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Imperial past papers Flashcards

1
Q

Runner with irregular periods, where is problem

A

Hypothalamus

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2
Q

Features of CF

A

AR inheritance
Recurrent chest infections
Bronchiectasis
Pancreatic dysfunction
Small and skinny

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3
Q

CXR showing multiple air filled sacs in lungs

A

Septic emboli

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4
Q

Milky fluid drained from chest drain

A

Chylothorax- leakage of lymph fluid

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5
Q

Which cell is primarily affected in multiple sclerosis

A

Oligodendrocytes- myelin producing cells

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6
Q

How diagnose FH

A

Simon broome criteria
TC > 7.5 mmol/l and LDL-C > 4.9 mmol/l
WITH evidence of
- family member with xanthomas
- early MI

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7
Q

Useful blood investigations for polymyositis

A

Anti-Jo (anti synthetase)
CK

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8
Q

Management of metastatic spinal cord compression

A

Dex and urgent MRI
Consideration of radiotherapy or spinal surgery depending on suitability for surgery

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9
Q

How calculate units in alcoholic drink

A

%*mls divided by 1000

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10
Q

Management of neuropathic ulcer with black crust

A

Urgent referral as ischaemic

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11
Q

Post partum thyroiditis presentation

A

Thyrotoxicosis
Hypothyroid

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12
Q

Management of post partum thyroiditis

A

Thyrotoxicosis- give propanolol
Hypothyroid- thyroxine replacement

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13
Q

Management of graves if breastfeeding

A

All thionamides safe

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14
Q

Caseating necrosis with langerhans cells in bowel

A

TB

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15
Q

Differentials for granulomas in bowel

A

TB- necrotising
Crohns

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16
Q

What diet use for IBS

A

FODMAP

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17
Q

What is FODMAP diet helpful for

A

IBS
SBOSS

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18
Q

Sprain ankle- most likely ligament affected

A

Anterior tabofibular ligament

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19
Q

Types of chemo
- neoadjuvant
- adjuvant
- palliative
- curative

A

Neo- before main treatment eg surgery
Adjuvant- after main treatment
Palliative- prolong life
Curative- in name

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20
Q

What do if chemical injury to eye

A

Irrigate for 30 mins with saline then refer to opthal

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21
Q

When refer corneal foreign bodies to opthal

A

Suspected penetrating eye injury
Significant orbital or peri-ocular trauma has occurred.
Chemical injury
Foreign bodies composed of organic material
Foreign bodies in or near the centre of the cornea
Any red flags e.g. severe pain; irregular, dilated or non-reactive pupils; significant reduction in visual acuity.

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22
Q

Management of high cholesterol

A

Start on 20mg statin
Review after 3 months and assess if over 40% reduction in non-HDLc
- if not increase dose
Review after 3 months and reassess
- consider alternate agent

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23
Q

Choking BLS

A

Get to cough
If becomes ineffective or cant do, do 5 back blows
5 abdominal thrusts
If ineffective unresponsive at any point do CPR

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24
Q

Difficulty swallowing relieved by drinking lots of water

A

Pharyngeal pouch

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25
Q

What causes trifasicular block

A

Complete HB

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26
Q

If fluid restriction does not work for SIADH what use

A

Demecycline or tolvaptan

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27
Q

What causes production of ketones in DKA

A

Increased lipolysis

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28
Q

What monitor in refeeding

A

Phosphate

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29
Q

Man working on construction site with rats and pigeons, living in caravan nearby. Has abdo pain and nausea. Blood film showed basophilic stippling and sideroblasts. What is cause

A

Lead poisoning

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30
Q

Notifiable infections

A

Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Monkeypox
Mumps
Plague
Rabies
Rubella
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever
Whooping cough
Yellow fever

