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Phase 2a > Key Points > Flashcards

Key Points Flashcards

1
Q

Define QRisk3 score

A

Estimated cardiovascular disease risk within the next 10 years for people aged 25-84

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2
Q

Define Wells score

A

Estimated clinical probability of a DVT

> 2 = likely.
- ultrasound within 4 hours
- D-dimer if results negative

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3
Q

Define ABCD2

A

Estimated the risk of stroke after a suspected TIA

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4
Q

Define CHA2DS2-Vasc Score

A

Stroke risk for patients with AF

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5
Q

Define modified Dukes Criteria

A

Provides diagnostic criteria for infective endocarditis

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6
Q

What stain would be used to show pneumonitis pneumonia

A

Silver stain

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7
Q

What would be seen in lung abscess

A

Anaerobic bacteria

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8
Q

What is the management of a spontaneous pneumothorax

A

Chest drain

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9
Q

What is the management of a tension pneumothorax

A

Large bore cannula inserted into the 5th intercostal space, mid axillary line

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10
Q

What is the initial management of a PE

A

Anticoagulation - warfarin or LWMH

LMWH if post surgery

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11
Q

What would be a result of a spirometry in someone with idiopathic pulmonary fibrosis

A

FEV1/FVC > 0.8 = restrictive

TLCO = reduced

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12
Q

Name the drug which can result in drug induced pulmonary fibrosis

A

Amiodarone

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13
Q

What is the ECG pattern of pulmonary embolism

A

Sinus tachycardia with right ventricular strain

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14
Q

What would be a key chest x-ray finding in COPD

A

Flattened hemi-diaphragms

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15
Q

What investigation would be conducted if there is suspicion of cor pulomale due to a chronic lung disease

A

Echocardiogram

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16
Q

On lifelong immunosuppressants what vaccination should be avoided

A

BCG

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17
Q

What does a long term catheter increase the risk of

A

Squamous cell carcinoma of the bladder

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18
Q

What is the blue dot sign

A

Torsion of the testicular appendage

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19
Q

Name a contradiction of PDE5 inhibitors (erectile dysfunction) that could produce fatal hypotension

A

Nitrates

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20
Q

What is the management of testicular torsion

A

Surgical exploration and orchiopexy fixation

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21
Q

What is used to grade tumours in prostate cancer

A

Gleason score

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22
Q

What can be used to medically treat stress incontinence

A

Duloxetine

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23
Q

What test is performed to indicate ankylosing spondylitis

A

Positive Schober’s test

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24
Q

What scoring system may be used following endoscopy to determine the severity of the gastrointestinal bleed?

A

Rockall Score

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25
Q

What medication can cause bile acid malabsorption and lead to diarrhoea

A

Metformin

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26
Q

What medication may lead to an increase in INR

A

Erythromycin

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27
Q

What is a grade 1 CKD eGFR

A

> (or equal to) 90 ml/min/1.73m^2

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28
Q

What is a grade 2 CKD eGFR

A

60-89 ml/min/1.73m^2

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28
Q

What is a grade 3a CKD eGFR

A

45-59 ml/min/1.73m^2

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29
Q

What is a grade 3b CKD eGFR

A

30-44 ml/min/1.73m^2

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30
Q

What is a grade 4 CKD eGFR

A

15 - 29 ml/min/1.73m^2

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31
Q

What is a grade 5 CKD eGFR

A

< 15 ml/min/1.73m^2

Kidney failure

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32
Q

What is kidney grading for CKD related to

A

Related to normal range for a young adult

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33
Q

Name the ACR CKD grading

A

A1 < 3
A2 3-30
A3 > 30

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34
Q

What nerve regulates a drop in BP from sitting to standing with no changes in ECG

A

Efferent pathway Vagus nerve

Regulates baroreceptor reflex - adjust HR and cardiac contracility

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35
Q

Under stress what nerve controls BP

A

Sympathetic nerve

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36
Q

An IVDU has IE what is the most likely cause

A

Staph aureus

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37
Q

Someone of ‘normal population’ has IE what is the most likely cause

A

Strep viridians

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38
Q

An individual has a prostatic heart valve has IE what is the most likely cause

A

Staph epidermis

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39
Q

What is the gold standard investigation for a PE

A

CTPA (computed tomography pulmonary angiography)

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40
Q

What is a complication of pharyngitis

A

Rheumatic fever

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41
Q

What is a complication of strep that cannot be prevented with prompt antibiotic use

