GP / Acute management Flashcards
1
Q
what blood test results would you see in osteoporosis
A
Normal ALP, Normal calcium, normal phosphate, normal PTH
2
Q
what can be used to reduce blood pressure during induced labour
A
Epidural anaesthesia
3
Q
causative organism for pyelonephritis
A
e. coli
4
Q
what should be used in the diagnosis of UTI in women over 65, men and catheterised patients
A
urine culture
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
6
Q
give an example of a medication that should be stopped for 48h after a CT with contrast
A
Metformin
7
Q
is the forehead affected in bells palsy
A
yes
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
9
Q
what is the triad of symptoms seen in pre-eclampsia ?
A
New onset HTN
proteinuria
oedema
10
Q
when can Lyme disease be diagnosed clinically and how is it managed
A
if erythema migrans is present - prescribe doxycycline
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
12
Q
what is the first line investigation to diagnose Lyme disease
A
ELISA
13
Q
are antibiotics recommended for tick bite
A
no - only if lyme disease
14
Q
how is disseminated Lyme disease managed
A
ceftriaxone
15
Q
what pain makes lateral epicondylitis worse
A
resisted wrist extension with elbow extended
16
Q
what 8is the first line investigation for chlamydia and gonorrhoea
A
vulvovaginal swab in women
urine is first line in men
NAAT
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
18
Q
what are they key features of parkinson’s
A
assymetrical features
bradykinesia
tremor - improves with voluntary movement
rigidity
19
Q
what is the most common psychiatric feature of Parkinson’s
A
depression
20
Q
what are the features of drug induced parkinsonism
A
more symptoms, rapid onset and bilateral
rigidity and rest tremor uncomonnon
21
Q
how can u distinguish between essential tremor and parkinsons
A
single photon emission computed tomography
22
Q
what medication slows disease progression in ADPKPD
A
tolvaptan
23
Q
what are the features of Lewy Body dementia ?
A
progressive cognitive impairment
parkinsonism
visual hallucinations
24
Q
fluctuating cognition?
A
Lewy Body dementia
25
what risks to the mother does chicken pox come with
pneumonitis
26
what is the management of chicken pox exposure in pregnancy
check varicella antibodies
oral aciclovir for PEP = given at day 7 to day 14 after exposure
27
what is the management of chicken pox in pregnancy
specialist advice
oral aciclovir if women is >20 weeks and presents within 24h of onset
< 20 weeks : consider aciclovir with caution
28
guidelines for checking urine sample in child
symptoms suggesting UTI
Unexplained fever of 38 or higher
alternative site of infection but remain unwell
29
what is the urine collection method for uti in child
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
30
management of UTI in child
< 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
31
what should be corrected before giving alendronic acid
correct hypocalcaemia/ vit d deficiency
32
what are the primary , secondary and tertiary features of syphilis
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
33
what is cubital tunnel syndrome caused by? what are its features
compression of ulnar nerve leading to intermittent tingling in the 4th and 5th finger
34
what is the management of pertusssis
oral macrolide indicated if onset of the cough is within the previous 21 days - clarithromycin, azithromycin, erythromycin
35
what are the school exclusion rules regarding pertussis
48 h after commencing antibiotics - or 21 days from onset of symptoms if no antibiotics
36
what is the z score adjusted for
age, gender and ethnic factors
37
what is the management of catheterised patients who are asymptomatic
no treatment needed
38
how to check if uti has resolved in pregnant women
urine culture
39
what is the first line management of syphilis
IM benzathine penicillin
40
how do the following present -
active syphilis
negative syphilis
false negative syphilis
false positive syphilis
successfully treated syphilis
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
41
most commonly diagnosed STI in the UK
chlamydia
42
which nerve root compression produces with reduced ankle reflex
S1 nerve root compression
43
how to distinguish L3 and L4 nerve root compression
L3 - anterior thigh
L4 - anterior knee and medial malleolus
44
L5 root compression
no loss of reflexes
sensory loss on the dorsum of the foot
45
What is the management of uti in pregnancy close to term ?
amoxicillin
46
what is the management of primary genital herpes during 3rd semester
oral aciclovir and delivery by c section
47
what is the adult dose of adrenaline
500 mcg ( 0.5 ml of 1 in 1000)
48
what is the management of trichomonas vaginalis ?
