MCQ Bank 2 Flashcards
Leading cause of death worldwide for people with HIV (1)
common cause of atypical yeast fungus in HIV (1)
TB
atypical opportunistic infection common in HIV
pneumocystitis jirovecii (if high viral load and LOW CD4 count –> opportunistic infection)
FUNGUS
Toxoplamsos - how spread
Toxoplasma gondii
transmitted through oocysts from undercooked meat/ contaminated vegetables/ cat faeces
can –> focal encephalitis
headaceh, confusion, seizures, motor weakness, fever
Cryptococcus
encapsulated fungus from isolated soils and aviation excreta
usually presents with meningitis or meningoencephalitis with fever, malaise, headache
Cytomegalovirus
remains latent in infected person following primary infection or can be transmitted from person to person
- retinitis is most common presentation
others: colitis, cholangitis, encephalitis, pneumoniti, gastritis
HRT increase risk of what cancers
breast cancer and ovarian
(ENDOMETRIAL if oestrogen only)
tetanus prone injuries
contaminated wounds
wounds containing foreign bodies
compound fractures
wounds or burns with systemic sepsis
certain animal bites/ scratches
prothrombin complex concentrate e.g. Octaplex - what does it contain
1972 factors
INR >8 on warfarin- difference of treatment
> 8= stop warfarin, gie oral vit K if risk of bleeding
ACTIVE major bleeding= stop warfarin, give prothrombin complex concentrate, give vit K INTRAVENOUSLY
tired, depression, renal stones, Ca levels high, PTH raised, ALP nromal
Primary hyperparathyroidism
usually due to single benign adenoma
most >40 year old women
most asymptomatic
PTH may be normal (inappropriately normal for the level of calcium)
what does raised ALP in hyperparathyroidism suggest
non parathyroid hypercalcaemia
high PTH, low Ca, high PO4
pseudohypopparathyoirism: unusual collection of developmental and skeletal defects including short stature, round face, shortened fourth metacarpals and other bones, obesity, dental hypoplasia
Shoulder dislocation: anterior or posterior
ANTERIOR 95% of the time
Glasgow criteria skin cancer: melanoma
3 major:
size, shape, colour
minor:
diamete >7mm, inflammation, oozing/bleeding, itch/odd sensation
Diabetes insipidus
thirsty
large amounts of very dilute urine (<300mOsm/kg low osmolarity)
high serum osmolarity
(can be caused but drugs e.g. lithium, demeclocycline)
Diabetes insipides management
- STOP drugs causing it (lithium, demeclocycline)
- THIAZINE DIURETICS which inhibit reabsorption of NaCl in distal renal tubule
- NSAIDS (e.g. indomethacin) may reduce volume of urine
- SODIUM RESTRICTION
Diabetes insipidus and ADH
DECFICIENCY OF ADH
(ADH encourages re-absorption of water –> reduces urine)
can get NEUROgenic DI (deficiency of ADH) or NEPHROgenic DI (insensitivity of kidneys to ADH)
Pseudoobstruction
gas in recturn
usually little or no ado pain
elderly and bedridden
colonic obstruction with no mechanical cause
chronic mesenteric ischaemia
fear of eating due to postprandial pain
N&V
irregular bowel
50-70yo cardiovascular disease
–> CT
colonic ischaemia
sudden onset cramping pain
L side
urgent desire for bowel movement
N&V
–> CT
–>SURGERY emergency
difference femoral aneurysm vs femoral pseudoaneurysm
PESUDOANEURYSM
- resent arterial puncutre/ trauma
- may change size with pressure
- iatrogenic, trauma, infection
- FLASE aneurysm (no arterial wall laters involved)
- vascular complication of CARDIAC CATHETERIZATION
ANEURYM
athletrosclereosis
- true aneursm
- uniform, stable
- HTN/ smoking
Syringomyelia
fluid filled tubular cavitation within the spinal cord
men
20-30
pain and temperature loss
one side may be more affected than the other
shawl/cape like districtuion
muscle wasting and weakness
progressive condition, no cause
Donald Duck speech and progressive stiff spastic gone, brisk jaw jerk
pseudobulbar palsy (UMN)
occurs in MS, monotornuetron disease, bilateral strokes
difficulty chewing
bells palsy treatment
prednisone 10/7
how long to continue oral iron for
once Hb normalised plus an additional 3 months
angular stomatitis and blood shot eye - what vitamin deficiency
B2 (riboflavin)
pneumonia with bulls myringitis, ad CXR signs more extensive than physical exam suggests
Mycoplasma pneumonia
bronchiolitis (respiratory syncytial virus (RSV))- when to do CXR
if cornered RE pneumonia / pneumothorax - if no concerns then CXR not needed
commonest cause gastroenteritis in england/wales
E coli
acute angle glaucoma management
lie face up and head not supported by pillows
AND
pilocarpine eye drops
AND
acetazolamide
AND
laser iridotomy
If primary open angle glaucoma then opthalmologist may start topical prostaglandin analogue or prostamide, topical beta-blocker
most commonest cause travellers diarrhoea
E coli
oral anti diabetic drug with greatest risk of hypoglycaemia
Sulfonylureas (gliclazide)
