Key Points Flashcards
1
Q
Define QRisk3 score
A
Estimated cardiovascular disease risk within the next 10 years for people aged 25-84
2
Q
Define Wells score
A
Estimated clinical probability of a DVT
> 2 = likely.
- ultrasound within 4 hours
- D-dimer if results negative
3
Q
Define ABCD2
A
Estimated the risk of stroke after a suspected TIA
4
Q
Define CHA2DS2-Vasc Score
A
Stroke risk for patients with AF
5
Q
Define modified Dukes Criteria
A
Provides diagnostic criteria for infective endocarditis
6
Q
What stain would be used to show pneumonitis pneumonia
A
Silver stain
7
Q
What would be seen in lung abscess
A
Anaerobic bacteria
8
Q
What is the management of a spontaneous pneumothorax
A
Chest drain
9
Q
What is the management of a tension pneumothorax
A
Large bore cannula inserted into the 5th intercostal space, mid axillary line
10
Q
What is the initial management of a PE
A
Anticoagulation - warfarin or LWMH
LMWH if post surgery
11
Q
What would be a result of a spirometry in someone with idiopathic pulmonary fibrosis
A
FEV1/FVC > 0.8 = restrictive
TLCO = reduced
12
Q
Name the drug which can result in drug induced pulmonary fibrosis
A
Amiodarone
13
Q
What is the ECG pattern of pulmonary embolism
A
Sinus tachycardia with right ventricular strain
14
Q
What would be a key chest x-ray finding in COPD
A
Flattened hemi-diaphragms
15
Q
What investigation would be conducted if there is suspicion of cor pulomale due to a chronic lung disease
A
Echocardiogram
16
Q
On lifelong immunosuppressants what vaccination should be avoided
A
BCG
17
Q
What does a long term catheter increase the risk of
A
Squamous cell carcinoma of the bladder
18
Q
What is the blue dot sign
A
Torsion of the testicular appendage
19
Q
Name a contradiction of PDE5 inhibitors (erectile dysfunction) that could produce fatal hypotension
A
Nitrates
20
Q
What is the management of testicular torsion
A
Surgical exploration and orchiopexy fixation
21
Q
What is used to grade tumours in prostate cancer
A
Gleason score
22
Q
What can be used to medically treat stress incontinence
A
Duloxetine
23
Q
What test is performed to indicate ankylosing spondylitis
A
Positive Schober’s test
24
Q
What scoring system may be used following endoscopy to determine the severity of the gastrointestinal bleed?
A
Rockall Score
25
What medication can cause bile acid malabsorption and lead to diarrhoea
Metformin
26
What medication may lead to an increase in INR
Erythromycin
27
What is a grade 1 CKD eGFR
> (or equal to) 90 ml/min/1.73m^2
28
What is a grade 2 CKD eGFR
60-89 ml/min/1.73m^2
28
What is a grade 3a CKD eGFR
45-59 ml/min/1.73m^2
29
What is a grade 3b CKD eGFR
30-44 ml/min/1.73m^2
30
What is a grade 4 CKD eGFR
15 - 29 ml/min/1.73m^2
31
What is a grade 5 CKD eGFR
< 15 ml/min/1.73m^2
Kidney failure
32
What is kidney grading for CKD related to
Related to normal range for a young adult
33
Name the ACR CKD grading
A1 < 3
A2 3-30
A3 > 30
34
What nerve regulates a drop in BP from sitting to standing with no changes in ECG
Efferent pathway Vagus nerve
Regulates baroreceptor reflex - adjust HR and cardiac contracility
35
Under stress what nerve controls BP
Sympathetic nerve
36
An IVDU has IE what is the most likely cause
Staph aureus
37
Someone of 'normal population' has IE what is the most likely cause
Strep viridians
38
An individual has a prostatic heart valve has IE what is the most likely cause
Staph epidermis
39
What is the gold standard investigation for a PE
CTPA (computed tomography pulmonary angiography)
40
What is a complication of pharyngitis
Rheumatic fever
41
What is a complication of strep that cannot be prevented with prompt antibiotic use
Post strep glomerulonephritis
42
What type of blockage is an STEMI
Transmural
43
What type of blockage is an NSTEMI
Subendocardial
44
What is a common symptom associated with mitral stenosis
Malar flush on face
Rf - rheumatic fever + IE
45
How do you remember the type of murmur heard in mitral stenosis
Mid (both m) diastolic murmur
46
What condition would asymmetrical radial pulses be seen
Aortic dissection
47
What is prophylaxis in AF
Direct acting anticoagulants (DOACs) - factor Xa inhibitors
48
What type of block is -- progressive lengthening of PR interval with a drop in QRS complex