metronidazole for 5-7 days
49
what are the key signs of trichomonas vaginalis
vaginal discharge
vulvovaginitis
strawberry cervix
pH > 4.5
urethritis in men if symptomatic
50
which antibiotic can cause achilles tendon disorders
ciprofloxacin
51
what dose of adrenaline is prescribed in anaphylaxis depending on age band
< 6m 100-150
6m-6y 150
6-12y 300
adult and child > 12 500
52
what stage of prostate cancer is ass,. with a histologically aggressive form of cancer
gleason score of 10
53
at what bp do you admit women w htn in pregnancyy
160/110
54
how is jarisch herxheimer reaction managed
antipyretics
55
what is the second line management of gonorrhoea if patient refuses IM Ceftriaxone
cefixime and azithromycin
56
which diabetic drug causes -
fractures
pancreatitis
glitazones
gliptins
57
what is the complication of using SSRI in the
1st trimester
third trimester
small increase of congenital heart defects, paroxetine can cause congenital malformations
Persistent pulmonary HTN
58
what values does the Modification of diet in renal disease use?
Creatinine, age, gender, ethnicity- CAGE
59
what is the first line laxative prescribed for constipation in children? what is added next ?
Osmotic laxative
Stimulant laxative
60
what is the management of bells palsy
prednisolone and lubricating eye drops
61
how does gonorrhoea present under the microscope? what is the treatment of choice?
gram negative diplococci
IM ceftriaxone
62
what does Simmonds triad include
Calf squeeze test
observation of the angle of declination
palpation of the tendiin
63
what is finkelsteins test? what condition does it diagnose
forced adduction and flexion of thumb is elicited- de quervains tenosynovitis
64
how is a severe polyarthritis managed
systemic steroids
65
Osgood-Schlatter disease
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
66
what is the presentation of Panic attack on ABG
normal pO2
low CO2
raised ph
bicarb on the higher side
67
what is flash pulmonary oedema and what does it present after?
occurs with acute mitral regurgitation due to an MI - early to mid diastolic murmur is heard
68
what are the features of Mycoplasma pneumoniae ( abbreviation)
multiforme ( erythema)
IgM haemolytic anaemia
Myocarditis
meningo-encephalitis and other immune mediate disease
macrolide treatment : erythromycin
69
what are the features of legionella ( abbrvt))
Lymphocytosis
Low sodium
look at the pee to diagnose
LFT's deranged
70
what is the oxford stroke classification
1. unilateral hemiparesis and / or hemisensory loss of face arm and leg
2. homonymous hemianopia
3. higher cognitive dysfunction ( dysphasia)
71
Pneumonia, peripheral blood smear showing red blood cell agglutination →
Mycoplasma pneumoniae
72
how can MI present in diabetic patients
without chest pain
73
what ABG picture is typical in a COPD patient who has received too much Oxygen
low pH and raised bicarb
74
what are the components of the ORBIT score?
anaemia -2
age > 74-1
bleeding history - 2
renal impairment -1
treatment with anti-platelet agents -1
75
bilateral pleural effusions
patchy infiltrates
new systolic murmur loudest at the apex radiating to the axilla
mi ---> flash pulmonary oedema --> acute mitral regurgitation
76
how does a chronic subdural haematoma appear on CT
hypodense, crescentic collection around convexity of the brain
77
what describes the appearance of a large acute subdural haematoma
Hyperdense, crescentic collection with evidence of mass effect
78
Metabolic alkalosis + hypokalaemia → ?
prolonged vomiting
79
which seizures are managed first line by sodium valproate ?
Tonic clonic , Tonic
Atonic
Myoclonic
80
what is the first line management of absence seizures ?
ethosuximide
81
what is the management of myoclonic seizures in women
levetiracetam
82
Tonic or atonic seizures: first line for females
Lamotrigine
83
what are the signs of right sided heart failure
raised JVP
ankle oedema
hepatomegaly
84
first-line investigation for a suspected osteoporotic vertebral fracture.
X-ray spine
85
how does DKA present on ABG
metabolic acidosis with increased anion gap.