A

Post strep glomerulonephritis

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42
Q

What type of blockage is an STEMI

A

Transmural

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43
Q

What type of blockage is an NSTEMI

A

Subendocardial

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44
Q

What is a common symptom associated with mitral stenosis

A

Malar flush on face

Rf - rheumatic fever + IE

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45
Q

How do you remember the type of murmur heard in mitral stenosis

A

Mid (both m) diastolic murmur

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46
Q

What condition would asymmetrical radial pulses be seen

A

Aortic dissection

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47
Q

What is prophylaxis in AF

A

Direct acting anticoagulants (DOACs) - factor Xa inhibitors

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48
Q

What type of block is – progressive lengthening of PR interval with a drop in QRS complex

A

Mobitz type 1

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49
Q

What type of block is - PR interval remains constant - QRS is dropped

A

Mobitz type 2

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50
Q

What type of block is this - no relationship is seen

A

3rd degree

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51
Q

What is a sine wave seen in

A

Hyperkalaemia

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52
Q

What type of shunt is seen in teratology of fallot

A

Right to left pulmonary shunting - Eisenmenger’s syndrome

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53
Q

Why do ACEi cause chronic dry cough

A

Due to bradykinin production

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54
Q

What are the 5 features of heart failure

A

ABCDE findings

Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobes
Pleural Effusions

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55
Q

Describe BNP as a marker of heart failure

A

Released from the heart in response to ventricular wall stress and volume overload.

Characteristic of heart exacerbations

Increased BNP = Increase insult to walls = worse prognosis

Used in risk stratification + manage

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56
Q

Symptoms of decompensated HF (end stage)

A

Breathlessness lying flat

Paroxysmal nocturia dyspnoea

Elevated jugular venous pressure (JVP) due to increased right-sided pressure

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57
Q

Name 4 signs of IE

A

Splinter haemorrhages
Janeway lesions
Osler’s nodes
Roth spots

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58
Q

What’s the criteria for IE

A

Modified Duke’s criteria

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59
Q

What’s the gold standard investigation IE

A

Transoesophageal echocardiogram

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60
Q

What is the most infected valve in IE

A

Tricuspid valve

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61
Q

A patients presents with confusion post IE treated

A

Septic embolization

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62
Q

What does troponin elevation in HF associated with

A

Worse outcomes

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63
Q

Describe the pharmacology of spironolactone

A

Inhibition of aldosterone receptor is distal tubules

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64
Q

A patient is referred to cardiology clinic after presenting to their GP with SOB after walking 50m and general fatigue

On auscultation there is an audible pan-systolic murmur at the apex

What is the most likely diagnosis?

A

Mitral regurgitation

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65
Q

Name a medication which can be prescribed prior to an adrenalectomy to stabilise her BP and K+ levels

A

Spironolactone

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66
Q

What is the GS investigation for renal colic

A

Non-contrast CT kidney, ureter, bladder

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67
Q

What are the key causes of a UTI

A

KEEPS

Klebsiella
E.coli - most common
Enterococcus
Proteus/pseudomonas
Staphylococcus saprophyticus

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68
Q

What are the 3 key features of nephrotic syndrome

A

Hypalbuminaemia
Peripheral oedema
Proteinuria

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69
Q

What is the most important U&E component of an AKI

A

Potassium

Risk of cardiac arrest

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70
Q

Describe furosemide pharmacology

A

Loop diuretic which acts on the ascending loop of henle

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71
Q

Describe stage 1 Ann Arbour classification

A

Single LN region

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71
Q

What is the Ann Arbour classification for

A

Non/-Hodgkins lymphoma

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71
Q

Which blood cancer results in pain when drinking alcohol

A

Hodgkin’s lymphoma

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72
Q

Describe stage 2 Ann Arbour classification

A

> /=2 nodal area on the same side of the diaphragm

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73
Q

Describe stage 3 Ann Arbour classification

A

Nodes on both sides of the diaphragm

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74
Q

Describe stage 4 Ann Arbour classification

A

Disseminate e.g. liver metastases

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75
Q

Describe B symptoms of Hodgkin/Non-Hodgkin lymphoma

A

Fever
Weight loss
Night sweats

76
Q

Name 4 key clinical features of iron deficiency anaemia

A

Brittle hair and nails
Koilonychia -brittle/spoon shaped
Pale conjunctivae
Systolic flow murmur

77
Q

Name a symptom in a patient who has recently started taking ceftriaxone for meningitis