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31
Q

Pathophysiology of BBPV

A

Crystals of calcium phosphate in ear- otoconia

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32
Q

Which x ray plane best to do for c spine fracture

A

Lateral

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33
Q

What do with regards to head CT if on antiplatelets

A

Within 8 hours
NOT ASPIRIN MONOTHERAPY

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34
Q

What does SMA vs IMA supply

A

SMA- ampulla of vater onwards to distal 1/3 of transverse colon
IMA- Distal 1/3 of transverse colon onwards

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35
Q

Inheritance of BRCA

A

AD

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36
Q

How manage candida in catheter

A

Asymptomatic- change catheter
Symptomatic- oral fluconazole

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37
Q

How manage proteinuria in nephrotic syndrome

A

Reduce dietary protein
Give ACEi

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38
Q

Patient is brain dead, what determines prognosis

A

Brainstem reflexes

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39
Q

Patient has chronic RUQ pain with dilatation of intrahepatic ducts, what antibody

A

ANCA as PSC

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40
Q

Man rescured from house fire is wheezy with soot in mouth and nose what give

A

100% oxygen (worried about CO poisoning)

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41
Q

How feed a patient with a prolonged postoperative ileus

A

IV parenteral feeding

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42
Q

Woman with history of radiation for cervical cancer presents with continuous dribbling of urine

A

Vesicovaginal fistula

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43
Q

First line investigation for suspected laryngeal cancer

A

Flexi-nasoendoscopy

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44
Q

Which substance is the primary factor facilitating platelet adhesion?

A

VWB factor

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45
Q

A 50 year old woman has suddenly become short of breath. She has found it painful to swallow for two months, and she has coughed up a small amount of blood. She is distressed and cannot lie flat.
Her temperature is 37.5°C. Her respiratory rate is 40 breaths per minute and her oxygen saturation is 78% using 15L pe minute via a re-breather mask. She has inspiratory stridor.
What is the most appropriate action to take?
Continuous positive airways pressure ventilation
Endotracheal intubation
Nebulised bronchodilators
Oral airway
Tracheostomy

A

Endotracheal intubation

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46
Q

What scan use to plan surgery on ankle fracture

A

CT

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47
Q

A 70 year old woman is admitted with a one week history of worsening breathlessness. She looks pale. She has a temperature of 36.2°C, pulse rate 100 bpm, BP of 132/68 mmHg, JVP +8 cm above the sternal angle and oxygen saturation 94% on 40% oxygen via a face mask. She has bilateral inspiratory crepitations to the midzones. She has a pansystolic murmur at the apex.Investigations:
Haemoglobin 52 g/L (115-150)
MCV 120 fL (80-96)
White cell count 3.0 x 109/L (3.8-10.0)
Platelets 87 x 109/L (150-400)
Which is the most likely diagnosis?
Acute myeloid leukaemia
Alcoholic cardiomyopathy
Hypothyroidism
Pernicious anaemia
Viral myocarditis

A

Pernicious anaemia
Think HF due to anaemia
Mitral regurg can be a result of HF
Pernicious anaemia would give the very high MCV and pancytopenia

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48
Q

First thing do if patient develops signs of transfusion reaction

A

Stop
ABC
Check details

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49
Q

If develop raised ALT as IVDU what is most likely cause

A

Hep C- incidence higher in IVDU

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50
Q

A 19 year old man has 3 weeks of diarrhoea. He is a student and has just returned from a gap year in Thailand.
Investigations:
Haemoglobin 96 g/L (130-175)
MCV 76 fL (80-96)
Eosinophils 3.1 x 109/L (0-0.4)
Which is the most likely diagnosis?
Amoebiasis
Campylobacter
Hookworm
Shigellosis
Typhoid fever

A

Hookworm
Causes IDA and also as parasite will cause eosinophillia
For protozoa like amoeba would not cause eosinophillia

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51
Q

What is trendelenburg manoeuvre

A

Where position patient lying down with head beneath body

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52
Q

Blood film shows smear cells what is next investigation

A

Immunophenotyping with flow cytometry

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53
Q

How best diagnose giardia

A

Stool sample will see parasites

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54
Q

Patient comes in unstable with blood diarrhoea on history of IBD like symptoms, what do next

