High-yield Flashcards
What is the common cause of nephrotic syndrome in children/young adults?
Minimal change glomerulonephritis
What are the common presentations of primary hyperaldosteronism?
Hypertension, hypernatraemia, hypokalemia
What does NICE recommend for vascular dementia?
Tight control of vascular risk factors
What are the absolute contraindications for combined oral contraceptive pills (COCP)?
More than 35 years old, smoking more than 15 cigarettes/day
When should aciclovir be started in suspected encephalitis cases?
In all cases of suspected encephalitis
What is the management for herpes zoster ophthalmicus?
Urgent ophthalmological review, 7-10 days of oral antivirals
What can sepsis cause in terms of acid-base balance?
Profound lactic acidosis
What should be assessed prior to induction of labor?
The Bishop Score
How is mastoiditis typically diagnosed?
Clinically
What is the preferred way to support nutrition in patients with motor neuron disease?
Percutaneous gastrostomy tube (PEG)
What are the increased risks associated with the combined oral contraceptive pill?
Breast cancer, cervical cancer
What is the first-line treatment for eclampsia?
Magnesium sulphate
Should compression stockings be routinely offered to all patients with deep vein thrombosis?
No
What is transient synovitis often associated with?
A mild fever
What is a risk factor for ectopic pregnancy?
Endometriosis
What are the classic symptoms of scarlet fever?
Sore throat, fever, headache, bright red tongue, coarse red rash
What is the first step to consider if a patient has a urine output of < 0.5ml/kg/hr postoperatively?
Fluid challenge, if no contraindications
Why are inhaled corticosteroids used in COPD?
To reduce exacerbations
What virus accounts for the majority of cases of croup?
Parainfluenza virus
What must be done if a person’s death occurs while under the mental health act?
Reported to the coroner
What is the first line of treatment for blepharitis?
Hot compresses
What is the recommended duration of DOAC treatment for cancer patients with VTE?
6 months
What should be screened for with an echocardiogram in Kawasaki disease?
Coronary artery aneurysms
What is caput succedaneum?
A puffy swelling over the presenting part that crosses suture lines
What may a chest x-ray show in transient tachypnoea of the newborn?
Hyperinflation, fluid in the horizontal fissure
When should breech babies at or after 36 weeks gestation have USS for DDH screening?
At 6 weeks regardless of mode of delivery
What can circumstantiality be a sign of?
Anxiety disorders, hypomania
What is the only option for hyperacute transplant rejection?
Removal of the graft
What is the first-line treatment for nocturnal enuresis if general advice has not helped?
Enuresis alarm
Where is an inguinal hernia located in relation to the pubic tubercle?
Superior and medial
What should be offered if HbA1c has risen to 58 mmol/mol in a patient with T2DM on metformin?
DPP-4 inhibitor, pioglitazone, sulfonylurea, SGLT-2 inhibitor
What is the first step when there is chickenpox exposure in pregnancy?
Check antibodies
What is the acute treatment for migraine?
Triptan + NSAID or triptan + paracetamol
What is the prophylactic treatment for migraine?
Topiramate or propranolol
What condition is Mycoplasma associated with?
Erythema multiforme
What are the metabolic abnormalities in tumor lysis syndrome?
High potassium, high phosphate, low calcium
What is the cause of sudden painless loss of vision characterized by a dense shadow starting peripherally?
Retinal detachment
What should patients with ascites secondary to liver cirrhosis be given?
An aldosterone antagonist
What are the symptoms of acute haemolytic reaction during a blood transfusion?
Fever, abdominal pain, hypotension
What are the symptoms of Roseola infantum?
Fever followed later by rash
What condition is made worse when arms are outstretched?
Essential tremor
What should you think of when CT head shows temporal lobe changes?
Herpes simplex encephalitis
What is a common side effect of atypical antipsychotics?
Weight gain
What is the first-line antibiotic for tonsillitis?
Phenoxymethylpenicillin
What movement is impaired in adhesive capsulitis?
External rotation
What is a missed miscarriage?
Gestational sac containing a dead fetus before 20 weeks without symptoms of expulsion
When should persistent oral ulceration of more than 3 weeks be referred to oral surgery?
Under the two-week wait
What heart condition is Turner’s syndrome associated with?
Ejection systolic murmur due to bicuspid aortic valve
What symptom may duct papilloma present with?
Blood-stained discharge
What is the initial management for duct-dependent congenital heart disease?
Maintenance of the ductus arteriosus with prostaglandins
What is the next step in treating haemodynamically stable SVT patients unresponsive to vagal manoeuvres?
Treating with adenosine
In suspected digoxin toxicity, when is the digoxin level monitored?
Routinely not monitored, except in suspected toxicity
What can precipitate lithium toxicity?
NSAIDs
What is the likely condition when a patient experiences episodic, intense, unilateral eye pain?
Cluster headache
What does ptosis and a dilated pupil indicate?
Third nerve palsy
What does ptosis and a constricted pupil indicate?
Horner’s syndrome
What is the initial investigation for palpitations?
Holter monitor
What is an important adverse effect of aminoglycosides?
Ototoxicity
What should be the insulin management in the acute management of DKA?
Fixed rate insulin while continuing regular long-acting insulin
According to NICE 2017, what should be added first in asthma patients not controlled with SABA + ICS?
LTRA (Leukotriene receptor antagonist)
What is the recommended immediate treatment for croup?
Single dose of oral dexamethasone (0.15 mg/kg)
For vestibular neuronitis, when should prochlorperazine be stopped?
After a few days
What are the indicative symptoms of Kawasaki disease?
High fever lasting >5 days, red palms with desquamation, strawberry tongue
What is the most common cause of discitis?
