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Exam book questions > Laz n Oli > Flashcards

Laz n Oli Flashcards

1
Q

Inguinal Canal contents

A

Males - Spermatic cord

Females - Round ligament

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2
Q

Inguinal canal anatomy

A

ASIS to pubic tubercle
Begins at deep inguinal ring (just above midpoint of inguinal ligament)
Ends at superficial inguinal ring (Superior and medial to pubic tubercle)

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3
Q

Direct inguinal hernia

A

Weakness in posterior wall of inguinal canal

Abdo viscera protrude directly through back of inguinal canal

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4
Q

Indirect inguinal hernia

A

Abdo contents pass through deep inguinal ring and along inguinal canal

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5
Q

Differentiating direct vs indirect inguinal hernia on exam

A

Place finger on deep ring and ask pt to cough. Only direct hernia will protrude

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6
Q

Spigelian hernia

A

Abdo contents herniate through linea semilunaris

Inferior and lateral to umbilicus

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7
Q

Obturator hernai

A

Abdo contents herniate through obturator canal and present with inner thigh pain when his internally rotated

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8
Q

Austin Flint murmur

A

Severe AR
Regurgitated blood apply pressure mitral valve = physiological MS
Low pitched, rumbling mid-diastolic murmur

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9
Q

Graham Steel murmur

A

High pitched early diastolic murmur at left sternal edge

Assoicated with PR

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10
Q

Gibson murmur

A

Machinery murmur associated with patent ductus arteriosus

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11
Q

Carey-Coombs murmur

A

Mid-diastolic murmur causede by turbulent blood flow over thickened mitral valve
Associated with acute rheumatic fever

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12
Q

Barlow murmur

A

Mid-systolic click + end systolic murmur heard best at apex

Associated with mitral valve prolapse

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13
Q

GCS Points breakdown

A

Eyes - 4
Verbal - 5
Motor - 6

Minimum = 3; Maximum = 15

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14
Q

GCS Eyes

A

1 – No eye opening
2 – Eyes open in response to pain
3 – Eyes open to verbal command
4 – Eyes open spontaneously

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15
Q

GCS Verbal

A 
1 – No verbal response
2 – Incomprehensible sounds
3 – Inappropriate responses
4 – Confused conversation
5 – Oriented
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16
Q

GCS Motor

A

1 – No motor response
2 – Abnormal extension in response to pain (decerebrate posture)
3 – Abnormal flexion in response to pain (decorticate posture)
4 – Withdraws from pain
5 – Purposeful movement towards painful stimulus
6 – Obeys commands for movement

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17
Q

Minimal change glomeruonephritis

A

Non-proliferative glomerulonephritis which causes nephrotic syndrome in young children

Light microscopy shows no visible changes to the glomerulus (hence, minimal change), but electron microscopy shows diffuse loss of the processes of the podocytes in the Bowman’s capsule.

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18
Q

Membranous gloerunephritis

A

Non-proliferative glomerulonephritis and is a cause of nephrotic syndrome in adults

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19
Q

IgA nephropathy

A

Most common cause of glomerulonephritis and tends to occur a few days after upper respiratory tract infections.

Cause nephritic syndrome - haematuria more prominent than proteinuria

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20
Q

Henoch-Schonlein purpura

A

Type of IgA nephropathy that tends to affect older children and presents with a triad of abdominal pain, arthritis and a purpuric rash

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21
Q

Rapidly progressive glomeuronephritis

A

acute nephritic syndrome characterised by rapid loss of kidney function within weeks to months.

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22
Q

Anterior MI

A

LAD

V1-V4

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23
Q

Laterla MI

A

L circumflex

aVL, I and V5-V6

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24
Q

Inferior MI

A

Right coronary artery

II, III, aVF

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25
Q

Posterior MI

A

Posterior descending artery

ST depression in V1-V4

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26
Q

Rheumatoid arthritis

A

Chronic AI inflammatory disease

Symmetrical polyarthritis, joint deformity, extra-articular manifestations (eg. subcutaneous nodules, pulmonary fibrosis & episcleritis)

O/E: tenderness and warmth or MCP and PIP.
Radial ddeviation of wrist, ulnar deviation of fingers
Z deformity of thumb
Swan neck deformity
Boutonniere deformity
Trigger finger

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27
Q

Reactive arthritis q

A

Sterile arthritis

Tends to occur days/weeks post GI/urogenital infection

Traid of arthritis, uveitis and urethritis

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28
Q

Osteoarthritis

A

Degenerative disease of cartilage, occuring in weight bearing joints eg kness, hips

Often assymetrical and stiffness worse with activity

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29
Q

Psoriatic arthritis

A

presence of arthritis in pts with psoriasis

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30
Q

Chronic pancreatitis

A

Weight loss, steatorrhoea, alcholic

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31
Q

Acute vs chronic pancreatitis blood tests

A

Acute - high aylase

Chronic - normal serum amylase

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32
Q

Investigation to aid diagnosis of chronic pancreatitis

A

Faecal elastase is usually low in chronic pancreatitis, indicative of pancreatic exocrine insufficiency

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33
Q

Peptic ulcer disease gold investigation

A

OGD

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34
Q

Ca19-9

A

Pancreatic cancer marker

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35
Q

Pancreatic cancer signs

A

Painless jaundice and palpable gallbladder (Courvoisier’s Law)

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36
Q

Subtle causes of SoB

A

Anaemia

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37
Q

Hereditary haemochromatosis

A

Autosomal recessive
Excessive intestinal absorption of iron

Bronze skin, diabetes, hepatomegaly (iron deposition in skin, pancreas & liver respectively)

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38
Q

Haemochromatosis Iron sudies

Serum iron
Ferritin
Trasnferring 
Transferring sats
TIBC
A

High serum iron

High ferritin - inc iron = inc ferritin in compensatory atttempt to increase intracellular iron storage

Low transferrin - inc iron = dec trasnferring to prevent more iron from plasma protein bound in blood

High trasnferring sat - high iron and low trasnferrin

Low total iron binding capacity - measure of blood’s capacity to bind iron to transferring. As trasnferring low, inc diff for iron to bind

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39
Q

Hepcidin

A

Protein that inhibits ferroportin –> thereby regulating amount of iron entering blood `

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40
Q

Secondary causes of osteoporosis

A

Cushing’s syndrome
Hyperthyroidism
Hypogonadism

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41
Q

Gold standard diagnosing osteoprosis

A

DEXA

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42
Q

T scores for osteoporosis

A

T-scores are interpreted as follows:
0 to -1 = Normal
-1 to -2.5 = Osteopaenia (at risk of developing into osteoporosis)
-2.5 or worse = Osteoporosis

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43
Q

Score used to assess risk of stroke in AF pts

A

CHA2DS2-VASc

Congestive heart failure
Hypertension
Age > 75 yrs (2 points)
Diabetes mellitus
Stroke/TIA symptoms previously (2 points)
Vascular disease (e.g. peripheral artery disease) Age 65-74 yrs (1 point)
Sex category (Female = 1 point)

Score >2 = anticoag with warfarin or NOAC

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44
Q

Score to predict risk of cardiovascular disease

A

Qrisk2

Used to decide whether to give statins

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45
Q

Predict patients risk of stroke in days following TIA

A

ABCD2

Allows triaging of TIA patient s

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46
Q

GRACE score

A

Risk assessment and triaging of patients with ACS

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47
Q

CURB-65

A

Score used to assess severity of community acquired pneumonia

> 2 hospital admission
3 or more sever and therefore ITU

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48
Q

Diabetic retinopathy sequence

A

background retinopathy –> pre-proliferative retinopathy –> proliferative retinopathy

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49
Q

BAckground retinopathy features

A

hard exudates (leaked lipid contents from blood vessels creating a cheesy yellow appearance)
Microaneurysms
Blot haemorrhages

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50
Q

Pre-proliferative features

A

Soft exudates - regions of retinal ischaemia

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51
Q

Proliferative retinopathy

A

New blood vessels begin to form in regions of retinal ischaemia

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52
Q

Guillain Barre syndrome

A

Acute demyelinating polyneuropathy that often occurs a few weeks or months after an infection (e.g. Campylobacter jejuni).

MONITOR FVC as can cause resp muscle weakness

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53
Q

Causes of CKD

A

Diabetes mellitus (most common), hypertension, idiopathic, glomerulonephritis, pyelonephritis, vasculitides, polycystic kidney disease, reflux nephropathy and obstructive nephropathy.

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54
Q

Polycythaemia Sx

A

Headaches, tinnitus, blurred vision, history of thromboses, angina, pruritus after a hot bath

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55
Q

Polycythaemia vera

A

Rare type of bone neoplasm resulting in clonal proliferation of myeloid cells

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56
Q

Secondary polycythaemia

A

Secondary to chronic hypoxia, renal tumours and erythropoeitin abuse in athletes

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57
Q

Secondary polycythaemia

A

Secondary to chronic hypoxia, renal tumours and erythropoeitin abuse in athletes

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58
Q

Myelofibrosis

A

Disorder characterised by progressive bone marrow fibrosis

Dec bone marrow output, extramedullary haematopoiesis and massive splenomegaly

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59
Q

Psoas sign

A

Lying the patient on their left-hand side, straightening their right leg and then passively extending their right hip. If pain is elicited, this suggests that the appendix is retrocaecal.