A

CT
X rays going out of fashion

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55
Q

What is preferred test nowadays for H pylori

A

Faecal antigen test

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56
Q

If HBe IgG what does this mean

A

NOT that necessarily actively replicating, just that previous infection

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57
Q

How diagnose Hep D

A

Anti Delta IgM

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58
Q

Thyroid cancer of parafollicular (C) cells

A

Medullary

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59
Q

How investigate RAS

A

MR/CT angio

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60
Q

How treat RAS

A

If very problematic then percutaneous renal artery angioplasty

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61
Q

How differentiate inferior vena cava obstruction from portal HTN

A

Look at vein underneath umbilicus and which direction blood is flowing
IVCO- blood flow upwards
Portal HTN- blood flows towards feet

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62
Q

SNAPP causes

A

Sulphonamides
NSAIDS
Allopurinol
Penicillin
Phenytoin

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63
Q

Most likely cause of amaurosis fugax

A

Cholesterol deposit emboli

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64
Q

If LP shows positive SAH what do next

A

CT angio

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65
Q

When give thiamine for seizures

A

Alcoholic
Malnutrition
Give straightaway in initial period before benzos

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66
Q

Most likely cause of medical third nerve palsy

A

DM

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67
Q

If third nerve palsy with dilated pupil only what must ensure do

A

Urgent imaging

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68
Q

If unstable UC presentation what is first thing do

A

CT abdomen
X rays not recommended anymore

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69
Q

What give for fluids refractory septic shock

A

Vasopressors- noradrenaline etc

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70
Q

When say consider stopping in AKI what is reasoning behind this

A

They are drugs which will accumulate and lead to toxicity if renal function is poor

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71
Q

When monitor CVP

A

Do on ITU
Helps tailor dose of inoptropes and vasopressors when treating shock

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72
Q

What do for AF incidentally picked up with no symptoms and normal HR

A

Just give DOAC

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73
Q

What use for AF if valvular disease

A

Warfarin

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74
Q

If cardiogenic shock from cardiac tamponade what use

A

Fluids
Inotropes will not work

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75
Q

If pericardiocentesis resistant cardiac tamponade what use to treat

A

Pericardial window

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76
Q

If someone is completely unable to take any anticoagulation what do for stroke risk in AF

A

Can insert left atrium appendage occlusion device

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77
Q

Does VT within 1 week of MI require ICD

A

No as very common then

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78
Q

What investigation do if raised troponin and angiogram normal

A

Cardiac MRI
Will help give idea of fibrosis/local damage to cardiac tissue

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79
Q

Most common site of AF impulse initiation

A

Pulmonary veins

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80
Q

What can be seen on CXR of mitral stenosis

A

Small nodules around lungs from haemosiderin depostion as pulmonary HTN has lead to haemolysis

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81
Q

How differentiate septic, cardiogenic and hypovolaemic shock

A

Cardiogenic= elevated BP
Septic= warm peripheries

82
Q

What is seen in background diabetic retinopathy

A

Hard exudates
Venodilation
Microaneurysms

83
Q

HTN retinopathy scale keith wagener

A

1- silver wiring
2- AV nipping
3- flame haemorrhages, cotton wool spots
4- papilloedema

84
Q

Patient comes in with suspected stroke, what is next most important step

A

Contact stroke team
Then do CT

85
Q

Headaches for past few days with painful eye and vomiting

A

Acute glaucoma

86
Q

What are different types of optic neuritis

A

Retrobulbar- involves part of nerve behind the eye
Papillitis- involves portion of optic nerve within the eye
Are differentiated by the presence of papilloedema seen in papillitis

87
Q

What type of drug is 5 fluoracil

A

Topical cytotoxic chemotherapy

88
Q

MSC equation for osmolality

A

2(Na)+urea+glucose

89
Q

What is difference between anterior ischaemic optic neuropathy vs central retinal artery occlusion