Staphylococcus aureus
What causes acute epiglottitis?
Haemophilus influenzae type B
What usually causes mucoid white vaginal discharge in newborn girls?
Normal hormonal changes
When should a referral to secondary care be considered for a family history of breast and ovarian cancer?
When there is a family history of breast and ovarian cancer
What can be used to reduce pyrexia in cases of non-haemolytic febrile transfusion reaction?
Paracetamol
What medications are used to promote duct closure in patent ductus arteriosus?
Indomethacin or ibuprofen
What are the common features of rosacea?
Nose, cheeks, forehead; flushing, erythema, telangiectasia; papules and pustules
What should be tried if analgesia doesn’t help with endometriosis?
Combined oral contraceptive pill or a progestogen
What do the risk factors for ovarian cancer relate to?
Increased number of ovulations
What can amoxicillin lead to in the presence of URTI symptoms?
Rash or glandular fever
What should a person with Addisons’ who vomits do?
Take IM hydrocortisone until vomiting stops
What is given for stabilization of the cardiac membrane in the presence of hyperkalaemia?
IV calcium gluconate
What can be given to slow the deterioration of visual loss in dry AMD?
High dose of beta-carotene, vitamins C and E, zinc
What is the investigation of choice for reflux nephropathy?
Micturating cystography
What does the ABG triad for chronic CO2 retention consist of?
Respiratory acidosis, hypoxemia, normal or increased pH
What are the characteristics of a strong suspicion of PE?
Normal pH, High pCO2, High HCO3
What symptoms are associated with acute viral labyrinthitis?
Sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting, vertigo
What potential side effect may be caused by sulphonylureas?
Cholestasis
Why is whole breast radiotherapy recommended after a wide-local excision?
To reduce the risk of recurrence by around two-thirds
How are most intracranial aneurysms treated following a subarachnoid haemorrhage?
With a coil by an interventional neuroradiologist
What deficits does Alzheimer’s Dementia produce on the Addenbrookes Cognitive Exam?
Global deficits
What may arise in a lung cavity developed secondary to previous tuberculosis?
An aspergilloma
What treatment is first-line for trigeminal neuralgia?
Carbamazepine
What is the first-line treatment for hypertension in diabetics?
ACE inhibitors/A2RBs
What is a common cause of speech and language delay in young children?
Glue ear
What is the classic presentation of episcleritis?
A red eye that is not painful
How does a meibomian cyst present?
As a firm painless lump in the eyelid
What are the symptoms of anterior uveitis?
Acute pain, red eye, photophobia, small pupil, reduced visual acuity
Why is prescribing anaesthetic eye drops not advisable for patients with corneal ulcer?
It may cause more harm and delay healing of the ulcer
What is the recommended action for acute sensorineural hearing loss?
Urgent referral to ENT for audiology assessment and brain MRI
How can ovulation be confirmed?
Take the serum progesterone level 7 days prior to the expected next period
What potential side effect may aromatase inhibitors cause?
Osteoporosis
What is the empirical antibiotic of choice for neutropenic sepsis?
Piperacillin with tazobactam (Tazocin)
What potential side effect may macrolides cause?
Prolongation of the QT interval
At what age does atopic eczema typically present in children?
Before the age of 2 years
What is the typical duration for Finasteride treatment of BPH before results are seen?
6 months
What is the risk associated with unopposed oestrogen in HRT?
Increased risk of endometrial cancer
What adverse effect may result from the concurrent use of methotrexate and trimethoprim containing antibiotics?
Bone marrow suppression and severe or fatal pancytopenia
What is the high-risk association of Clindamycin treatment?
C. difficile infection
What condition should be considered if a newborn lacks red reflex?
Retinoblastoma
What should be done if 2 pills are missed in week 3 of COCP?
Finish the pills in the current pack and start a new pack immediately
By what age should children be able to combine two words?
2 years
When must Levonorgestrel be taken?
Within 72 hours of UPSI
What are the characteristics of Scleritis?
Classically painful, may be associated with reduced visual acuity and blurred vision
Is Trimethoprim considered safe to use during breastfeeding?
Yes
What is a red flag symptom related to polyps?
Unilateral polyps
How long are ‘unprovoked’ pulmonary embolisms typically treated for?
6 months
What medication may be used to treat bile-acid malabsorption?
Cholestyramine
Is Campylobacter infection often self-limiting?
Yes
What may be indicated if Campylobacter infection is severe?
Treatment with clarithromycin
What is the most common feature of carbon monoxide poisoning?
Headache
What is the recommended age for achieving sitting without support?
7-8 months, refer if not achieved by 12 months
What is the best first line management for NAFLD?
Weight loss
What is an important complication of femoral hernias?
Strangulation
What are the red flags for endophthalmitis following intraocular surgery?
Red eye, pain, visual loss
What is the recommended treatment for bacterial conjunctivitis in pregnant women?
Topical fusidic acid
What potential side effect may loop diuretics cause?
Ototoxicity
What action should be taken if a 2-level DVT Wells score is ≥ 2 points?
Arrange a proximal leg vein ultrasound scan within 4 hours
What is the first line radiological investigation for suspected stroke?
Non-contrast CT head scan
How can local anesthetic toxicity be treated?
With IV 20% lipid emulsion
In which patients is azithromycin prophylaxis recommended for COPD?
Patients who meet certain criteria and continue to have exacerbations
What investigation is required for adult patients with a hydrocele to exclude underlying causes?
Ultrasound
What is the antiplatelet choice for managing NSTEMI conservatively?
Not specified
What is the recommended medication combination for a patient with aspirin and high bleeding risk?
Clopidogrel
What is the first-line treatment for polycythaemia vera to maintain normal haemoglobin levels?