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60
Q

Rovsing’s sign

A

Palpation of the left iliac fossa causes pain in the right iliac fossa

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61
Q

Cope’s sign

A

Pain on flexion and internal rotation of the hip and indicates that the appendix lies close to the obturator internus

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62
Q

Aaron’s sign

A

Referred epigastric pain when pressure is applied over McBurney’s point

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63
Q

Murphy’s Sign

A

Cessation of inspiration when two fingers are placed below the right costal margin in the midclavicular line and the patient is asked to take a deep breath in. This is suggestive of cholecystitis.

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64
Q

Squamous cell carcnioma

A

Arise in sun- exposed areas and have raised, everted edges with an ulcerated centre and a keratotic core

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65
Q

Keratoacanthoma

A

Variant of SCC which grows rapidly but does not metastasise.

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66
Q

Basal cell carcinoma

A

Skin lesion with raised pearly edges and fine telangiectasia on the surface. It grows across the skin but rarely metastasises.

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67
Q

Melanoma

A

Asymmetrical pigmented skin lesion with an irregular border.

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68
Q

Actinic keratosis

A

Thick crusty surface

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69
Q

AAA surgery indiciations

A

Diameter >5.5cm or rapidly expanding AAA

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70
Q

Diabetes insipidus

A

Production of large volumes of dilute urine and is caused by insufficient production of vasopressin (central DI) or the inability of the kidneys to respond to vasopressin (nephrogenic DI)

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71
Q

Water deprivation test

A

Pt not allowed to drink for 8hrs
Urine osmolality measured every 2 hrs and weight every hr

Inc in osmolality (>600 mOsm/kg) is normal response

Failure to concentrate indicates DI
When desmopressin administered, should cause increase with central DI

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72
Q

Kaposi’s sarcoma

A

systemic disease caused by infection with human herpesvirus 8 (HHV-8), presenting as cutaneous tumours

First AIDS related complication in HIV

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73
Q

Paracetamol overdose complications

A

Hepatic necrosis

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74
Q

Paracetamol overdose antidote

A

IV n-acetylcysteine

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75
Q

Opiate overdose antidote

A

Naloxone

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76
Q

Benzodiazepine overdose antidote

A

Flumenzanil

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77
Q

Organophosphate overdose antidote

A

Atropine

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78
Q

Aspirin overdose antidote

A

Sodum Bicarb

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79
Q

Haemolytic uraemic syndrome

A

Triad of:

  • microangiopathic haemolytic anaemia (MAHA)
  • acute renal failure
  • thrombocytopaenia

WIll followed diarrhoeal infection by E.coli 0157 in children

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80
Q

Atypical pneumonia

A

Present with vague symptoms such as malaise, headache and diarrhoea.

Legionella pneumophila - bodies of water at temp below 60, associated with confision. produces antigens excreted in urine

Mycoplasma pneumoniae - red cell agglutination, associated with transveerse myelitis

Chlamydia psittaci - found in birds

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81
Q

Prostate cancer scoring system

A

Gleason

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82
Q

Breslow thickness

A

Prognostic indicator for melanoma based on depth to which tumour cells invade surround tissues

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83
Q

Grace score

A

Risk stratify people suffered ACS

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84
Q

Wells score

A

PE probability

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85
Q

Dukes staging

A

Colorectal cancer

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86
Q

UTI treatment

A

trimethoprim or nitrofurantoin

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87
Q

Haemorrhoid grades

A

Grade 1: no prolapse

Grade 2: prolapse on defecation but reduces spontaneously

Grade 3: prolapse requires manual reduction

Grade 4: remain persistently prolapsed and cannot be reduced

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88
Q

Type 1 rectal prolapse

A

only the rectal mucosa protrudes through the anus

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89
Q

Tpe 2 rectal prolapse

A

All layers of the rectum protrude through the anus, creating a mass which has palpable, concentric muscular rings

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90
Q

Dresslers vs post MI pericarditis

A

Dresslers 2-10 weeks post MI, wheres post Mi pericarditis is 2-4days psot

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91
Q

Intermitten claudication

A

Cramping pain in the lower limb muscles that occurs on exercise and is relieved by rest

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92
Q

Critical limb ischaemia

A

cramping pain in the lower limb muscles that occurs on exercise and is relieved by rest

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93
Q

Leriche syndrome

A

Type of intermittent claudication resulting in buttock claudication, erectile dysfunction and weak distal pulses, due to aortoiliac stenosis.

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94
Q

HSV

A

dsDNA virus that is transmitted via close contact with an individual shedding the virus in oral secretions.

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95
Q

Tietze’s syndrome

A

form of costochondritis characterised by painful swelling of costal cartilage

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96
Q

Causes of pleuritic chest pain

A 
PE
Pneumothorax
Pericarditis 
Pleurisy 
Pneumonia

Subphrenic pathology
Rib fractures
Costochondritis

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97
Q

Molluscum contagiosum

A

Skin condition caused by pox virus

Occurs in children, spread via skin-to-skin contact

In adults, via sex

Lesions dome shaped, firm and smooth with umbilicated centre. Will last for around 8 months

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98
Q

Varicella zoster virus

A 
Chicken pox (children)
--> suddent appearance of extremely itchy rash. Vesicles appear, weep and crust over. Accomanied by prodromal flu-like symtoms

Shingles (adults) –> reactivation of VZV, which lies in dorsal root ganglia

Causes painful and tingling sensation in dermatone

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99
Q

Syphilis

A

Sexually transmitted disease caused by Treponema pallidum

Begins as single painless genital ulcer, followed by generalised lymphadenopathy and widespread skin lesions

Tertiary syphilis = infection spreads to brain and causes neuro complications

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100
Q

Gonorrhoea

A

Sexually-transmitted infection, caused by N.gonorrhoeae

Presents vaginal or urethral discharge, dysuria and dyspareunia (in women)

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101
Q

Sebaceous cyst

A

Keratinous, epithelium line cyst arising from blocked hair follicle

Very common, and appear as smooth lumps with overlying punctum that may discharge creamy substance

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102
Q

1st step management with temporal arteritis

A

Oral prednisolone

Delaying treatment = loss of vision

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103
Q

Temporal arteritis Sx

A

Unilateral headache
Scalp tenderness
Jaw claudication

Malise
Fever
Weight loss

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104
Q

Hep B

A

Prevalent in Sub-Saharan Afria and SE asia

Sexual contact, blood and vertical transmission from mum to child

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105
Q

Hep B antigen location

A

Surface antigen on outer envelope (HBsAg)

Inside is nucelocaspid, with the viral DNA

Nucleocaspid carries core antigen (HBcAg), involved in viral replication

e antigen (HbeAg) also closed associated with nucloecaspid

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106
Q

What antigen is administered in Hep B vaccine

A

HBsAg administered in HB vaccine

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107
Q

Antibody generated by immune system in response to HBsAg

A

HBsAb

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108
Q

Individuals with vaccination for Hep B serology presentation

A

HBsAb+

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109
Q

Serology in previously infected Hep B who have cleared the virus

A

HBsAb+ & HBcAb IgG+

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110
Q

Hep B progression of serology

A

Early marker of infection = inc HBsAg

Then rise HbcAb IgM (only present for acute phase) and HBcAb IgG (will persist if virus is cleared or if infection chronic)

HBeAg present both acute and chronic

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111
Q

Summary Hep B serology in acute infeciton

A 
HBsAg+
HBsAb-
HBcAb IgM+
HBcAb IgG+ 
HBeAg +/-.
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112
Q

Summary Hep B serology in chronic infection

A 
HBsAg+
HBsAb- 
HBcAb IgM-
HBcAb IgG+ 
HBeAg +/-
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113
Q

Blood groups A/B

A

Group A – has A antigens, produces anti-B antibodies

Group B – has B antigens, produces anti-A antibodies

Group AB – has A & B antigens, produces no antibodies against A or B antigens

Group O – has no antigens, produces anti-A and anti-B antibodies

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114
Q

Rhesus antigen

A

If rhesus positive, you have antigen on your RBC, therefore can accept any blood.

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115
Q

Ankylosing spondylitis

A

Seronegative spondyloarthropathy that presents with lower back pain and stiffness that is worst in the morning and improves with activity.

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116
Q

Test to diagnose ankylosing spondylitis

A

Schober’s

During this clinical test, a mark is made on the skin overlying the 5th lumbar spinous process (usually at the level of the posterior superior iliac spine) and a second mark is made 10 cm above the first. The patient is then asked to bend over, which flexes the spine. In normal subjects, the distance between the two marks will increase to > 15 cm. If the distance is less than 15 cm, this indicates a reduction in spinal flexion, which supports a diagnosis of ankylosing spondylitis.