Mobitz type 1
49
What type of block is - PR interval remains constant - QRS is dropped
Mobitz type 2
50
What type of block is this - no relationship is seen
3rd degree
51
What is a sine wave seen in
Hyperkalaemia
52
What type of shunt is seen in teratology of fallot
Right to left pulmonary shunting - Eisenmenger's syndrome
53
Why do ACEi cause chronic dry cough
Due to bradykinin production
54
What are the 5 features of heart failure
ABCDE findings
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobes
Pleural Effusions
55
Describe BNP as a marker of heart failure
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
56
Symptoms of decompensated HF (end stage)
Breathlessness lying flat
Paroxysmal nocturia dyspnoea
Elevated jugular venous pressure (JVP) due to increased right-sided pressure
57
Name 4 signs of IE
Splinter haemorrhages
Janeway lesions
Osler's nodes
Roth spots
58
What's the criteria for IE
Modified Duke's criteria
59
What's the gold standard investigation IE
Transoesophageal echocardiogram
60
What is the most infected valve in IE
Tricuspid valve
61
A patients presents with confusion post IE treated
Septic embolization
62
What does troponin elevation in HF associated with
Worse outcomes
63
Describe the pharmacology of spironolactone
Inhibition of aldosterone receptor is distal tubules
64
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?
Mitral regurgitation
65
Name a medication which can be prescribed prior to an adrenalectomy to stabilise her BP and K+ levels
Spironolactone
66
What is the GS investigation for renal colic
Non-contrast CT kidney, ureter, bladder
67
What are the key causes of a UTI
KEEPS
Klebsiella
E.coli - most common
Enterococcus
Proteus/pseudomonas
Staphylococcus saprophyticus
68
What are the 3 key features of nephrotic syndrome
Hypalbuminaemia
Peripheral oedema
Proteinuria
69
What is the most important U&E component of an AKI
Potassium
Risk of cardiac arrest
70
Describe furosemide pharmacology
Loop diuretic which acts on the ascending loop of henle
71
Describe stage 1 Ann Arbour classification
Single LN region
71
What is the Ann Arbour classification for
Non/-Hodgkins lymphoma
71
Which blood cancer results in pain when drinking alcohol
Hodgkin's lymphoma
72
Describe stage 2 Ann Arbour classification
>/=2 nodal area on the same side of the diaphragm
73
Describe stage 3 Ann Arbour classification
Nodes on both sides of the diaphragm
74
Describe stage 4 Ann Arbour classification
Disseminate e.g. liver metastases
75
Describe B symptoms of Hodgkin/Non-Hodgkin lymphoma
Fever
Weight loss
Night sweats
76
Name 4 key clinical features of iron deficiency anaemia
Brittle hair and nails
Koilonychia -brittle/spoon shaped
Pale conjunctivae
Systolic flow murmur
77
Name a symptom in a patient who has recently started taking ceftriaxone for meningitis
Dark urine
78
What is a mechanism of action of penicillin antibiotics
Inhibits bacterial cell wall synthesis
79
What food would decrease the effects of warfarin
Spinach
80
What is the 1st line drug prescribed in pheochromocytoma to prepare patients for upcoming surgeries
Phenoxybenzamine
81
What antibiotic is not indicated in staphylococcus aureus infection
Ampicillin
82
What is most common cause of bacterial pneumonia
Streptococcus pneumoniae
83
What is the 1st line treatment for osteoporosis
Alendronic acid
84
What is the 2nd line management in osteoarthritis
Denosumab
84
Whats the 1st line treatment for tension headache
Ibuprofen
84
What medication is used to control jerky movements in Huntington's disease
Risperidone
85
What antibody is involved in Goodpasture's syndrome
Anti-glomerular basement membrane
86
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
Pancreatic head tumour
87
What artery supplies blood to the pylorus and proximal part of the duodenum
Gastroduodenal artery
88
When and why cant trimethoprim be used in pregnancy
For UTI
Not in 1st trimester
Due to being a folate antagonist
89
What antibiotic is linked to c. diff infections
Ciprofloxacin
90
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?
Plasmodium vivax
91
The initial gaze and head deviation to the opposite side indicate a seizure onset in the...