Venesection
What is the recommended treatment for acute presentation of atrial fibrillation with signs of haemodynamic instability?
Electrical cardioversion
What condition is indicated by fluctuating confusion/consciousness?
Subdural haematoma
What is the likely diagnosis for thyrotoxicosis with a tender goitre?
Subacute (De Quervain’s) thyroiditis
What is the cause of cubital tunnel syndrome?
Compression of the ulnar nerve
What should be considered in the differential diagnosis for women presenting with a breast lump and a history of trauma?
Fat necrosis
What type of hearing loss does presbycusis present with?
Bilateral high-frequency hearing loss
What may cause painless, monocular loss of vision in Marfan’s syndrome?
Lens dislocation
What requires an immediate CT scan to assess for raised ICP and tentorial herniation?
A unilaterally dilated pupil that responds sluggishly to light
What can erythromycin cause in terms of cardiac function?
Prolonged QT interval
What is a risk factor for developmental dysplasia of the hip?
Breech presentation
What should be added if blood glucose targets are not met with diet/metformin in gestational diabetes?
Insulin
What are the treatment options for latent tuberculosis?
3 months of isoniazid with pyridoxine and rifampicin, or 6 months of isoniazid with pyridoxine
What is refractory anaphylaxis defined as?
Respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline
What should be added for COPD patients still breathless despite using SABA/SAMA?
LABA + ICS
What are the symptoms of delirium?
Impairment of conscious level, often involves psychotic symptoms
What is the transfusion threshold for patients with ACS?
80 g/L
What should be considered in Raynaud’s phenomenon with extremity ischaemia?
Buerger’s disease
What are the symptoms of acute angle closure glaucoma?
Ocular pain, decreased visual acuity, worse with mydriasis
What should be added for COPD patients still breathless despite using SABA/SAMA and having asthma/steroid responsive features?
LABA + ICS
What are the symptoms of delirium?
Impairment of conscious level and often involves psychotic symptoms
What are the symptoms of acute angle closure glaucoma?
Ocular pain, decreased visual acuity, worse with mydriasis, haloes around lights
What is the differential for raised paraproteins in the blood?
MGUS
What is cavernosal blood gas analysis useful for?
Investigation for priapism
What is the difference between affect and mood?
Affect is the current, observed emotional state, whereas mood is the more pervasive, predominant state over a longer period
What does the ‘M rule’ stand for in primary biliary cholangitis?
IgM, anti-Mitochondrial antibodies (M2 subtype), Middle aged females
Is antibiotic prophylaxis routinely recommended in the UK for dental and other procedures to prevent infective endocarditis?
No
What is recommended for the acute management of renal colic?
Use of IM diclofenac
What are the characteristics of Broca’s dysphasia?
Speech non-fluent, comprehension normal, repetition impaired
What can rifampicin cause?
Orange tears/urine
What is the first-line treatment for lichen planus?
Potent topical steroids
What is a contraindication to statin therapy?
Pregnancy
Is sickle cell anemia an autosomal recessive condition?
Yes
What can precipitate thrombotic crises in sickle cell?
Infection, dehydration, or deoxygenation
What does tangentiality refer to?
Wandering from a topic without returning to it
Is new LBBB always pathological?
Yes, it is always pathological and never normal
What is a potential consequence of obesity with abnormal LFTs?
Non-alcoholic fatty liver disease
What may Methotrexate cause as a side effect?
Lung fibrosis
What can lead to complete heart block following a myocardial infarction?
Right coronary artery lesion
What is a life-threatening side effect of clozapine?
Agranulocytosis/neutropenia
What should be given to all patients with Bell’s palsy within 72 hours of onset?
Oral prednisolone
How should otitis externa in diabetics be treated to cover Pseudomonas?
With ciprofloxacin
Do pleural plaques undergo malignant change and require follow-up?
No, they are benign and do not undergo malignant change
What does a pizza pie appearance on fundoscopy indicate?
Chorioretinitis
What commonly causes an itchy rash affecting the face and scalp distribution?
Seborrhoeic dermatitis
What should be done if the cervical cancer screening sample is hrHPV positive and cytologically normal?
Repeat smear at 12 months
What should be assessed following ocular trauma to determine the need for immediate decompression?
Orbital compartment syndrome
How long should the symptoms be present to make a diagnosis of chronic fatigue syndrome?
3 months
When should stages 1 & 2 of chronic kidney disease be diagnosed?
If supporting evidence accompanies eGFR
At what age does bow legs in a child under 3 usually resolve?
By the age of 4 years
What may topical corticosteroids cause in patients with darker skin?
Patchy depigmentation
How can the risk of peripheral neuropathy with isoniazid be reduced?
By prescribing pyridoxine
What can cause blurring of vision years after cataract surgery?
Posterior capsule opacification
When is pure tone audiometry typically done in most areas of the UK?
At school entry
What may cause pelvic pain in women around ovulation with no PV bleeding?
Mittelschmerz
What does an ACE inhibitor cause?
Hyperkalaemia
What does allopurinol increase the risk of?
Azathioprine toxicity
What is the association of SSRIs?
Hyponatremia
What should be added for an adult with uncontrolled asthma by SABA?
Low-dose ICS
What is Kocher’s criteria used for in children?
Assessing the probability of septic arthritis
What should be tried if metformin is not tolerated due to GI side-effects?
Modified-release formulation
How should oral bisphosphonates be taken?
With plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking
What is recommended for symptom control in non-CF bronchiectasis?
Inspiratory muscle training + postural drainage
What is the increased risk associated with antipsychotics in the elderly?
Stroke and VTE (Venous Thromboembolism)
What are PDE 5 inhibitors contraindicated by?
