MD2 High Yield Flashcards
(1714 cards)
1
Q
Which two common factors (one disease and one medication) often reduce pain - leading to typical pain signs not being present? Eg. no chest pain for an MI
A
Diabetes - neuropathy reduces pain response
Steroids - typically pred, reduce inflammation leading to less pain - eg. no pain for burst diverticulum
2
Q
Tooth pain is a common presentation for which set of diseases?
A
Ischemic heart issues - either AMI or angina.
3
Q
Fine crackles on lung auscultation are indicative of which group of diseases?
A
Interstitial Lung Disease (pulmonary fibrosis)
4
Q
Describe the spirometry findings for interstitial Lung disease?
A
Full vital capacity is reduced.
FEV1/FVC is in normal range or even heightened.
Diffusion capacity (gas exchange) is impaired.
5
Q
Why is GTN used in heart attacks and how does this relate to use in atypical heart attack presentations.
A
GTN is primarily used to treat chest pain. This means in cases where chest pain is not present, eg. In some NSTEMIs, it may not be necessary. The vasodilator effects must be considered, what will vasodilation achieve?
6
Q
Best immediate treatment for an NSTEMI?
A
Anticoagulation. Clexane/Enoxaparin or Heparin IV. Clot busters are inappropriate because there is no clot unlike a STEMI. However a clot may form following damage to heart, so thinners are the best bet.
7
Q
Which biochemical test can easily confirm pancreatic pathology, what does the number value relate to?
A
Lipase.
Number is irrelevant, if it’s heightened, whether it’s 300 or 3 million, it confirms pancreatic involvement and does not relate to severity of disease.
It’s a yes or no test.
8
Q
How does a PE impact vital signs (/5)?
(3 main, 2 possible)
A
- oxygen saturation falls
- resp rate increases
- Heart Rate increases
- BP can fall - especially in severe embolism - due to reduced LA filling
- Temp - mild temp increase is common but not always present
9
Q
IV magnesium is used in the ED as a potential treatment for which presentation?
A
Asthma that doesn’t respond to first line treatments.
(Would also accept arrhythmias.)
10
Q
What is a Hartmann’s procedure?
A
Creation of a stoma after bowel resection
11
Q
Which vitamins and minerals are in IV Hartmann’s (CSL).
A
NaCl
- KCl
- CaCl2
- sodium lactate
More physiologically similar to serum.
12
Q
Order of vessels + nerve in the intercostal space?
A
VAN - top to bottom
Vein, Artery, Nerve
13
Q
Opiods commonly cause which side effect and what are the first line treatments for this side effect?
A
Cause slowing of the bowel/constipation - treat with movicol/coloxyl
14
Q
Name the 4 main categories of anticoagulants and a common example of each?
A
ORAL
Warfarin
NOAC - Apixiban
IV
Heparin
LMWH - Enoxaparin
15
Q
Which types of nosocomial infections are the most common?
A
Chest, Skin, Urine.
(SUC)
16
Q
What is amlodipine?
A
A vessel-selective Calcium Channel Blocker.
17
Q
What are the 3 symptoms of Horner’s syndrome?
A
PAM is Horny
P - Ptosis - droopy lids
M- Miosis - constricted pupil
A - Anhydrosis - loss of sweating
18
Q
How could you differentiate aortic stenosis from aortic sclerosis on examination? (provided a aortic murmur was heard)
A
Palpation of the carotids - a weak carotid pulse indicates stenosis, as blood is not effectively making it past the aortic valve. Maintained pulse strength indicates sclerosis rather than stenosis.
19
Q
Heart failure most commonly causes which valvular defect?
A
Mitral regurgitation
20
Q
What is the most common congenital valvular defect?
A
Bicuspid aortic valve
21
Q
What is a worrisome level of weight loss?
A
10% of body weight over a less than 3 month period is worrisome.
22
Q
Name 2 common medications for neuralgia.
A
Gabapentin, Pregabalin
23
Q
A big square on the ECG represents how much time?
A
0.2 seconds
24
Q
Name the 2 ways to calculate HR from ECG.
A
Divide 300 by no. of large squares between QRS’ (if regular rate)
If irregular - multiply number of QRS on rhythm strip by 6.
25
What is a sinus rhythm?
There is a P wave for every QRS and vice versa.
26
What are some causes of ST depression?
ischemia and digoxin are main ones.
27
How would you identify an old infarct on an ECG?
Pathological Q waves - 1/4 of the R height in any given area.
28
Of the 12 heart leads, name those that contribute to each heart region.
Lateral - I, avL, V5 and V6
Inferior - II, III, aVF
Anteroseptal - V1, V2, V3, V4
29
Name a unique side effect caused by thiazide diuretics not caused by the other diuretics.
Hyponatremia (hypokalemia too but frusemide does that too).
30
What are the 5 magic cardio risk factors?
HTN, FMHx, Dyslipids, Smoking, T2DM
31
What are the 4 red flag cardiothoracic pathologies?
AMI, PE, Pneumothorax, Aortic Dissection
32
What are the history presentations for PE and vital changes?
