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MCCQE1 > MCCQE1 > Flashcards

MCCQE1 Flashcards

1
Q

Bariatric surgery thresholds

A

Any patient with a BMI > 40 kg/m
Patients with BMI > 35 kg/m and serious coexisting medical problems (e.g. OSA , severe DM, cardiomyopathy, Pickwickian syndrome)

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2
Q

Most likely cause of hypercalcaemia and hyperphosphatemia

A

Vitamin D excess

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3
Q

Dysphasia

A

Broca’s - Expressive. Word finding difficulties.

Wernicke’s - Receptive. Fluent but meaningless speech.

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4
Q

Acute intermittent porphyria

A

Abdominal pain, psychiatric episodes, neurological deficits, abnormal LFTs and elevated porphobilinogen.

Avoid barbiturates (sodium thiopental) and any medication that induces P450 cytochrome

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5
Q

TTP pentad

A

MAHA, thrombocytopenic purpura, neurological abnormalities, fever and renal disease.

Avoid platelet transfusion

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6
Q

Genu varus

A

Bow legs

Usually spontaneously corrects by age 2

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7
Q

Myeloma symptoms

A 
CRAB
Calcium
Renal
Anaemia
Bone
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8
Q

Conservative management of splenic injuries

A

Grade 1-2 splenic injury, haemodynamically stable, < 55 years old, no additional injuries on CT, recovery of bowel function, no loss of consciousness, no rebound tenderness or guarding.

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9
Q

Cervical cancer screening

A

Recommended for all women > 25 who have been sexually active every 3 years
Women > 70 with 3 normal tests in a row and no abnormal tests for the last 10 years can stop screening
Requires Thin Prep of endocervical, transformation zone and exocervical cells.
Smears shouldn’t be taken during menstruation, mid-cycle (just before ovulation) is ideal. Date of LMP required at screening.

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10
Q

Evaluation of pulmonary artery hypertension

A

1st) Doppler echocardiography

2nd) Right heart catheterisation

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11
Q

Roseola infantum

A

Sixth disease, exanthem subitum, humar herpes virus type 6
9-12 month old infant with abruptly high fever (> 40 degree) which lasts 3 days then disappears with the appearance of a maculopapular rash

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12
Q

Fragile X syndrome

A

X linked disorder (males have more severe symptoms than females)
Intellectual disability
Prominent jaw, forehead and nasal bridge with large protuberant ears
Macroorchidism
Hyperextensibility
High arched palate
Complications: MVP, seizures, scoliosis

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13
Q

S4

A

Extra sound prior to SI (Tennessee)
Atria forcefully contracting against a stiff or hypertrophic ventricle
Associated with aortic stenosis, pulmonary hypertension and systemic hypertension

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14
Q

Varicella zoster immunoglobulins

A

IgG - Previous exposure and natural immunity

IgM - Active infection

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15
Q

Phase 2 of drug trials

A

Proof of concept - Trialled on disease

Highest rate of failure

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16
Q

Hypothermia

A

Mild 32-35
Moderate 28-32
Severe 20-28
Profound < 20
Bretylium used for arrhythmias
Rewarming at a rate of > 2 degrees/hr improves mortality
Rewarming can lead to hypotension, metabolic acidosis, hyperkalaemia, hypocalcaemia and hypomagnesemia

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17
Q

Peptic ulcer disease

A

Treat with PPI for 4-8 weeks. Extend duration if persistent.

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18
Q

Classification of bipolar disease

A

1) Manic episodes and depressive episodes

2) No manic episodes. Hypomanic episodes and depressive episodes.