Nitrates and nicorandil
What is caput succedaneum?
Scalp edema that crosses suture lines
What is the Barlow manoeuvre used for?
Attempted dislocation of a newborn’s femoral head
What are the characteristics of acute epiglottitis?
Rapid onset fever, stridor, and drooling
What testing is recommended in patients with non-alcoholic fatty liver disease to aid diagnosis of liver fibrosis?
Enhanced liver fibrosis (ELF) testing
What does amaurosis fugax affect?
The retinal/ophthalmic artery
What are typically raised in iron-deficiency anaemia?
Total iron-binding capacity (TIBC) + transferrin levels
What are topical aluminium chloride preparations first-line for?
Hyperhidrosis
What is prominent and severe in Stevens-Johnson syndrome?
Mucosal involvement
What is Ulipristal (EllaOne)?
A type of emergency hormonal contraception
How long after UPSI can Ulipristal (EllaOne) be used?
Up to 120 hours
What type of inhibitor is imatinib in chronic myeloid leukaemia?
Tyrosine kinase inhibitor
What should ‘fasciculations’ make you think of?
Motor neuron disease
What are the symptoms of retinitis pigmentosa?
Night blindness and tunnel vision
In which condition should ACE-inhibitors be avoided?
Hypertrophic obstructive cardiomyopathy (HOCM)
What is associated with optic neuritis?
Relative afferent pupillary defect
What do low-level gonadotrophins indicate in secondary amenorrhoea?
Hypothalamic causes
When do capillary haemangiomas develop rapidly?
In the first month of life
What can cause bilateral gritty, sore eyes?
Dry eye syndrome
What does a section 135 allow the police to do?
Remove a person from their property for a mental health assessment or treatment
Why are tricyclic antidepressants used less commonly now for depression?
Due to the danger in overdose
What severe side effect may antipsychotics cause?
Akathisia (severe restlessness)
What is the most important risk factor for cervical cancer?
Human papillomavirus infection (particularly 16, 18 & 33)
What are the signs and symptoms of lithium toxicity?
Diarrhoea, vomiting, abdominal pain, coarse tremor, weakness, seizures, muscle twitches, and blurred vision
What can cause pruritus?
Chronic kidney disease
What can quinine cause?
Drug-induced thrombocytopenia
What are the signs of central retinal vein occlusion?
Sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
What is the strongest risk factor for the development of Barrett’s oesophagus?
GORD (Gastroesophageal reflux disease)
Under what supervision should oral isotretinoin be used?
Specialist supervision
What are Gottron’s papules seen in?
Dermatomyositis
What is Chvostek’s sign?
Facial muscle spasm triggered by percussion over the facial nerve in hypocalcemia
What is the first-line treatment for syphilis?
Intramuscular benzathine penicillin
What is the first-line treatment for seborrhoeic dermatitis?
Topical ketoconazole
What is the recommended treatment for a recurrent episode of C. difficile within 12 weeks of symptom resolution?
Oral fidaxomicin
What can constipation cause in the elderly?
Delirium
What are the characteristics of otosclerosis?
Conductive hearing loss, tinnitus, positive family history
What type of disorder is cystic fibrosis?
Autosomal recessive
What does ocular pain, tearing, and photophobia with corneal uptake of fluorescein indicate?
Corneal ulcer
How is blepharitis initially managed?
With good lid hygiene techniques
What should be added for poorly controlled hypertension in a patient already taking an ACE inhibitor?
A calcium channel blocker or a thiazide-like diuretic
Who should be treated for threadworms?
Household contacts, even if they have no symptoms
What is the treatment of choice for biliary colic?
Elective laparoscopic cholecystectomy
What should be tried if a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance?
Extensive hydrolysed formula
How is symphysis-fundal height measured after 20 weeks of gestation?
In centimeters, which is equal to the gestation in weeks
What is the first-line management for patients with hypercalcaemia?
IV fluid therapy
What may patients allergic to aspirin also react to?
Sulfasalazine
What are the main components for managing sickle cell crisis?
Analgesia, oxygen, and IV fluids
What symptoms warrant urgent ENT evaluation for a deeper airway infection?
Acute sore throat with no obvious oropharyngeal signs, inability to swallow, sepsis, or trismus
What is a useful test of exocrine function in chronic pancreatitis?
Faecal elastase
What should be considered in the case of disproportionate microcytic anemia?
Beta-thalassemia trait
What are the symptoms associated with vestibular neuronitis?
Recurrent vertigo attacks lasting hours to days, associated with nausea
What is a stye?
Infection of the glands of the eyelids
What is the first-line management for young females with small fibroadenomas?
Watchful waiting without biopsy
What is Marfan’s syndrome associated with?
Repeated pneumothoraces
What is the treatment for Ramsay Hunt syndrome?
Oral aciclovir and corticosteroids
What are the symptoms of osteomalacia?
Bone pain, tenderness, and proximal myopathy (waddling gait)
What condition is associated with an acute onset of tear-drop scaly papules on trunk and limbs?
Guttate psoriasis
What is rouleaux formation seen in?
Myeloma
Why can sickle cell anaemia and other haemoglobinopathies give falsely low HbA1c readings?
Due to the decreased lifespan of RBCs
What is the diagnosis for a young woman who has stopped seeing her old friends due to fear of criticism?
Avoidant personality disorder
What are the typical symptoms of conversion disorder?
Loss of motor or sensory function, possibly caused by stress
What is the first-line medication used to prevent angina attacks?
Beta-blocker or calcium channel blocker
What should be done in the case of major bleeding while on warfarin?
Stop warfarin, give intravenous vitamin K 5mg, prothrombin complex concentrate
What causes hyperacute transplant rejection?