Sudden onset SOB, can have chest pain, signs of hypoxia in older people.
Reduced BP, tachycardia, RR up, reduced sats, HR up.
33
Why do oesophageal pathologies cause chest pain?
It is immediately posterior to the heart.
34
Best way to differentiate MSK chest pain from other systems?
MSK chest pains can be reproduced by firm palpation.
35
Dermatomal pattern of pain, including chest pain, should cause suspicion for?
Shingles
36
A raised or invisible JVP indicates what?
Raised = fluid buildup due to pathologies such as SVC obstruction, tricuspid valve stenosis, tricuspid regurgitation etc
Invisible - dehydration or hypovolemia
37
What are the main diastolic murmurs?
Aortic regurgitation is the main one but mitral stenosis is possible if there is a history of rheumatic fever.
38
A widened pulse pressure is commonly caused by which valvular defect?
Aortic regurgitation
39
What is dyspepsia?
Indigestion (can't digest the pepsi)
40
What is bronchiectasis?
Permanent widening of the bronchioles, which become plugged with mucus leading to chronic cough and infections.
41
What is the first investigation to do if a brain bleed is expected?
CT non contrast
42
What are the 4 broad steps to the neuromotor exams?
Tone
Power
Reflexes
Coordination
43
What is a laminectomy?
Surgery to remove part of the vertebrae to create space.
44
Describe the 3 key examinations for acute appendicitis?
McBurney's Point - slow pressure and release to point between umbilicus and ASIS
Rosving's sign - palpation of LLQ will elicit pain in RLQ
Psoas sign - activation of psoas muscle causes pain as psoas overlies appendix.
45
What is Murphy's sign?
A sign of acute cholecystitis.
Ask patient to take a deep breath, palpate RUQ beneath subcostal area, exhale = Pain in RUQ.
46
Risk factors for gallstones?
Fat fertile female in forties.
47
What is Charcot's Triad?
A triad of symptoms that indicate Cholangitis - an emergency.
- FEVER
- RUQ pain
- Jaundice
48
How will the bowel appear on X ray during an obstruction?
Dilated proximal to the obstruction, collapsed distal to the block.
49
How would you refine a presentation of dysphagia into different categories?
Oropharyngeal dysphagia (difficulty breathing and swallowing) vs oesophageal dysphagia (food and drink getting stuck.
50
Upper GI pathologies tend to be associated with _____ and lower GI pathologies tend to be associated with _____.
- Eating
- Pooing
51
Why would someone with a Hx of chronic alcohol abuse vomit blood?
Most likely reason: burst oesophageal varicose vein, due to portal hypertension from liver disease.
52
Loin to groin pain is a description of which pathology?
Renal stones
53
Name 2 common diseases improved by leaning forward.
- Pericarditis
- Pancreatitis
54
Name 3 molecules that could cause metabolic flap.
Ammonia (liver), Urea, CO2 (respiratory).
55
Which organ is responsible for extravascular haemolysis?
Spleen
56
Name the key endocrine products of the kidney.
EPO and Vit D.
57
Which electrolyte balance is the most important and what causes this?
Potassium levels. Hyperkalemia can kill you.
Due to crap kidney function /diuretics OR due to acid/base balance as cells will swap H+ in blood for their K+.
58
Why is serum creatinine a somewhat poor indicator of renal function?
Serum Creatinine doesn't start to rise until eGFR is around 60% or less.
59
Differentiate IgA nephropathy from Post-Strep glomerulonephritis on history.
IgA - sore throat AND hematuria concurrently, or within 4 days of each other.
Post-Strep - sore throat THEN hematuria, week or more later.
60
Is urine output a good measure of kidney function?
No. End stage renal disease kidneys could still make the right amount of urine. The urine balance with other molecules will just be fucked.
61
What is the relationship between renal failure and calcifications?
Poor renal function leads to poor calcium absorption primarily and kidney and also poor calcitriol release. This causes an increase in PTH and bone breakdown, which can chronically cause hypercalcemia. This can lead to calcifications in other systems such as the heart.
62
Compare the use of ACE inhibitors in an AKI vs in CKD?
AKI never use ACEi, stop use immediately. Low perfusion with added efferent arteriole dilation puts glomerulus in an awful position.
CKD always use ACEi. Takes pressure off the already damaged/reduced glomeruli - renoprotective.
63
Main risk factor for end stage renal failure?
diabetes
64
how does an ideal PaO2 on a blood gas relate to oxygen concentration?
PaO2 should be 4-5x of O2 concentration. On room air, O2 concentration is 21%, so PaO2 should be 84-100%. We want that PaO2 to be as high as possible, definitely above 60.
But if we are giving supplemental O2 at 40% O2 conc, their PaO2 should be 160-200. If it's still 100, that looks good but is actually still showing a defect in ventilation.
65
Most common cause of hyperventilation in a clinical setting?
Forced mechanical ventilation - leading to a respiratory alkalosis.
66
Why might cardiac arrest cause acidosis?