86
If patients treated with PCI for MI are experiencing pain or haemodynamic instability post PCI --->
coronary artery bypass graft (CABG)
87
what is the management of raised ICP
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
88
Causes of raised SAAG
liver disorders ( cirrhosis, failure, mets)
cardiac ( RHF, Constrictive pericarditis)
budd chiari
portal vein thrombosis
89
causes of low SAAG
hypolbuminaemia
malignancy
infection
pancreatitis
obstruction
ascites
lymphatic leak
90
severe pancreatitis signs
age > 55
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
increased LDH, AST
91
which scoring system is most specific for acute pancreatitis
glascow
92
examples of other features of aortic dissection depending upon location
coronary arteries → angina
spinal arteries → paraplegia
distal aorta → limb ischaemia
93
mx of nutrition in moderate-severe pancreatitis
oral nutrition and do not keep nil by mouth unless moderate to severe in which case enteral nutrition
94
how does a fibroadenoma present ? when is surgical excision recommended?
mobile, firm, smooth breast lump
if > 3 cm = surgical excision
95
most common cause of pelvic inflammatory disease in the UK
chlamydia trachomatis
96
what is the management of PID
Oral ofloxacin + oral metronidazole / IM ceftriaxone, oral doxy and oral metronidazole
97
what is fitzhughcurtis syndrome
peri-hepatitis characterised by RUQ and may be confused with cholecystitis - seen in PID
98
what investigations are performed in PID
pregnancy test
high vaginal swab - negative
screen for chlamydia and gonorrhoea
99
mx of testicular torsion
emergency bilateral orchidopexy
100
what is the surgical management of breast cancer
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
101
when is trastuzumab useful
HER2 +ve
102
what is a systemic complication of acute pancreatitis
ARDS
103
What are the features of testicular torsion
tender testis retracted upwards
cremasteric reflex lost
elevation of the testis does not ease the pain ( Prehn's sign)
104
when are prosthetic valves the choice vs when are mechanical valves the right choice ?
old ppl - prosthetic ( > 65 for aortic , > 70 for mitral)
mechanical - younger ( thrombosis needed)
105
how does mastitis present ?
painful, tender and hot breast
fever + general malaise
106
1st line management of mastitis
keep breastfeeding, warm compress and analgesia etc
107
abx for mastitits - when and what
if after 12-24 h symptoms dont improve give oral flucloxacillin
108
what is the investigation of choice for chronic venous disease
venous doppler ultrasound- demonstrating retrograde venous flow
109
management of varicose veins
Leg elevation
weight loss
regular exercise
graduated compression stockings
110
what investigation is suggested for persons with suspected aortic dissection who are too unstable for CT scanning
TOE
111
When is a referral to secondary recommended in a patient with a varicose vein / chronic venous insufficiency
troublesome lower limb symptoms
bleeding
skin changes like pigmentation and eczema
superficial thrombophlebitis
active / healed venous ulcer
112
epigastric hernia
: lump in the midline between umbilicus and the xiphisternum
113
umbilical vs paraumbilical hernia
umbilical : under umbilicus
para-umbilical : above or below umbilicus
114
Periductal mastitis
recurrent episodes of infection
smoking
115
s/e of colchicine
diarrhoea
116
common side effect of verapamil
constipation
117
management of bell's palsy
eye care
oral pred
118
In type 1 diabetics, blood glucose targets:
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
119
who should have a frax assessment
They advise that all women aged >= 65 years and all men aged >= 75 years should be assessed.
120
when should younger patients be considered for frax assessment
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.
121
investigation of choice for ectopic pregnancy
TV USS
122
what is the criteria for expectant management of an ectopic pregnancy
Size < 35 mm
Unruptured
asymptomatic
no foetal Heartbeat
hCG < 1,000 IU/ L
123
what is expectant management of an ectopic
Expectant management involves closely monitoring the patient over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed.
124
what is the criteria for medical management of ectopic pregnancy
Size < 35 mm
Unruptured
minimal pain
no foetal Heartbeat
hCG < 1,500 IU/ L
125
what is the medical management of an ectopic
methotrexate + patient available for follow up
126
criteria for surgical mx of ectopic
size > 35 mm
can be ruptured
foetal heartbeat
hcg > 5000
127
what is the management of cardiogenic shock
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.