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19
Q

Zinc deficiency

A

Poor wound healing
Hypogonadism secondary to low testosterone
Seen in Crohn’s disease

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20
Q

High-grade squamous intraepithelial lesions (HSIL)

A

Pap smear result that should always lead to colposcopy

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21
Q

Streptococcus gallolyticus

A

Previously known as streptococcus bovis-associated endocarditis
Causes villous adenomas and colonic cancer

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22
Q

Proctalgia fugax

A

Recurrent rectal pain unrelated to defecation
Sharp pain last from seconds to minutes
Absence of pain between episodes

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23
Q

Sick euthryroid syndrome

A

Low T3, normal T4, normal TSH

Following disease/trauma

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24
Q

Common variable immune deficiency (CVID)

A

B cell dysfunction
Upper and lower respiratory tract infections, otitis media and sinusitis
Increased risk of autoimmune conditions (RA, vitiligo, ahaemolytic anaemias, thrombocytopenia, GI disease)
Increased risk of lymphoma

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25
Q

Endometriosis

A

Mulberry spots
Infertility
Dyspareunia, pre and post menstrual spotting, sacral backache with menses, bowel and bladder symptoms

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26
Q

Wallenberg syndrome

A

Lateral medullary syndrome
Posterior inferior cerebellar artery
Ipsilateral Horner’s syndrome with contralateral temperature and pain sensation loss, ipsilateral ataxia and dysphagia, dysarthria and dysphonia

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27
Q

MEN 1

A

Pituitary
Parathyroid
Pancreas

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28
Q

Lead poisoning

A

Levels > 45 micrograms/dL require chelation treatment
Oral chelation - Succimer
Emergency hospitalisation and IV chelation if levels > 70 micrograms/dL

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29
Q

Bacterial meningitis

A

Hearing impairment in children

Hyponatraemia from SIADH

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30
Q

Erythema marginatum

A

Rheumatic fever

Serpiginous central blanching

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31
Q

Amenorrhoea

A

Primary - Ultrasound abdomen. Is there a uterus?
Secondary - Pregnancy test, TSH + prolactin, progesterone challenge test, eostrogen-progesterone challenge test, hysteroscopy (is there an outflow obstruction - Asherman’s syndrome secondary to surgical procedures, endometriosis, terminations)

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32
Q

Hereditary spherocytosis

A 
Gallstones
Jaundice
Splenomegaly
Haemolytic anaemia
Treat with splenectomy
More common in Northern Europeans
Due to mutation in the gene for ankyrin and spectrin proteins of red blood cells
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33
Q

ALL good prognosis

A

Age 1-10
Leucocyte count < 50
B cell immunophenotype
Rapid response to initial chemotherapy

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34
Q

Botulism

A

Clostridium botulinim (gram positive rod)
Honey often the source
Avoid aminoglycosides
Flaccid paralysis

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35
Q

Turner syndrome

A

45X
Short stature and infertility
Webbed neck and sausage shaped digits
Cardiac defects and coarctation of the aorta
Oestrogen given to commence puberty at age 12 (if given earlier causes short stature)

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36
Q

Medications causing galactorrhea

A 
Antipsychotics
Cimetidine
Metoclopramide
Methyldopa
Tricyclic antidepressants
AND MORE...
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37
Q

Giardia lambilia

A 
1-2 week incubation period
Watery diarrhea
Abdominal pain
Loss of appetite
Flatulence
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38
Q

Chlamydia conjunctivitis

A

Bilateral conjunctivitis at 5-14 days age
Acquired from birth canal
Systemic treatment (Erythromycin)

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39
Q

SIADH

A

Urine osmolality > 100 mOsm/kg

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40
Q

Croup

A 
Laryngotracheobronchitis
Ages 4 months to 5 years
Stridor and seal like barking coughing
Caused by parainfluenza
Treated with steroids (dexamethasone)
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41
Q

Bacterial vaginosis

A

Diffuse milky discharge with a fishy odor
Wet mount test - clue cells
Positive Whiff test (addition of KOH leads to odor)
Vaginal pH > 4.5
Gardnerella
Only treat pregnant patients: Metronidazole 500mg BID for 7 days or topical clindamycin cream (which can lead to vaginal candidiasis)