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117
Q

Schirmer’s test

A

Assesses teat production in pts with Sjogren’s

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118
Q

Tensilon test

A

Diagnose Myasthenia gravis

Admin short acting AChest inhibitor –> see rapid improvement in muscle weakness

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119
Q

Hypertension NICE guidelines

A

STEP 1: Patients < 55 years old should be offered an ACE inhibitor (ACEI e.g. enalapril) or angiotensin receptor blocker (ARB e.g. losartan). Patients > 55 years old and patients of Afro-Caribbean origin should be offered a calcium channel blocker (CCB e.g. amlodipine) or, if there is any evidence (or high risk) of heart failure, a thiazide-like diuretic (e.g. bendroflumethiazide).

STEP 2: Offer a CCB with an ACEI or ARB. If CCBs are not suitable, a thiazide-like diuretic can be used instead.

STEP 3: Offer a combination of an ACEI or ARB with a CCB and a thiazide- like diuretic.

STEP 4: If these three steps are unsuccessful in gaining control of blood pressure, it is considered ‘resistant hypertension’. Expert help should be sought and a 4th antihypertensive may be added e.g. spironolactone.

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120
Q

Symptoms of storage (renal)

A

FUN

Frequency
Urgency
Nocturia

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121
Q

Symtpoms of voiding

A

WISE

Weak stream
Intermittency
Straining
incomplete Emptying

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122
Q

Prostate cancer secondary symtpoms

A 
Back pain (mets)
Paraneoplastic syndromes (hypercalcaemia)
Constitutional upset (weight loss, malaise)
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123
Q

Major features of Lewy Body dementia

A

HALLUCINATIONS
Fluctuating levels of confusion
Resting tremor

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124
Q

Symtpoms of Alzheimers disease

A

Anterograde amnesia
confusion
Changes in personality and mood and difficulty planning

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125
Q

Frontotemporal dementia

A

First present with change in personality or behaviour

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126
Q

Vascular dementia

A

Multipe small cerebral infarcts = loss brain function

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127
Q

Diagnostic criteria for diabetes

A

• One fasting blood glucose measurement > 7 mmol/L in a symptomatic patient

• Two fasting blood glucose measurements > 7 mmol/L in an asymptomatic
patient

• One random blood glucose measurement > 11.1 mmol/L in a symptomatic
patient

• Two random blood glucose measurements > 11.1 mmol/L in an asymptomatic
patient

  • Oral glucose tolerance test – 2 hr blood glucose > 11.1 mmol/L
  • HbA1c > 48 mmol/mol or > 6.5%
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128
Q

Lack of red reflex

A

Sth obscurring retina = no red reflection

Cataracts (opacification of lens)
Retinoblastoma

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129
Q

Herpes simplex keratitis

A

Infection of cornea
Dendritic ulcer

Often in adults due to reactivation of HSV lying dormant in trigeminal nerve

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130
Q

Long HX of abdo pain, increased freq and PR bleeding in young person

A

IBD

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131
Q

Red ring around cornea

A

Anterior uveitis

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132
Q

Villous atrophy and crypt hyperplasia

A

Coeliac disease

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133
Q

High grade dysplasia and metaplastic columnar epithelium

A

Barrett’s oesophagus

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134
Q

Features of hyperviscosity

A

Blurred vision & headaches

Others:
Vertigo
Seizures
HEaring loss 
Ataxia 
Increased bleeding tendency
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135
Q

Relative vs absolute polycythaemia

A

relative (normal red cell mass but reduced plasma volume)

Absolute (increased red cell mass)

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136
Q

Primary vs secondary polycythaemia

A

Polycythaemia rubra vera is a primary polycythaemia caused by clonal proliferation of myeloid stem cells.

Secondary polycythaemia is caused by natural or artificial increases in erythropoietin (EPO) production. This increase in EPO production may be appropriate (e.g. in response to chronic hypoxia in COPD) or inappropriate (e.g. EPO abuse amongst athletes).

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137
Q

Subclavian steal syndrome

A

Stenosis of the subclavian artery proximal to the origin of the vertebral artery results in blood being ‘stolen’ from the brain by retrograde blood flow down the vertebral artery and into the arm. This tends to occur when there is an increased demand for blood in the arm

Retrograde flow = dec blood to brain = blackout

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138
Q

Guillain Barre occurs often following waht

A

Infection

30% of these are gastroenteritis caused by C. jejuni

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139
Q

Treatment of CAP

A

co-amoxiclav (effective against S. pneumoniae) and clarithromycin (provides cover against atypical organisms).

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140
Q

Co-trimoxazole indications

A

combination of trimethoprim and sulfamethoxazole, is used to treat
Pneumocystis jiroveci pneumonia in HIV patients.

Can also be used for UTIs and resp tract infections

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141
Q

Metronidazole indicaitons

A

effective against anaerobes, and, so, is used to treat several GI infections (e.g. C. difficile colitis), pelvic inflammatory disease and aspiration pneumonia.

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142
Q

Flucloxacilin

A

enicillin that is effective against Gram-positive bacteria (mainly S. aureus). It is often used to treat skin and soft tissue infections

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143
Q

Side effects of morphine

A

Constipation, respiratory depression, nausea and drowsiness

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144
Q

Anti-muscarinic side effects

A

Blurred vision

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145
Q

ACEi side effect

A

Cough

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146
Q

B-adrenergic receptor agonists

A

Tremor

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147
Q

Ampicillin and amoxicillin in glandular fever side effects

A

RAsh

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148
Q

Gout most common location

A

Metatarsophalangeal joint of great toe

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149
Q

Microscopy of synovial fluid in gout

A

Negatively birefringent, needle-shaped crystals

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150
Q

Pseudogout microscopy of synovial fluid

A

Positively birefringent, rhomboid-shaped crystals

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151
Q

Turbid synovial fluid with high WCC

A

Septic arthritis

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152
Q

Causes of adrenal insufficiency

A

AI attack

TB

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153
Q

WHy vitiligo in adrenal insufficiency

A

AI attack of melanocytes leading to skin depigmentation patches

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154
Q

Short synacthen test

A

Adrenal insuffiency diagnosis

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155
Q

Change in bowel habit, PR bleeding and weight loss in elderly person

A

Suspicion of colorectal cancer

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156
Q

Left vs R sided colorectal cancer

A

L: present earlier with a change in bowel habit and PR bleeding

R: tends to present later with abdominal pain and symptoms of anaemia

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157
Q

Tenesmus

A

SoL in rectum

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158
Q

Tumour marker for colorectal cancer

A

CEA

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159
Q

Virchow’s node

A

Indicative of all abdominal malignancies, but most often gastric cancer

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160
Q

Courvoirsier’s law

A

painless jaundice in the presence of a palpable gallbladder is unlikely to be due to gallstones

More likely due to cancer

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161
Q

Anterior cerebral artery (location and infarct presentation)

A

Medial aspect of the frontal and parietal lobes

Behavioural changes
Weakness of contralateral leg > arm
Mild sensory deficit

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162
Q

Middle cerebral artery (location and infarct presentation)

A

Lateral aspect of the frontal, temporal and parietal lobes
Subcortical structures e.g. basal ganglia, internal capsule

Contralateral hemiparesis of face > arm > leg
Aphasia
Hemisensory deficits
Loss of contralateral half of visual field

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163
Q

Posterior cerebral artery (location and infarct presentation)

A

Occipital lobes
Inferior and medial portion of temporal lobes

Loss of contralateral half of visual field
Sensory deficit
Visual agnosia
Prosopagnosia

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164
Q

Mild hyponatraemia

A

130-135 mmol/L

Asymptomatic

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165
Q

Moderate hyponatraemia

A 
125-130 mmol/L 
Nonspecific Sx (headaches, nausea, lethary, muscle cramps)
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166
Q

Severe hyponatraemia

A

< 120 mmol/L and is associated with neurological symptoms such as seizures, hallucinations, confusion and memory loss

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167
Q

Sail sign appearance on CXR

A

Left lower lobe collapse

= left tracheal deviation and edge of collapsed lower lobe forms what looks like 2nd heart border

Contrast between collapsed left lower border and heart shadow = sail shape

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168
Q

Framingham criteria

A

Congestive cardiac failure = 2 major criteria or 1 major & 2 minor

Major Criteria
• Paroxysmal nocturnal dyspnea
• Crepitations
• S3 gallop
• Cardiomegaly
• Increased central venous pressure
• Weight loss > 4.5 kg in 5 days in response to treatment
• Neck vein distention
• Acute pulmonary oedema
• Hepatojugular reflex
Minor Criteria
• Bilateral ankle oedema
• Dyspnoea on ordinary exertion
• Tachycardia (> 120 bpm)
• Decrease in vital capacity by 1/3 from maximum recorded
• Nocturnal cough
• Hepatomegaly
• Pleural effusion
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169
Q

Meralgia paraesthetica

A

Numbness, pain or paraesthesia affecting an area of skin on the outside of the thigh caused by injury to the lateral femoral cutaneous nerve.