128
causes of metabolic acidosis with raised anion gap
lactate : shock, sepsis, hypoxia
ketosis
renal failure
poisoning
129
causes of metabolic acidosis with normal anion gap
diarrhoea
renal tubular acidosis
addisons
130
what vessels are damaged in an epidural haemorrhage
middle meningeal artery
131
what vessels are damaged in SAH
circle of Willis - such as basilar and anterior circulating arteries
132
what is the management of chronic symptomatic subdural
surgical decompression with burr holes
133
how is TCA overdose investigated
ECG - shows widening of the QRS complex
134
mx of TCA overdose
IV Bicarbonate
135
what is the pattern of acid base disturbance seen in salicylate overdose
resp acidosis followed by met acidosis
136
how does seretonin syndrome present and how is it managed
hyperreflexia, myoclonus , rigidity
hyperthermia + sweating
confusion
137
what is the mx of seretonin syndrome
iv fluids and benzos
138
how to differentiate between serotonin syndrome and neuroleptic malignant syndrome
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
mx of neuroleptic malignant syndrome
dantrolene
140
what type of arrest rhythm does tension pneumo cause
PEA reversible
141
what is the management of salicylate overdose
charcoal
urinary alkalinzation with iv sodium bicarb
142
what is the acceptable daily amount of glucose
50-100 g
143
how to tell prerenal aki
high urine to creatinine ratio
144
If a patient with AF has a stroke or TIA, the anticoagulant of choice should be ____________
apixaban, warfarin or direct thrombin / factor Xa inhibitor
145
what drugs should a patient be offered for secondary prevention of MI
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin
146
which patients are at risk of developing hepatotoxicity post paracetamol overdose
liver enzyme inducing drugs -
malnourished patients
chronic alcohol excess
147
which meds interact with SSRI's to cause seretonin syndrome
tramadol
148
what is a normal anion gap?
8-14 mmol/L
149
how to calculate anion gap
sodium + potassium - bicarb + chloride
150
which ivx is most important when assessing a patient with bilateral UTI
u+e
151
which type of stroke causes torsades de pointes
sah
152
Idiopathic intracranial hypertension signs -
papilledema, 6th nerve palsy
153
can u continue aspirin in aki
yes
154
how does narcolepsy present
cataplexy in which patient suddenly loses muscle control , usually triggered by some form of +ve emotion
155
what abg result does aspirin toxicity give
mixed primary respiratory alkalosis and metabolic acidosis
156
which bridging veins does a subdural haemorrhage damage
between cortex and venous sinuses
157
what are the signs of aspirin overdose
hyperventilation
tinnitus
lethargy
sweating
vomiting
seizures coma
158
shortest time over which 40 mmol of potassium can be administered
4h
159
what feature of COPD can mimic pneumothorax
large bullae
160
what is the most common pulmonary manifestation of methotrexate use? how does it present
pneumonitis, presenting with hypersensitivity pneumonitis , non productive cough, dyspnoea malaise and fever
161
which malaria is associated with nephrotic syndrome
plasmodium malariae
162
what are the general features of malaria
fever headache splenomegaly
cyclical fever
163
most common cause of non falciparum malaria
Plasmodium vivax
164
management of malaria
ACT therapy or chloroquine followed by primaquine to prevent relapses
165
how often should chest physiotherapy and postural drainage be conducted in the mx of cystic fibrosis
twice daily
166
mirror image nuclei - what condition ?
