign is seen with a mid shaft humeral fracture

A

radial nerve affected causing wrist drop

187
Q

_____________should be considered for the prevention of calcium stones

A

potassium citrate

188
Q

where should adrenaline be given

A

anterolateral aspect of the thigh

189
Q

what type of hypersensitivity reactions are autoimmune conditions

A

type 3

190
Q

diagnosis of mesothelioma

A

histology, following a thoracoscopy

191
Q

‘egg-shell’ calcification of the hilar lymph nodes

A

Silicosis

192
Q

Symptoms of leprosy

A

hypo-pigmented patches, loss of sensation in fingers and toes, thickening of peripheral nerves, and thickening of the skin on the hands and face. Muscle weakness is also a relevant symptom.

193
Q

signs and symptoms of meralgia paraesthesia

A

burning, tingling coldness or shooting pain
numbness
deep muscle ache
aggravated by standing and relieved by sitting

194
Q

rf’s for meralgia paraesthesia

A

obesity, pregnancy , sports, trauma, iatrogenic

195
Q

gastric volvulus

A

vomiting, pain and failed attempts to pass an NG tube

196
Q

management of colonic cancer in patient with HNPCC

A

panproctocolectomy

197
Q

how is a cancer of the sigmoid colon managed

A

high anterior resection

198
Q

how is cancer of the rectum managed

A

anterior resection

199
Q

how are cancers of the anal verge managed

A

abdomino-perineal excision of the rectum

200
Q

when is Hartmann’s procedure is used in the resection of cancer

A

when bowel has perforated then the risk of anastomosis is greater so a Hartmann’s procedure is used

201
Q

what is a sign of chronic hepatitis on light microscopy

A

Ground glass hepatocytes

202
Q

why does a fixed and dilated pupil develop in extradural haematoma

A

compression of the parasympathetic fibers of the third cranial nerve.

203
Q

how does neurogenic thoracic outlet syndrome present

A

muscle wasting of the hands, numbness and tingling, autonomic symptoms

204
Q

what osseous abnormality can be present in thoracic outlet syndrome

A

cervical rib

205
Q

primary lateral sclerosis

A

UMN signs only

206
Q

progressive muscular atrophy

A

LMN only

207
Q

progressive bulbar palsy

A

palsy of tongue, muscles of chewing, swallowing and facial muscles.

208
Q

explain homonymous hemianopias based upon location

A

incongruous : lesions of optic tract
congruous : lesions of optic radiation/ occipital cortex
macula sparing : occipital cortex

209
Q

which condition has a poor response to a fluid challenge

A

acute tubular necrosis

210
Q

what is a common presentation of haemophilia

A

haemoarthroses

211
Q

what are pancreatic pseudocysts and how are they managed ?

A

collection of peripancreatic fluid typically occurring after an attack of acute pancreatitis

generally managed conservatively but can be managed with endoscopic or surgical cyst gastrostomy or aspiration

212
Q

mx of pancreatic abscess

A

trans-gastric drainage or endoscopic drainage

213
Q

how is HER2 receptor breast cancer managed

A

Trastuzumab, often known by its brand name Herceptin, is a monoclonal antibody that acts to block HER2

214
Q

how is latent TB managed

A

3 months of isoniazid w pyridoxine and rifampicin for 3m
or 6m of isoniazid with pyridoxine

215
Q

most common cause of large bowel obstruction

A

cancer

216
Q

characteristic feature of anal fissures

A

pain and bleeding

217
Q

definitive management of SAH aneurysm

A

coiling

218
Q

action of aromatase inhibitors

A

reducing peripheral synthesis of oestrogen

219
Q

appropriate ivx for appendicitis

A

abdominal ultrasound

220
Q

how can nutrition be supported in patients with MND

A

PEG

221
Q

Progressive multifocal leukoencephalopathy is caused by

A

JC virus or BK virus

222
Q

Mx of CMPA

A

formula fed - extensive hydrolysed formula, amino acid based formula

breastfed -
continue breastfeeding
eliminate cow milk from mumms diet

223
Q

prognosis of CMPA

A

IgE - 55% milk tolerant by 5
non IgE - most tolerant by 3

224
Q

Ivg for SAH

A

Non contrast CT head -

if done within 6h of symptom onset no need for LP

if its done > 6h of symptoms then do LP

225
Q

early x-ray feature of rheumatoid arthritis

A

Juxta-articular osteoporosis/osteopenia

226
Q

Schistosomiasis is a risk factor for

A

squamous cell carcinoma of the bladder

227
Q

Sister Mary Joseph nodule -

A

sign of metastasis to periumbilical lymph nodes, classically from gastric cancer primary

228
Q

Functional tricuspid regurgitation often occurs secondary to

A

pulmonary hypertension

229
Q

when should LP be done post suspected SAH

A

at least 12 hours following the onset of symptoms to allow the development of xanthochromia

