Internal Med

Question 1

Mx of provoked PE

Answer 1

E.g. long flight

Loading dose then 3 months DOAC

Question 2

What drugs given to treat oesophageal varices and then prevent it

Answer 2

Treat= terlipressin

Prevent= Propranolol

Question 3

Which drug to offload fluid in ascites

Answer 3

Spirinolactone

Question 4

Which kind of seizure is normally associated with lip/ mouth involvement

Answer 4

TempORAL lobe partial seizure

Question 5

Most common cause of endogenous Cushing

Answer 5

Pituitary adenoma

Drugs is most common cause (steroids)

Question 6

If no asthma signs and ipratropium not working what to do

Answer 6

Stop the SAMA (ipratropium)

Start LAMA and LABA so tiotropium and formoterol

LAMA and SAMA work on the same receptors

Also add salbutamol ?

Question 7

Crypt abscesses which GI problem

Answer 7

Ulcerative colitis

Goblet cells and granulomas, villus atrophy are coeliac

Question 8

Which antihistamines are sedating and non-sedating

Answer 8

Clhlorphenamine is sedating

Cetirizine, fexofenadine and loratadine are non sedating

Question 9

Which test determines whether kidney injury is acute or chronic

Answer 9

If hypocalcaemic it is chronic

Question 10

How to manage bilateral adrenocortical hyperplasia vs adrenal adenoma

Answer 10

Hyperplasia treat with spirinolactone (aldosterone antagonist)

Adenoma treat with surgery

Question 11

How to treat trigeminal neuralgia

Answer 11

Carbemazepine is first line

Neuro referall if that doesn’t work

Question 12

How to differentiate lambert Eaton and myasthenia gravies

Answer 12

Lambert Eaton usually gets a bit better with muscle use, MG worsened

MG affects the face and arms earlier, then legs

LES affects legs

Question 13

What size of AAA requires what monitoring

Answer 13

3-4.5cm = every 12 months USS
4.5-5.5 = every 3 months USS
>5.5cm= 2ww to vascular surgery

Question 14

Breastfeeding with HIV

Answer 14

No

Question 15

What condition is carbimazole used to treat

Answer 15

Propanolol initially to help with Sx

Then if graves

Then carbimazole

Question 16

How to treat mild/ moderate UC flares vs severe

Answer 16

Mild/moderate treat at home with topical (rectal) aminosalicylate -> add oral if that doesn’t work

Severe colitis treat with IV steroids -> add IV cyclosporine if that doesn’t work

Question 17

Which cardiac abnormality occurs with high calcium

Answer 17

Short QT

Question 18

Triad of budd-chiari syndrome,e

Answer 18

Sudden onset abdominal pain

Ascites

Tender hepatomegaly

Question 19

How to manage idiopathic intracranial hypertension

Answer 19

Weight loss

Carbonic anhydrase inhibitors e.g. acetazolamide

Can also use topiramate which helps with WL also

Question 20

Which seizure Types do you not give sodium valproate

Answer 20

Focal seizure (partial) give lamotrigine or levetriacetam

Absence seizures (petit mal) give ethosuximide

Question 21

How do discern between anaemia of chronic disease and IDA from iron studies

Answer 21

Total iron binding capacity (body’s ability to take in iron)

High in IDA as there’s no iron

Low/ normal in AOCD as the body is storing iron outside of the blood so no free space

Question 22

How to diagnose chronic pancreatitis

Answer 22

CT pancreas

Question 23

Which type of prostate drug is likely to cause gynaecomastia

Answer 23

GnRH agonists e.g. goserelin

Not doxazosin as much but i think it still can

Question 24

Which diabetes drug causes weight gain

Answer 24

Sulphonylureas e.g. gliclazide

Question 25

Why could u do an ECG before starting SSRIs or TCIs

Answer 25

Risk of prolonged QT syndrome

So can do a baseline ECG

Seen more in higher dose

Question 26

Severe acute alcoholic hepatitis Mx

Answer 26

Glucocorticoids e.g. pred in acute episode

Pentoxyphylline is also sometimes used

Question 27

Which BP drug causes ED

Answer 27

Indapamide or other thiazide-like diuretics

Question 28

Which clotting screen does warfarin affect

Answer 28

PT (prolongs it )

No effect on APTT

Because warfarin reduces F7 levels which is in the extrinsic pathway afffecting PT but nt the intrinsic pathway which affects APTT

Question 29

How to differentiate between gastric and duodenal ulcer

Answer 29

Gastric worse on eating

Duodenal better on eating

As when eating the sphincter is closed between the stomach and duodenum so no acid in duodenum and all in stomach

Question 30

Lyme disease Mx

Answer 30

If caught early then 14-21daycourse of oralodxycycline

IV cef when there is CNS involvement

Question 31

What should all people with peripheral artery disease be taking

Answer 31

Statin 80mg

Clopidogrel

Question 32

what us Chvostek’s sign

Answer 32

Twitching of facial muscles on percussion

Classic indication of hypocalcaemia

E.g. after thyroid surgery, damage to PT gland

Question 33

What rate should maintainance fluids be prescribed at

Answer 33

30 ml / kg / DAY

So someone who weighs 75kg needs 2250mls over 24 hours

So they need 93.75 ml/hr aka 100 ml/hr

Question 34

What is a normal anion gap

Answer 34

8-14

Question 35

How do you investigate a suspected perforated duodenal ulcer

Answer 35

Erect CXR

As you can see pneumoperitoneum

Which is suggestive of the above

Question 36

Which analgesic is first line in renal colic pain

Answer 36

IM diclofenac 75mg

In less severe pain you can do rectal or oral route

Question 37

How to manage alcohol withdrawal in those with and without liver cirrhosis

Answer 37

Without cirrhosis= chlordiazepoxide (long-acting benzodiazepine)

With cirrhosis= lorazepam (metabolism less affected by liver dysfunction)

Question 38

How to discern between IgA nephropathy and post-streptococcal glomerulonephritis

Answer 38

IgA nep is shorter word so comes on after 1-3 days of infection

Post-strep glom is longer so comes on 1-2 weeks after infection

Question 39

Which t2dm meds can cause pancreatitis

Answer 39

DPP-4 inhibitors e.g. gliptins e.g. sitaliptin