mekels diverticulum most common symptom
gastrointestinal bleeding
clinically indistinguishable Fromm acute appendicitis
mot common diagnostic tool is technetium-99m pertechnetate scan
managed by surgical resection
what does exercise stress testing test for
evaluating the presence of obstruction coronary artery disease (CAD) by assessing hearts response to physical stress and identifying ischaemia
plasma osmolarity
2Na + urea + glucose
thumbprint sign on lateral neck XR
epiglottis (haemophiliac influenza B)
ages 2-8years
–> cefotaxime + steroids
earliest clinical manifestation of diabetic nephropathy
microalbuminuria (raised Cr and urea occurs later)
rectal bleeding with red/purplish pea sized lump at anal margin
perianal haematoma
monoclonal protein on serum electrophoresis
bone lesions
renal disease
immunodeficiency
bone pain
anaemia
multiple myeloma
thaimine - what viatmin
B1
nephrocalcinosis
parenchymal calcium deposition in the kidneys –> usually due to hypercalacemia
causes:
malignany
mulitple myeloma
hyperparathyroidism
sarcoidiosis
vitamin D intoxication
Fanconi syndrome
disturbance of renal tubular transport
polyuria, bones deformities (rickets/ osteomalacia), glycosuria, photosphauria, renal tubular acidosis type.2
anorexia in terminal cancer- what drug can help with appetite
prednisolone
malignant otitis externa
pseudomonas aeruginosa
tine capitis/ scalp ringworm
final infection of scalp
ORAL GRISEOFULVIN AND KTOCONAZOLE SHAMPOOO
amoebic liver abscess management
metronidazole
headaches, palpiutations, diaphoresis, severe HTN (vary in occurrence from monthly to several times per day)
pheochromocytoma
A/w MEN IIa, IIb, neurofibromatosis
chronic renal failure- what type of anaemia
Normocytic
causes normocytic anaemia
liver disease
alcoholism
hypothyroidism
myelodysplaisa
drugs - anticonvulsants
keraatoconus
progressive eye condition - dome shaped cornea thins and begins to bulge into cone shape –> blurred vision
pterygium
fibrovascular overgrowth of subconjunctival tissue, triangular shape, encroaching onto cornea
gallstone treatment if not fit for surgery
ursodeoxycholic acid
philadelphia chromosome
chronic myeloid leukaemia CML
Antiemetic:
- functional bowel obstruction
- mechanical bowel obstruction
- hypercalacemia
FUNCTIONAL= metoclopramide
MECHANICAL= cyclizine
HYPERCALCAMEIA= haliperidol
what type of nausea is haliperdiol good for
METABOLIC
1st line management for ankylosing spondylitis
physio/ exercise
de quervains tenosynovitis
extensor pollicis breves and abductor policies longs tendons thickened and inflamated
women
30-50y
unaccustomed exercise e.g. rose pruning.
Finkelsteins test: thumb placed in palm of hand and hand is then ulnar deviated –> pain radial styloid
most common conductive hearing loss older children and adults
wax
(can swell with swimming/ showering)
Azathioprine and ACEi
induces anaemia and severe leukopenia
3yo boy with rash and low grade fever. oval shaped vesicles on palms and soles, and ulcers present in mouth
Coxsackievirus A (hand-foot-mouth disease)
lasts for 7 days
thyroid storm management
Sx= volume depletion, congestive heart failure, confusion, N&V, agitation
- cooling
- correct volume status
- propylthiouracil
waterhouse friderichsen syndrome
massive haemorrhage into one of both adrenal glands
usually caused by bacterial infection e.g. meningococcaemia, low BP and shock, disseminated intravascular coagulation –> adrenal insufficiency
“good baby”: for feeding, constipations, symetrically poor weight gain, head circumference
facial features coarse
macroglossia
hypotonic
large fontanelles
umbilical hernia
congenital hypothyroidism
growth hormone deficiency - what test to do
GH
then MRI to exclude tumor
non haemolytic tranfusion reaction
non severe reaction occurring approx 2 hr into a transfusion
otic barotrauma
pressure –> ear problems
(divers, descent in aircraft)
furunculosis
infection of hair follicle In distal meats
complex febrile seizure
partial (focal)
>15 mins duration
reoccurrence within 24hr within same febrile illness
incomplete recovery within 1hr
1st line management of rheumatoid arthritis
DMARD: methotrexate OR sulfalazine
(steroids to rapidly improve Sx if already receiving DMARD)
influenza virus also callled
orthomyxovirus (RNA)
Viral warts caused by
Papovavirus (DNA virus)
encapsulated bacteria - splenectomy
SHiN SKiS
Streptococcus pneumoniae
Haemophilus menginitidis
Group B strep
Klebsielle pneumoniae
Salmonella typhi
(that’s why they get penumonoccocal vaccine)
hallux valgus
foot deformity –> big toe going sideways into second toe
gout vs pseduogout
PSEUDO= POSITIVE birefringent crystals
GOUT= NEGATIVE birefringent crystals
Trauma: what scans to do in RTC but well on exam
CXR, pelvic XR, lateral cervical spine XR
Lachmans test
ACL injury
Dantron stimulant (or co-dantrusate/ co-danthramer) causes..