Right frontal lobe
92
What is the treatment for severe community acquired pneumonia
Co-Amoxiclav 1.2g TDS IV plus Clarithromycin BD PO
93
What is this - on cheek below glasses, firm nodule with ulcerated appearance
Basal cell carcinoma
94
What is this - pigmented and high growth (skin)
Maliganant melanoma
95
What is this - keratotic appearance without central ulceration
Squamous cell carcinoma
96
What anaemia causes increased reticulocyte count
Haemolytic anaemia
97
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
Joint culture
98
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.
Reporting culture
99
The organisation: is committed to learn safety lessons; communicates them to colleagues; remembers them over time.
Learning culture
100
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).
Informed culture
101
patient safety culture in which staff feel comfortable discussing patient safety incidents and raising safety issues with both colleagues and senior managers
Open culture
102
Pharmacokinetics is the study of
How the body affects drugs
103
principal neurotransmitter associated with mediating the effects of the sympathetic arm of the autonomic nervous system
Noradrenaline
104
Adrenaline is used in anaphylaxis and vasoconstricts via its effects on which receptor
A1-adrenoreceptor
105
Name a medication which needs monitoring due its narrow therapeutic window
Ciclosporin
106
What feature of the clinical examination would suggest that the aortic stenosis is now severe?
A small volume and slow rising pulse
107
Name a feature of ECG seen in acute pericarditis
PR segment depression
108
What is this a presentation of - weight loss, fatigue, diarrhoea, sore eyes and double vision
Grave's disease
109
Name the liver attenuated vaccines
rubella, measles, oral polio, mumps or bacteria - bacillus Calmette-Guerin (BCG).
110
What arrythmia is seen in Grave's disease
Atrial fibrillation
111
Name the physiological processes in osteoporosis
Increase bone turnover
Bone resorption
Increase osteoblast activity
Reduced osteoblast activity
Micro architectural deterioration
112
Name the 1st line medication for osteoporosis
Oral alendronic acid
113
Name the 2nd line management for osteoporosis
Calcium + vitamin D supplementation
114
What investigations should be done for anyone who has definitely had an epileptic seizure
EEG
MRI - brain or head
CT scan head
CT brain
115
What histological features would be seen in UC
Increase in plasma cells in the lamina propria
Crypt distortion/branching/abscess
Ulceration
116
What would be seen in a spirometry test of asthma with bronchodilator
Increase in FEV1 > 20%
117
What histological features should be seen in primary carcinomas
Abundant mitotic figures
Areas of necrosis
Hyperchromatic nuclei
Pleomorphic nuclei
Ulceration
Endophytic growth
Invasion/poorly circumscribed margin
Variable resemblance to normal tissue (differentiation)
118
What are the 3 diagnostic criteria for nephrotic syndrome
Proteinuria > 3g/L
Hypalbuminaemia < 25g/L
Oedema
119
What is the mechanism of action of adrenaline
alpha and beta adrenergic receptor agonist
120
Name the 2 additional drugs given in anaphylactic shock
IV chlorpheniramine
IV hydrocortisone
121
What cell medicates anaphylaxis
Mast cells
122
What is the antibody most associated with anaphylaxis
IgE
123
What type of bacteria is Neisseria gonorrhoea
Gram-negative diplococci
124
What can be a complication of spironolactone
Hyperkalaemia
125
Describe the mechanism of action of beta-lactams
Inhibit trans glycosylation involved in peptidoglycan utilisation in cell wall synthesis
126
Describe the rules on driving post TIA
Do not notify DVLA but do not drive for 1 month
127
Name a derivative of common myeloid progenitor cells
Neutrophil
128
Describe an ECG of conn's disease
Flat T-wave, prolonged QT interval, ST depression
129
What is the treatment for chlamydia
Doxycycline 100mg 2x daily for 7 days
130
What is prophylaxis for cluster headaches
Verapamil
131
What chromosome is affected by hereditary haemochromatosis
6
132
Name the diabetes medication which blocks reabsorption of glucose in the kidneys
SGLT-2 inhibitor
133
What type of hypersensitivity reaction is hypersensitivity pneumonitis
Type III
134
What structure does the medulla oblongata develop from
Myelencephalon
135
Name a medication that would not be indicated in heart failure
Verapamil
136
What STI is linked with reactive arthiritis
Chlamydia pneumoniae
137
What date is used to remember the clotting factors of warfarin
1972
10, 9, 7, 2
138
Name a treatment for chronic myeloid leukaemia
Imatinib
139
Describe the mechanism of action of quinolone
Disrupts the function of DNA Gyrase