Often caused by weight gain

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170
Q

PBC

A

T cell mediated AI inflammation and destruction of intrahepatic ducts

Persistently elevated ALP, GGT

ANTI-MITOCHONDRIAL ABs

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171
Q

Trigeminal neuragia

A

Caused by compression of trigeminal nerve

Associated with MS

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172
Q

Shingles

A

Reactivation of varicella zoster virus

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173
Q

Ramsey hunt syndrome

A

Type of shingles caused by reactivation of varicella zoster in geniculate ganglio of facial nerve

Facial nerve palsy
Altered taste
Dry eyes/mouth
Vesicular rash in ear canal

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174
Q

Cluster headaches

A

Recurrent, severe unilateral headaches
Located around eye

Eye Sx:
Lacrimation
Conjunctival injection
Eyelid swelling

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175
Q

Ischaemic colitis occurs in

A

elderly patients

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176
Q

Dermatitis herpetiformis

A

Blistering, papulovesicular rash

Extra-GI manifestation of coeliac disease

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177
Q

Coeliac disease

A

Inflamm condition due to gluten intolerance

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178
Q

Coeliac pathophysiology

A

Gluten = immunological reaction in SB by T cells = disruption of S+F of mucosal lining

Leads to malabsorption, malnutrition & anaemia (due to iron deficiency)

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179
Q

First line investigation for coeliacs

A

Tissue transglutaminase antibodies
Anti-endomysial antibodies
Anti-gladin antibodies

Definitive diagnosis: OGD and biopsy

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180
Q

Histological appearance due to coeliacs

A

Subtotal villous atrophy with crypt hyperplasia

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181
Q

Chest Xray of HF

A

ABCDE

Alveolar oedema
Kerley B lines
Cardiomegaly 
Upper lobe Diversion 
Pleural Effusion
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182
Q

Hypercalcaemia Sx

A 
Stones
bones
abdominal groans
thrones (urinary freq, commode = throne?!)
psychiatric overtones
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183
Q

Multiple myeloma

A

Haem malignancy

Excessive proliferation of plasma cells

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184
Q

Multiple myeloma Sx

A

CRAB

hyperCalcaemia
Renal failure
Anaemia
Bone Pain

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185
Q

Blood cells seen in multiple myeloma

A

Rouleaux

Stacks of red cells seen on blood film, form due to high conc of plasma proteins

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186
Q

Schistocytes

A

Red cell fragments –> indicator of intravascular haemolysis

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187
Q

Granulocytes with absent granulation and hyposegmented nuclei

A

Myelodysplastic syndrome

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188
Q

Dacrocytes

A

Teardrop shaped cells in myelofibrosis §

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189
Q

Smear cels

A

Chronic Lymphocytic leukaemia

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190
Q

TB

A 
Haemoptysis
Weight loss 
Night sweats 
Cervical lymphadenopathy 
Erythema nodosum
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191
Q

TB Xray

A

Tends to affect upper lobes

May show hilar lymphadenopathy

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192
Q

Best investigation for TB

A

Sputum sample, tested for presence of acid-fast bacilli using Ziehl-Neelsen stain

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193
Q

Mantoux test

A

Intradermal injection of tuberculin protein derivative

Reaction producing raised, hardened area 72 hrs post injection = previous exposure to TB

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194
Q

Urinary tract stone prevalance

A

Calcium oxalate – 75%
Magnesium ammonium phosphate (struvite) – 15% Urate – 5%
Hydroxyapatite – 5% Cysteine – 1%

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195
Q

First line investigation for pancreatitis

A

Transabdominal USS

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196
Q

Cushing’s reflex

A

Physiological response to raised ICP

Triad of high BP, bradycardia and irregular breathing

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197
Q

Kussmaul sign

A

parafoxical rise in JVP on inspiration, occuring in pts with imparied right ventricular filling

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198
Q

Beck’s triad

A

Raised JVP, muffled heart sounds and low BP

Cardiac tamponade

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199
Q

Charcot’s traid

A

RUQ pain
Jaundice
Fever with rigors

Ascending cholangitis

200
Q

5 malaria species

A 
P. falciparum, 
P. vivax, 
P. malariae, 
P. ovale  
P. knowlesi
201
Q

Diagnosis of malaria

A

Microscopic analysis of blood films

Thin films preserve the appearance of the parasites allowing species identification.

Thick films screen a larger volume of blood allowing higher sensitivity when picking up low level infections.

202
Q

Two hormones responsible for inc serum Ca2+

A

PTH

Calcitriol

203
Q

Hypercalcaemia of malignancy

A

Condition - Release of calcium from bone metastases or from the paraneoplastic effect of PTH-related peptides, which can be released by cancer cells and mimic the action of PTH.

Ca2+ level will be raised but the PTH feedback loop will be intact, so the PTH level will be low

204
Q

Milk-Alkali syndrome

A

Rare condition caused by the ingestion of too much calcium and alkali (e.g. from dietary supplements used to prevent osteoporosis).

205
Q

Causes of VT

A

Coronary artery disease, valvular disease, electrolyte imbalances (e.g. low Mg2+) and long QT syndrome

206
Q

Varicocoele

A

Scrotal mass formed by the dilation of the veins of the pampiniform plexus

207
Q

Varicocoele L or R?

A

90% L

Angle at which testicular vein meets renal vein and inc reflux from compression of vein

208
Q

Common causes of bowel obstruction

A

Tumours
Adhesions
Volvuli
Hernias

209
Q

Embryo sign on AXR

A

Caecal volvulus

210
Q

Coffee bean sign

A

Sigmoid volvulus

211
Q

Onycholysis

A

Painless separation of fingernail or toenail from nailbed

212
Q

Causes of onycholysis

A

DR PITHS

  • Drugs (e.g. tetracyclines, oral contraceptive and diabetes drugs)
  • Reactive arthritis, Reiter’s syndrome
  • Psoriais
  • Infection (especially fungal)
  • Trauma
  • Hyper- and Hypothyroidism
  • Sarcoidosis, Scleroderma
213
Q

Wernicke’s area damage

A

Inability to understand language, but pts can produce fluent but nonsensical speech

214
Q

Broca’s area damage

A

Inability to produce fluent speech, despite intact undestanding of language

215
Q

Arcuate fasciculus damage

A

Intact language comprehension and fluent speech production; however, speech repetition is poor

216
Q

Hippocampus function

A

Memory and learning

217
Q

Amygdala function

A

Flight or fight response

218
Q

Drawing blood too fast =

A

Hyperkalaemia

Fast blood withdrawal = red cell lysis, releasing all intracellular potassium into sample

219
Q

B symtpoms of lymphoma

A

Fever, night sweats and weight loss

220
Q

Malar flush

A

Mitral stenosis

Occurs due to CO2 retention leading to vasodilation of vascular beds of cheeks

221
Q

4 ways to detect H.pylori

A

1) Urea breath test
- If Co2 containing labelled carbon detected in breath 30 mins after, suggests urea has been cleaved by urease produced by H.pylori

2) Blood antibody test
3) Stool antigen test
4) Rapid urease test/Campylobacter-like organism test

222
Q

Appropriate management of H.pylori negative peptic ulcer disease

A

Stop NSAIDs and start omeprazole

223
Q

Appropriate manaagement of H.pylori positive peptic ulcer disease

A

triple therapy

PPI & 2 ABs

224
Q

De Quervain’s thyroiditis

A

Viral thyroiditis

Halts thyroxine production

Initially = hyperthyroid as stored thyroid hormone release

After few weeks = hypothyroid

Initially damaged thyroid gland doesnt take up iodine .>. gland doesnt show up on scan

225
Q

Graves’ disease thyroid scan

A

Diffuse uptake throughout an enlarged gland

226
Q

Toxic multinodular goiter (Plummer’s disease) thyroid scan

A

Multinodular gland with single hot nodule

227
Q

Thyroid cancer uptake scan

A

Diffuse uptake with single cold nodule

228
Q

Fibroadenoma

A

A firm, smooth, mobile breast lump without axillary lymphadenopathy, skin changes or nipple discharge in a young woman

229
Q

Pt presents with acute neurological Sx (eakness, slurring of speech, facial droop, amaurosis fugax) resolving within 24 hrs

What should be done?

A

Administer 300mg aspirin

230
Q

Henoch-Schonlein purpura triad of signs

A 
Arthritis
Abdo pain 
Purpuric rash (often buttocks and lower legs)
231
Q

Causes of LIF pain

A 
Diverticulitis, 
Constipation
Irritable bowel syndrome
Ulcerative colitis (UC), 
Colorectal cancer and gynaecological causes
232
Q

Whooping cough

A

Bordatella pertussis

233
Q

Syphilis

A

Treponema pallidum

234
Q

Diarrhoeal illness in immunocompromised patients

A

Cryptosporidium

235
Q

Atypical pneumonia

A

Mycoplasma pneumoniae

236
Q

The plague

A

Yersinia pestis

237
Q

JVP A wave

A

Atrial contraction causing some blood to flow back up the superior vena cava

238
Q

JVP C wave

A

ventricular contraction causes the tricuspid valve to bulge into the right atrium resulting in a pressure wave passing up the superior vena cava

239
Q

JVP X descent

A

Atrial relaxation and filling

240
Q

JVP V wave

A

Caused by increased venous return to the right atrium occurring in late
systole

241
Q

JVP Y descent

A

Flow of blood from the right atrium into the right ventricle through an open tricuspid valve

242
Q

Cannon A waves

A

Atrai and ventricles contract simultaneously

Complete heart block

243
Q

Larve V waves

A

Tricuspid regurg

244
Q

Raised JVP with absent pulsation

A

SVC obstruction

245
Q

Slow Y descent

A

Tricuspid stenosis

246
Q

Ankylosing spondylitis

A

Seronegative inflammatory arthropathy

Mainly affects axial skeleton & large joints.