No pump = no O2 delivered = anaerobic respiration = production of lactic acid
67
What are the three broad mechanisms of cardiothoracic chest pain?
- ischemic chest pain
- pericardial inflam
- pleural inflam
68
What descriptors are typically used to describe cardiac ischemia?
Tightness, pressure, squeezing, someone sitting on my chest.
69
What descriptors make cardiac ischemia less likely?
Sharp pain, reproducable, pleuritic, localised (if they can point to pain with one finger, it's MSK).
70
What are the two 'great maskers' of pain?
Diabetes and Anti-Inflammatories (especially steroids).
71
What are the surgical and non-surgical treatments for a STEMI?
Clotbuster - thrombolytics
Surgery - PCI (acute) or CABG
72
What is the goal of GTN and how does it work?
Reduce chest pain.
Causes vasodilation to reduce preload.
73
Which 3 pharmacological agents are NECESSARY in acute coronary syndrome and which fourth is often added?
Heparin/Clexane, Aspirin, GTN.
The typical fourth is morphine.
74
Which two leads can be checked to easily assess axis.
If leads 1 and aVF are both + then axis is normal
75
Which arrythmia is described as sawtooth?
Atrial flutter
76
Describe the ECG changes for atrial hypertrophy (dilation).
P pulmonale (right atria) - tall P wave
P mitrale (left atria) - 'M' shape P wave
77
What ECG findings occur in pericarditis?
ST elevation with PR depression
78
How does Guillian Barre impact reflexes?
What are you most concerned about with this illness?
Hyporeflexia/absent reflexes.
Respiratory depression.
79
What is myasthenia gravis?
Autoimmune destruction of the synaptic terminals of neurons - widening of synapse.
80
What would a postural BP check reveal on a diabetic with autonomic neuropathy?
BP would fall as is normal, but rebound tachycardia is not present as it would be in healthy people (if they have autonomic dysfunction)
81
Which biochemical molecule is the best to check if dialysis is working?
Urea. Creatinine no longer useful - the horse has bolted.
82
What does the CSF look like in Guillian Barre?
CSF is high in protein (Ig) but low in WCC.
83
Define shock.
Supply and demand mismatch of blood - can happen to any tissue
84
What are the different causes of Shock?
SHOC N Awe
S - septic
H - hypovolemic
O - obstructive
C - cardiogenic
N - neurogenic
A - anaphylactic
85
Give 3 examples of obstructive shock.
PE, cardiac tamponnade, pneumothorax.
86
Describe the ECG findings of a Bundle Branch Block.
Wide QRS.
RBBB - MarroW
LBBB - WillaM
It's meant to be William but Willam makes more sense to me - six letters, V6.
87
Pathological difference in cause of Vtach vs Vfib.
Vtach is due to ventricular ectopics that originate in the ventricular wall, cause contraction with inability to fill properly in time - syncope common. Only one site is causing the ectopics.
Vfib - ectopics arising from all over the ventricle.
Basically dead.
88
How to spot a pacemaker on an ECG?
Vertical lines present in front of the P wave or QRS (depending on if they have atrial or ventricular pacing).
89
How to spot a pacemaker on an ECG?
Vertical lines present in front of the P wave or QRS (depending on if they have atrial or ventricular pacing).
90
Name a drug that causes ST depression.
Digoxin
91
What is the most common ECG finding for a PE?
Sinus tachycardia
92
Which body landmark can be used to differentiate small gut pain from large gut pain?
Umbilicus. Pain above the umbilicus is more likely to be the small gut, below it is more likely to be the large gut. - Due to dermatomes.
93
Compare ovarian pain to acute appendicitis pain.
Ovarian pain is way more acute, it is essentially sudden. In comparison to the evolving diffuse pain over time common with appendix issues.
94
Should you be wary of someone with appendicitis feeling suddenly better?
Yes. Often they feel better when their appendix has popped. Feel good for about an hour until the sepsis sets in.
95
What colour are body fluids at each stage of the digestive tract?
Stomach - clear
Proximal small bowel - radioactive green
Distal small bowel - like feces (closer to colon).
96
What are the shockable rhythms?
Vfib and unconscious V tach.
97
How does Adenosine work?
Slows AV node and conduction. Causes heart rate to slow down. Patients feel like they're going to die.
98
How does Adenosine work?
Slows AV node and conduction. Causes heart rate to slow down. Patients feel like they're going to die.
99
Which coronary artery controls the inferior region? Which controls the anteroseptal region? Lateral?
Inferior - RCA.
Anteriorseptal - LMDA.
Lateral - LCA
100
Vital sign consequence of a STEMI in the Right Coronary Artery?
RCA feeds Right Atrium and SA node - damage to SA node will lead to bradycardia.
101
What are the main symptoms of aortic stenosis?
SAD
S - syncope
A - angina
D - dyspnea
102
What is the most common cause of aortic stenosis?
Calcifications related to age.
103
List 2 causes of secondary hypertension.
Renal issues - stenosis, disease
Adrenal disease - leading to hyperaldosteronism etc
104
Explain isolated systolic hypertension and the common cause.
