MCQ learning points Flashcards
What is the main causative organism of Ascending cholangitis?
E. Coli (Gram negative rod)
The combination of Low BP, raised JVP and muffled heart sounds indicates which condition?
Cardiac tamponade
Triad due to gas/fluid building up around the heart
What are the following positive antibodies indicative of:
ASMA, p-ANCA
AMA
Anti-endomysial
Anti-jo
ASMA, p-ANCA: Primary sclerosing cholangitis
AMA: Primary biliary cirrhosis
Anti-endomysial: coeliac disease
Anti-jo: myositis (dermato, poly)
How does mitral stenosis and mitral regurgitaiton differ on auscultation
Stenosis: mid-diastolic rumble
Regurgitation: Pan-systolic murmur
What history detail helps distinguish duodenal from gastric ulcer
Duodenal relieved on eating
Gastric worsens
Which dyspepsia patients get an urgent endoscopy? What do you do if they do not qualify?
Endoscopy if ALARMS + > 55 years
Stool or breath test if they don’t qualify
What is the management pathway for unspecified dyspepsia symptoms?
- Trial high dose PPI for 1 month OR Investigate for H. Pylori
- If one does not work try other
- If H. pylori positive, eradicate with PPI + amox + clarithromycin/metronidazole
- If fails, trial H2RA (ranitidine) or consider alternative diagnosis
How do you distinguish an exudative from a transudative effusion and how does that sway diagnosis?
If fulfills one of below (lights criteria)…
- Pleural:serum protein ratio >0.5
- Pleural: serum LDH >0.6
- Pleural LDH >2/3s that of serum
…Then its exudative
Exudative: Inflammation, increased permeability due to cancer, infections, auto-immune
Transudative: increased hydrostatic pressure
Which 4 drugs have prognostic benefit in heart failure
SAAB
Spironolactone
ACE inhibitors
Angiotensin II antagonists
Beta-blockers (selective) eg Metoprolol, bisoprolol, atenolol
Which 3 drugs are of symptomatic but not prognostic benefit in heart failure?
Loop diuretics (eg furosemide)
Digoxin
Nitrates, hydralazine (vasodilators)
Patient presents confused and hypotensive. HR is 114, temp 39deg and BP 95/45. They have a PMHx of gallstones and AUS confirmed multiple stones, thickened gall bladder wall and dilated ducts. Following fluids and antibiotics what would you want to do?
Emergency ERCP
Allows decompression and insertion of stents
Which antibody test is most specific for autoimmune hepatitis?
Anti-smooth muscle antibodies
ANA is also positive but less specific as systemic sclerosis, rheumatoid arthritis and Sjogren’s all positive too
What are the side effects of metformin?
Gastrointestinal upset
Lactic Acidosis is rare but fatal
Regarding metformin’s action, which common drugs do you need to watch for?
Alcohol: hypoglycaemia, lactic acidosis
B-blockers: Can mas hypoglycaemia
Ketotifen (anti-allergic): can reduce platelet count
Topiramate: Increase metformin action
Which T2DM drugs cause hypoglycaemia?
Sulfonylureas (glicazide, glibenclamide)
Low risk in GLP-1 mimetics
Which diabetic drugs induce weight loss?
SGLT-2 inhibitors (-gliflozins)
GLP-1 mimetic (exenatide, liraglutide)
Which diabetic drugs induce weight gain?
Thiazolinediones (pioglitazone)
Sulfonylurea (glicazide)
Which diabetic drugs do not affect weight?
Metformin
DPP4-inhibitors (glitpins)
Which diabetic drugs is most associated with glucosuria?
SGLT-2 inhibitors (gliflozins)
Which diabetic drug is most associated with fluid retetion?
Thiazolidinediones (pioglitazone)
Gliptins are part of x class of drug
Flozins are y kind of drugs
X: DPP-4 inhibitors
Y: SGLT-2 inhibitors
What is the first line HTN therapy for a diabetic?
ACE inhibitor (ramipril, lisinopril)
How do you manage a first miscarriage?
<6 weeks + painless bleeding: Repeat pregnancy test in a week
Positive repeat: Refer to EPAU
>14 days symptoms/haemorrhage/infection risk:
1st line: Vaginal misoprostol alone
1st fails or incomplete: Vaccuum or surgical removal
What constitutes recurrent miscarriage? Once identified what should you do?
>=3 miscarriages before 10 weeks gestation OR >=1 normal foetal loss after 10 weeks
Advise: If no cause found then chances of term pregnancy 75%
Screen for APL antibodies, genetic abnormalities, pelvic US for pathology.
When can a post-miscarriage woman…
a) Have sex
b) Have another pregnancy
a) Whenever symptoms have settled
b) When comfortable once menstruation occurs 4-8 weeks post-miscarriage
Amenorrhea, hot flushes under 40 with raised gonadotrophins suggests what? What do you treat this with?
Primary ovarian failure
Uterus: COC pill until 51
No uterus: Progesterone only pill until 51
Lower left quadrant pain, bloating, altered bowel habit with fever suggests what condition?
Diverticulitis
Investigate with AXR, CT is gold standard
Oral antibiotics if mild
Admit for IV if severe
How do you screen for diabetic nephropathy?
Albumin creatinine ratio >70mg/mmol
Repeat with first pass morning sample if initially inadequate
Severe colic worse after eating, weight loss and abdominal bruit suggests what diagnosis?
Mesenteric ischaemia
