Imperial Formatives and Past Papers Flashcards by Laura Lazzari

How do you differentiate PMR from autoimm arthritides

PMR stiffness takes A LOT LONGER to improve in the monring (2-3 hours)

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how do you manage PMR

PREDNISOLONE

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whhat must you check if suspecting a carbon monoxide poisoning

check CARBOXYHAEMOGLOBIN

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what drugs must patients with mechanical valves be on

WARFARIN and ASPIRIN

NOT DOACs yet !!!

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what can trigger psoriasis

TRAUMA (skin injury) 
alcohol 
drugs (lithium, beta blockers, antimalarials, NSAIDS, ACEI) 
withdrawals of steroids 
Infection

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what infection triggers guttate psoriasis

STREP

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whicih airway device protects against aspiration

ENDO TRACHEAL TUBE

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what other type of mass in the testis transilluminates that is not a hydrocoele, and how does it present differently

EPIDIDIMAL CYSTS also transilluminate (because fluid filled)

aka spermatocoele (they are the same thing!)

cysts do NOT surround the testis (unlike hydrocoeles)
- they are well defined and you can GET ABOVE THEM

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how should you measure MG respiiratory failure

FVC <1L

negative inspiratory force (NIF) < 20 cm H2O

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what is first line antipsychotic for delirium

HALOPERIDOL (PO >if refuse, IM)

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when is haloperidol contraindicatedd

if Parkinsons disese, ECG abnormalities

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what must you five when haloperidol is contraaindicated

give LORAZEPAM instead

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when do you NOT need to give anything for suspected tetanus wound?

if last VACCINE dose <10 years ago

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what do you need to give in high risk tetanus wound with vaccine more than 10 years ago

if tetanus prone: reinforce vaccine dose
if very HIGH risk: reinforce vaccine dose + tetanus IVIG

(treat like this if you are unsure of tetanus vaccine status)

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what feature on urine MCS is suggestive of contamination

mixed bacterial growth

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what can commonly precipitate lithium toxicity

DEHYDRATION (e.g. due to diarrhoea and vomiting)

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what is opening pressure like in bacterial men

HIGH

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what is opening pressure like in viral men

NORMAL

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first line reccomended ix for renal stones

unenhanced CT KUB

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when must you stop an ACE i

STOP when creatinine increases by MORE THAN %30 over the first two months

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how do you investigate a vestibular schwannoma (or any concerning cause of tintinnus / hearing loss to exclude this)

with an MRI

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how does catapexy present

loss of skeletal muscle tone with strong (happy) emotions

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what is second line for OA (after paracet / topical NSAID)

oral NSAID + PPI

weak opioid

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which virus causes tonsillar adenocarcinoma

HPV

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what are risk factors for tonsillar adenocarcinoma

HPV smoking alcohol

what is first line mx for DCIS breast cancer (unless >4cm)

Wide local excision (for cancers <4cm)

when is colectomy reccomended for UC

when there is EPITHELIAL DYSPLASIA | because this means there is a high risk of mutating to cancer

what do red cell casts suggest

NephrITIC syndrome

what do brown granular casts suggest

ATN

what is the difference on LP between viral meningitis and encephalitis

NO DIFFERENCE | they both only have slightly raised lymphoocytes

so how do you tell the difference betweel viral men and enceph

encephalitis will have seizures, more focal neuro degficits, altered mental state

describe the presentation of PSORIATIC ARTHRITIS in detail

- Psoriasis - Nail POSh - Enthesitis (incl sacroilitis) - Dactylitis (swollen fingers) - Arthritis (asymmetrical, DIPJ affected, asthtiris mutilans, SPINAL ARTHRITIS)

what type of arthritis presents with DIPJ pain and back pain?

PSORIATIC

what is the most common arrythmia and cause of death after MI?

Ventricular FIBRILLATION

what bad thing could myelodysplasia become?