Just the systolic is high, not the diastolic. This is evidence of a widening pulse pressure. The most common cause is stiff arteries from age/atherosclerosis.
105
List the ideal progression of medications for control of hypertension.
- ACEi (ideal)/ Calcium blocker
- both of the above
- both of the above + diuretic
- if still poorly controlled, check for compliance/secondary causes
106
Which program is needed for long term management following an AMI?
Cardiac Rehab
107
List five categories of post-AMI complications and an example of each.
Further Ischemia - angina, reinfarct
Mechanical - heart failure, valve dysfunction, cardiogenic shock
Arrhythmia - SA or AV issue or other arrhythmia
Embolic - self explanatory
Inflammatory - Pericarditis
108
Why might an epidural spinal cause an AKI?
Turning off sympathetic system will decrease tone, leading to fall in BP which can cause AKI.
109
How to differentiate the small and large bowels on CT?
Large bowel has double semi circle shape - two bent lines across colon.
Small bowel lines go all the way across the intestine.
110
Which colours are common in Raynaud's?
French Flag
Blue, White, Red
111
Which types of joints tend to be targeted in RA vs OA? What about fingers?
RA targets synovial joints.
OA targets weightbearing joints.
RA spares the distal interphalangeal joints, OA targets them because they are weight bearing.
112
What is crepitus?
Creaking/grating of damaged joints. Typical of OA.
113
Compare the broad action of the jejunum to the ileum/colon.
The jejunum is all about food absorption and will secret fluid to aid in food digestion and absorption.
The ileum and colon are largely about water resorption.
114
List 2 causes of non-pitting edema.
Lymphedema or parasites
115
What is a dangerous symptom of hyponatremia?
Encephalopathy
116
Which coagulation test checks efficacy of Warfarin?
INR
Think WINR
W(arfarin)INR
117
Best way to remember Apixaban function?
Api 'Xa' Ban
It bans factor Xa
- NOAC/DOAC
118
What is an ileus and how would you know it had resolved?
An ileus is a non-mechanical small bowel obstruction.
You'll know it's resolved when they fart. Poo is also used but is a poorer indicator of resolution than gas.
119
What do stomach parietal cells produce?
HIP
HCl, Intrinsic factor - Parietal cells
120
'partial or total separation of previously approximated wound edges, due to a failure of proper wound healing' Describes which pathology?
Dehiscence
121
Strawberry milkshake type fluid in a drain is likely to be?
Chyle - white fat drained from lymphatics that is tinged pink from a bit of blood
122
Which vitamin injection would be administered in suspected pancreatitis?
Vit K - inability of pancreas to function will stop ADEK fat soluble vitamins from being absorbed.
Vitamins ADE are not an acute worry.
123
Does the size of a gallstone matter for pathology progression?
Yes. Large gallstones tend to lodge at the opening of the gallbladder and cause a solely cholecystitis picture.
Smaller stones can exit the gallbladder and block distal areas of the biliary tree leading to pancreatitis etc.
124
Which biochemical marker tests for pancreatic dysfunction?
Lipase
125
Which liver enzymes are reflective of the gallbladder and which of the liver?
GGT and ALP = gall
AST and ALT = liver
126
Why would we examine the sides of the face in the GIT exam?
Parotidomegaly - sign of alcohol abuse.
127
What are the two main causes of gynocomastia (aside from natural gyno)?
Chronic liver disease and spironelactone use.
128
What are the two key signs of peritonitis?
GUARDING - tensing of abdominal muscles on light palpation
REBOUND TENDERNESS - pain felt on release of pressure rather than application of pressure
129
What are the typical pre-surgical changes to:
Aspirin
NOACS
Warfarin
Metformin
Aspirin - do not cease
NOAC - stop 3 days before
Warfarin - takes 5 days to wash out
Metformin - stop night before surgery
130
Upper GI pain radiating to the back indicates?
Pancreatitis
131
Compare a type A and B Aortic Dissection
Type A - dissection arises before the 3 aortic offshoots. Way more dangerous.
Type B - dissection starts after the offshoots.
132
What is pleurodesis?
permanent joining of the lung to the chest wall (really is a joining of the visceral and parietal pleura) to remove the pleural space.
133
What is the ideal time to take pain relief before physio?
40 minutes beforehand
134
What is Naloxone? What is Targin?
Naloxone (Narcan) is a medication to treat the effects of opiods. It can be used in overdoses or just to combat side effects of opiod analgesia.
Targin is a mix of oxycodone and naloxone - an opiod and a side effect medication in one.
135
What is endone?
Immediate release oxycodone.
136
What is cholestasis?
Low/no bile flow through biliary tree
137
What is leg claudication?
Angina of the leg
138
Is Hb level proof of bleeding?
Not acutely.
If bleeding, concentration of blood does not change, only the volume changes. So the Hb number won't change but they are bleeding. The Hb will change when you give fluids (unless that fluid is blood) because you have diluted them. It will also change in a chronic bleed as the body tries to fix the volume issue.