Pre-existing antibodies against ABO or HLA antigens
What are the NICE guidelines for NSTEMI/unstable angina based on?
6 month mortality risk
What are the features of ankylosing spondylitis known as the ‘A’s?
Apical fibrosis, Anterior uveitis, Aortic regurgitation, Achilles tendonitis, AV node block, Amyloidosis
What deficiency can isoniazid therapy cause?
Vitamin B6 deficiency causing peripheral neuropathy
What is the first-line treatment for otitis externa?
Topical antibiotics with or without steroid
In which patients is Donepezil generally avoided?
Patients with bradycardia
What is the initial management for epistaxis?
Adequate first aid - pinch the nasal ala (nostrils) firmly and lean forward for 20 minutes
How can spider naevi be differentiated from telangiectasia?
By pressing on them and watching them fill
How does spider naevi fill when pressed?
From the centre
How does telangiectasia fill when pressed?
From the edge
What is the classic presentation of IgA nephropathy?
Visible haematuria following a recent URTI
What is the investigation of choice for suspected aortic dissection?
CT angiography (depending on stability of patient)
What is the primary use of Propofol?
As an antiemetic for patients at high risk of post-operative vomiting
What is the most common adverse effect of the Progestogen-only pill?
Irregular vaginal bleeding
What is the breakthrough dose in relation to the daily morphine dose?
1/6th
What is the recommended treatment for flexural psoriasis?
Topical steroid
What causes secondary hypothyroidism?
Pituitary failure
What is a potential side effect of Lithium?
Tremor
What is the initial management for suspected pulmonary embolism?
Direct oral anticoagulant (DOAC)
What are common complications of seborrhoeic dermatitis?
Otitis externa and blepharitis
What is the management for children under 5 years with nocturnal enuresis?
Reassurance and advice
What does a left homonymous hemianopia indicate?
Visual field defect to the left, i.e. lesion of right optic tract
When can plasma paracetamol levels obtained less than 4 hours since ingestion be interpreted?
Cannot be interpreted
How is mild acute pancreatitis defined?
By the absence of both organ failure and local complications
What are the medical treatments for postpartum haemorrhage secondary to uterine atony?
Oxytocin, ergometrine, carboprost, and misoprostol
What worsens lateral epicondylitis?
Resisted wrist extension/suppination while elbow extended
What is the recommended action if chorioretinitis is suspected?
Must do an HIV test
What is the diagnostic maneuver for BPPV?
Dix-Hallpike maneuver
What additional medication is recommended for poorly controlled hypertension if already taking a calcium channel blocker?
Add an ACE inhibitor, angiotensin receptor blocker, or thiazide-like diuretic
What is Curling’s ulcer?
A stress ulcer that can occur after severe burns
How is NSTEMI management determined?
By a risk assessment score such as GRACE
What is the recommendation for surgery/sulfonylureas on the day of surgery?
Omit on the day of surgery, except for morning surgery in patients who take BD - they can have the afternoon dose
What is the preferable medication for rate control in atrial fibrillation?
Beta blockers
What examination is required for patients taking hydroxychloroquine long-term?
Baseline ophthalmologic examination
What should be done during testicular torsion surgery to prevent torsion of the other testes?
Fixation of both testes
What neurotransmitter changes result in alcohol withdrawal?
Decreased inhibitory GABA and increased NMDA glutamate transmission
What type of condition is Bell’s palsy?
Lower motor neuron condition
What is the likely cause of stepwise deterioration in cognitive function?
Vascular dementia
What is the recommended procedure if a colonic tumor is associated with perforation in an emergency setting?
End colostomy
What are the common gastrointestinal side-effects associated with metformin?
Diarrhoea and bloating
What is infrapatellar bursitis associated with?
Kneeling, as seen in clergymen
What condition is indicated by a patient’s inability to complete sentences?
Severe asthma
What is Gower’s sign seen in?
Duchenne muscular dystrophy
What symptoms does a positive Dix–Hallpike test recreate?
Benign paroxysmal positional vertigo
What may diltiazem cause the precipitation of?
Digoxin toxicity
What side effect may pioglitazone cause?
Fluid retention
What is the mechanism of action of Memantine?
NMDA receptor antagonist
What is an important form of acute dystonic reaction caused by antipsychotics?
What is an important form of acute dystonic reaction caused by antipsychotics?
Oculogyric crisis
What is the characteristic metabolic disturbance in Cushing’s syndrome?
Hypokalaemic metabolic alkalosis
What adverse effect can Ciprofloxacin lead to?
Tendinopathy
What can GPs use Section 4 of the Mental Health Act for?
To transfer a patient as an emergency for psychiatric assessment
What are the causes of scarring alopecia?
- Trauma/burns
- Radiotherapy
- Lichen planus
- Discoid lupus
- Tinea capitis
What adverse effect can Tamoxifen cause?
Hot flushes
What does RUQ pain with raised inflammatory markers in a patient with a history of gallstones point to?
Acute cholecystitis or cholangitis rather than biliary colic
What is the recommended dose of adrenaline to give during advanced ALS?
1mg
What is the recommended treatment for Dermatophyte nail infections?
Use oral terbinafine
How long should antidepressants be continued after remission of symptoms to decrease the risk of relapse?
At least 6 months
What is the most common organism causing a UTI in both children and adults?
E. coli
When is the anomaly scan done during antenatal care?
At 18-20 + 6 weeks
What are port wine stains?
Vascular birthmarks that do not spontaneously resolve
What are polyurethane condoms used for?
Latex allergies
What may thiazides cause in relation to digoxin?
Precipitation of digoxin toxicity
How is surgical excision of sebaceous cyst performed to prevent reoccurrence?