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42
Q

Best SSRI in children

A

Fluoxetine

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43
Q

Positive predictive value

A

The proportion of positives that correspond to the presence of a condition
(TP/(TP+FP))x100

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44
Q

Latent TB treatment

A

9 months of isoniazid

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45
Q

G6PD deficiency

A

Mediterranean and African-American greatest at risk
Jaundice and haemolytic anaemia
X-linked recessive
Fava beans

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46
Q

Hypertrophic cardiomyopathy

A 
Double apical pulse
Bifid carotid impulse
Exertional syncope and dyspnea
Increased murmur with valsalva
1st line Ix: ECG THEN echo (systolic anterior motion defect of mitral valve) THEN cardiac MRI
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47
Q

Mesenteric angiography

A

Can only spot bleeds > 0.5ml/min

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48
Q

What type of reaction is anaphylaxis?

A

T1 hypersensitivity reaction

IgE mediated

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49
Q

Fastest progressing cause of aortic stenosis?

A

Degenerative calcification

More so than bicuspid valves and rheumatic fever

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50
Q

Froment’s sign

A

Assessment of ulnar nerve damage
Ask a patient to hold a sheet of paper in between thumb and index finger (pinch grip), if paper can be pulled out it’s positive

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51
Q

Placenta praevia

A

Painless bright red vaginal bleeding in third trimester
Risk factors - Advanced maternal age, previous uterine surgery, gestational hypertension, multiparity, multifetal gestation and smoking

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52
Q

Neural tube defects

A

Screening with serum alpha fetoprotein (abnormal if high)
USS to confirm gestational age for dating errors
Amniocentesis alpha fetoprotein acetylcholinesterase (elevation is highly specific)

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53
Q

Antiphospholipid syndrome

A

Multiple miscarriages
Lupus anticoagulant and anticardiolipin antibodies
False negative syphilis (VDRL) testing
Thrombocytopenia

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54
Q

Valproic acid side effects

A

Can lead to elevated ammonia levels

Treated with carnitine

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55
Q

Encephalitis vs meningitis

A

Altered mental status in encephalitis

Treat early with acyclovir

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56
Q

Renal vein thrombosis

A

Secondary to nephrotic syndrome (especially membranous)

Nausea, vomiting, flank pain, haematuria, worsening proteinuria and high LDH

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57
Q

Courvoisier’s sign

A

Enlarged gallbladder, non-tender and associated with jaundice
Pancreatic carcinoma, ampulla carcinoma, cholangiocarcinoma

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58
Q

Lead time bias

A

Overestimation of survival duration among screen detected cases where survival is measured from diagnosis

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59
Q

Pap smear results most likely to signify carcinoma

A

Atypical glandular cells not otherwise specified (AGC-NOS)

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60
Q

Miliary TB

A

Seen in alcoholics due to immunosuppression
Diffuse small pulmonary nodules on x-ray
Weight loss, fatigue and cough

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61
Q

Hantavirus

A

Exposure to mouse droppings
Indistinguishable from influenza
Lifethreatening respiratory syndrome in western hemisphere
Eastern hemisphere presents as haemorrhagic fever with renal failure

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62
Q

Trichomonal vaginitis

A 
Yellow frothy discharge
Abnormal vaginal odor
Vulvovaginal itching and soreness
Dyspareunia and dysuria 
Strawberry cervix
Positive Whiff test on wet mount with flagellated protozoa
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63
Q

Freidreich’s ataxia

A 
Autosomal recessive
Progressive ataxia with loss of deep tendon reflexes
Extensor plantars
Kyphoscoliosis
Pes cavus
Family history
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64
Q

Intranuclear ophthalmoplegia

A

Lesion in the medial longitudinal fasciculis
Slow adduction of contralateral gaze
Suggestive of MS but also seen in vascular disease and other rarer conditions