139
What is a definition of cardiac failure and what are the two broad types?
Cardiac output is not sufficient to meet need.
Typically due to cardiac damage but can also be due to increased demand.
The two broad types are HFrEF (systolic) and HFpEF (diastolic).
140
What is Starling's Law and how does it relate to heart failure?
Starling's law states that increased volume will increase cardiac contractility.
For heart failure, this means that in order to meet tissue demands, cardiac output can be raised by increasing contractility by holding onto more fluid (volume).
141
What are the four broad causes of edema?
Increased venous pressure
Hypoalbuminemia
Blocked lymphatics
Leaky Capillaries (infection)
142
How does heart failure impact the kidneys?
Inability to meet cardiac output will result in poor perfusion to the kidneys. Nephrons will assume BP is low as the reason and will activate RAAS to hold onto fluid.
143
Which two radiological Ix would you do for heart failure?
CXR and ECHO
144
Does a normal ECHO exclude heart failure?
No, it could still be HFpEF
145
What is the key physiological target when treating cardiac failure?
AFTERLOAD.
The aim is to treat afterload so that the heart is capable meeting the demand with less strain.
146
What is your first suspicion if you see broad complex tachycardia?
V tach
147
List 3 causes of extreme axis deviation on an ECG.
- incorrectly placed leads
- hyperkalemia
- V tach
148
Which two heart block types are more or less benign?
Type 1 and Mobitz I (Wechenbach) (gradual lengthening of PR interval.
149
Describe the impact of potassium on the ECG.
High potassium - tall T waves
Low potassium - short T waves and potential U wave
150
What are the numerical cutoffs for type 1 and type 2 respiratory failure?
Type 1 - O2 level below 60
Type 2 - CO2 level above 50
151
What is acute respiratory distress syndrome?
ARDS is a respiratory emergency that usually follows trauma.
'Wet lung' where fluids and proteins leak into the alveoli en masse
152
What is the mnemonic for Nephrotic Syndrome.
O he's PALE.
(O for nephrOtic instead of nephritic)
P - proteinuria (massive)
A - albumin (hypo)
L - lipids (hyperlipidemia)
E - edema
153
Stoney Dullness is synonymous with which condition?
Pleural effusion
154
What is the gold standard test for a PE?
CTPA. (pulm artery should be thinner than aorta diameter) (pulm artery is Y shaped as it splits in two)
Don't say D dimer.
155
Is a Troponin only raised in AMI?
No, anything that strains the heart could cause a rise in troponin. A PE leading to right heart strain could cause it to rise.
156
What is the main Treatment for a PE?
Anticoagulation. DOACs usually.
Thrombolysis only if severe.
157
Chronic asthma leads to which changes to the lungs?
Chronic bronchoconstriction, goblet cell hyperplasia, mucosal thickening, smooth muscle thickening, increased inflammation (underpinning the rest).
158
What is the primary treatment for asthma?
Acute symptoms - B2 agonist bronchodilator
Underpinning inflammation - steroids
159
Side effects of oral steroids?
Thrush, hoarse voice.
160
Best test to measure endogenous insulin production?
C peptide
161
name a factor that could render HbA1c inaccurate.
Red cell turnover - if they are readily needing new RBC then the glycation of those cells will not be representative of the truth. Could be due to anemia etc.
162
Describe the timeline of pharmacological intervention in type 2 diabetes.
- Lifestyle
- Metformin
- Metformin + 1 other oral
-Metformin + 2 other oral
- Insulin + oral
- Insulin alone
163
Name the major contraindication for Metformin.
Renal failure due to acidosis risk.
164
Main Metformin side effect?
GI disturbances
165
Name the two diabetes drug groups that target the incretin system and how these drugs work.
The incretin system is a gut based hormone system that releases the hormones GLP1 and GIS to modulate hunger and insulin release. The incretin hormones are quickly degraded by the DPP4 enzyme naturally.
Two drugs that target this system:
DPP4 inhibitors (Oral) - inhibit DPP4 enzyme, allowing incretin hormones to act for longer
GLP-1 analogues (IV) - an exogenous form GLP1 that is altered to resist DPP4. Extremely effective in both diabetes control and weight loss (ozempic).
166
Name a diabetes medication that typically causes weight gain.
Sulphonylureas
167
Aside from its diabetes effects, SGLT-2 inhibitors are beneficial to which other organs?
Renoprotective and great for heart failure
168
Aside from its diabetes effects, SGLT-2 inhibitors are beneficial to which other organs?
Renoprotective and great for heart failure
169
Name 2 side effects of SGLT-2 inhibitors.
UTIs, polyuria
170
At what eGFR would you cease metformin?
30 or less
171
Is bariatric surgery effective in weight loss?
Yes. Some of the lost weight will be regained but long term it does lead to weight loss.
172
What are the 5 aspects of metabolic syndrome?
- Central adiposity
- HTN
- High triglycerides
- Low HDL
- Impaired blood glucose
173
What is the FEV1/FVC for interstitial lung disease?