hodgkins lymphoma
167
at what t score would you start bisphosphonates with patients on steroids
- 1.5
168
where are struvite calculi normally formed
pelvis - stag horn
169
action of tamoxifen
oestrogen receptor selective antagonism
170
diagnostic investigation of ankylosing spondilytis
pelvic xray
171
why do patients with coeliac disease need pneumococcal
due to functional hyposplenism
172
contraindication to surgery for lung cancer
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
how is colorectal cancer staged
CEA
CT CAP
174
how is a cancer of the caecal, ascending or proximal transverse colon resected
Right hemicolectomy
175
how is the cancer of distal, transverse or descending colon resected
left hemicolectomy
176
how to exclude diabetes insipidus
urine osmolality of > 700 mOsm/kg
177
what picture is seen on blood tests in polycythaemia vera
isolated rise in Hb
178
define volvulus
Torsion of the colon around its mesenteric axis resulting in compromised blood flow and closed loop obstruction
179
what is the management of volvulus
sigmoid : rigid sigmoidoscopy with rectal tube insertion
caecal : operative with right hemicolectomy
180
how does sigmoid volvulus present
large bowel obstruction = large dilated loop of colon , often with air fluid levels and coffee bean sign
181
how does caecal volvulus present
small bowel obstruction
182
when would you refer to ENT - bells palsy
no sign of improvement after 3 weeks
183
features associated with bell''s palsy
post-auricular pain
altered taste
dry eyes
hyperacusis
184
what feature can be used to differentiate between primary and secondary hypoadrenalism
skin hyperpigmentation
185
diff between primary secondary and tertiary hypoadrenalism
Primary - Pigments (skin and mucosa)
Secondary - Spares (no pigmentation)
Tertiary - Treatment (iatrogenic, steroid use)
186
what sign is seen with a mid shaft humeral fracture
radial nerve affected causing wrist drop
187
_____________should be considered for the prevention of calcium stones
potassium citrate
188
where should adrenaline be given
anterolateral aspect of the thigh
189
what type of hypersensitivity reactions are autoimmune conditions
type 3
190
diagnosis of mesothelioma
histology, following a thoracoscopy
191
'egg-shell' calcification of the hilar lymph nodes
Silicosis
192
Symptoms of leprosy
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
signs and symptoms of meralgia paraesthesia
burning, tingling coldness or shooting pain
numbness
deep muscle ache
aggravated by standing and relieved by sitting
194
rf's for meralgia paraesthesia
obesity, pregnancy , sports, trauma, iatrogenic
195
gastric volvulus
vomiting, pain and failed attempts to pass an NG tube
196
management of colonic cancer in patient with HNPCC
panproctocolectomy
197
how is a cancer of the sigmoid colon managed
high anterior resection
198
how is cancer of the rectum managed
anterior resection
199
how are cancers of the anal verge managed
abdomino-perineal excision of the rectum
200
when is Hartmann's procedure is used in the resection of cancer
when bowel has perforated then the risk of anastomosis is greater so a Hartmann's procedure is used
201
what is a sign of chronic hepatitis on light microscopy
Ground glass hepatocytes
202
why does a fixed and dilated pupil develop in extradural haematoma
compression of the parasympathetic fibers of the third cranial nerve.
203
how does neurogenic thoracic outlet syndrome present
muscle wasting of the hands, numbness and tingling, autonomic symptoms
204
what osseous abnormality can be present in thoracic outlet syndrome
cervical rib
205
primary lateral sclerosis
UMN signs only
206
progressive muscular atrophy
LMN only
207
progressive bulbar palsy
palsy of tongue, muscles of chewing, swallowing and facial muscles.
208
explain homonymous hemianopias based upon location
incongruous : lesions of optic tract
congruous : lesions of optic radiation/ occipital cortex
macula sparing : occipital cortex
209
which condition has a poor response to a fluid challenge
acute tubular necrosis
210
what is a common presentation of haemophilia
haemoarthroses
211
what are pancreatic pseudocysts and how are they managed ?