Seronegative cos significant level of serum antibodies.

Strong association HLA-B27 allele

247
Q

Ankylosing spondylitis presentation

A

Males more common

Lower back and sacroiliac pain worst in morning and better with activity

Reduced range of spinal motion

248
Q

Lumbar disc herniation

A

Acute back pain with shooting pains in the lower limbs. The location of pain depends on the nerves affected

249
Q

Vocal resonance increased

A

Consolidation (tumour, pneumonia)

SOund conducts better through solids

250
Q

Bronchial breath sounds

A

Consolidation in between surface of sthethoscope and bronchi

Normally arent meant to hear air in bronchi as too small and far away

If consolidation, sound conducts better through solid, therefore will be able to hear bronchial breath sounds better

251
Q

Poylmyalgia rheumatic

A

Inflamm condition

Pain and stiffness (withouth weakness) of shoulder and pelvic girldle which is worst in the morning

252
Q

Bladder cancer types

A

Transitional cell carcinoma
Squamous cell carcinoma

Strong association with exposure to dye stuffs

253
Q

Romano-Ward Syndrome

A

Hereditary condition causing long QT syndrome

254
Q

Seborrhoeic eczema

A

Affects areas rich in sebaceous glands ie scalp, eyebrows and nasolabial folds

255
Q

Discoid eczema

A

Distinc coin-shaped lesions seen on shins, forearms and trunk

256
Q

Contact eczema

A

Type iV delayed hypersensitivity to allergen

Affects part of body exposed to allergen

257
Q

Atopic excema

A

Froms atopic triad

258
Q

Pompholyx eczema

A

Fluid-filled blisters restricted to palms of hands and soles of feet

259
Q

Long term oxygen therapy for COPD

A

• Patients with PaO2 < 7.3 kPa despite maximal treatment
• Patients with PaO2 7.3-8.0 kPa and one of: pulmonary hypertension,
polycythaemia, peripheral oedema or nocturnal hypoxia
• Terminally ill patients

260
Q

Acute mesenteric ischaemia triad

A

Severe abdo pain
Normal abdo examination
Shock

261
Q

Acute mesenteric ischaemia

A 
Arterial thrombosis (atherosclerosis)
Embolism (AF)
Venous thrombosis (hypercoagulable states)
Non-occlusive disease (hypotension)
262
Q

CHronic mesenteric ischaemia

A

Combination of low-flow state, ie heart failure & atherosclerotic disease

Presents with gut claudication:

Poorly localised, colicky, post-prandial abdo pain
PR bleeding
Weight loss

263
Q

Signs of perforation in bowel

A

Pneumoperitoneum

Rigler’s sign

264
Q

Toxic multinodular goitre

A

Plummer’s Disease

Very high T3/T4
Low TSH & TRH

265
Q

Features of acute limb ischaemia

A

6Ps

Pale
Pulseless
Paraesthesia 
Paralysis
Perishingly Cold 
Painful
266
Q

Most common causes of viral meningitis

A

Enteroviruses (e.g. poliovirus,
Coxsackie A)

Herpes viruses (e.g. HSV, VZV, EBV)

267
Q

Bacterial LP

A

Cloudy/turbid
High neutrophils
High protein
Low glucose

268
Q

Viral LP

A

Clear
Lymphocytes high
High protein
Normal glucose

269
Q

TB LP

A

Fibrinous
High Lymphocytes
High protein
Low glucose

270
Q

Ruddy/red complexion

A

Feautre of polycythaemia

271
Q

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

A

Systemic vasculitis

Characterised by triad of upper and lower respiratory tract involvement (nosebleeds and haemoptysis) & glomerulonephritis (haematuria and proteinuria)

Saddle nose

272
Q

Test for granulomatosis with polyangitis

A

cytoplasmic anti-neutrophil cytoplasmic antibdoies (cANCA)

273
Q

Goodpasture’s syndrome

A

autoimmune
condition attacking the basement membrane in the kidneys and lungs leading to
renal failure and haemoptysis.

274
Q

Goodpasture’s test

A

Anti-GBM antibodies

275
Q

pANCA

A

UC
PSC
Microscopic polyangiitis
Churg-Strauss syndrome

276
Q

Anti-liver/kidney microsomal (anti-LKM)

ASMA

A

autoimmune hepatitis

277
Q

Systemic inflammatory response syndrome (SIRS)

A 
• Heart Rate > 90 bpm
• Respiratory Rate > 20/min or PaCO2 < 4.3 kPa
• Temperature > 38°C or < 36°C
• White Cell Count < 4 x 109
/L or > 12 x 109
/L

Sepsis = SIRS & septicaemia (organism in the blood)

278
Q

Psoriatic arthritis presentation

A

1) DIP joint disease
2) Psoriatic spondylopathy
3) Symmetrical polyarthritis
4) Asymmetrical oligoarthritis
5) Arthritis mutilans

279
Q

Epilepsy faint

Before, during, after

A

Before:
Aura (partial seizure)
No warning (generalised seizure)

During:
Mins
Tongue biting 
Limb jerking 
Incontinence

After:
Slow recovery
Confusion

280
Q

Vasovagal faint

Before, during,after

A

Before:
Vagal symptoms (nausea, pallor, sweating)
Precipitants (hot weather etc)

During:
Secs
Rarely twitching and incontinence

After:
Rapid recovery on sitting or lying

281
Q

Arrhythmia fainting

A

Before:
Chest pain
Palpitations
No warnings

During:
Secs

After:
Rapid spontaneous recovery

282
Q

Light detection

A

Light is detected by rods and cones in the retina, which then generate an electrical
signal that passes along the optic nerve. The optic nerve contains two main bundles
of nerves, one will carry signals from the medial half of the retina (responsible for the
temporal half of the visual field) and the other will carry signals from the lateral half of
the retina (responsible for the nasal half of the visual field). The two optic nerves will
meet at a point called the optic chiasma. At the chiasm, the neurons from the lateral
half of the retina will continue to the optic tract on the ipsilateral side. Whereas the
neurons from the medial half of the retina will decussate at the chiasm and join the
optic tract on the contralateral side. Therefore, the optic tract in the left hemisphere is
responsible for the right half of the visual field and the optic tract in the right
hemisphere is responsible for the left half of the visual field. The optic tract ends at
the lateral geniculate nucleus (LGN) in the thalamus. Optic radiations link the LGN to
the visual cortex. The optic radiations have an upper division (passing through the
parietal lobe) and a lower division (passing through the temporal lobe). The upper
division is responsible for the inferior quadrant of the visual field (e.g. the upper
division of the optic radiation in the right hemisphere, is responsible for the left
inferior quadrant) and the lower division is responsible for the superior quadrant. The
primary visual cortex will then integrate the information from these inputs.
Damage to the optic nerve will lead to complete loss of vision in one eye, with intact
vision in the other eye. Disruption of the optic chiasm (e.g. by pituitary tumours)
mainly affects the neurons from the medial half of the retina, which decussates at the
chiasm. This leads to bitemporal hemianopia. The optic tract carries information from
one half of the visual field – i.e. right half of the visual field in the left optic tract and
vice versa. Disruption of this tract leads to homonymous hemianopia (loss of one half
of the visual field). Disruption of the upper and lower divisions of the optic radiations
will lead to superior or inferior homonymous quadrantopia.
This patient has left homonymous hemianopia, meaning that his right optic tract has
been damaged.