A

Dark urine

78
Q

What is a mechanism of action of penicillin antibiotics

A

Inhibits bacterial cell wall synthesis

79
Q

What food would decrease the effects of warfarin

A

Spinach

80
Q

What is the 1st line drug prescribed in pheochromocytoma to prepare patients for upcoming surgeries

A

Phenoxybenzamine

81
Q

What antibiotic is not indicated in staphylococcus aureus infection

A

Ampicillin

82
Q

What is most common cause of bacterial pneumonia

A

Streptococcus pneumoniae

83
Q

What is the 1st line treatment for osteoporosis

A

Alendronic acid

84
Q

What is the 2nd line management in osteoarthritis

A

Denosumab

84
Q

Whats the 1st line treatment for tension headache

A

Ibuprofen

84
Q

What medication is used to control jerky movements in Huntington’s disease

A

Risperidone

85
Q

What antibody is involved in Goodpasture’s syndrome

A

Anti-glomerular basement membrane

86
Q

painless cholestatic jaundice with weight loss in an elderly. His bloods showed a cholestatic picture and the low albumin and raised CRP

What is this a presentation of

A

Pancreatic head tumour

87
Q

What artery supplies blood to the pylorus and proximal part of the duodenum

A

Gastroduodenal artery

88
Q

When and why cant trimethoprim be used in pregnancy

A

For UTI

Not in 1st trimester

Due to being a folate antagonist

89
Q

What antibiotic is linked to c. diff infections

A

Ciprofloxacin

90
Q

A 36 year old man originally from India reports recurrent episodes of fever, sweats and malaise over the past few months. He had malaria several years ago but is unsure of the treatment he received. He last travelled to India 8 months ago.

What organism is this?

A

Plasmodium vivax

91
Q

The initial gaze and head deviation to the opposite side indicate a seizure onset in the…

A

Right frontal lobe

92
Q

What is the treatment for severe community acquired pneumonia

A

Co-Amoxiclav 1.2g TDS IV plus Clarithromycin BD PO

93
Q

What is this - on cheek below glasses, firm nodule with ulcerated appearance

A

Basal cell carcinoma

94
Q

What is this - pigmented and high growth (skin)

A

Maliganant melanoma

95
Q

What is this - keratotic appearance without central ulceration

A

Squamous cell carcinoma

96
Q

What anaemia causes increased reticulocyte count

A

Haemolytic anaemia

97
Q

Staff, patients and carers are treated fairly, with empathy and consideration when they have been involved in a patient safety incident or have raised a safety issue

A

Joint culture

98
Q

Staff have confidence in the local incident reporting system and use it to notify healthcare managers of incidents that are occurring, including near misses. Barriers to incident reporting have been identified and removed - staff not blamed/punished when they report incidents and they receive constructive feedback.

A

Reporting culture

99
Q

The organisation: is committed to learn safety lessons; communicates them to colleagues; remembers them over time.

A

Learning culture

100
Q

The organisation has learnt from past experience and has the ability to identify and mitigate future incidents because it: - learns from events that have already happened (for example, incident reports and investigations).

A

Informed culture

101
Q

patient safety culture in which staff feel comfortable discussing patient safety incidents and raising safety issues with both colleagues and senior managers

A

Open culture

102
Q

Pharmacokinetics is the study of

A

How the body affects drugs

103
Q

principal neurotransmitter associated with mediating the effects of the sympathetic arm of the autonomic nervous system

A

Noradrenaline

104
Q

Adrenaline is used in anaphylaxis and vasoconstricts via its effects on which receptor

A

A1-adrenoreceptor

105
Q

Name a medication which needs monitoring due its narrow therapeutic window

A

Ciclosporin

106
Q

What feature of the clinical examination would suggest that the aortic stenosis is now severe?

A

A small volume and slow rising pulse

107
Q

Name a feature of ECG seen in acute pericarditis

A

PR segment depression

108
Q

What is this a presentation of - weight loss, fatigue, diarrhoea, sore eyes and double vision

A

Grave’s disease

109
Q

Name the liver attenuated vaccines

A

rubella, measles, oral polio, mumps or bacteria - bacillus Calmette-Guerin (BCG).

