Make a Medic Mock 2021 Flashcards
How is an NSTEMI and unstable angina differentiated?
NSTEMI will cause raised troponins, however both can cause ECG abnormalities
Which drugs have a positive prognostic indication on patients with heart failure with reduced ejection fraction?
Beta blockers and ACE inhibitors
What is the management of SVT?
Haemodynamically unstable:
- DC cardioversion
Haemodynamically stable:
- Vagal manoeuvres
- 6mg Adenosine
- 12mg Adenosine
- Verapamil (or beta blockers/ diltiazem)
- DC cardioversion
Which murmurs are loudest on inspiration?
Right sided murmurs
Which murmurs are loudest on expiration?
Left sided murmurs
What is the triad of characterising critical limb ischaemia?
- Tissue loss
- Gangrene
- Pain at rest
What is the management of AF?
What is the management of ascending cholangitis?
- IV fluids
- Broad spectrum antibiotics
- ERCP to remove obstruction
What are the manifestations of portal hypertension?
- Caput medusae
- Oesophageal varices
- Haemorrhoids
- Splenomegaly
What does SAAG <11 g/L indicate?
Exudate
- Infection
- Peritoneal mets
*
What does SAAG >11 g/L indicate?
Transudate
What is the SAAG of nephrotic syndrome?
Nephrotic syndrome gives a SAAG of <11 g/L due to the decreased serum albumin
How is spontaneous bacterial peritonitis diagnosed?
Paracentesis of ascitic fluid with neutrophils >250 per mm3
Which organism most commonly causes SBP?
E.coli
What will histological analysis of a Crohn’s patient show?
- Transmural inflammation
- Non-caseating granulomas
- Skip lesions
Which artery is occluded in chronic mesenteric ischaemia?
Superior mesenteric artery
What is the presentation of chronic mesenteric ischaemia?
Post-prandial colicky abdominal pain (pain on exertion of the gut)
Occlusion of which artery leads to ischaemic colitis?
Inferior mesenteric artery
What is the most common cause of small bowel obstruction?
Adhesions
What is the class of carbocisteine?
A mucolytic
What is the most useful biomarker of chronic CO2 retainers?
HCO3-, as chronic CO2 retainers will get increased bicarb as a compensatory mechanism
Rasied CO2 doesn’t equal CO2 retainer
What are the three subgroups of beta-lactam antibiotics?
- Amoxicillin
- Cephalosporins
- Carbapenems
What is the management of provoked PE? (following surgery etc)
3 months of DOACs (some trusts use LMWH and Warfarin)
What is the management of unprovoked PE? (not following surgery)
6 months of DOACs (LMWH and warfarin depending on trust) and screening for pro-thrombotic conditions
What is the clinical difference between meningitis and encephalitis?
Meningitis rarely causes neurological symptoms, therefore focal neurology or seizures should raise suspicion for encephalitis
What is the most common cause of encephalitis?
HSV1 (managed with acyclovir)
Which arteries supply the primary motor cortex?
Anterior and middle cerebral arteries
What is the pathophysiology of dementia with Lewy bodies?
Deposition of alpha synuclean proteins
How can Parkinson’s and dementia with Lewy bodies be distinguished?
Parkinson’s will present with >= one year of motor symptoms before cognative, whereas cognative symptoms will preceed motor in DwLB
What is the most common cranial bleed following head trauma?
Extradural haemorrhage, usually following damage to the middle meningeal artery after trauma to the pterion
What is the presentation of an extra dural haemorrhage?
- Loss of consciousness
- Lucid period of feeling generally fine
- Rapid deterioration with focal neurology
What feature of urea makes it a useful marker for dehydration?
Urea is reabsorbed in states of low circulating volume, to utilise its osmotic properites therefore high concentration of urea indicates dehydration
What are the indications for haemodialysis in a patient with renal impairment?
- Pulmonary oedema
- Acidosis
- Hyperkalaemia
- Uraemic complications
- Pericarditis
- Encephalitis
Which enzyme do the kidneys produce?
1-alpha hydroxylase
What is the mechanism of post-streptococcal glomerulonephritis?
Molecular mimicry
What is the function of the direct antiglobulin test?
Autoimmune haemolytic anaemia
What is the best investigation for multiple myeloma?
- Serum electrophoresis
- Bone marrow biopsy
What are the gold standard investigations for Conn’s syndrome?
Renan:aldosterone ratio
What is the mechanism of action of calcium resonium?
K+, H+ exchange in the bowel leading to increased K+ excretion via the bowel
What is the management of DKA?
- A-E assessment
- IV fluids and fixed rate insulin
- 10% dextrose to avoid hypoglycaemia
Which patients are nitrites contraindicated in?
Patients with risk of hypotension and patients with aortic stenosis
