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Phase 3a > GP / general medicine > Flashcards

GP / general medicine Flashcards

1
Q

What are the indications for TIPPS (Transjugular intrahepatic portosystemic shunt)

A

Secondary prophylaxis for oesophageal variceal bleeding
Treatment of refractory ascites
Treating portal hypertension in Budd-Chiari syndrome

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2
Q

What type of laxative is Senna?

A

Stimulant laxative
(Bisacodyl and sodium picosulphate are also stimulants)

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3
Q

What type of laxative is Movicol?

A

Osmotic laxative
(lactulose, laxido also)

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4
Q

What type of laxative is docusate?

A

Poo-softener

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5
Q

What type of laxative is Fybogel?

A

Bulk-forming laxative
(also methylcellulose)

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6
Q

What is the order of laxatives that you try?

A
  1. Bulk-forming
  2. Osmotic
  3. Stimulant
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7
Q

What is a common side effect of calcium channel blocker?

A

Ankle swelling

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8
Q

When are carpal tunnel symptoms worse?

A

At night

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9
Q

What is the most likely cause of an atraumatic vertebral collapse fracture in an elderly man

A

Metastatic malignancy

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10
Q

What is the management for an atraumatic vertebral collapse fracture due to metastatic malignancy?

A

Steroids
+/- surgical decompression if fit for surgery

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11
Q

Signs of heart failure on a chest x ray: (ABDCE)

A

Alveolar oedema
(Kerley) B lines
Cardiomegaly
Dilated upper lobe vessels
(pleural) Effusions

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12
Q

If coeliac isn’t treated with a gluten-free diet, what serious condition can it lead to in the future?

A

Lymphomas
Small bowel adenocarcinoma

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13
Q

What is the proper name for tennis elbow?

A

Lateral epicondylitis

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14
Q

What is the proper name for golfer’s elbow?

A

Medial epicondylitis

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15
Q

Is lateral epicondylitis (tennis elbow) pain worse on pronation or supination of the forearm?

A

Supination (and extension of the wrist)
Remember:
Putt = pronation
Serve = supination

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16
Q

Is medial epicondylitis (golfer’s elbow) pain worse on pronatin or supination of the forearm?

A

Pronation (and flexion of the wrist)
Remember:
Putt = pronation
Serve = supination

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17
Q

What is CREST syndrome in scleroderma?

A

Calcinosis (white calcium deposits in pulp of fingers)
Raynaud’s phenomenon
Esophaegeal dysmotility
Sclerodactyly (tight skin across fingers)
Telangiectasia

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18
Q

What is Morbilliform Eruption?

A

Maculopapular rash due to EBV + Amoxicillin

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19
Q

Is episcleritis or scleritis painful?

A

Scleritis - also has reduced visual acuity. Tender on movement. Most common in middle-aged women.

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20
Q

What are risk factors for scleritis?

A

Rheumatoid arthritis
Connective tissue disease

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21
Q

What is the management of scleritis?

A

Ophthalmic emergency - requires systemic immunosuppression

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22
Q

What is the aetiology of episcleritis?

A

Idiopathic, often in younger patients

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23
Q

What is tumour lysis syndrome?

A

Life-threatening condition associated with rapid lysis of cancer cells, generally following chemotherapy.
Particularly high-grade lymphoma and leukaemia

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24
Q

What are the features of tumour lysis syndrome?

A

AKI
U&E disturbance (high uric acid, potassium and phosphate, low calcium)
Symptoms: non specific features (e.g. Nausea and D&V, lethargy), tetany cardiac arrhythmias, seizures

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25
Q

What is the management of tumour lysis syndrome?

A

Rasburicase - recombinant urate oxidase: metabolises uric acid to allantoin.

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26
Q

What are some antibiotic risk factors for Clostridium Difficile?

A

Clindamycin
Ciprofloxacin
Cephalosporins
Penicillins

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27
Q

What is the management of Clostridium Difficile infection?

A

PO vancomycin +/- IV metronidazole if severe infection

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28
Q

What is the most common hereditary thrombophilia?