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65
Q

Maintaining remission of MS

A

Interferon beta
Glatiramer acetate
Natalizumab
Fingolimod

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66
Q

Patau syndrome

A 
Trisomy 13
Severe congenital anomalies
Micro/anophthalmia
Clef lip and/or palate
Postaxial polydactyly
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67
Q

Confirmatory test for CLL

A

Flow cytometry of peripheral blood cells

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68
Q

Chronic stable angina investigation

A

Exercise ECG

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69
Q

Steady state of drugs

A

Achieved by 5 half lives (i.e. if OD dosing check levels at 5 days after changing dose or initiating)

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70
Q

Apnea

A

Prolonged absence of airflow for > 20 seconds or associated with bradycardia or cyanosis
Idiopathic - 2nd to 7th day of life. Persists until 37 weeks gestational age

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71
Q

ARDS

A

Acute onset
Bilateral infiltrates on chest radiograph
PCWP < 18 or no evidence of increased left atrial pressure
PaO2/FiO2 < 200

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72
Q

Gestational hypertension treatment

A

Nifedipine

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73
Q

Rotavirus schedule

A

Oral vaccine given from 6 weeks of age at ages 2, 4 and 6 months OR 2 doses at 2 and 4 months

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74
Q

SAAG

A

> 1.1 Portal HTN related

< 1.1 Non-portal HTN related

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75
Q

Heparin induced thrombocytopenia

A

Platelet drop of 50% or more within 5-15 days of starting heparin therapy
Treat with danaparoid

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76
Q

Normal pressure hydrocephalus

A

Triad: Ataxia, urinary incontinence, dementia

Gold standard diagnostic test: Lumbar puncture and drainage of CSF

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77
Q

Barrett’s oesophagus

A

Normally squamous epithelium of distal oesophagus becomes columnar epithelium (precursor to adenocarcinoma)
No dysplasia - 3-5 yearly EGDs
Low grade dysplasia - 6-12 monthly EGDs
High grade dysplasia - 3 monthly EGDs

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78
Q

Transient tic disorder

A

Same diagnostic criteria as Tourette syndrome

Treat with fluphenazine or pimozide

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79
Q

Levodopa dosing

A

Start at 100mg TID

Sinemet (levodopa/carbidpoa) 100/25mg

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80
Q

Meningococcal prophylaxis

A

PO 4 x doses of rifampicin Q12H
IM 1 x dose of ceftriaxone if pregnant
Respiratory isolation can be discontinued 24 hours after antibiotic therapy has started

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81
Q

Specificity

A

The proportion of patients without the condition that test negative
TN/(TN+FP)

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82
Q

Sensitivity

A

The proportion of patients with the condition that test positive
TP/(TP+FN)

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83
Q

Number needed to treat

A

1/Absolute Risk Reduction

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84
Q

Exudative effusion (Light’s criteria)

A

Ratio of pleural fluid protein to serum protein is > 0.5

Ratio of pleural fluid LDH to serum LDH is >0.6 or 2/3 the upper limit for serum LDH

85
Q

Cruciate ligaments

A

Rupture anterior - anterior movement of tibia

Ruptured posterior - posterior movement of tibia

86
Q

Shoulder dystocia

A

Associated with clavicular fractures which are treated conservatively and will recover over several months
Rarely brachial plexus injuries or pneumothoraces can occur

87
Q

Down’s syndrome and triple screening

A

Majority of births (70%) are by women < 35
Likelihood if positive triple test = 2%
Alpha fetoprotein and unconjugated estriol are low and hCG levels high in a positive test

88
Q

Plan B contraception

A

Emergency contraception - 2 x 0.75mg levonorgestrol 12 hours apart
Delays/inhibits ovulation
Effective up to 72 hours post intercourse

89
Q

Tourette’s syndrome

A

Both multiple motor and vocal tics have been present for < 1 year
Before the age of 18
Treat with clonidine (alpha agonist)