230
Q

grading of haemorrhoids

A

grade 1 - no prolapse
grade 2 - prolapse on defecation but reduce spontaneously
grade 3 - manually reduced
grade 4 - cannot be reduced

231
Q

ivg for suspected bowel obstruction

A

abdo xray first line
CT diagnostic

232
Q

AAA screening UK

A

single abdominal ultrasound aged 65

233
Q

most common cause of small bowel obstruction

A

adhesions

234
Q

small bowel obstruction vomiting

A

bilious, early

235
Q

Caecal volvulus associations

A

all ages
adhesions
pregnancy

236
Q

which oral symptom can methotrexate cause

A

Mucositis

237
Q

The most common site of metatarsal stress fractures

A

2nd metatarsal shaft

238
Q

HIV-associated nephropathy

A

focal segmental glomerulosclerosis

239
Q

Management of necrotising fasciitis

A

immediate surgical debridement and IV antibiotics

240
Q

What is the most effective single step to reduce the incidence of MRSA?

A

hand hygiene

241
Q

what is the indication for ABG in patients with acute asthma

A

sats < 92

242
Q

which neurovascular structure is compromised in scaphoid fracture

A

dorsal carpal branch of the radial artery

243
Q

mx of chronic vs acute anal fissure

A

acute : dietary changes and stool softeners –> topical anaesthetics
chronic : topical GTN –> sphincterotomy

244
Q

Which is associated with a good prognosis in rheumatoid arthritis?

A

Rheumatoid factor negative.

245
Q

most common breast tumour

A

Invasive ductal carcinomas

246
Q

What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism?

A

Loss of antithrombin III.

247
Q

herpes simplex encephalitis- CT

A

CT head showing temporal lobe changes

248
Q

Joint aspirate in rheumatoid arthritis shows

A

high WBC count, predominantly PMNs.

249
Q

lumbar puncture show a yeast and a capsule in the CSF stained with India ink.

A

Cryptococcus neoformans

250
Q

Perianal abscess- symptoms

A

severe pain in the perianal region, and may have spiking temperatures

251
Q

treatment of perianal abscess

A

incision and drainage

252
Q

risk factors for anorectal abscesses

A

anorectal abscesses
diabetes mellitus
underlying malignancy

253
Q

what marker can be raised in small bowel obstruction

A

Serum amylase levels

254
Q

greatest rf for bells palsy

A

Pregnant

255
Q

Electrical cardioversion is synchronised to

A

R wave

256
Q

what medications cause gingival hyperplasia

A

phenytoin
ciclosporin
CCB’s

257
Q

management of heparin induced thrombocytopenia

A

switch to direct thrombin inhibitor such as argatroban

258
Q

VTE prophylaxis in kidney failure

A

unfractionated heparin

259
Q

left ventricular aneurysm

A

persistent ST elevation 4 weeks after MI
exam shows bi-basal crackles and 3rd and 4th heart sound

260
Q

What is the best drug to prescribe that both improves symptoms and prognosis in heart failure?

A

spironolactone

261
Q

NIV should be considered in all patients with an acute exacerbation of COPD in whom

A

respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment

262
Q

when is adrenaline given in VF/VT

A

adrenaline 1mg to be given once chest compressions have restarted after third shock

263
Q

which medications should be stopped in C.diff

A

Opioids- meds that are anti-motility and anti-peristaltic

264
Q

features of periarticular juvenile idiopathic arthritis

A

joint pain and swelling, ANA +ve

265
Q

who needs an MSU

A

aged > 65
visible/non-visible haematuria
men

266
Q

when is adrenaline given in VF/pulseless vt

A

after 3 shocks

267
Q

mx of herpes in 3rd trimester of pregnancy

A

oral acyclovir 400 mg TDS

268
Q

less severe vs more severe depression on PHQ9

A

< 16 - less severe
> 16 more severe

269
Q

what is important to co-prescribe prostate cancer when it is being managed with Goserelin

A

bicalutamide, cyproterone acetate , abiterone

these are anti androgen treatments

270
Q

Medications that may worsen osteoporosis

A

SSRIs
antiepileptics
proton pump inhibitors
glitazones
long term heparin therapy
aromatase inhibitors e.g. anastrozole

271
Q

gene mutation associated with HNPCC

A

MSH2/MLH1

272
Q

which medication is prescribed after NSTEMI if patient is on oral anticoagulation