283
Q

Constipation features

A

Lower abdo pain
Bloating
Abdo distention
Palpable mass in LIF

284
Q

Common side effect of codein (and other opioids)

A

Constipation

285
Q

Faecal impaciton in distal colon =

A

Liquid stools in little space left in lumen

286
Q

Rectocoele

A

Herniation of rectum into vagina due to tear

May experinece constipation, tensemus, faecal incontinence and dyspareunia

287
Q

PCOS

A

Characterised by oligomenorrhoea/amenorrhoea and features of hyperandrogenism

Menstrual irregularities, hirsuitism

288
Q

Turner syndrome

A

Females born with only 1 X chromosome

Short stature
Lower posterior hair line
Primary amenorrhoea
Webbed neck

289
Q

Asterixis

A

hepatic encephalopathy, azotaemia due
to renal failure, carbon dioxide retention, Wilson’s disease and drugs-induced (e.g.
phenytoin)

290
Q

Bacterial conjunctivits

A

Yellow crust

291
Q

Hypopyon

A

Yellow exudate in lower part of anterior chamber of eye

292
Q

Hyphaema

A

Collection of blood in anterior chamber, usually by injury to eye

293
Q

HOCM distinguising features

A

Jerky carotid pulse
Ejection SM
Double apex beat

294
Q

Phenobarbital

A

Barbiturate

Used in epilepsy treatment

295
Q

Loperamide

A

Weak opiod used as anti-diarrhoeal

296
Q

Risperiodne

A

Antipsychotic used in shizophrenia and bipola treatment

297
Q

AML special signs

A

Auer rods

Sudan black stain

298
Q

CML special signs

A

Philadelphia Chromosome

Massive splenomegaly

299
Q

CLL special signs

A 
Smear/smudge cells
Warm agglutinins (AIHA)
300
Q

Hodgkin’s lymphoma special signs

A

Panful lymph nodes after alcohol digestion

Reed-Sternberg cells

301
Q

Myelodysplasia special signs

A

Ringed sideroblasts

NO splenomegaly

302
Q

Myelofibrosis

A

MASSIVE splenomegaly
Dry tap (no aspirate)
Dacrocytes (tear drop cells)
Associated with polycythaemia rubra vera

303
Q

Infectious mononucleosis (glandular fever)§

A

non-specific flu-like symptoms (fever, malaise, sore throat) along with cervical
lymphadenopathy and splenomegaly

304
Q

What shouldnt be givent to person with glandular fever

A

Ampicillin and amoxicilin

causes maculopapular rash

305
Q

TB treatment

A

Rifampicin and Isoniazid – 6 months

Pyrazinamide and Ethambutol – 2 months

Pyridoxine (vit B6) given as well as isoniazid = B6 deficiency = peripheral neuropathy

306
Q

Normal pressure hydrocephalus

A

Confusion/dementia
Gait disturbance
Urinary incontinence

307
Q

Systemic sclerosis

A

Scleroderma

Small blood vessel damge & fibrosis in skin & organs

308
Q

Limited cutaneous systemic sclerosis

A

CREST sydnrome

Calcinosis 
Raynaud's phenomenon
oEsophageal dysmotility 
Sclerodactlyl
Telangiectasia
309
Q

Brudzinski’s sign

A

Passive flexion of neck causes pt to involuntarily flex their hip

If passive extension of knee causes pain –> kernig’s positive

Caused by meningeal irriation

310
Q

Uhthoff’s sign

A

Worsening of neuro symptoms when body is overheated

Sign of Multiple Scleorisis

311
Q

Lhermitte’s sign

A

Flexion of neck = shooting pain down spine

Sign of Multiple sclerosis

312
Q

Tinel’s sign

A

Carple tunnel syndrome

Tapping the wrist at the point at which the median nerve runs under the flexor retinaculum causes pain and a tingling sensation in the area of the hand supplied by the median nerve

313
Q

Courvoisier’s Law

A

Palpably enlarged and non-tender gallbladder in presence of painless jaundice is unlikely to be due to gallstones - its cancer

314
Q

Flecanide CI

315
Q

Recurrent epsiodes of sweating, palpitations and anxiety in young people =

A

Phaeochromocytoma

316
Q

Multiple endocrine neoplasia Type 2A

A

Associated with parathyroid adenomas, medullary thyroid cancer and phaeochromocytomas

317
Q

IX phaeochromocytoma

A

24hr urine vanillymendelic acid (VMA)

By product of adrenaline synth

318
Q

Serum 17-hydroxyprogresterone elevation

A

Congenital adrenal hyperlasia

319
Q

24 hr urine 5- hydroxyindoleacetic acid (5-HIAA)

A

Main metabolite of serotonin

Released in excess in carcinoid sydrome

320
Q

Carcinoid syndrome buzzword

A

Facial flushing

321
Q

SAAG

A

Serum albumin - ascities albumin

322
Q

SAAG <11 g/L

A

Ascitic fluid is exudative (high protein)

323
Q

Nephrotic syndrome with SAAG

A

Causes low SAAG as albumin freeely filtered

324
Q

Causes of low SAAG

A

Malignancy
Pancreatitis
Infeciton
bowel obstruction

325
Q

SAAG >11 g/L

A

Transudative (low protein)

OFten due to portal hypertension

326
Q

Causes of high SAAG

A 
Cirrhosis, 
Constrictive pericarditis 
CCF
Budd-Chiari sydnrome 
Hepatic venous obstruction
327
Q

Prothrombin time

A

Funciton of extrinsic pathway

328
Q

Prolonged pT

A

Pt deficienct in 1 or more componenet of extrinsic and common pathways

Causes:

Warfarin
Liver disease

329
Q

Activated partial thromboplastic time

A

Function of intrinsic and common pathways

330
Q

Haemophilia

A

Deficiency in factor 8 or 9

Both part of intrinsic pathways .>. prolonged APTT

Pt normal

331
Q

Trying to find PE in pregnant woman

332
Q

CXR rare abnormalities in PE

A

Hampton’s Hump (peripheral wedge of opacity), Westermark sign (regional oligaemia) and Fleischner sign (enlarged pulmonary artery)

333
Q

CA 15-3

A

Breast cancer

334
Q

CA125

A

Ovraian Cancer

335
Q

CEA

A

Colorectal cancer

336
Q

aFP

A

Liver Cancer, Testiculaar Cancer

337
Q

b-hCG

A

Choriocarcinoma, Germ Cell Tumours

338
Q

S100

339
Q

Calcitonin

A

Medullary thyroid cancer

340
Q

PSA p

A

prostate cancer

341
Q

Thyroglobulin

A

Thyroid cancer

342
Q

Spinalal cord stenosis & causes

A

Narrowing of spinal canal

Caused by osteophytes, disk herniation, ligamentum flavum hypertrophy

343
Q

SPinal cord stenosis Sx

A

Sciatica-like pain experience when walking downhill

Stooped posture

344
Q

Acute vs gradular cord compression

A 
Acute = LMN
Gradual = UMN
345
Q

Rheumatic fever major criteria

A

JONES

Joints (arthritis),
O – looks like a heart (carditis e.g. tachycardia, murmurs)
subcutaneous Nodules,
Erythema marginatum (a rash with red, raised edges and a clear centre)
Sydenham’s chorea (involuntary semi-purposeful movements).

346
Q

RHEUMATIC Fever minor criteria

A

Fever, raised ESR/CRP, arthralgia, prolonged PR interval and previous rheumatic fever

347
Q

Kussmaul breathing

A

Deep sighing breaths

Comprensatoruy response to met acidosis

348
Q

Cheyne-Stokes breathing

A

Cyclic breathing patter where breathing gets progressively deeper then progressively shallowed then apnoea

Causes: Brainstem damage or herniation

349
Q

Main risk factors for testicular cancer

A

Maldescended or ectopic testes

350
Q

Testicular cancer spreads to which lymph node

A

Para-aortic

351
Q

Rectal bleeding in young people causes

A

Haemorrhoids
Anal fissures
Coeliac disease
IBD

352
Q

Anal fissure

A

Painful tear in squamous lining of lower anal canal

Pain on defecation & bright red blood streaked on toilet paper/stoosl

353
Q

Anal fissure people diet

A

Low fibre and poor fluid intake –> have to strain

354
Q

Haemorrhoids blood in stool

A

Bright red

Separate to stool and may drip into pan post defecation

355
Q

Felty’s syndrome

A

Triad of rheumatoid arthritis, splenomegaly and neutropenia

356
Q

Giemsa stain

357
Q

India Ink Stain

A

Cryptococcus spp.

358
Q

Sudan Black stain

359
Q

First thing to do in a stroke

A

See if ischaemic or haemorrhagic by doing CT head

360
Q

Stroke with Sx onset <4.5 hrs

A

Thrombolysis with alteplase and aspiring within 24 hrs

361
Q

Stroke with Sx onset >4.5 hrs

A

Antiplatelet therapy and undergo swallw assessment and GCS monitoring

362
Q

Prognostic indicator of melanoma

A

Dept of penetraiton of melanoma - Breslow thickness

363
Q

Central pontine myelinolysis

A

Neuro condition caused by damage to myelin sheath of neurones that makes up pons

364
Q

Central pontine myelinolysis SX

A

Acute paralysis
Dysarthria
Dysphagia

365
Q

Consequence of rainsing plasma sodium conc too quickly

A

Osmotic gradient between myeling cells and extracellular environment = water out of myeling cells, resulting in central pontine myelinolysis

366
Q

Signs of liver failure

A

A to J

Asterixis
Bruising 
Clubbing 
Dupuytren's contracture
Erythema
Fetor hepaticus 
Gynaecomastia 
Hepatomegaly 
Itching 
Jaundice

Other findings are:

spider naevi, leukonychia, testicular atrophy and signs of portal hypertension, such as splenomegaly, GI bleeds, caput medusae, haemorrhoids and ascites