90
Q

Cystic fibrosis

A

Autosomal recessive
1 in 3000 Caucasians (much less common in Asians and blacks)
Psuedomonas most common organism in CF patients, however in new patients S. Aureus and H. influenzae most common

91
Q

Good prognostic factors in schizophrenia

A 
Late onset disease
Obvious precipitating factors/stressors
Acute onset
Presence of mood disorders
Good support system
Positive symptoms of schizophrenia
92
Q

Charcot’s triad

A

RUQ pain
Fever
Jaundice
Indicative of cholangitis

93
Q

Beta HCG

A

Peaks at 8-12 weeks gestational age then falls

94
Q

Neutropenic enterocolitis

A

Clostridium septicum

95
Q

Pyloric stenosis

A 
3-6 week old infants
Projectile vomiting post feeds
Olive shaped mass
Peristaltic waves
Hypochloraemia, hypokalaemic, metabolic alkalosis
96
Q

Hyperthyroidism in pregnancy

A

Propylthiouracil - For 1st trimester
Methimazole - For 2nd and 3rd trimesters
Titrate NOT block and replace

97
Q

Chronic vs acute immunoglobulins

A

IgG - Chronic

IgM - Acute

98
Q

Selective dorsal rhizotomy

A

Treatment of spasticity in CP

Targets Ia sensory fibres

99
Q

Cervical radiculopathy

A

X-ray

Treat with NSAIDs

100
Q

Tanner staging

A

1) Prepubertal breasts
2) Breast bud
3) Breast become conical
4) Areolar elevates off breast mound
5) Normal breast development

101
Q

Cushing’s triad

A

Bradypnoea
Bradycardia
Hypertension

102
Q

Samter’s triad

A

Aspirin induced asthma
Nasal polyps
Asthma

103
Q

Beck’s triad

A

Muffled heart sounds
Distended neck veins
Hypotension

104
Q

Bartholins abscess

A

Incision and insertion of Word catheter

105
Q

Haemophilus influenzae

A

Nontypeable isn’t vaccinated and causes otitis media

H. Influenzae B causes epiglottitis, septic arthritis and meningitis

106
Q

Diabetic nephropathy protein excretion

A

> 300mg/day albuminuria confirmed on 2 occasions 3-6 months apart

107
Q

Acute psychosis treatment

A

Haloperidol 5mg IM+/- lorazepam 2gm IM
Olanzapine 2.5-10mg PO/IM
Risperidone 2mg PO

108
Q

Neuroleptic malignant syndrome

A 
FARM
Fever
Autonomic changes
Rigidity of muscles
Mental status change
109
Q

Cholangitis vs cholecystitis treatment

A

Cholangitis - Sphincterotomy

Cholecystitis - Chilecystectomy

110
Q

Nasopharyngeal carcinoma

A

More common in Asian males
EBV risk factor
Nasal or ear symptoms
Treat with chemoradiotherapy

111
Q

Scleroderma renal crises

A

Stop steroids

Start ACE inhibitor

112
Q

BNP

A

Released from ventricles
Increased in CKD
Inhibits the RAAS

113
Q

CIDP

A

Chronic inflammatory demyelinating polyneuropathy
Associated with HIV, Hodgkin’s lymphoma, monoclonal gammopathy, MS and IBD
Paraneoplastic syndrome

114
Q

Hodgkin’s lymphoma treatment

A

ABVD regime

115
Q

Rubella

A

Live vaccine - delay until delivery in pregnancy

Avoid contact with people with rubella

116
Q

Uterine fibroids

A 
Benign tumours of uterus 
Most likely subserous 
Change with oestrogen (grow and become painful)
Menorrhagia
Irregular bleeding 
Chronic pain
Urinary frequency and urgency
Can cause spontaneous abortions 
USS gold standard 
Myomectomy - removes thyroids 
Uterine artery embolisation 
Leuprolide (analogue)
117
Q

Ebstein’s anomaly

A

Displacement of septal leaflet of tricuspid valve towards the apex
Increase in right heart volume and atrialization of RV
RA enlargement
TR +/- TS
CYANOTIC heart disease