A

clopidogrel instead of prasugrel/ticagrelor

273
Q

how to differentiate between prerenal uraemia and acute tubular necrosis

A

pre-renal uraemia :
raised urea : creatine ratio
high urine osmolality
low urine sodium

acute tubular necrosis :
raised urine sodium
low urine osmolality

274
Q

which ccb’s do not cause worsening of HF

A

Nifedipine, amlodipine etc

275
Q

type 1 vs type 2 bipolar

A

type 1 - mania
type 2 - hypomania

276
Q

Adhesions from previous surgery are the most common cause of

A

small bowel obstruction

277
Q

when is the pneumococcal vaccine given for a patient undergoing elective splenectomy

A

2 weeks prior to surgery

278
Q

how to distinguish between toxoplasmosis and lymphoma on CT

A

toxoplasmosis -
multiple lesions
ring/nodular enhancement
thalliaum spect negative

lymphoma
single lesion
solid enhancement
thallium spect positive

279
Q

Whichis the most likely result if a fetus is homozygous for alpha-thalassaemia

A

hydrops fetalis

280
Q

At what pH is the patient with COPD most likely to receive benefit from non-invasive ventilation?

A

7.25-7.35

281
Q

Refractory anaphylaxis

A

respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline

282
Q

mx of refractory anaphylaxis

A

IV fluids + call for help for IV adrenaline

283
Q

side effects of warfarin

A

haemorrhage
teratogenic
skin necrosis

284
Q

monitoring of methotrexate

A

FBC, U+E, LFT every 3 months

285
Q

what causes cranial diabetes

A

craniopharyngioma

286
Q

which scoring system is helpful in diagnosing secondary osteoporosis

A

Z score

287
Q

mx of localised prostate cancer

A

conservative- active monitoring and watchful waiting
radical prostatectomy
radiotherapy - external beam

288
Q

s/e of radiotherapy for prostate cancer

A

proctitis and increased risk of bladder, colon and rectal cancer

289
Q

what are complement levels in SLE useful for

A

monitoring flares - low in active disease

290
Q

what does MS show on MRI

A

demyelinating lesions disseminated in time and space

291
Q

which laxative to avoid in IBS

A

lactulose

292
Q

How should a patient be screened for MRSA?

A

nasal swab and skin lesions or wounds
the swab should be wiped around the inside rim of a patient’s nose for 5 seconds

293
Q

Suppression of MRSA from a carrier once identified

A

Nasal mupirocin + chlorhexidine for the skin

294
Q

hep E in pregnancy

A

reduced GCS, Flapping tremor, DIC, deranged lfts - fulminant hep E

295
Q

explain Hartmanns procedure

A

end colostomy

296
Q

most common cardiac manifestation of SLE

A

pericarditis

297
Q

radial nerve palsy

A

wrist drop , known as Saturday night palsy due to compression of the radial nerve against humeral shaft

298
Q

what are the CSF findings in SAH

A

bilirubin and normal opening pressure

299
Q

polymyositis antibody

A

Anti Jo 1

300
Q

polymyositis features

A

proximal muscle weakness and tenderness
Raynaud’s
ILD
no rash

301
Q

Proximal muscle weakness + raised CK + no rash → ?

A

polymyositis

302
Q

which types of shock cause warm peripheries

A

neurogenic, septic and anaphylactic

303
Q

which infection is polyarteritis nodosa associated with

A

Hepatitis B

304
Q

pellagra

A

dermatitis
diarrhoea
dementia
delusions
death

due to vitamin B3 deficiency

305
Q

epididymal cysts

A

most common cause of scrotal swellings
separate from the body of the testicle and posterior to it
ass. w/ PKD, VHL

306
Q

varicocele

A

left sided
bag of worms texture

307
Q

CT head showing temporal lobe changes -

A

herpes simplex encephalitis

308
Q

___________is the most common cause of diarrhoea in patients with HIV infection.

A

cryptosporiduium

309
Q

Gait ataxia is caused by cerebellar

A

cerebellar vermis lesions

310
Q

most common cause of dysphagia in HIV patients

A

oesophageal candidiasis

311
Q

The gene encoding the __________ is mutated in familial hypercholesterolaemia

A

low-density lipoprotein (LDL) receptor

312
Q

Adductor pollicis is innervated by

A

ulnar nerve

313
Q

duke classification

A

Dukes’ A Tumour confined to the mucosa 95%
Dukes’ B Tumour invading bowel wall 80%
Dukes’ C Lymph node metastases 65%
Dukes’ D Distant metastases

314
Q

is the strongest risk factor for anal cancer

A

HPV infection

315
Q

Axillary freckles are indicative of

A

neurofibromatosis type 1

316
Q

mx of renal cell carcinoma

A

RCC > 7cm → radical nephrectomy
RCC < 7cm → partial nephrectomy

317
Q

mx of acute prostatitis

A

cipro

318
Q

In acute uncomplicated sinusitis, first-line therapy as per NICE guidelines would be

A

phenoxymethylpenicillin

319
Q
A

SBA passmed Flashcards (30 decks)

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