A

Anterior ischaemic optic neuropathy occurs from inflammation of vessels supplying optic nerve like in GCA
Central retinal artery occlusion occurs when is “eye stroke”

90
Q

Fundoscopy differences between anterior ischaemic optic neuropathy and central retinal artery occlusion

A

Anterior ischaemic optic neuropathy- engorged disc which appears swollen
Retinal artery occlusion- pale retina with cherry red spot in macula

91
Q

Choice of neuropathic analgesic in DM

A

Duloxetine or amitryptyline
If renal impairment use amitryptyline

92
Q

In MSC questions which factor often rules out TB

A

Absence of fever

93
Q

Difference in colour of BCC vs SCC

A

BCC= pale
SCC= red

94
Q

When are antibiotics with catheter change indicated

A

Neutrophils 1 x 109/L
Multiple attempts or traumatic insertion,
Post trans-urethral urological surgery
Previous episode of catheter change related sepsis
Frank pus at the urethral meatus
Critical care patients

95
Q

What is a monitored dosage system

A

Method of dispensing tablets that enables you to keep track of medications particularly helpful in people with cognitive dysfunction or poor adherance

96
Q

Causes of headache with visual disturbance

A

Migraine
SAH
Acute glaucoma
Haemorrhage into pituitary
Cerebral venous sinus thrombosis

97
Q

Which hormonal contraceptive use for acne

A

Co-cyprindiol is licensed for acne
Progesterone often exacerbates it

98
Q

If getting oral candidiasis on inhaled steroids, what do to prevent

A

Take with a large colume spacer
Wash mouth after taking

99
Q

Patient sitting on chair all day with area if redness over lower back, what do

A

At risk of pressure sore so refer to district nurse who can make an assessment and think about - dressing, nutritional assessment and analgesia

100
Q

What do immediately after puncture from needlestick

A

Let it bleed, can apply antiseptic like alcohol hand solution

101
Q

Recent falls in elderly person, BP is 132/80 mmHg sitting and 138/84 mmHg standing, what drug is causing

A

Unlikely to be antihypertensive as no postural drop therefore consider alternate cause such as benzo or Z drug

102
Q

If had asthma attack what give long term on top of meds etc

A

Personalised asthmatic action plan

103
Q

How monitor if on orlistat or semaglutide

A

Review in 3 months
If not lost over 5% then STOP

104
Q

If distal aortic and external iliac stenosis what operation do

A

Aorto bi femoral bypass graft

105
Q

What area of congition is most affected in alzheimers

A

Short term memory

106
Q

What makes C.diff difficult to treat

A

Spore formation

107
Q

55 year old, smoker, has chest pain and SOB, what do as next investigation

A

CXR to rule out cancer

108
Q

DCIS management

A

> 4cm= mastectomy
<4cm= wide local excision

109
Q

Which cellular feature on biopsy of UC patient would encourage to have colectomy

A

Epithelial dysplasia

110
Q

Old man confused and shouting after hip replacement, obs are stable, no pain, Mx?
Stop morphine
Haloperidol
Midazolam
Well-lit room

A

Well lit room

111
Q

Woman calls GP about husband with terminal prostate cancer who is breathless?
Call 999
Ask another GP to visit next week
Tell her you will prescribe Abx for LRTI
Visit them in morning and community palliative discussion

A

Visit them in morning and community palliative discussion

112
Q

What causes non pulsatile raised JVP

A

SVCO

113
Q

Pneumonia with 30 pack year history, background of prostate antigen, blood gas shows low sodium, high urea, blood and sputum cultures already done, next?

A

Urinary legionella test

114
Q

How long does OA stifness last in morning

A

Up to 30 mins

115
Q

Which investigation diagnoses myositis

A

Muscle biopsy

116
Q

Person has very low urinary output with epidural in what need to do

A

Bladder scan to check not in retention

117
Q

Man with epidural which fell out, took a long time to get patient controlled analgesia, has a fever 1 day post-op?