118
Q

Bronchiolitis

A

Ignore steph and give oxygen

Cause by RSV

119
Q

Birth weight

A

Initially drops up to 10% in first few days
By 14 days should be back at birthweight
Should gain 20-30g a day

120
Q

Vulval cancer

A

HPV 16 and 18 leading risk factor

Lichen sclerosis in older women

121
Q

Prognosis of pancreatitis at admission (non gallstone)

A 
Ranson’s criteria 
BG > 11
Age > 55
Serum LDH > 350
AST > 250
WCC > 16
122
Q

Scleroderma prognosis

A

No new organ involvement once skin involvement has peaked

123
Q

Transcervical amniotransfusion

A

Variable decelerations and thick meconium fluid

124
Q

Ischaemic stroke

A

1st line aspirin

If already on aspirin then switch to clopidogrel

125
Q

CIN

A

I - Mild. Pap at 6 months or colposcopy
II - Moderate. Colposcopy at 6 and 12 months
III - Severe. Conization of cervix (LEEP)

126
Q

ASA poisoning

A

Nausea, vomiting, sweating and tinnitus

127
Q

Infantile strider

A

Laryngomalacia - worse supine improves postionally

Choanal atresia - improves with crying

128
Q

Pancreatitis haemorrhage signs

A

Grey turner sign - flanks

Cullen’s - periumbilical

129
Q

Sleep apnoea associated with CHF, CVA, DM, hypothyroidism or other conditions

A

CENTRAL

130
Q

Polycythaemia rubra vera

A

Haemoglobin > 165 in men > 160 in women OR HCT > 49% in men or > 48 % in women
Bone marrow biopsy showing hypercellularity
Presence of JAK2 mutation
Low serum EPO

131
Q

Vitamin B9

A

Folate - reduces rates of ALL if supplemented in pregnancy

132
Q

Removal of IUDs in pregnancy

A

Reduces rates of septic abortion

Small increased risk of spontaneous abortion

133
Q

Androgenic alopecia

A

Finasteride and minoxidil

134
Q

Endometriosis

A

Dysmenorrhoea, dyspareunia, dyschezia, dysuria
Cyclical symptoms
Laparoscopy gold standard

135
Q

Bone metastases from prostate cancer

A

Osteoblastic lesions

136
Q

HPV

A

16 & 18 malignant

6 & 11 genital condylomata

137
Q

Skin malignancy on face

A

Mohs procedure

138
Q

Spinal stenosis

A

Pain worse on walking and standing

139
Q

Disc herniation

A

Pain relieved when standing

140
Q

Abruption

A

Abdominal pain, bleeding, contractions, hypotonicity of uterus
Risk factors PROM, hypertension, cocaine, smoking, multiparty, trauma
Management depends on foetal compromise (can be managed conservatively)

141
Q

Gingko

A

Used in dementia, tinnitus and intermittent claudication

142
Q

Conversion disorder

A

Treated with CBT

143
Q

PCP intoxication

A

Hallucinations, dissociative feelings, confusion, odd behaviour, agitation, tachycardia, pupillary dilation and nystagmus
ONLY ilciit drug to cause vertical nystagmus

144
Q

Tay-Sach’s disease

A

Lysosomal lipid storage disease
Infantile deafness, blindness and hypotonia
Seizures, developmental delay

145
Q

Asbestos pleural effusion

A

Much more likely benign than malignant

Benign are commonly haemorrhagic

146
Q

Periodinitis - Tooth abscess

A

Treat with Clindamycin or Co-Amoxiclav

147
Q

Burkitt lymphoma

A 
Non-hodgkins lymphoma
Facial swelling in Africans
Associated with HIV
Starry sky appearance of H&amp;E staining
Translocation of 8;14
Commonly causes tumor lysis syndrome
148
Q