367
Q

Koilonychia sign of

A

Chronic iron deficiency

368
Q

5 organisms causing bloody diarrhoea

A

CHESS

Campylobacter jejune
Haemorrhagic E.coli (0157)
Entamoeba histolytica
Salmonella 
Shigella
369
Q

Giardia

A

Parasite causing giardiasis

Presents with:
- non bloody diarrhoea
Abdo cramps
Fould smelling flatulence
Belching
370
Q

Polycystic kidney disease

A

Autosomal dominant

Bilaterally enlarged kidneys
Hypertension
Haematuria

(strongly associated with subarachnoid haemorrhage)

371
Q

Secondary cause of hypertension that’s common

A

Renal artery stenosis

372
Q

Hyperkalaemia Sx

A 
General muscle weakness
Flaccid paralysis 
Paraesthesia of hands &amp; feet
Lethargy 
Confusion 
Palpitations
373
Q

Adverse effect of spironolactone

A

Hyperkalaemia

as its a potassium sparking diuretic

374
Q

ECG changes of hyperkalemia

A
  • Tented T waves - K+ > 5.5 mmol/L
  • Flattening of P waves - K+ > 6.5 mmol/L
  • Widening of the QRS complex and bradycardia - K+ > 7.5 mmol/L
375
Q

Hyperkalaemia management

A
  1. 10ml 10%calcium gluconate - stabilises the myocardium and protects against arrhythmias but does not lower serum potassium levels
  2. 50ml of 50%dextrose with 10U insulin - insulin drives potassium into cells and dextrose is also given to prevent hypoglycaemia
376
Q

Generalised seizure

A

Occur in both hemispheres of brain

377
Q

Portal HTN signs

A

Ascites
Splenomegaly
Caput medusa

378
Q

Hepatopulmonary sydrome

A

Rare complication of cirrhosis

Hypoxaemia in its with portal HTN

Results from microscopic pul vasodilation due to dec hepatic clearance of vasodilators

Vasodilation = hyperperfusion of lungs and hypoxaemia

379
Q

Multiple myeloma

A

Haem malignancy

Proliferation of plasma cells

Lytic bone lesions and excess Ig production

380
Q

Multiple myeloma Sx

A

Bone pain
Pathological fractures
Recurrent infections
Hypercalcaemia features

Raised ESR and Ca2+

381
Q

Multiple myeloma special protein

A

Bence-Jones

382
Q

COPD treatment

A
  1. Short-acting muscarinic antagonist (SAMA e.g. ipratropium) or short-acting beta-agonist (SABA e.g. salbutamol) PRN
  2. Add long-acting muscarinic antagonist (LAMA e.g.tiotropium) or long-acting beta-agonist (LABA e.g. salmeterol)
  3. Consider using a LAMA + LABA or LABA with an inhaled corticosteroid(ICS)
    • Symbicort = Budesonide (ICS) + Formoterol (LABA)
383
Q

UMN lesion tone

A

First flaccid paralysis

Then spastic paralysis

384
Q

LMN features

A

Hypotonia
Hyporeflexia
Muscle atrophy

Fasciculations
Fibrillations - not visible to naked eye

385
Q

Granulomatosis with polyangitis

A

Small and medium vessel vasculitis.

Classic triad of organ involvement:
Upper respiratory tract (nosebleeds)
Lungs (haemoptysis)
Kidneys (glomerulonephritis)

Rhinitis
Saddle nose deformity
Purpura

Increased cANCA

386
Q

Microscopic polyangitits

A

SKin, lung and kidney involvement, but no granulomatous disease

387
Q

Goodpastures syndrome characterised by

A

anti-GBM antibodies

388
Q

Churg-Strauss syndrome

A

Triphasic vasculitis

1) allergic phase
2) eosinophilic has
3) vasculitis phase

389
Q

Behcet’s disease

A

Small vessel vasculitis characterised by triad of oral ulcers, genital ulcers and uveitis

390
Q

Gas gangrene

A

Clostridium perfringens

391
Q

Necrotising fasciitis organisms

A

S. progenies & S.aureus

392
Q

Most common organisms for cellulitits

A

S.pyogenes & S.aureus

393
Q

What diabetes drug could cause hypoglycaemia

A

Sulfonylurea

394
Q

Cancer of lung associated with cavitating lesions

A

Squamous cell carcinoma

395
Q

Best investigation for ureteric colic

A

Non-contrast CT-KUB

396
Q

Tricuspid regurg JVP

A

Giant V waves

397
Q

Tension test

A

Administer edrophonium brome (short acting anticholinergic) & observe pt response

Improvement in muscle movement = myasthenia gravis

398
Q

Dix-Hallpike test

A

Identify BPPV

399
Q

Schirmer’s teset

A

Assess tear production

Sjogren’s syndorme

400
Q

Romberg’s test

401
Q

Trendelenburg test

A

Abductor muscles of hip

402
Q

Anaphylaxis first step management

A

IM adrenaline

IV used in cardiac arrest but not here

403
Q

Microcytic anaemia causes

A

TAILS

Thalassaemia, Anaemia of chronic disease, Iron deficiency, Lead poisoning and Sideroblastic anaemia (an abnormality of haem synthesis resulting in the inability to incorporate iron into haemoglobin)

404
Q

Normocytic anaemia causes

A

MR I CALM

Marrow failure, Renal failure, Iron deficiency (early), anaemia of Chronic disease (early), Aplastic anaemia (and acute blood loss), Leukaemia and Myelofibrosis

405
Q

Acanthosis nigricans

A

Dark, velvety skin found in body folds

Associated with:

T2DM
Cushing’s
PCOS

Paraneoplastic due to gastric cancer

406
Q

Diabetic dermopathy

A

Slight depressed red-brown patch occurring on shins

407
Q

Granuloma annulare

A

peculiar skin condition that looks like a ring of pink-purple skin lumps most often found on the backs of the hands and feet.

T2DM
Thyroid

408
Q

Intrinsic causes of gynaecomastia

A

Hypogonadism
Cirrhosis
Oestrogen-producing tumours

409
Q

Gynaecomastia as drug side effect

A

Oestrogen
Spironolactone
Digoxin
Cimetidine

410
Q

BPH which zone

A

Transitional zone

411
Q

Prostate cancer zone

A

Peripheral zone

412
Q

Leriche Syndrome

A

aortoiliac occlusive disease

Intermittent claudication of buttocks
Erectile dysfunciton
Reduced/absent distal pulses

413
Q

Chronic compartment syndrome

A

when the pressure within a fascial compartment increases during exercise, causing pain

414
Q

Spinal stenosis

A

Narrowing of spinal canal, applying pressure on spinal cord.

415
Q

Lumbar spinal stenosis

A

Pain in lower limbs when walking or standing for long periods of time

Pain eased by bending forwards

416
Q

Behcet’s disease

A

Systemic inflammatory disease

TRIAD:

Mouth ulcers
Genital ulcers
Uveitis

417
Q

Most common ECG finding in PE pts

A

sinus tachy

418
Q

Long term PE ECG finding

419
Q

Riverse tick sign

A

Digoxin toxicity

420
Q

Characteristic Parkinson’s disease

A 
Pill-rolling resting tremor
Lead pipe muscle rigidity 
Bradykinesia
Narrow gait 
Postural instability
Hypomimia (dec facial expression)
Hypophonia (soft voice)
Micrographia (progressively smaller handwriting)
Up-gaze impairment
Drooling tendency 
Furrowed eyebrows
421
Q

Polycystic kidney disease inheritance

422
Q

Huntingdon’s inheritance

423
Q

Marfan’s inheritance

424
Q

MEN inhertance

425
Q

Cystic fibrosis inheritance

426
Q

Sickle Cell inheritane

427
Q

Thalassemia inheritance

428
Q

Colour blindness inheritance (red green)

429
Q

Haemophilia inheritance

430
Q

G6PD deficiency inheritance

431
Q

Aspirin overdose

A 
Fever
Sweating 
Hyperventilation 
Tinnitus 
Deafness
432
Q

Paracetamol overdose

A

Asymptomatic for first 24 hrs then features of liver failure

433
Q

TCA overdose

A 
Tachycardia
Drowsiness
Dry mouth 
N&amp;V
Confusion
434
Q

Painless lymphadenopathy that becomes painful after alcohol ingestion

A

Hodgkin’s lymphoma

435
Q

Cough - large vols purulent sputum

Recurrent rest infections

A

Bronchiectasis

436
Q

Tumour lysis sundrome

A

Group of metabolic abnormalities that results from cancer treatment

Most commonly occurs in treatment of leukaemia and lymphoma

High K+
High PO4 3-
High uric acid
Low ca2+

437
Q

Portal hypertension problems

A

Problems in Butt (haemorrhoids), ‘gut’ (oesophageal varices) and ‘caput’ (caput medusae)

438
Q

Variceal bleed first thing to do

A

Terlipressin - vasopressin analogue causes splanchnic vasoconstriction, thereby reducing mesenteric blood flow and portal pressure

439
Q

Duct ectasia buzzword

A

Cheesy yellow/green discharge

440
Q

SLE features (>4 of these =SLE)