Interstitial lung disease is restrictive, meaning FVC is significantly reduced.
Depending on the FEV this can lead to an FEV1/FVC that is normal or elevated.
174
Name a medication that causes pulmonary fibrosis?
Methotrexate (also accept amioderone)
175
What is the lung interstitium?
The tissue between and lining the alveoli and the vessels.
176
What are the main two symptoms of chronic interstitial lung disease AKA pulmonary fibrosis
Shortness of Breath and dry cough
177
Name 3 findings on examination that point toward pulmonary fibrosis.
- FINE CRACKLES !!!!
- evidence of pulmonary hypertension
- clubbing
178
Does interstitial lung disease have a bronchodilator response?
No, that's really just asthma
179
What is the deadliest form of interstitial lung disease?
IPF - idiopathic pulmonary fibrosis - mortality rates just below pancreatic and lung cancer
180
'honeycombing' on CT is typically related to which condition.
Idiopathic Pulmonary Fibrosis
181
How is the GCS divided score-wise.
Eyes - 4
Voice - 5
Motors - 6
15 points all up.
182
Aggressive diabetes treatment must be balanced against risk of ____.
Hypoglycemia
183
90% of small bowel obstructions are due to what?
Adhesions
184
What is TPN?
Feeding through a tube
185
Which antibody types are common in Type 1 Diabetes?
Anti GAD and Anti islet cells
186
Which common drugs could cause incorrectly elevated random/fasting blood glucose levels?
Steroids
187
Does hypoglycemia affect the heart?
Yes, it can cause arrhythmias
188
Name 2 diabetes medications that can cause weight loss and 2 that can cause weight gain.
loss - SGLT2 inhibitors and GLP1 analogues.
gain - sulphonylureas and insulin
189
What is the 'basal bolus' approach to insulin administration?
Long term insulin given around bedtime to mimic basal insulin levels and counter nighttime gluconeogenesis.
Short acting insulin given at meals as a bolus to mimic mealtime insulin release.
190
How can we further refine diabetic neuropathy into two categories and give some examples.
Split into autonomic neuropathy and peripheral neuropathy.
Autonomic - postural BP drop without compensation tachycardia, erectile dysfunction.
Peripheral - loss of sensation or abnormal sensation. Glove and stocking.
191
Larger people often have raised creatinine levels. How could you check for renal damage in overweight diabetics?
Albumin:creatinine ratio to check if they're leaking protein
192
Absent/reduced pulses are evidence of which macrovascular diabetic complication?
Peripheral vascular disease
193
What is the best anti-HTN medication for diabetics?
ACE inhibitors/ARBs
194
Why should we treat fat tissue as an endocrine organ?
Because it is. It produces inflammation and impacts HTN and atherosclerosis and thrombosis.
Aside from these inflammatory signals, they also make SCFA.
195
Why is PCOS related to diabetes?
Increases insulin resistance --> increases risk of diabetes
196
How do short chain fatty acids released by adipose tissue impact diabetes?
They are used by liver in gluconeogenesis to make more sugar and they also lodge as triglycerides (due to VLDL) in muscle leading to insulin resistance.
197
The -liptin drugs are which class of medication?
DPP4 inhibitors for diabetes
198
The -tide drugs are part of which medication class?
GLP1 analogues
199
The -flozin drugs are in which medication class?
SGLT2 inhibitors
200
Glipizide is what type of medication?
Sulphonylurea
201
What is an S3 sound and what does it indicate? What about S4?
Treat S4 as S0.
S3 is just after S2, it is often a response to volume overload.
S4 is just before S1 (think S0) and is indicative of pressure overload. (stiff ventricles)
both occur in diastole
202
Aortic Stenosis is often described as a _____ murmur.
Crescendo Decrescendo
203
Mitral regurgitation is often described as a ____ murmur.
Late systolic
204
Aortic Regurgitation is often described as a ____ murmur.
Early diastolic
205
Mitral stenosis is often described as a ____ murmur.
Mid/late diastolic
206
List the abdominal layers in order.
organs
visceral peritoneum
Parietal peritoneum
fat layer
transversalis fascia
transversus abdominus
internal oblique
external oblique
superficial fascia
subcutaneous fat
skin
Think of it as mirrored layers. Fat covers fascia which covers 3 muscles, repeat.
207
Which dimension of the inguinal canal is formed by the inguinal ligament?
the inguinal ligament forms the floor (inferior) of the inguinal canal
208
The deep and superficial inguinal rings are the openings of the inguinal canal. Which abdominal layers do they occur in?
Deep ring - transversalis fascia
Superficial ring - external oblique (with internal oblique aponeurosis)
209
Why are groin hernias more common in males?
Process vaginalis must be longer (stretch farther) to deliver male gonads to scrotum in comparison to delivery of female gonads to pelvis.
210
Why does the inguinal canal form?
To deliver gonads
211
Outline the difference between a direct and indirect hernia - which inguinal rings are involved in each?
Indirect - abdominal contents move through an un-obliterated process vaginalis (can end up in scrotum). Contents pass through both superficial and deep rings.