Tardive dyskinesia treatment

A

Clozapine as antipsychotic alternative

149
Q

Colonoscopy screening

A

HNPCC - Colonoscopy every 1-2 years from age 20
FAP - Annual sigmoidoscopy from age 12
AAPC - Annual colonoscopy from age 18
1st degree relative with cancer < age of 60 or 2 relatives at any age - Colonoscopy every 5 years
1-2 adenomas at colonoscopy - Colonoscopy every 5 years
> 2 adenomas at colonoscopy - Colonoscopy every 3 years

150
Q

Inferior MI with ST depression in leads V1-3

A

Left circumflex rather than RCA

151
Q

Uterine rupture vs placental abruption

A

Uterine rupture will give - absent foetal heart tones, tense abdominal wall, hypovolaemia

152
Q

Borderline personality disorder

A

Unstable relationships with parents or spouse
Efforts to avoid abandonment
Labile affect
Outbursts of anger and impulsivity
Frequent suicide attempts
Treat with dialectical behavioral therapy or psychodynamic psychotherapy

153
Q

Serotonin syndrome treatment

A

Cyproheptadine

154
Q

Patch testing classification

A

Type IV delayed hypersensitivity (contact dermatitis)
1 + erythema and oedema
2 + papules
3 + vesicles or bullae

155
Q

PID in pregnancy

A

Inpatient IV cefoxitin or cefotetan and oral azithromycin 1g orally

156
Q

Budd-Chiari syndrome

A

Abdominal pain
Ascites
Hepatomegaly

157
Q

Tinea capitis

A

Treat with oral antifungal agents to penetrate hair follicles

158
Q

Hypercalcaemia symptoms

A 
Constipation
Lethargy
Confusion
Increased urinary frequency
Anorexia
159
Q

Anion gap calculation

A

Na - (HCO3 + Cl)

160
Q

Hyperemesis gravidarum gas

A

Ketosis leads to high anion gap with normal pH due to hypochloraemic alkalosis

161
Q

Pulsatile tinnitus and grooving in skull vault

A

Dural arteriovenous fistula

Digital subtraction angiography

162
Q

Physiological jaundice

A

Maximal at 3 days of life
Bedside phototherapy if bilirubin > 15mg/dl
Direct Coombs test

163
Q

H. Pylori treatment

A

PPI, amoxicillin, metronidazole and clarithromycin
OR
PPI, bismuth subsalicylate, metronidazole and tetracycline

164
Q

Dravet syndrome

A

Myoclonic epilepsy of infancy usually preceded by prolonged, frequent febrile seizures. Developmental delay ensues.

165
Q

Hypercalcaemia with low 24 hour urine calcium

A

Familial hypocalciuric hypercalcaemia

166
Q

Respiratory depression in pre-eclampsia

A

Magnesium toxicity

167
Q

Symptomatic fibroids but wants to maintain fertility

A

Myomectomy

168
Q

Staghorn calculus

A

Struvite stones
Ammonium phosphate and magnesium phosphate
Acetohydroxamic acid inhibits bacterial urease

169
Q

Thalassaemia - frequent transfusions lead to…

A

Haemosiderosis (grey skin and pulmonary crackles)

Treat with hydroxyurea to increase production of foetal haemoglobin

170
Q

Most common cause of jaundice in pregnancy

A

Viral hepatitis

171
Q

High risk of gestational diabetes

A 
Severely obese (BMI > 35)
Previous GDM
Previous birth weight of > 4000g
Heavy glycosuria
PCOS
Strong history of T2DM
If initial screening (OGTT on discovery of pregnancy) is negative then it should be repeated at the end of the 2nd trimester
172
Q

Somatization disorder

A

Symptoms

Regular appointments every 2-4 weeks

173
Q

Migratory thrombophlebitis

A

Trousseau’s sign

Pancreatic carcinoma

174
Q

Mothers with anti Ro/SSA (Sjogren syndrome antibodies)