As a whole structure
What is the time until effectiveness for contraceptives if not used on the first day of the period?
- Instant: IUD
- 2 days: POP
- 7 days: COC, injection, implant, IUS
What is the significance of drusen in the context of eye health?
Dry macular degeneration
What are the side effects of calcium channel blockers?
- Headache
- Flushing
- Ankle edema
How can Acute Kidney Injury (AKI) be diagnosed in adults?
- Increase in creatinine by more than 26µmol/L in 48 hours
- Increase in creatinine by more than 50% in 7 days
- Decrease in urine output to less than 0.5ml/kg/hr for more than 6 hours
What can a right coronary infarct cause after infarction?
Arrhythmias due to the supply to the AV node
What is a characteristic sign of aortic regurgitation?
Wide pulse pressure
In what condition can caffeine be used as a respiratory stimulant in newborn babies?
Apnea of prematurity
What medical condition is anterior uveitis associated with?
Ankylosing spondylitis
What medication should be added for a newly diagnosed hypertensive patient under 55 years old?
An ACE inhibitor or an angiotensin receptor blocker
What is the mechanism of action of Finasteride?
It inhibits 5 alpha reductase, which converts testosterone into DHT
What type of blood product has the highest risk of bacterial contamination?
Platelet transfusions
What does progressive peripheral polyneuropathy with hyporeflexia suggest?
Guillain-Barre syndrome
What is the recommended score to help identify outpatients with a pulmonary embolism?
Pulmonary Embolism Severity Index (PESI) score
What is calcitonin a marker for in medullary thyroid cancer?
Tumour marker
How does retinitis pigmentosa classically present on fundoscopy?
Black bone-spicule pigmentation
How could orbital lymphoma present?
Like a chronic unilateral conjunctivitis resistant to treatment
Should amiodarone be avoided in breastfeeding?
Yes
What may precipitate Pompholyx eczema?
- Humidity (e.g. sweating)
- High temperatures
What should be given to patients undergoing fibrinolysis for a STEMI?
An antithrombin drug
What does somatization refer to?
Symptoms
What does hypochondria refer to?
Cancer
How long is the warfarin treatment for provoked venous thromboembolism?
3 months
How long is the warfarin treatment for unprovoked venous thromboembolism?
6 months
What do small testes in precocious puberty indicate?
An adrenal cause of the symptoms
What complication can result from damage to parathyroid glands during thyroid surgery?
Hypocalcemia
What is carbamazepine?
A P450 enzyme inducer
What condition should be considered with raised FSH/LH in primary amenorrhea?
Gonadal dysgenesis (e.g. Turner’s syndrome)
What visual changes can be secondary to Viagra?
Blue vision
What visual changes can be secondary to digoxin?
Yellow-green vision
What condition is commonly associated with anterior uveitis?
HLA-B27 conditions
What does red eye, gritty sensation, swollen conjunctivae, and discharge crusting the eyelashes indicate?
Conjunctivitis
What is idarucizumab used for?
Reversal agent for dabigatran
What type of hypersensitivity reaction is allergic contact dermatitis?
Type IV
What medication should be added for a newly diagnosed patient of black African or African–Caribbean origin with hypertension?
Calcium channel blocker
What is the medical term for the sensation of smelling roses without losing consciousness?
Focal aware seizure
What further tests are offered to women with a ‘higher chance’ combined or quadruple test result?
NIPT or diagnostic tests (amniocentesis, CVS)
What do statins inhibit in hepatic cholesterol synthesis?
HMG-CoA reductase
What is the positive predictive value (PPV) of FOB in colorectal cancer screening?
5-15%
What is the adjuvant hormonal therapy for ER +ve breast cancer in post-menopausal women?
Anastrozole
What are the three symptoms of Charcot’s cholangitis triad?
- Fever
- Jaundice
- Right upper quadrant pain
What is an epididymal cyst a cause of?
Scrotal swelling
What is the most commonly performed operation for rectal tumors, except in lower rectal tumors?
Anterior resection
How long can a Section 136 be used for?
Up to 24 hours
What does pulmonary fibrosis cause in spirometry?
Restrictive pattern (FEV1:FVC >70%, decreased FVC)
What does pulmonary fibrosis cause in gas exchange?
Impaired gas exchange (reduced TLCO)
Are antibiotics indicated in uncomplicated acute sinusitis?
No
What may loop diuretics cause?
Hypokalemia
In ALS, what is the ratio of chest compressions to ventilation?
30:2
What may trigger an exacerbation in psoriasis?
Lithium
What is the next step in cervical cancer screening if the 1st repeat smear at 12 months is hrHPV negative?
Return to routine recall
What are antihistone antibodies associated with?
Drug-induced lupus
What does the presence of Auer rods on a blood film strongly suggest?
Acute promyelocytic leukemia
When should the dose of metformin be reviewed according to NICE recommendations?
If the creatinine is > 130 micromol/l (or eGFR < 45 ml/min)
When should metformin be stopped according to NICE recommendations?
If the creatinine is > 150 micromol/l (or eGFR < 30 ml/min)
What is the most common reason for total hip replacements to be revised?
Aseptic loosening
What does maternal mortality include?
Any death in pregnancy and labor as well as up to six weeks postpartum
What extrapyramidal side effect can metoclopramide cause, mainly as the earliest symptom?
Acute dystonia
What may antipsychotics cause?
Tardive dyskinesia
What is associated with schistocytes due to microangiopathic haemolytic anaemia?
DIC (Disseminated Intravascular Coagulation)
What is telogen effluvium?
The loss and thinning of hair in response to severe stress
What surgical procedure is recommended for caecal, ascending, or proximal transverse colon cancer?