140
What symptom of a patient with fibromyalgia most likely to report
Swollen joints
141
Which marker is more specific for highlighting acute liver damage
ALT
142
What condition is this - unilateral, firm, painless lump felt. Not transilluminate
Testicular cancer
143
Name the causes of AF
Mrs SMITH
Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
Hypertension
144
What chromosome does sickle cell anaemia occur on
Chromosome 11
145
In Addinson's what is there autoimmune destruction of
Adrenal cortex
146
What is made in the medulla of the kidney
Catecholamines
147
What is made in the zona fasciculata of the kidney
Glucocorticoids - cortisol
148
What is made in the zona glomerulosa of the kidney
Mineralocorticoids - aldosterone
149
What is made in the zone reticularis of the kidney
Androgens
150
How do you remember what is made in the layers of the kidney
Salt, sugar, sex and GFR
Glomerulosa - mineralocorticoids e.g. aldosterone (outer)
Fasciculata - glucocorticoids e.g. cortisol
Reticularis - Androgens (inner)
151
Describe strep viridians
Gram negative
Catalase negative
Alpha haemolytic
Optochin resistant
152
What immunoglobulin can pass through the placenta
IgG
153
What is given in community acquired pneumonia
Amoxicillin
High severity - co-amoxiclav
154
What is given in hospital acquired pneumonia
Co-amoxiclav
High severity - tazocin
155
What is the best agar to grow fungal culture on
Sabouard plate
156
Name a side effect of verapamil
CCB
Ankle swelling
157
Describe boutonnieres deformity
Hyperextended DIP and flexed PIP
158
Describe swann neck deformity
Hyperextended PIP and flexed DIP
159
Where does Z-shaped deformity usually occur
Occurs in the thumb
160
Name two features that are associated with osteoarthritis
Bouchard's nodes (PIP joints)
Heberden's nodes (DIP joints)
161
Describe mechanism of action of leflunomide
Interferes with the production of pyrimidine - important component in RNA and DNA
162
How do you remember the side effects of rifampicin
Red-pissin
Red/orange discolouration of urine and tears
163
How do you remember the side effects of isoniazid
I'm-so-numb-azid
Peripheral neuropathy
164
How do you remember the side affect of pyrazinamide
Hyperuricemia > gout
165
How do you remember the side effect of ethambutol
Eye-thambutol
Colour blindness and reduced visual acuity
166
Name the 3 hallmarks for horner's syndrome
Ptosis
Miosis
Anhidrosis
167
What is used to assess acute pancreatitis
Modified Glasgow criteria
168
Describe modified Glasgow criteria
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
What is the sign of a palpable gallbladder in a jaundice patient in the absence of pain
Courvoisier's sign
170
What is the radiological intervention used to treat renal tract stones
Ultrasound shock wave lithotripsy
171
What is it called in heart failure where you cough at night and need 3 pillows to sleep
Paroxysmal nocturnal dyspnoea
172
What scoring system is used in heart failure
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
Name the 2 actions of metformin
Increases peripheral glucose uptake and sensitivity
Inhibits hepatic gluconeogenesis
174
What are the 2 most common subtypes of HPV
16 and 18
175
Define TCLO
The transfer capacity of the lung, for the uptake of carbon monoxide
176
What does CRP show
Raised in acute inflammation
177
Name the antibiotics that increase the risk of c. diff
Broad spectrum antibiotics
Clindamycin
Cephalosporins
Quinolones
Co-amoxiclav
Aminopenicillins
178
What does TDS on prescription mean
To be taken 3 times a day
179
What is the key ECG of pericarditis
Saddle shaped ST elevation expect in aVR
180
What is the role of IL-1
Causes fever and activates lymphocytes
181
What is the role of IL-6
Causes fever, stimulates the liver to produce acute phase proteins eg. CRP. Activates lymphocytes and promotes antibody production
182
What is the role of IL-8
Causes neutrophil chemotaxis
183
What is the role of IL-12
Activates NK cells and TH1 cells (important for intracellular infections)
184
What is the role of TNF-alpha
Increases vascular permeability to allow immune cells to reach tissues
185
What is the role of IL-4, IL-5, IL-13
Promote IgE production and eosinophilic reactions in patients with allergies
186
What is the role of Interferon gamma (IFNy)
Essential in activating cell-mediated immunity in viral infections
187
What is the role of IL-10
Has an anti-inflammatory affect
188
Name some proinflammatory cytokines important in acute inflammatory response
IL-1
IL-6
IL-8
IL-12
TNF-alpha
IL-4, IL-5 + IL-13
Interferon gamma (INFy)
IL-10
189
What is secreted by the posterior pituitary gland
Oxytocin
Antidiuretic hormone