Direct - abdo contents push on a weak area of transversalis fascia (posterior wall of inguinal canal) due to increased abdominal pressure. Then it comes out the superficial inguinal ring. Deep ring NOT involved.
212
A pansystolic murmur is typical of which murmur?
Mitral regurgitation
213
What is the immediate treatment of Sepsis?
SEPSIS SIX - 3 in 3 out
In: O2, fluid, antibiotics
Out: Hb/lactate, blood for micro, urinary catheter for monitoring.
214
Why does albumin effectively increase BP?
Increases the ‘half life’ of given fluid. The increased osmotic pressure stops the fluid from entering the interstitium as quickly - keeps it in the vessels
215
Which antibiotic classically causes tubular necrosis?
Gentamicin
216
Which type of murmur tends to radiate to the axilla?
Mitral murmurs
217
What are the 3 foramina of the pelvis, which structures run through these? Which does the femoral artery use?
The greater and lesser sciatic foramen (split by the sacrospinous ligament) and the obturator foramen.
Greater sciatic - path of most structures including sciatic nerve
Lesser sciatic - for pudendal structures
Obturator - for obturator structures
Femoral artery, nerve and vein don’t pass through any of these - they pass underneath the inguinal ligament - very anterior
218
What are the nerve roots of the sciatic nerve?
L4 to S3
219
What are the two main causes of pancreatitis?
Gallstones and alcohol
220
Which nerve controls shoulder abduction?
Axillary - muscle Is deltoid, axillary controls deltoid.
221
Which two muscles form the bladder, what are their functions?
Detrusor - controls bladder contraction = urination.
Trigone - triangle shaped one that stops urinary reflux.
222
Mnemonic for post-MI complications?
PRIME
Pericarditis
Rhythm
Ischemia
Mechanical
Embolus
223
Which coronary artery gives off the posterior interventricular artery?
The RCA (usually)
224
Which white blood cell rises particularly in parasitic infection?
Eosinophils
225
Severe anemia can cause cardiac ischemia due to _____ ischemia.
Demand
226
Where do MI's tend to radiate to?
Jaw and left arm
227
Which types of chest pain are aided by GTN? Which aren't?
Cardiac ischemia and esophageal chest pain are aided by GTN, the rest, notably pleuritic pain, are not.
228
Does a PE elevate troponin?
It can, due to right heart strain
229
What is the difference between stable/unstable angina and an AMI?
The rise of cardiac biomarkers (troponin).
230
What are the three required categories to diagnose an MI? (need 2/3)
- symptoms
- ECG changes
- Raised biomarkers (troponin)
231
What is the treatment for an NTSEMI?
Therapeutic anticoagulation
232
What are the pros and cons of heparin vs clexane?
Heparin - short acting and reversible but huge ballache to monitor
Clexane - no need to monitor as much, way easier but irreversible.
233
What is the treatment for AF?
Two pronged approach:
- Anticoagulation
- Rate/Rhythm control
234
Mnemonic for causes of AF?
PIRATES
Pulmonary
Infection/ischemia
Rheumatic heart disease
Alcohol/anemia
Thyroid
Electrolytes
Sepsis
235
What is Wolff Parkinson White disease?
Person has a 2nd conduction pathway in the heart leading to bouts of tachycardia and Vtach risk
236
What is the biggest consideration when wondering whether to cardiovert someone to sinus rhythm from Afib?
CLOT RISK - return to sinus is associated with short term increase in clot risk - they may need to be anticoagulated depending on how long the AF has been present.
237
What is the primary treatment for adult hernias?
Surgery
238
Why does hypotension cause tachypnea?
hypotension --> poor perfusion --> anaerobic respiration --> lactate production --> acidosis --> tachypnea.
239
What is rigor?
Shivers + high temp
240
What amount of urine is typical during an AKI?
Depends on the cause.
Anuria and oliguria are the most common, but can have polyuria if the cause is tubular damage.
241
What is Piptaz?
Pipercillin - broad antibiotic
Taz = betalactmase inhibitor
242
Why does an AKI cause hyperkalemia?
- poor excretion of K+ in exchange for Na+
- cells regulating high H+ (as kidneys can't excrete) by taking it in in exchange for K+.
243
Compare the pain differences in inflammatory, perforation and colic pain.
Inflammatory - tends to start sudden then build
Perforation - sudden and immediately severe and stays at that level
Colic - come and go pain
244
If pain radiates to the back, which organs are likely to be involved?
pain in back = involvement of retroperitoneal organs
(Aorta, pancreas, duodenum).
245
What is the approximate time course for peritonitis?
very acute, pain will occur very shortly after perforation - NOT hours, earlier.
246
List 4 causes of pancreatitis (2 main ones).
Gallstones and alcohol are the main 2.
Viral illness, autoimmune disease, ERCP and tumours can all also do it.
247
What is an AXR?
Abdominal X ray
248
What is loperamide?
Opiod medication used to slow digestion (allow for better absorption or stop diarrhea).