red urine
philadelphia chromosome
9 and 22
Mydl’s hernia
“W” hernia of bowel loops coming through the abdominal wall
small tender, tense, red irreducible lump in lower part of abdominal wall on R side of lateral edge of rectus muscle at semilunar line (costal arch to the uric tubercle)
Spigelian
Neonatal life support: if bradycardia
if bradycardia (normal RR=30-40) but all else normal –>
observe and see how they get on
may need ECG +/- atropine
normal neonatal values <1
RR 30-40
HR 110-160
Systolic 70-90
Neonatal life support after delivery:
- Warm and stimular
- Assess colour, tone, breathing, pulse
- control airway (Bag-valve-mask)
- if no breathing >90 s –> 5 inflation breaths
- if no response try jaw thrust, sucking out oropharynx, consider intubation
- if HR <60 –> 3:1 chest compressions
- Consider epinephrine IV or via ET tube or umbilical venous line
Cephalosporins (e.g. cefuroxme) and CKD
reduce frequency as renal excreted
Furosemide and CKD
increase dose size
failure to pass meconium during first 48hr of life
Hirschsprungs disease
2nd/3rd week of life, bloody stools, abdominal distension, distended bowel loops
necrotising enterocolitis (NEC)
14 year old asylum seeker
nasal discharge
started watery but now blood stained
temp 38.5oC
greyish membrane over pharynx
lymph nodes enlarged and swollen
difficulty swallowing
“bull neck appearance”
diphtheria (corynebacterium diphtheria)
at first similar to common cold
Diptheria
starts like a cold –> bloody cold
–> exotoxin affects other parts of the body e.g. paralysis or cardiac failure
Diphtheria management
Benzylpenicillin IV then penicillin V for 10-14 days
AND
antitoxic
McMurrays test
meniscal tears
Thomas test
fixed flexion of deformity of hip
Posterior draw test
posterior cruciate ligament injury
Maisoneeuve fracture
spiral fracture of the upper thirst of the fibula associated with tear of distal tibiofibular syndesmosis and the interosseous membrane - associated tin fracture of mediaul malleolus or rupture of deep deltoid ligament
–> difficult to pick up –> proximal fibular must be examined in all ankle and Xray preformed if tender
blast cells
ALL
peak 2-4 years old
B cel origin
bone pain, splenomegaly, lymphadenopathy, thymus enlargement, CNS involved
responds well to chemo
rust coloured, blood tinged sputum in CAP
Strep pneumonia
HIV test- when does to test to see if positive
3 MONTHS post exposure
Central scotoma (loss of central vision)
MS, damage to retina (e.g. HTN), toxic substances (methy alcohol, ethambutol, quinine, nutritional deficiencies, vascular blockages)
L temporal lobe lesion –> what visual defect
RIGHT SUPERIOR homonymous quantranopia
patietal lobe lesion –> what visual defect
INFERIOR quandrantopia
fungal nail infection (Tinea) management
AKA onychomycosis
amorolfine
head lice management
dimeticone - DimetiCONE
Risk factors onychomycosis (Tinea fungal nail infection)
nail trauma
immunocompromised e.g. diabetes, HIV infection
PVD (peripheral vascular insufficiency)
–> amorolfine nail lacquer
OR
tervinafine (systemic)
causative organismi of peitonisllar abscess
streptococcus pyogenes
25 M
holiday In Thailand
swimming in lakes
headache, mailaise, muscle and joint pains
O/E mild pyrexia, urticarial papular rash on body
Schistosomiasis
24 W trekking in SA
fever, bloody diarrhoea, abdo pain
O/E diffuse abdo tenderness
US - liver abscess
Amoedbiasis
TREAT= metronidazole
40 W
has cats
fever, sore throat, malaise
O/E discrete non tender lymphadenopathy
Toxoplasmosis
25 M progressive hair low vertex area
thinning of hair both temporal areas
3 years
otherwise healthy
pull test -ve
androgenetic alopecia
80 yo F
FOOSh
“dinner fork deformity”
Colles fracture
30 F
thumb pain after fall whilst skiing
tenderness over medial portion of base of right thumb
injury to ulnar collateral ligament on thumb
avulsion fracture
Bennetts fracture
AKA skiers thumb / Gamekeepers thumb
20 M fell off moribike
feel with wrist flexed
Smiths fracture
(AKA reverse colles fracture)
5th metacarpal neck fracture