A

Atelectasis- in pain so didnt breathe in properly

118
Q

Man on motorbike crashes into a car, has an internal rotated and shortened leg, adducted and flexed?

A

Posterior dislocation of femur

119
Q

59 y/o female with pruritus, IgM anti-mitochondrial antibodies, what makes PBC likely?
Tendon xanthomas
Hepatomegaly 8cm
Macroglossia
Facial rash
Xanthelasma

A

Xanthelasma

120
Q

Pathophysiology of thyroid eye disease

A

Rectus muscle thickening

121
Q

Deltoid wasting, weakness of flexion and supination?

A

Upper brachial plexus injury

122
Q

Which nerves affected in upper vs lower brachial plexus injury

A

Upper- axillary or musculocutaneous
Lower- radial and ulnar
Will see lower motor nuerone signs in all brachial plexus injuries

123
Q

40 year old patient whacked by football 2 days ago, noticed swelling in left groin, diffuse swelling at upper pole of left testis, does not transilluminate, right testis normal?

A

Seminoma
Testicular tumours often found incidentally after minor trauma to scrotum

124
Q

Man has footdrop after hip fracture, which nerve was damaged?
Common peroneal
Gluteal
Sciatic
Femoral

A

Sciatic

125
Q

Tolvaptan MOA

A

Vasopressin receptor antagonist

126
Q

DVT prophylaxis following elective hip vs knee replacement

A

LMWH and TED for 28 days with hip
LMWH and TED for 14 days with knee
Can use rivaroxaban

127
Q

What is bronchial breathing and what causes it most likely

A

Where get equally harsh sounds on both inspiration and expiration
Pneumonia

128
Q

Displaced fracture NOF in young person vs old

A

Under 55= Cannulated screws/internal fixation
Over 65= total/hemi arthroplasty depending on morbidity

129
Q

70 y/o patient has 2cm irregular, mobile lump in outer quadrant of breast, most likely diagnosis?
DCIS
LCIS
Invasive ductal carcinoma
Invasive lobular carcinoma
Medullary carcinoma

A

DCIS as invasive would not be mobile

130
Q

Most common breast malignancy

A

Invasive ductal

131
Q

Patient had inguinal lymphadenopathy, LN biopsy finds sheets of rapidly growing moderately sized B cells, diagnosis?

A

Burkitts lymphoma

132
Q

In a RCT, what is the most likely form of bias?

A

Attrition

133
Q

Pathophysiology of dupyutrens contracture

A

Thickened palmar fascia

134
Q

Which cell is responsible for uptake of fat in fatty plaque formation?

A

Macrophages

135
Q

Causes of pleural rub

A

PE
Pneumonia
Pleural effusion

136
Q

Someone has industrial liquid splashed in their eye after workplace accident, eye is now red and painful, what to do next?

A

Saline washout

137
Q

If sore throat with pain swallowing but throat appears fine, what is cause

A

Acute laryngitis

138
Q

Woman lost 6kg, diplopia in every direction, can see sclera on downward gaze, difficulty with most movements of the eyes, what do you do?

A

TFTs

139
Q

Man has posterior hip dislocation, what is he most at risk of?

A

Sciatic nerve injury

140
Q

Patient on various meds with hyperkalaemia, ECG changes showing bradycardia with 2:1 block . Cause?