Right hemicolectomy
In autosomal recessive conditions, if both parents are carriers, what is the chance of having an affected child?
25%
What should be checked before starting treatment with Azathioprine?
Thiopurine methyltransferase deficiency (TPMT)
What is the consequence of pneumothorax in relation to deep sea diving?
A lifelong ban
What condition is associated with micrognathia, low-set ears, rocker bottom feet, and overlapping of fingers?
Edward’s syndrome
What may laughter trigger in individuals with cataplexy?
Fall/collapse
What are the characteristics of Fitzpatrick skin type 1?
- Pale skin
- Freckles
- Blue eyes
- Red hair
- Always burns, never tans
What condition may volatile liquid anaesthetics cause?
Malignant hyperthermia
What are the common features associated with fragile X syndrome in a young boy?
- Learning difficulties
- Macrocephaly
- Large ears
- Macro-orchidism
What is chondrodermatitis nodularis helicis?
A benign, painful nodule on the ear, more common in men than women
What does an anion gap of > 14 mmol/L typically indicate?
A raised anion gap metabolic acidosis
What can obesity cause in children?
Snoring
What is a known effect of beta-blockers on plaque psoriasis?
Exacerbation
Is it considered safe to use cephalosporins while breastfeeding?
Yes
What is a common symptom of organophosphate insecticide poisoning?
Bradycardia
What are the features of Grade 1 hypertensive retinopathy?
- Tortuosity
- Silver wiring
What route is no longer recommended for giving drugs in ALS if IV access cannot be achieved?
Tracheal route
What is a characteristic feature of benign rolandic epilepsy?
Partial seizures at night
What is the antidote for opiate overdose?
Naloxone
What is the Rinne result in conductive hearing loss?
Bone conduction > air conduction in affected ear, Air conduction > bone conduction in unaffected ear
What is the Weber result in conductive hearing loss?
Lateralises to affected ear
What are Brushfield spots associated with?
Down syndrome
What is the probable condition with short stature and primary amenorrhoea?
Turner’s syndrome
What are the characteristics of Cotard syndrome?
Believing they are dead or non-existent
What syndrome is associated with a webbed neck, pulmonary stenosis, ptosis, and short stature?
Noonan syndrome
What surgical procedure is indicated for rectal cancer on the anal verge?
Abdomino-perineal excision of rectum
What type of COX inhibitor is aspirin?
Non-reversible COX 1 and 2 inhibitor
What may cause anal ulceration?
Nicorandil
What are the characteristic features of Patau syndrome?
- Microcephaly
- Small eyes
- Low-set ears
- Cleft lip
- Polydactyly
What treatment may be useful for keloid scarring?
Intra-lesional steroids
What may anthracyclines (e.g. doxorubicin) cause?
Cardiomyopathy
What are the GCS components and their respective points?
- Motor (6 points)
- Verbal (5 points)
- Eye opening (4 points)
What mnemonic can be used to remember GCS components and their points?
‘654…MoVE’
What type of conditions are autosomal recessive conditions?
‘Metabolic’
What are the exceptions for autosomal recessive conditions?
‘Inherited ataxias’
What type of conditions are autosomal dominant conditions?
‘Structural’
What are the exceptions for autosomal dominant conditions?
‘Gilbert’s, hyperlipidemia type II’
What is Capgras syndrome?
The delusion that a friend or partner has been replaced by an identical-looking impostor
When is an intrauterine system (e.g. Mirena) particularly useful?
When patients have underlying medical problems (e.g. hypertension) and/or menstrual problems such as heavy periods
What is the recommended management for congenital inguinal hernias?
Repair ASAP
What is the recommended management for congenital umbilical hernias?
Manage conservatively
Who should be referred to gynaecology for investigation?
All patients with secondary dysmenorrhoea
What are non-hormonal methods that may help vasomotor symptoms of menopause?
- Selective serotonin reuptake inhibitors
- Venlafaxine
When should Methotrexate be stopped before conception in both men and women?
At least 6 months before conception
What should be corrected before giving bisphosphonates?
Hypocalcemia/vitamin D deficiency
What is oesophageal adenocarcinoma associated with?
GORD or Barrett’s
When is external pacing used for symptomatic bradycardia?
If atropine fails
How may acute lymphoblastic leukaemia present?
With haemorrhagic or thrombotic complications due to DIC
When should circumcision not be performed for infants with hypospadias?
The foreskin may be used in the corrective procedure
What does metabolic acidosis with low pCO2 indicate?
Respiratory compensation
What is the combined oral contraceptive pill a protective factor for?
Endometrial cancer
What infection classically triggers Guillain-Barre syndrome?
Campylobacter jejuni
When should patients ≤ 25 years started on an SSRI be reviewed?
After 1 week
What are women with diabetes considered at high risk of conceiving?
Child with neural tube defects
How can premature menopause be diagnosed in women?
- Irregular menstrual cycle before age 45
- Blood tests showing raised FSH/LH and low oestradiol
What is the management required for bronchiolitis in children?
Supportive management only, no antibiotics
What are the typical symptoms associated with phaeochromocytoma?
- Sweating
- Headaches
- Palpitations
- Severe hypertension
What is the indication for surgical management in the context of an ectopic pregnancy?
Presence of a foetal heartbeat on ultrasound
What condition is suggested by the presence of raised haemoglobin, plethoric appearance, pruritus, splenomegaly, and hypertension?
Polycythaemia vera
What should children with new-onset purpura be immediately referred for investigations to exclude?
ALL and meningococcal disease
What is the first-line management for ankylosing spondylitis?
Exercise regimes and NSAIDs
What should a patient suspected of TIA within 7 days receive immediately?