110
Q

What arrythmia is seen in Grave’s disease

A

Atrial fibrillation

111
Q

Name the physiological processes in osteoporosis

A

Increase bone turnover
Bone resorption
Increase osteoblast activity
Reduced osteoblast activity
Micro architectural deterioration

112
Q

Name the 1st line medication for osteoporosis

A

Oral alendronic acid

113
Q

Name the 2nd line management for osteoporosis

A

Calcium + vitamin D supplementation

114
Q

What investigations should be done for anyone who has definitely had an epileptic seizure

A

EEG
MRI - brain or head
CT scan head
CT brain

115
Q

What histological features would be seen in UC

A

Increase in plasma cells in the lamina propria
Crypt distortion/branching/abscess
Ulceration

116
Q

What would be seen in a spirometry test of asthma with bronchodilator

A

Increase in FEV1 > 20%

117
Q

What histological features should be seen in primary carcinomas

A

Abundant mitotic figures
Areas of necrosis
Hyperchromatic nuclei
Pleomorphic nuclei
Ulceration
Endophytic growth
Invasion/poorly circumscribed margin
Variable resemblance to normal tissue (differentiation)

118
Q

What are the 3 diagnostic criteria for nephrotic syndrome

A

Proteinuria > 3g/L
Hypalbuminaemia < 25g/L
Oedema

119
Q

What is the mechanism of action of adrenaline

A

alpha and beta adrenergic receptor agonist

120
Q

Name the 2 additional drugs given in anaphylactic shock

A

IV chlorpheniramine
IV hydrocortisone

121
Q

What cell medicates anaphylaxis

A

Mast cells

122
Q

What is the antibody most associated with anaphylaxis

A

IgE

123
Q

What type of bacteria is Neisseria gonorrhoea

A

Gram-negative diplococci

124
Q

What can be a complication of spironolactone

A

Hyperkalaemia

125
Q

Describe the mechanism of action of beta-lactams

A

Inhibit trans glycosylation involved in peptidoglycan utilisation in cell wall synthesis

126
Q

Describe the rules on driving post TIA

A

Do not notify DVLA but do not drive for 1 month

127
Q

Name a derivative of common myeloid progenitor cells

A

Neutrophil

128
Q

Describe an ECG of conn’s disease

A

Flat T-wave, prolonged QT interval, ST depression

129
Q

What is the treatment for chlamydia

A

Doxycycline 100mg 2x daily for 7 days

130
Q

What is prophylaxis for cluster headaches

A

Verapamil

131
Q

What chromosome is affected by hereditary haemochromatosis

A

6

132
Q

Name the diabetes medication which blocks reabsorption of glucose in the kidneys

A

SGLT-2 inhibitor

133
Q

What type of hypersensitivity reaction is hypersensitivity pneumonitis

A

Type III

134
Q

What structure does the medulla oblongata develop from

A

Myelencephalon

135
Q

Name a medication that would not be indicated in heart failure

A

Verapamil

136
Q

What STI is linked with reactive arthiritis

A

Chlamydia pneumoniae

137
Q

What date is used to remember the clotting factors of warfarin

A

1972

10, 9, 7, 2

138
Q

Name a treatment for chronic myeloid leukaemia

A

Imatinib

139
Q

Describe the mechanism of action of quinolone

A

Disrupts the function of DNA Gyrase

140
Q

What symptom of a patient with fibromyalgia most likely to report

A

Swollen joints

141
Q

Which marker is more specific for highlighting acute liver damage

A

ALT

142
Q

What condition is this - unilateral, firm, painless lump felt. Not transilluminate

A

Testicular cancer

143
Q

Name the causes of AF

A

Mrs SMITH

Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
Hypertension

144
Q

What chromosome does sickle cell anaemia occur on

A

Chromosome 11

145
Q

In Addinson’s what is there autoimmune destruction of

A

Adrenal cortex

146
Q

What is made in the medulla of the kidney

A

Catecholamines

147
Q

What is made in the zona fasciculata of the kidney

A

Glucocorticoids - cortisol

148
Q

What is made in the zona glomerulosa of the kidney

A

Mineralocorticoids - aldosterone

149
Q

What is made in the zone reticularis of the kidney

A

Androgens

150
Q

How do you remember what is made in the layers of the kidney

A

Salt, sugar, sex and GFR

Glomerulosa - mineralocorticoids e.g. aldosterone (outer)

Fasciculata - glucocorticoids e.g. cortisol

Reticularis - Androgens (inner)