A

Digoxin toxicity

141
Q

What electrolyte abnormality does digoxin toxicity lead to

A

Hyperkalaemia

142
Q

Cholestasis drug induced causes

A

Penicillins
Macrolides
COCP
Steroids
Phenothiazines- prochlorperazine, chlorpromazine
Sulphonylureas
Nitrofurantoin

143
Q

Dry eyes first line eye drop

A

Hypromellose articial tears

144
Q

TB chest x ray findings

A

Latent- calcified gohn focus
Post primary- bilateral hilar lymphadenopathy, cavitating lesion, consolidation in upper lobes
Miliary- if immunocompromised see diffuse infiltrates

145
Q

Person with HIV but on anti-retrovirals,
however has oral thrush. No symptoms. Has lobar consolidation on CXR. Cause? Strep Pneum, P. jirovecii, TB

A

TB is asymptomatic and HIV will reactivate the TB

146
Q

If have spatial neglect after a stroke where is lesion

A

Parietal lobe

147
Q

Asthmatic, which indicates severe?
BP 105, RR 30, O2 sats 94%

A

RR>25

148
Q

What do for OSA if day time alertness a crucial part of job like lorry driver

A

Urgent referral and ensure that DVLA aware

149
Q

After treatment for OSA, what is most likely to improve?
Weight, exercise tolerance, vital capacity, hypertension

A

HTN

150
Q

What does spiculated lesion mean

A

Irregular lines originating from lesion

151
Q

Spiculated lesion in lung, what is it

A

Cancer

152
Q

Patient with lumbar back pain and hypotensive. What investigation do first line in emergency department?

A

Aortic USS

153
Q

If patient needs to be on a sliding scale for surgery, when do you start it

A

The morning of the surgery

154
Q

Male patient in his 70’s is adamant he wants to be at home instead of hospital and understand this may mean he can’t get all of his treatment. What is the best action to proceed with for this to happen?

A

Advanced directive

155
Q

What tests must be done prior to doing dialysis

A

Screeed for HIV, Hep B and Hep C
HIV- antibodies done prior to starting dialysis
Hep B- HBsAg (every 3 months)
Hep C- HCV antibodies (every 3 months)

156
Q

If is tetraplegic following neck hyperextension, where is lesion likely to be in spinal cord

A

Anterior cord

157
Q

What causes hypotension if epidural in

A

Interruption of sympathetic supply-> vasodilation

158
Q

Management of hypotension with epidural infusion

A

Stop infusion
Lie flat with legs elevated
IV fluids and O2
May require anaesthetics for vasopressors

159
Q

Patient refuses colonoscopy what offer instead

A

CT colonography

160
Q

If elderly person with osteoarthritis and HTN, what use as analgesia

A

Paracetamol

161
Q

Patient has back pain with a depression depression felt along spinal cord

A

Spondylolisthesis- vertebra pushed forward

162
Q

Spondylolisthesis presentation

A

Back pain that worsens with exercise
Palpable depression felt along spine

163
Q

Management of vaginal prolapses in GP

A

If mild then pelvic floor exercises
If severe or is severe bowel/urinary incontinence then refer to urogynae

164
Q

What is pagetoid spread

A

“upward spreading” of abnormal cells in the epidermis

165
Q

What is transcolemic spread

A

Spread across the surface which encompasses a cavity- eg ovarian cancer spreads to liver via peritoneal membrane

166
Q

Painless persistent lymphadenopathy in elderly person

A

Follicular lymphoma

167
Q

Patient with chronic sinusitis, when lean forward fluid pours from nose, which sinus is most likely affected

A

Maxillary sinus- most commonly affected in chronic sinusitis

168
Q

Pain in shoulder at night with painful abduction between 80 and 120 degrees

A

Subacromial bursitis

169
Q

Breathing in palliative patient described as rattly

A

Excess secretions in mouth

170
Q

30 year old man unable to straighted DIP following injury- what use

A

Finger splint

171
Q

First line for hodgkins lymphoma

A

Chemo

172
Q

If patient is admitted to hospital with confusion and metastatic cancer, who makes decision regarding DNR
- oncology team
- admitting team
- wait 24 hours to see if he regains capacity

A

Admitting team

173
Q

Man with T1DM for short procedure, HbA1c control is good and needed to be fasted from midnight, what do with usual basal insulin