boxers fracture
tobacco-alcohol amblyopia
loss of colour vision
Mortons neuroma
29 F
pain in L forefoot
came on gradually
like electric shock between second and third toes
high heel shoes make it worse
Bibasal atelectasis
occurs after 48hr post operative
v common
analgesia and physiotherapy
paralytic ileus
ileus of gut for > 3 days
hypo motility of GI tract in abscence of mechanical bowel obstruction
Different to obstructer due to ABSENT or HYPOACTIVE bowel sounds (obstruction= high pitched sounds)
sjogrens syndrome eye manifestation
keratoconjunctivitis sicca
reduced tears, gritty eyes
–> Artificial tears (hypromellose eye drops)
28 M excessive sweating, headache, palpitations, BP 240/130
phaeochromocytoma
30 F BP 220/115
muscle cramps and weakness
K+ 2.2
Conns syndrome
(increased aldosterone)
45 F headache
visual field deficit
prominent forehead
enlarged tongue
BP 175/105
Acromegaly
most common type or renal stone
calcium oxalate (75%)
thiazides and glucose
worsen glycemic control
25 M
punched in L side of face
can’t open teeth properly
numbness on L side of chin
Mental nerve
who is MMR contraindicated in
undiagnosed neurological condition
CAN HAVE in egg allergy/ HIV
NICE: if CCB not tolerated because of oedema..
offer thiazine-like diuretic e.g. indapamide
nasopharyngeal carcinoma:
what ethnicity
what virus
SE asians
Epstein-Barr virus
MRI with gadolinium and fat suppression radiology modality of choice
external irradiation= treatment
Pinworm infection
Enterobius vermicularis
–> MEBENDAZOLE
Thyroglossal cyst vs cystic hygromas vs bronchial cyst
Thyroglossal= midline, moves up with tongue sticking out
Branchial= more laterally
Cystic hygromas= posterior triangle
cat scratch disease
Bartonella henselae
cat scratch –> papule at incoluation site –> solitary lymphadenopathy within 1-2 weeks
(usually sponetansously resollves)
H pylori cuases
- peptic ulcer disease
- MALT tumor
- gastric adenocarcinoma
- Menetriers disease= gastropathy
- coronaritis
- iron deficiency anaemia
Scarlet fever
slapped cheek
hand foot mouth
Scarlet fever= Strep pyrogens (strep a)
slapped cheek = parvovirus
hand foot mouth= coxsachievirus
oesophageal cancer: initially have problems swallowing..
solids then liquids
which vaccines contain egg
MMRI and influenza
yellow fever
Causes UTI in young women
E Coli (80%)
Proteus
Klebsiela
Staphylococci saprophyticus
(if abnormalities of urinary tract= pseudomonas aeruginosa and staphylococcus epidermidis)
penile fracture
traumatic rupture of corpus cavernous –> urological emergency
–> surgical therapy to evacuate the haematoma
commonest cause of pain beneath the heel
plantar fasciitis
left flank mass, left varicocele, haematuria
RENAL CANCER
renal cell carcinoma most common in adults
(Wilms tumor most common in kids)
Myths about acne
not cuased by sunbathing
not cured by drinking water
not contagious
not stres induced
not caused by poor hygiene
MINI PILL MAKES IT WORSE
raynauds - treatment if conservative management fails
CCBs
pseudohypoparathyroisism
resistance to PTH
hypokalaemica
hyperphosphataemia
raised PTH
developmental and skeletal defects e.g. short stature, rounded face, shortened hands, random collection
40 W with RA presents with severe occur pain and reduced visual acuity
scleritis
Alport syndrome
X lined autosomal recessive
sensorineural deafness, pyelonephritis, haematuria, renal failure
—> dialysis or renal transplant
pyelonephritis 1st line treatment
cefalexin
hyphaema
blood in anterior chamber of eye
often post trauma
–> urgent referral to ophthalmologist
Subclinical HYPOthyrodisism
High TSH, normal T4
(TSH trying to push it up higher as it’s low)
IgA antibodies
found in tears, digestive tracts, eats, eyes, vagina
IgG antibodies
most common, fight infection, longer term (IgM first to be made in infection)
IgM antibody
first to be made in infection
Rheumatoid factor is IgM
IgE antibodies
react against foreign substances e.g. pollen/ fungus/ spores
Gold standard for confirmation of cows milk protein allergy
clinical