A

SOAP BRAIN MD

Serositis (pleuritis, pericarditis)
Oral ulcer
Arthritis (non-erosive)
Photosensitivity
Blood disorders (haemolytic anaemia, leukopaenia, thrombocytopaenia)
Renal disorders (e.g. proteinuria, red cell casts)
Anti-nuclear antibodies (ANA)
Immunological disorders (presence of anti-dsDNA/anti-Sm/anti-phospholipid antibodies)
Neurological disease (psychosis, seizures) Malar rash (butterfly rash)
Discoid rash

441
Q

Hashimoto’s thyroiditis

A

Hypothyroidism

442
Q

Ridel’s thyroiditis

A

Normal thyroid tissue replaced by dense fibrous tissue

Thyroid is described as woody

443
Q

Cavitating lesion with air fluid level

A

Infectious causes:

  • S. aureus
  • Klebsiella
  • pneumonia
  • TB

Squamous cell carcinoma
Rheumatoid arthritis
Granulomatosis with polyangitis

444
Q

Legionella pneumophila distinctive feature

A

Air conditioning units

445
Q

4 main components of AKI management

A
  • Protecting from hyperkalaemia
  • Optimising fluid balance
  • Stopping nephrotoxic drugs
  • Assessing need for dialysis
446
Q

Spontaneous bacterial peritonitis

A

Neutrophil count > 250 cells/mm^3

Most commonly E.coli & K. pneumonia

447
Q

Hypertensive retinopathy changes order

A

Grade 1 = Silver Wiring

Grade 2 = AV Nipping

Grade 3 = Flame Haemorrhages and Cotton Wool Exudates

Grade 4 = Papilloedema

448
Q

Carpal tunnel syndrome

A

sensory impairment in the distribution of the median nerve (lateral half of the palm and the first three digits) leading to a tingling pain and weakness of the affected hand

Idiopathic
Obesity
Infiltrative disease

449
Q

Why low Hb in haemolytic anaemia

A

Microangiopathy haemolytic anaemia component of DIC

450
Q

Immediate management of PE

A

High flow O2 & SC LMWH

451
Q

GOld standard diagnostic test for acromegaly

A

Oral glucose tolerance test

452
Q

Insulin suppression test

A

To investigate hypopituitarism

453
Q

Why elevated MCV in alcoholic pts?

A

Harmful effect of alcohol on erythroblast development

454
Q

AST:AKT >2

A

Liver damage secondary to alcohol abuse

455
Q

Treating MRSA

A

Vancomycin

456
Q

Tazocin indication

457
Q

Three causes of raised JVP

A

Constrictive pericarditis
Right heart failure
Tricuspid regurgitation

458
Q

Peaked P waves on ECG

A

P pulmonale

Due to right atrial enlargement

459
Q

4 histopathological sybtypes of melanoma

A

Superficial spreading - from pre-existing naves –> slowly changing mole

Nodular melanoma –> rapidly out of area of skin with no pre-existing navi. Grow vertically as blue-black or blue-red nodules

Acral lentiginous melanomas - soles & palms. Brown black mace with irregular borders

Lentigo maligna

460
Q

Bowen’s disease

A

Squamous cell carcinoma in situ

461
Q

MRC scale

A

Grade 0 = no muscle movement
Grade 1 = flicker of movement
Grade 2 = active movement with gravity eliminated
Grade 3 = active movement against gravity (but not against resistance)
Grade 4 = active movement against gravity and resistance Grade 5 = normal power

462
Q

Best Ix to confirm sliding hiatus hernia

A

Barium Swallow

463
Q

Diagnosis of AKI criteria

A

• Rise in urea > 26 micromol/L in in 48 hrs
• Rise in creatinine > 1.5 x baseline (baseline measured in the last 3
months)
• Urine output < 0.5 mL/kg/h for > 6 hrs (i.e. your urine production in mL
over 2 hours should match your body weight in kg)

464
Q

Indications for Aki dialysis

A

• Refractory pulmonary oedema
• Persistent hyperkalaemia
• Severe metabolic acidosis
• Uraemic complications (e.g. encephalopathy, pericarditis)
• Drug overdose by the BLAST drugs: Barbiturates, Lithium, Alcohol,
Salicylates and Theophyline

465
Q

Causes of HAP

A 
Gram-ve enterobacteriaee (eg. E.coli)
S.aureus
Pseudomonas
Klebsiella
Bacteriodies 
Clostridia
466
Q

Causes of CAP

A 
S. pneumoniae
H. infleunzae 
M. pneumoniae
Moraxella 
Chalmydia 
Legionella
467
Q

Neurofibromatosis

A

Autosomal dominant

Tumour development in nervous system

468
Q

Type 1 neurofibromatosis

A

Peripheral manifestations

Cafe-au-lait macules 
Axiallry ferckling 
Neurocutaneous fibromas
Phaeos 
Renal artery stenosis
469
Q

Type 2 neurofibromatosis

A

Central features

Bilateral vestibular schwannomas
Meningiomas
Gliomas

470
Q

Xeroderma pigmentosum

A

Genetic disorder of DNa repair

.>. pts susceptible to DNA damange by UV radiation = multiple skin cancers

471
Q

Dercum disease

A

Presence of several painful lipomas across body

472
Q

Extra articular features of ankylosing spondylitis

A

5 A’s

Apical lung fibrosis 
Amyloidosis 
Anterior uveitis 
Achilles tendinitis 
Aortic regurgitation
473
Q

Erythema ab igne

A

Reticulated rash caused by long term exposure to heat

Sometimes seen in chronic pancreatitis, hypothyroidism and lymphedema

474
Q

Subcut nodules

A

Seen in rheumatoid arthritis

475
Q

Tophi

A

Deposits of monosodium urate crystsal in joints

Occur in gout

476
Q

Cardiac tamponade

A

Beck’s triad

Muffled heart sounds
Raised JVP
Hypotension

477
Q

Causes of erythema nodusum

A

LOST BUSH

Leprosy, Lymphoma, Leukaemia 
OCP
Sarcoidosis, Sulphonamides
TB, Toxoplasmosis 
Behcet's disease
Ulcerative Colitis (&amp; Chron's)
Salmonella, Strep
Histoplasmosis
478
Q

Hypervolaemic causes of hyponatraemia

A

Congestive cardiac failure
Cirrhosis
Nephrotic syndrome

479
Q

Euvolaemia causes of hyponatraemia

A

Adrenal insufficiency
SIADH
Hypothyroidism

480
Q

Hypovolaemic causes of hyponatraemia

A

Diarrhoea
Vomitting
Diuretics

481
Q

Sharp chest pain

A

Pleuritic pain

482
Q

Chronic dry cough and SoB in Afro-Caribbean origin person

A

Think Sarcoidosis

483
Q

Bilateral hilar lymphadenopathy

A

Radiological hallmark of sarcoidosis, although it can be caused by TB and lymphoma

484
Q

Sarcoid what parameter would be raised

485
Q

Extra-GI feature of coeliac disease

A

Dermatitis herpetiformis

Papulovesicular rash

486
Q

Anti-tTG antibodies

A

Diagnostic test for Coeliac

487
Q

Most common causes of septic arthritis

A

S.aureus,
Streptococci
Neisseria gonorrhoeae

488
Q

CKD definition

A

GFR < 60 mL/min/1.73m2 for more than 3 months

489
Q

Heart failure management

A
  1. Sit the patient upright
  2. Administeroxygen
  3. Gain IV access and monitor ECG (treat arrhythmias)
  4. IV Diamorphine
  5. IV Furosemide
  6. GTN spray or infusion
  7. Consider CPAP if the patient’s condition worsens
490
Q

Microcytic anaemia causes

A

Iron deficiencyy
ACD
Thalassemia
Sideroblastic anaemia

491
Q

Normocytic anaemia cuases

A 
Aplastic anaemia 
Haemolysis 
Post haemorrhage 
Pregnancy 
Fluid overload
492
Q

Macrocytic anaemia causes

A 
B12 defieicny 
Folate deficiency 
Drugs (methotrexate)
Alcohol excess
Liver disease
Myelodysplasia 
Hypothyroidism 
Multiple myeloma
493
Q

SVC syndrome

A

COmpression of SVC often by lung tumours

Dyspnoea
Orthopnoea
Swollen face &amp; arms
Plethora
Cough 
Engorged neck &amp; facial veins (raised and non pulsatile)
494
Q

Pulsus alternans

A

Seens in left ventricular systolic failure

EF low = low SV, .>. high end diastolic vol –> Starling’s law –> stronger subsequent contraction

Alternating pattern of strong and weak pulses

495
Q

Pulsus paradoxus

A

Abnormally large dec in BP and pulse amplitude during inspiration

Constrcitve pericarditis
Cardiac tamponade

496
Q

Pulsus bisferiens

A

Biphasic pulse that has two peaks per cardiac cycle

Detected in HOCM

497
Q

IgA nephropathy vs post-strep glomerulonephritis

A

Post-strep 4-6 weeks after strep infeciton

IgA nephropathy 5-7 days after pharyngitis

Exam book questions (4 decks)

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