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
mx of pancreatic abscess
trans-gastric drainage or endoscopic drainage
213
how is HER2 receptor breast cancer managed
Trastuzumab, often known by its brand name Herceptin, is a monoclonal antibody that acts to block HER2
214
how is latent TB managed
3 months of isoniazid w pyridoxine and rifampicin for 3m
or 6m of isoniazid with pyridoxine
215
most common cause of large bowel obstruction
cancer
216
characteristic feature of anal fissures
pain and bleeding
217
definitive management of SAH aneurysm
coiling
218
action of aromatase inhibitors
reducing peripheral synthesis of oestrogen
219
appropriate ivx for appendicitis
abdominal ultrasound
220
how can nutrition be supported in patients with MND
PEG
221
Progressive multifocal leukoencephalopathy is caused by
JC virus or BK virus
222
Mx of CMPA
formula fed - extensive hydrolysed formula, amino acid based formula
breastfed -
continue breastfeeding
eliminate cow milk from mumms diet
223
prognosis of CMPA
IgE - 55% milk tolerant by 5
non IgE - most tolerant by 3
224
Ivg for SAH
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
early x-ray feature of rheumatoid arthritis
Juxta-articular osteoporosis/osteopenia
226
Schistosomiasis is a risk factor for
squamous cell carcinoma of the bladder
227
Sister Mary Joseph nodule -
sign of metastasis to periumbilical lymph nodes, classically from gastric cancer primary
228
Functional tricuspid regurgitation often occurs secondary to
pulmonary hypertension
229
when should LP be done post suspected SAH
at least 12 hours following the onset of symptoms to allow the development of xanthochromia
230
grading of haemorrhoids
grade 1 - no prolapse
grade 2 - prolapse on defecation but reduce spontaneously
grade 3 - manually reduced
grade 4 - cannot be reduced
231
ivg for suspected bowel obstruction
abdo xray first line
CT diagnostic
232
AAA screening UK
single abdominal ultrasound aged 65
233
most common cause of small bowel obstruction
adhesions
234
small bowel obstruction vomiting
bilious, early
235
Caecal volvulus associations
all ages
adhesions
pregnancy
236
which oral symptom can methotrexate cause
Mucositis
237
The most common site of metatarsal stress fractures
2nd metatarsal shaft
238
HIV-associated nephropathy
focal segmental glomerulosclerosis
239
Management of necrotising fasciitis
immediate surgical debridement and IV antibiotics
240
What is the most effective single step to reduce the incidence of MRSA?
hand hygiene
241
what is the indication for ABG in patients with acute asthma
sats < 92
242
which neurovascular structure is compromised in scaphoid fracture
dorsal carpal branch of the radial artery
243
mx of chronic vs acute anal fissure
acute : dietary changes and stool softeners --> topical anaesthetics
chronic : topical GTN --> sphincterotomy
244
Which is associated with a good prognosis in rheumatoid arthritis?
Rheumatoid factor negative.
245
most common breast tumour
Invasive ductal carcinomas
246
What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism?
Loss of antithrombin III.
247
herpes simplex encephalitis- CT
CT head showing temporal lobe changes
248
Joint aspirate in rheumatoid arthritis shows
high WBC count, predominantly PMNs.
249
lumbar puncture show a yeast and a capsule in the CSF stained with India ink.
Cryptococcus neoformans
250
Perianal abscess- symptoms
severe pain in the perianal region, and may have spiking temperatures
251
treatment of perianal abscess
incision and drainage
252
risk factors for anorectal abscesses
anorectal abscesses
diabetes mellitus
underlying malignancy
253
what marker can be raised in small bowel obstruction
Serum amylase levels
254
greatest rf for bells palsy
Pregnant
255
Electrical cardioversion is synchronised to
R wave
256
what medications cause gingival hyperplasia
phenytoin
ciclosporin
CCB's
257
management of heparin induced thrombocytopenia
switch to direct thrombin inhibitor such as argatroban
258
VTE prophylaxis in kidney failure
unfractionated heparin
259
left ventricular aneurysm
persistent ST elevation 4 weeks after MI
exam shows bi-basal crackles and 3rd and 4th heart sound
260
What is the best drug to prescribe that both improves symptoms and prognosis in heart failure?