A

Neonatal lupus and heart block

175
Q

Worsening of central sleep apnoea

A

Anything that lowers PCO2 (High altitude) or lowers cardiac output (Heart failure)

176
Q

Acute pancreatitis with ALT threefold elevation

A

Gallstones

177
Q

Cervical length < 25mm

A

Cervical insufficiency

Treat with cervical cerclage

178
Q

Lithium with hypothyroidism

A

Start levothyroxine, continue lithium

179
Q

Warfarin induced skin necrosis

A

Localized parasthesia with erythema progresses to petechiae and haemorrhagic bullae
Discontinue warfarin, give FFP, vitamin K and LMWH

180
Q

PCP lab results

A

Raised LDH

181
Q

Cocaine associated chest pain

A

Treat with ASA and benzodiazepines
IV NTG and nitroprusside for resistant hypertension
AVOID beta blockers

182
Q

Endometrial cancer risk factors

A

Risk factors: PCOS, excess oestrogen exposure, tamoxifen, early menarch, late menopause, nulliparity.

Protective factors: Multiparity, late menarche, COCP, breastfeeding, smoking!

183
Q

Clavicular fractures when to perform surgery

A

Open fractures
Neurovascular compromise
Presence of a ‘floating shoulder’
Complete displacement

184
Q

Biggest risk factor for post partum fever

A

C section

185
Q

Oral hypoglycaemic that acts on alpha and beta cells

A

DPP4 inhibitors e.g. Sitagliptin

Prevent breakdown of GLP-1

186
Q

Predictive values

A 
PPV = TP / (TP+FP)
NPV = TN / (TN + FN)
187
Q

Breath holding spells

A

Associated with iron deficiency anaemia

188
Q

Solitary brain metastasis

A

Surgical resection followed by whole brain radiotherapy

189
Q

Colonic volvulus

A

Insertion of rectal tube

Elective sigmoidectomy

190
Q

PMR treatment

A

Prednisone 15mg/day

191
Q

BPPV

A

Otoliths in the posterior semicircular canal

192
Q

Gold standard test for carcinoid

A

24 hour urine hydroxyindoleacetic acid (5-HIAA)

193
Q

Oppositional defiant disorder treatment

A

Parental management training (PMT)

194
Q

Osteogenesis imperfecta

A

Blue sclera, easily fractured bones, joint laxity and hearing loss

195
Q

Ruxolitnib

A

Post polycythaemia myelofibrosis. Reduces splenomegaly

196
Q

Congenital adrenal hyperplasia

A

21-hydroxylase deficiency

197
Q

Pregnancy with hypothyroidism

A

Immediately increase dose

198
Q

JIA extra-articular effects

A

Uveitis

199
Q

Lead poisoning

A

Burton’s lines (blue lines on gums)
Wrist drop
Foot drop
Basophilic stippling

200
Q

G6PD triggers

A

TMP-SMX

Fava beans

201
Q

Typhoid fever

A

Abdominal pain, fever, altered mental status

Positive Widal test

202
Q

Inferior MI with ST depression in V1-3

A

Left circumflex rather than RCA

203
Q

Interstitial cystitis

A

Urinary frequency up to 60 times a day
Diagnose with cystoscopy - reveals benign bladder ulcers
Pentosan polysulfate sodium or oxybutynin

204
Q

Starting isotretinoin

A

Check CBC, LFTs and lipid profile

205
Q

Urge incontinence

A

Oxybutynin

Common in demyelinating disease

206
Q

Dystonic reactions

A

Metoclopramide (not domperidone)

Treat with benztropine or diphenhydramine

207
Q

Measles complication

A

Subacute sclerosing panencephalitis 7-10years post infection beginning with behavioural changes

208
Q

Amniotic fluid embolism

A

Sudden hypotension, hypoxia or cardiac arrest within 30 minutes of C section or labor
Associated with oxytocin stimulated labor

MCCQE1 (1 decks)

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