A

Factor V Leiden - 1 in 20 people

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29
Q

What are the features of MALT lymphoma?

A

Helicobacter pylori with gastric MALT (mucosa-associated lymphoma tissue): associated with non-Hodgkin’s lymphoma

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30
Q

What is triple therapy?

A

PPI, Amoxicillin and clarithromycin or metronidazole

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31
Q

Is hereditary spherocytosis autosomal dominant or recessive?

A

Autosomal dominant. In severe cases it is treated with childhood splenectomy

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32
Q

What is the difference between erysipelas and cellulitis?

A

Cellulitis involves the dermis and the subcutaneous tissue whereas erysipelas involves the dermis and the upper subcutaneous tissue

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33
Q

What is erysipelas caused by?

A

Group A beta-haemolytic streptococci

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34
Q

What is management for primary idiopathic autoimmune haemolytic anaemia?

A

Corticosteroids

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35
Q

How is beta-thalassaemia major managed?

A

Fortnightly blood transfusions

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36
Q

What autoimmune condition is particularly linked to autoimmune haemolytic anaemia

A

SLE

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37
Q

What is the treatment for CML?

A

Imatinib

38
Q

What is the investigation for osteomyelitis?

A

Bone biopsy

39
Q

What is contraindicated with Sildenafil?

A

Nitrates: they both work in a similar way leading to vasodilation of the peripheral vasculature leading to a drop in the blood pressure in a similar way to how nitrates work. Can compound and cause death

40
Q

Which viral infection is associated strongly with Hodgkin’s lymphoma?

A

EBV

41
Q

What cancer do you find Reed-Sternberg cells?

A

Hodgkin’s lymphoma: they are large cells with bilobed nuclei and eosinophilic nucleoli

42
Q

Where is the majority of alcohol absorbed in the digestive system?

A

Proximal small intestine

43
Q

What is a indirect indicator of the rate of proliferation of non-Hodgkin’s lymphoma?

A

Raised LDH

44
Q

What is pernicious anaemia?

A

Autoimmune condition which targets the parietal cells in the stomach that produce intrinsic factor

45
Q

What is intrinsic factor essential for?

A

The absorption of vitamin B12 in the terminal ileum

46
Q

What is a seroma?

A

A localised accumulation of fluid beneath the skin surface. They commonly occur 7-10 days after surgery.

47
Q

What is Rovsing’s sign

A

Palpation of the left lower abdomen causes pain in the right lower abdomen (appendicitis)

48
Q

What is seen on blood film in CLL?

A

Smudge cells

49
Q

What is the target INR in recurrent VTE?

A

3-4

50
Q

What is given in acute and severe falciparum malaria?

A

IV artesunate

51
Q

What happens in refeeding syndrome?

A

At risk of low phosphate, magnesium and potassium levels as well as hyperglycaemia

52
Q

What is an ECG feature of hypokalaemia?

A

prominent U waves

53
Q

What is an ECG feature of hyperkalaemia?

A

Flattened P waves

54
Q

What is sideroblastic anaemia?

A

When a microcytic anaemia is not responding to iron replacement consider this. Sufficient iron but ineffective erythropoiesis.
Causes deposition of iron in multiple organs.
Examination of the marrow will reveal ring sideroblasts in the nucleus

55
Q

What is used in high risk patients for essential thrombocythaemia?

A

Hydroxyurea

56
Q

What do you do in any man or woman who isn’t menstruating who presents with iron deficiency anaemia with no obvious cause?

A

2 week wait referral for gastroscopy and colonscopy

57
Q

What is the mutation associated with Polycythaemia rubra vera?

A

JAK2

58
Q

What is the long-term management for a provoked PE?

A

Apixaban for 3 months

59
Q

What apart from abuse can cause a subconjunctival haemorrhage in a baby?

A

Coughing and sneezing

60
Q

How would you distinguish Menieres and BPPV?

A

Meniere’s has tinnitus and hearing loss whereas BPPV doesn’t

61
Q

What should a patient do if she misses 1 pill on COCP?

A

Take missed pill along with the pill that is due

62
Q

What is a factor in a patient’s history that is associated with a good prognosis in schizophrenia?