A

Keep evening dose
Omit morning dose

174
Q

What part of inhaler has greatest carbon footprint

A

Hydrofluorocarbon propellant in MDI

175
Q

If tumour lysis syndrome, what is most likely to identify cause of deterioration

A

Urate

176
Q

What does a CVP of +12 indicate in shock

A

Adequate hydration

177
Q

If present with a tender lump in breast during pregnancy what is management

A

Triple assessment

178
Q

Hypotension post op and has epidural in

A

Assess if operation has lead to fluid losses and hypovolaemia is cause
If evidence of dehydration then give fluids
DO NOT ASSUME EPIDURAL IS CAUSE

179
Q

If on dialysis which painkiller best to use

A

Tramadol

180
Q

HIV patient had SOBOE, CXR clear, what do next

A

BAL- best definitive option for PJP

181
Q

TB patient develops photosensitive rash after starting meds, what antibody

A

Anti-histone

182
Q

Investigations to do prior surgery for COPD

A

CXR
Spirometry if no idea about severity- risk of bronchoconstriction
Echo may show RHF

183
Q

If on warfarin, what do prior to surgery

A

Stop 5 days
If moderate/high risk then give bridging LMWH/UFH until night before
If very recent VTE then consider need for surgery/ put in IVC filter

184
Q

What do with addisons/long term steroids post op

A

Minor procedure- oral prednisolone post op
Major- 3 days of IV hydrocortisone

185
Q

Addisons patient becomes hypotensive in operation

A

Add fludrocortisone

186
Q

ATIN causes

A

antibiotics like β-lactams, cephalosporins, and flouroquinolones, NSAIDs, diuretics, rifampicin, allopurinol, and proton-pump inhibitors

187
Q

Unable to differentiate between asystole and v fib on ECG in crash call, what do

A

Continue compressions- will increase amplitude and help differentiate

188
Q

Vit D defic management

A

If requires acute rise like if about to go on strong bisphosphonate or symptomatic then loading dose of 300,000 units over 6 weeks
If not then maintenance 800-2000 units daily or up to 4000 if malabsorption

189
Q

Causes of hypoalbuminaemia (not liver and kidney)

A

Poor oral intake and sepsis (liver favours production of inflam makers)

190
Q

Assessment of diabetic foot wound infection

A

Counts as infection if 2 of
- erythema
- fever
- discharge
- hot
- swelling
Take swab and give abx
If suspect osteomyelitis do X ray then MRI if unclear

191
Q

When suspect charcot arthropathy in diabetics

A

If broken or if foot is deformed/warm/redness or swelling in presence of CKD or neuropathy

192
Q

Management of charcot arthropathy

A

Refer to foot MDT within 1 working day
X ray then MRI to confirm if needed
Weight bearing support given form moment suspect it

193
Q

Rheumatic fever management

A

Stat dose of benzylpenicillin then 10 days pen V
Aspirin for joint pain
Steroids if carditis leading to HF
Carbamazepine for sydenhams chorea

194
Q

Schistoscomiasis
- presentation
- diagnosis
- management

A

Bowel involvement and bladder involvement
Itchy rash
Ix- stool or urine culture
Rx- praziquantel ASAP and again in 2 months

195
Q

Dressler syndrome rx

A

NSAIDs
Can increase aspirin dose

196
Q

Post oesophagectomy, drain starts to drain with white fluid

A

Chylothorax
Let it drain and start TPN

197
Q

Standard pre abdo surgery antibiotic cover

A

Co amoxiclav

198
Q

Patient develops ulnar nerve palsy, then common peroneal then a few weeks later 6th CN

A

Mononeuritis multiplex
Can be caused by systemic inflam conditions like RA or vasculitis then can be infective like lyme or HIV

199
Q

For breakthrough pain what is % of total daily dose tend to give

A

10-25%

200
Q

How go to oxycodone from morphine

A

Times by 2

201
Q

Raised ICP headache management with mets

A

Cyclizine first line for nausea
Dexamethasone
Radiotherapy can be used

Finals (29 decks)

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