AML (1/3)

how does PCP show up on CXR

may be normal | or may present as bilat interstitial infiltrates / perihilar haziness

nail change in hyperthyroidism

onycholysis

which bacterium causing bloody diarrhoea is comma shaped / curved gram -ve rod

Campylobacter jejuni

what does an enlarged mediastinum om CXR indicate

aortic dissection

which tachyarrythmia does prolonged QT suggest

what does a positive McMurray's indicate

a TORN meniscus

where does BCC spread to

it doesn't - LOCAL INVASION ONLY

whar do FLOATERS + SUDDEN LOSS OF VISION SUGGEST

Retinal detachment

in graves disease what causes exopthalmos (EYE BULGING OUT)?

Thickening of the rectal muscle

what is the most common benign solid renal lesion

Angiomyolipoma

if on asthma on inhaler therapy, what causes painful swallow?

the steroid e.g. betamethasone | as it causes candidiasis

which neuropathic pain drug causes urinary retention

amiltyptiline

electrolytic imbalances in TLS

HIGH potassium, urate, phosphate Low calcium and mg

effect of HYPOkalaemia on muscles

twitching, cramps

what do you do to metformin before surgery in well pateitn

if BD: take as normal | if TDS: omit lunch dose

what do you do with sulphonylurea before surgery in well pt

if OD: omit | if BD: take afternoon dose only

when do you need to start insulin sliding scale before surgery in diabetic pt

if poor contol of DM HbA1c >69 T2DM and missing more than 1 meal and BM >12 Emergency surg

which epicondilytis is LATERAL, causing pain on wrist EXTENNSION?

Tennis epicondylitis

which artery is affected in LAT MEDULLARY SYNDROME

PICA Posterior inferior cerebellar artery

which investigation is diagnostic for Sjogren

biopsy

mx alk spond

Physio | NSAID > NSAID > anti-TNFalpha (e.g. etanercep) or infiximab

what advice can you give to pt on inhaled beclometasone experiencing oral candidiasis

stop smoking rinse mouth after using spacer

what is the oonly first line abx for UTI in pregnant women, except for at term?

nitrofurantoin!

second line abx for pregnant women with UTI

cefalexin | amoxicillin

who do you need to fill out an advanced request for

for patients who WILL LOSE CAPACITY

what is the BIGGEST RF for adenocarcinoma of the oesophagus

Barrett's

what is the pathophysiology of dupytrens contnracture

thickened palmar fascia

what is costoconndritis

inflammation of cartilage in the aterior chest wall

sx costochondritis

pleuritic chest pain | pain on palpation of chest

what is a chylothorax

lymphatic fluid leaked into pleural space | milky white

what causes chylothorax

surgery | cancer

Most common side effect of radiotherapy for SCC lung cancer

oesophagitis

hepatocell carcinoma marker

AFP

which screening test can you use for malnutrition

MUST Malnutrition Universal Screen Tool | it takes into account BMI, recent weight change and the presence of acute disease

how do you treat SC compression caused by mets

if non-frail, few lesions: surgical decom | if frail: dexamethasone PO/IV + radiotherapy

what test investigates sleep disorders (i.e. people who keep falling asleep in daytime )

Polysomnography (incl narcolepsy, OSA)

which bacterium causes pneumonia in CF pt

pseudomonas aeroginosa

27. Blood supply to 2nd part of duodenum

gastroduodenal artery

how do you calculate alcohol units

Volume x ABV / 1000

how do you manage a necrotic neuropathic ulcer

sharp debridement

whic cancer has keratin pearls

SCC

what type of pleural effusion does a PE cause

EXHUDATIVE

what is the preferred antithyroid drug in pregnancy

PROPILTHIOURACIL | carbimazole is teratogenic

what disease causes Colon biopsy showed caseous necrosis and Langerhans histiocytes

what kind of renal disease does SLE cause

NEPHRITIC (blood, protein in urine)

how do you manage COPD pt with low sats if If the saturation remains below 88% in prehospital care despite a 28% Venturi mask

Change to nasal cannulae at 2– 6 L/min or a simple face mask at 5 L/min with target saturation of 88–92% and alert the emergency department that the patient is to be treated as a high priority.

what diet do you use for IBS

FODMAP diet

what does the FODMAP diet involve

stop eating certain foods, reitroduce slowly Dairy-based milk, yogurt and ice cream Wheat-based products such as cereal, bread and crackers Beans and lentils Some vegetables, such as artichokes, asparagus, onions and garlic Some fruits, such as apples, cherries, pears and peaches