A

High IQ

63
Q

What should you do next if you suspect iron deficiency anaemia from a FBC?

A

Order haematinics

64
Q

What types of contraception can a woman with current breast cancer use?

A

Non-hormonal types

65
Q

GPs have a legal duty of care to anyone who needs emergency help where?

A

In the practice area

66
Q

What is the first line management of PCOS for contraception?

A

COCP

67
Q

What are the red flags for suspected malignant melanoma?

A

Asymmetry
Border irregularity
Colour variation
Diameter >6mm
Evolves over time

68
Q

What should women taking the COCP have monitored?

A

Blood pressure

69
Q

What are the features of rheumatic fever?

A

Joint pain
Pancarditis
Nodules
Erythema marginatum
Syndenham’s chorea (late sign)

70
Q

What anti-hypertensive drug can cause gynaecomastia?

A

Spironolactone

71
Q

How do haemorrhoids often present?

A

Increased mucous
Fresh red bleeding not mixed in with stool
Itching

72
Q

What type of human herpesvirus is chickenpox?

A

HHV-3

73
Q

What type of human herpesvirus is EBV?

A

HHV-4

74
Q

What type of human herpesvirus is roseola?

A

HHV-6.
Roseola presents with a febrile prodrome and a lace-like rash that starts on the chest and spreads to the limbs. The rash is not itchy

75
Q

What is a contraindication for ellaOne (Ulipristal acetate)?

A

Severe asthma due to its antiglucocorticoid effect

76
Q

What are the symptoms of hypercalcaemia?

A

Bones Stones Groans and Moans
Bone pains
Renal stones
Abdo discomfort and constipation
Poor concentration, mood and fatigue

77
Q

What is the most common cause of hypercalcaemia?

A

Primary hyperparathyroidism

78
Q

What is a febrile non-haemolytic transfusion reaction?

A

Fever but otherwise well
No haemolysis
After blood transfusion
Paracetamol

79
Q

What is the karyotype of Klinefelter’s?

A

47XXY

80
Q

A starry sky appearance on lymph node biopsy is pathognomic for what?

A

Burkitt’s lymphoma

81
Q

What is Waldenstrom’s macroglobulinaemia?

A

A low-grade lymphoma where monoclonal plasmacytoid lymphocytes in the marrow and organs secrete monoclonal IgM.
Clinical features are caused by IgM deposition (hyperviscosity, polyneuropathy, organ infiltration, and pancytopaenia)

82
Q

What is myelofibrosis?

A

An uncommon type of bone marrow cancer that disrupts your body’s normal production of blood cells. Causes extensive scarring in your bone marrow, leading to severe anaemia that can cause weakness and fatigue

83
Q

What does the blood film look like in myelofibrosis?

A

Leukoerythroblastic with massive splenomegaly
(nucleated red blood cells, imature neutrophils, tear drop poikilocytes)

84
Q

What antibiotics are given in neutropenic sepsis?

A

IV piperacillin with taxobactam

85
Q

What is eosinophilia with granulomatosis and polyangiitis?

A

A rare, small vessel vasculitis characterised by late onset asthma and prominent upper resp tract symptoms
Typical petechial/purpuric rash, and positive anti-myeloperoxidase antibody

86
Q

After the initial CAGE questionnaire, what other questionnaire can be used to further assess alcohol intake?

A

AUDIT (alcohol use disorders identiication test)

87
Q

Thrombotic thrombocytopenic purpura is associated with a deficiency in what?

A

ADAMTS-13 (an enzyme that cleaves vWF)

88
Q

Weakness and difficulty walking which improves with walking should make you suspicious of what?

A

Lambert-Eaton myasthenic syndrome (LEMS)
Often due to small-cell lung cancer

89
Q

How does Lambert-Eaton myaesthenic syndrome usually present?

A

In smokers
Ascending weakness which improves with use

90
Q

What are the small cell cancer paraneoplastic syndromes?

A

SCLC:
SIADH
Cushing’s
LEMS
Cerebellar degeneration

Phase 3a (12 decks)

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