151
Q

Describe strep viridians

A

Gram negative
Catalase negative
Alpha haemolytic
Optochin resistant

152
Q

What immunoglobulin can pass through the placenta

A

IgG

153
Q

What is given in community acquired pneumonia

A

Amoxicillin

High severity - co-amoxiclav

154
Q

What is given in hospital acquired pneumonia

A

Co-amoxiclav

High severity - tazocin

155
Q

What is the best agar to grow fungal culture on

A

Sabouard plate

156
Q

Name a side effect of verapamil

A

CCB

Ankle swelling

157
Q

Describe boutonnieres deformity

A

Hyperextended DIP and flexed PIP

158
Q

Describe swann neck deformity

A

Hyperextended PIP and flexed DIP

159
Q

Where does Z-shaped deformity usually occur

A

Occurs in the thumb

160
Q

Name two features that are associated with osteoarthritis

A

Bouchard’s nodes (PIP joints)
Heberden’s nodes (DIP joints)

161
Q

Describe mechanism of action of leflunomide

A

Interferes with the production of pyrimidine - important component in RNA and DNA

162
Q

How do you remember the side effects of rifampicin

A

Red-pissin

Red/orange discolouration of urine and tears

163
Q

How do you remember the side effects of isoniazid

A

I’m-so-numb-azid

Peripheral neuropathy

164
Q

How do you remember the side affect of pyrazinamide

A

Hyperuricemia > gout

165
Q

How do you remember the side effect of ethambutol

A

Eye-thambutol

Colour blindness and reduced visual acuity

166
Q

Name the 3 hallmarks for horner’s syndrome

A

Ptosis
Miosis
Anhidrosis

167
Q

What is used to assess acute pancreatitis

A

Modified Glasgow criteria

168
Q

Describe modified Glasgow criteria

A

PANCREAS - 3 or more indicated HDU

PaO2 < 8
Age > 55
Neutrophils - WBC > 15x109/l
Calcium < 2mmol/l
Renal function - urea > 16 mmol/l
Enzymes - AST/ALT > 200 iu/L or LDH > 600 iu/L
Albumin < 32 g/l
Sugar - glucose > 10mmol/L

169
Q

What is the sign of a palpable gallbladder in a jaundice patient in the absence of pain

A

Courvoisier’s sign

170
Q

What is the radiological intervention used to treat renal tract stones

A

Ultrasound shock wave lithotripsy

171
Q

What is it called in heart failure where you cough at night and need 3 pillows to sleep

A

Paroxysmal nocturnal dyspnoea

172
Q

What scoring system is used in heart failure

A

New York Heart Association classification

1 - No limitation
2 - comfortable at res, symptomatic on ordinary activities
3 - comfortable at rest, symptomatic on any activity
4 - symptomatic at rest

173
Q

Name the 2 actions of metformin

A

Increases peripheral glucose uptake and sensitivity

Inhibits hepatic gluconeogenesis

174
Q

What are the 2 most common subtypes of HPV

A

16 and 18

175
Q

Define TCLO

A

The transfer capacity of the lung, for the uptake of carbon monoxide

176
Q

What does CRP show

A

Raised in acute inflammation

177
Q

Name the antibiotics that increase the risk of c. diff

A

Broad spectrum antibiotics

Clindamycin
Cephalosporins
Quinolones
Co-amoxiclav
Aminopenicillins

178
Q

What does TDS on prescription mean

A

To be taken 3 times a day

179
Q

What is the key ECG of pericarditis

A

Saddle shaped ST elevation expect in aVR

180
Q

What is the role of IL-1

A

Causes fever and activates lymphocytes

181
Q

What is the role of IL-6

A

Causes fever, stimulates the liver to produce acute phase proteins eg. CRP. Activates lymphocytes and promotes antibody production

182
Q

What is the role of IL-8

A

Causes neutrophil chemotaxis

183
Q

What is the role of IL-12

A

Activates NK cells and TH1 cells (important for intracellular infections)

184
Q

What is the role of TNF-alpha

A

Increases vascular permeability to allow immune cells to reach tissues

185
Q

What is the role of IL-4, IL-5, IL-13

A

Promote IgE production and eosinophilic reactions in patients with allergies

186
Q

What is the role of Interferon gamma (IFNy)

A

Essential in activating cell-mediated immunity in viral infections

187
Q

What is the role of IL-10

A

Has an anti-inflammatory affect

188
Q

Name some proinflammatory cytokines important in acute inflammatory response

A

IL-1
IL-6
IL-8
IL-12
TNF-alpha
IL-4, IL-5 + IL-13
Interferon gamma (INFy)
IL-10

189
Q

What is secreted by the posterior pituitary gland

A

Oxytocin

Antidiuretic hormone

Phase 2a (15 decks)

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