spironolactone
261
NIV should be considered in all patients with an acute exacerbation of COPD in whom
respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment
262
when is adrenaline given in VF/VT
adrenaline 1mg to be given once chest compressions have restarted after third shock
263
which medications should be stopped in C.diff
Opioids- meds that are anti-motility and anti-peristaltic
264
features of periarticular juvenile idiopathic arthritis
joint pain and swelling, ANA +ve
265
who needs an MSU
aged > 65
visible/non-visible haematuria
men
266
when is adrenaline given in VF/pulseless vt
after 3 shocks
267
mx of herpes in 3rd trimester of pregnancy
oral acyclovir 400 mg TDS
268
less severe vs more severe depression on PHQ9
< 16 - less severe
> 16 more severe
269
what is important to co-prescribe prostate cancer when it is being managed with Goserelin
bicalutamide, cyproterone acetate , abiterone
these are anti androgen treatments
270
Medications that may worsen osteoporosis
SSRIs
antiepileptics
proton pump inhibitors
glitazones
long term heparin therapy
aromatase inhibitors e.g. anastrozole
271
gene mutation associated with HNPCC
MSH2/MLH1
272
which medication is prescribed after NSTEMI if patient is on oral anticoagulation
clopidogrel instead of prasugrel/ticagrelor
273
how to differentiate between prerenal uraemia and acute tubular necrosis
pre-renal uraemia :
raised urea : creatine ratio
high urine osmolality
low urine sodium
acute tubular necrosis :
raised urine sodium
low urine osmolality
274
which ccb's do not cause worsening of HF
Nifedipine, amlodipine etc
275
type 1 vs type 2 bipolar
type 1 - mania
type 2 - hypomania
276
Adhesions from previous surgery are the most common cause of
small bowel obstruction
277
when is the pneumococcal vaccine given for a patient undergoing elective splenectomy
2 weeks prior to surgery
278
how to distinguish between toxoplasmosis and lymphoma on CT
toxoplasmosis -
multiple lesions
ring/nodular enhancement
thalliaum spect negative
lymphoma
single lesion
solid enhancement
thallium spect positive
279
Whichis the most likely result if a fetus is homozygous for alpha-thalassaemia
hydrops fetalis
280
At what pH is the patient with COPD most likely to receive benefit from non-invasive ventilation?
7.25-7.35
281
Refractory anaphylaxis
respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline
282
mx of refractory anaphylaxis
IV fluids + call for help for IV adrenaline
283
side effects of warfarin
haemorrhage
teratogenic
skin necrosis
284
monitoring of methotrexate
FBC, U+E, LFT every 3 months
285
what causes cranial diabetes
craniopharyngioma
286
which scoring system is helpful in diagnosing secondary osteoporosis
Z score
287
mx of localised prostate cancer
conservative- active monitoring and watchful waiting
radical prostatectomy
radiotherapy - external beam
288
s/e of radiotherapy for prostate cancer
proctitis and increased risk of bladder, colon and rectal cancer
289
what are complement levels in SLE useful for
monitoring flares - low in active disease
290
what does MS show on MRI
demyelinating lesions disseminated in time and space
291
which laxative to avoid in IBS
lactulose
292
How should a patient be screened for MRSA?
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
Suppression of MRSA from a carrier once identified
Nasal mupirocin + chlorhexidine for the skin
294
hep E in pregnancy
reduced GCS, Flapping tremor, DIC, deranged lfts - fulminant hep E
295
explain Hartmanns procedure
end colostomy
296
most common cardiac manifestation of SLE
pericarditis
297
radial nerve palsy
wrist drop , known as Saturday night palsy due to compression of the radial nerve against humeral shaft
298
what are the CSF findings in SAH
bilirubin and normal opening pressure
299
polymyositis antibody
Anti Jo 1
300
polymyositis features
proximal muscle weakness and tenderness
Raynaud's
ILD
no rash
301
Proximal muscle weakness + raised CK + no rash → ?
polymyositis
302
which types of shock cause warm peripheries
neurogenic, septic and anaphylactic
303
which infection is polyarteritis nodosa associated with
Hepatitis B
304
pellagra
dermatitis
diarrhoea
dementia
delusions
death
due to vitamin B3 deficiency
305
epididymal cysts
most common cause of scrotal swellings
separate from the body of the testicle and posterior to it
ass. w/ PKD, VHL
306
varicocele
left sided
bag of worms texture
307
CT head showing temporal lobe changes -
herpes simplex encephalitis
308
___________is the most common cause of diarrhoea in patients with HIV infection.
cryptosporiduium
309
Gait ataxia is caused by cerebellar
cerebellar vermis lesions
310
most common cause of dysphagia in HIV patients
oesophageal candidiasis
311
The gene encoding the __________ is mutated in familial hypercholesterolaemia
low-density lipoprotein (LDL) receptor
312
Adductor pollicis is innervated by
ulnar nerve
313
duke classification
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
is the strongest risk factor for anal cancer
HPV infection
315
Axillary freckles are indicative of
neurofibromatosis type 1
316
mx of renal cell carcinoma
RCC > 7cm → radical nephrectomy
RCC < 7cm → partial nephrectomy
317
mx of acute prostatitis
cipro
318
In acute uncomplicated sinusitis, first-line therapy as per NICE guidelines would be
phenoxymethylpenicillin
319