300mg aspirin
What is the initial empirical therapy for meningitis if > 3 months of age?
IV 3rd generation cephalosporin
What is the first-line treatment for pediatric migraine?
Ibuprofen
What should pregnant women with a BMI >= 30 kg/m² receive daily until the 13th week of pregnancy?
5 mg folic acid
When are topical antibiotics recommended for stye?
If associated with conjunctivitis
What is the first-line pharmacological treatment of COPD?
SABA or SAMA
What are the early signs of necrotising enterocolitis?
- Feeding intolerance
- Abdominal distension
- Bloody stools
What is a good first-line anti-emetic for intracranial causes of nausea and vomiting?
Cyclizine
What is tested as the first step in cervical smear samples?
hrHPV
What is the initial approach for acute onset of atrial fibrillation if ≥ 48 hours?
Rate control initially, then delay cardioversion until maintained on therapeutic anticoagulation for a minimum of 3 weeks
What is gastroschisis associated with, in contrast to exomphalos?
Stand alone bowel condition
What should be avoided in patients co-prescribed warfarin?
SSRIs
At what age is a child assumed competent to consent for treatment?
Over 16 years old
Is intermittent squint in newborns less than 3 months normal and needs investigation?
No, it is normal and does not need investigation
What is the initial management for atrial fibrillation if present for 48 hours or more?
Rate control initially, then delay cardioversion until maintained on therapeutic anticoagulation for a minimum of 3 weeks.
What is gastroschisis associated with in contrast to exomphalos?
Stand alone bowel condition.
What should be avoided in patients co-prescribed warfarin?
SSRIs.
At what age is a child assumed competent to consent for treatment?
Over 16 years old.
Is intermittent squint in newborns less than 3 months normal and needs investigation?
No, it is normal and does not need investigation.
What is contraindicated for ventricular tachycardia?
Verapamil.
What are the characteristics of antiphospholipid syndrome?
(Paradoxically) prolonged APTT + low platelets.
What is the treatment for life-threatening C. difficile infection?
ORAL vancomycin and IV metronidazole.
What condition should be considered if dysphagia affects both solids and liquids from the start?
Achalasia.
What should be given to patients with an uncertain tetanus vaccination history?
Booster vaccine + immunoglobulin, unless the wound is very minor and < 6 hours old.
What is the screening test for adult polycystic kidney disease?
Ultrasound.
What daily supplement should all pregnant women take?
10 micrograms of vitamin D.
At what stage of pregnancy are women offered the pertussis vaccine?
Between 16-32 weeks.
What should patients with ascites and low protein concentration be given as prophylaxis?
Oral ciprofloxacin or norfloxacin.
What is Citalopram associated with?
Dose-dependent QT interval prolongation.
When should proton pump inhibitors be stopped before an upper GI endoscopy?
2 weeks before.
What is St John’s Wort’s effect on the combined oral contraceptive pill?
Reduces effectiveness.
Is jaundice in the first 24 hours always pathological?
Yes.
What are the recommended medications for hiccups in palliative care?
Chlorpromazine or haloperidol.
How long is the Mirena intrauterine system licensed for use as the progesterone component of HRT?
4 years.
What is the first-line treatment for pneumonia in children who are not allergic to penicillin?
Amoxicillin.
What should all patients be offered following an ACS?
Dual antiplatelet therapy (aspirin plus a second antiplatelet agent).
What type of drug is an ACE inhibitor?
It is an antihypertensive drug.
What is the main function of a beta-blocker?
To reduce blood pressure and treat heart conditions.
What is the primary purpose of a statin?
To lower cholesterol levels.
What should be given to reduce the risk of GI bleeding when combining SSRI and NSAID?
A PPI (Proton Pump Inhibitor).
What is a potential side effect of GnRH agonists like goserelin used in prostate cancer management?
Gynaecomastia.
Why is diclofenac now contraindicated with any form of cardiovascular disease?
Due to increased cardiovascular risk.
What is the characteristic feature of polymyalgia rheumatica?
Abrupt onset of bilateral early morning stiffness in the over 60s.
Why should a child with suspected acute epiglottitis not undergo an oral or throat examination?
To avoid triggering airway obstruction.
What risk can PPIs increase in patients?
Osteoporosis and fractures.
What is a risk factor for macular degeneration?
Smoking.
What is the first-line treatment for moderate/severe obstructive sleep apnoea following weight loss?
CPAP (Continuous Positive Airway Pressure).
How is Trichomonas vaginalis treated?
With oral metronidazole.
What is an important and common interaction with statins?
Erythromycin/clarithromycin.
What are the requirements for a urea breath test?
No antibiotics in the past 4 weeks, no antisecretory drugs (e.g. PPI) in the past 2 weeks.
When should allopurinol be offered to patients?
After their first attack of gout.
What condition is associated with no mucosal involvement?
Bullous pemphigoid.
What condition is associated with mucosal involvement?
Pemphigus vulgaris.
What is a loop ileostomy used for?
To defunction the colon and protect an anastomosis.
What are actinic keratoses?
Premalignant skin lesions.
What may varicoceles be associated with?
Infertility.
What is the triad of the shaken baby syndrome?
Retinal haemorrhages, subdural haematoma, and encephalopathy.
What is a possible differential diagnosis for a child presenting with petechiae and no fever?
ITP (Idiopathic Thrombocytopenic Purpura).
What would favor a calcium channel blocker over a thiazide for a patient with hypertension already taking an ACE inhibitor and a history of gout?
A history of gout.
What are the first-line antibodies tested for coeliac disease?
Tissue transglutaminase antibodies.
What is the strongest risk factor for psychotic disorders?
Family history.