249
What molecule does octreotide imitate? What does it do?
Mimics somatostatin - broadly, it stops the gut, stops gut motility, exocrine functions and stops release of GH.
250
How does metoclopramide function, what is it used for?
Anti-emetic/nausea drug - dopamine antagonist - therefore promotes gut motility (dopamine inhibits gut movement).
251
What is the best history qn to ask to establish rigors vs regular shivers?
Could you hold a cup of water without spilling any?
252
A splenectomy should raise alarm bowels for what type of disease causing agent?
Encapsulated Bacterial infection
253
Fever with new onset backpain should always be treated as an ____?
Epidural abscess (note - pancreatitis pain is in the RUQ with radiations to back).
254
Fever in a traveller is ____ until proven otherwise.
Malaria (would probably accept TB)
255
Name the 3 broad groups of beta lactams as well as well as key antibiotics in each group.
Penicillins - split into narrow, mid and broad spectrum.
Narrow - penicillin G or V and flucloxacillin.
Mid - amoxicyllin or ampicillin
Broad - PipTaz
Cephalosporins - 1st and 3rd generation.
1st - Cephazolin (IV) and Cephalexin (oral)
3rd - Ceftriaxone
Carbapenems
- Marepenem - nuclear bomb of antibiotics
256
Which are the two main medications for pseudomonas treatment, which other two are sometimes used with unfortunate side effects? What are these side effects?
PipTaz (Tazosin) and Maropenem are the usual 2.
Gentamicin is also used but it causes tubular necrosis and damage to the 8th cranial nerve, causing renal injury and ototoxicity respectively.
Ciprofloxacin is the other one, but it often leads to C.diff infections.
257
What is the go to antibiotic for anaerobes?
Metranidazole
258
What is trimethoprim used for? When is it contraindicated?
UTIs - can't use in pregnancy
(Try Meth in the Pram)
259
Rifampicin is used for what disease? What is a side effect?
TB. Turns body fluids red or orange
260
What is the only oral antibiotic for pseudomonas?
Ciprofloxacin - but many strains are resistant
261
Which antibiotic class is often responsible for C.diff infections?
Fluoroquinolones - eg. ciprofloxacin
262
Which antibiotics would be used for cellulitis?
Flucloxacillin is the textbook answer, but it can cause liver injury (jaundice). So many people use Cephalexin instead even though it is more broad.
263
What are the atypical causes of pneumonia?
What are the hospital acquired pneumonias?
A legion of Mike's with chlamydia (think Mike Wazowski).
Legionella, Mycoplasma, Chlamydia.
no-socomial is all the regular ones and klebsiella or pseudomonas
264
Is Staph in the urine a concern?
Yes. A huge concern. Staph in the urine goes beyond simple UTI. You no longer have a UTI you have staph bactermia and must treat it as such.
265
What is the choice antibiotic for febrile neutropenia and which groups typically experience this diagnosis?
PipTaz or Meropenem - think of need to cover pseudomonas.
Febrile neutropenia is classically in cancer patients and people receiving chemotherapy.
266
What is the chance of a penicillin allergy also applying to cephalosporins?
About 1%, typically very safe.
267
Describe a UTI in terms of volume, frequency and post-void feeling.
Frequency - very often
Volume - only small amounts of urine each time
Post-void - feel that bladder is still full
268
In hypocalcemia, what are the first line treatment options?
eg. following a thyroidectomy with PTH sort of all over the place.
Use caltrate with calcitriol to up blood calcium.
269
Where are the borders of each of the gut segments and why is this relevant when removing bowel cancers?
Foregut - ends at end of D2 in duodenum.
Midgut - From D2 to 2/3 way through transverse colon.
Hindgut - distal 1/3 of transverse colon to anus.
For cancer removal, you want to remove area supplied by blood supply of cancer to limit potential metasteses.
I.e if a tumour was present halfway through the transverse colon you would do a right EXTENDED hemicolectomy, to remove the colon all the way to the 2/3 mark of the transverse colon where the blood supply switches to the Inferior Mesenteric artery.
270
Which common biochemical marker is a good indication of nutrition level?
Albumin
271
What are colloids? Crystalloids?
Colloids - fluids given to raise oncotic pressure eg. gellofusine or albumin
Crystalloids - salts dissolved in water, eg. saline or Hartmann's
272
What is the vocal resonance difference between pneumonia and pleural effusion.
Pneumonia - solidity causes increases resonance.
Pleural effusion - the one that doesn't make sense - resonance is decreased.
273
How does hyperchloremia cause acidosis? What causes hyperchloremia?
the excess Cl- leads to a reduction in free bicarb (to maintain net negative charge), which lowers the pH. It's typically due to too much saline. Give Hartmann's instead.
274
What are the desired SO2 sats for an adult? what about an adult wit COPD?
95+, 88-92 for COPD.
275
What can an altered mental/conscious state indicated in someone with dyspnea?
Hypoxia of the brain = severe respiratory distress
276
Compare stridor vs wheeze.
Wheeze = lower resp system
Stridor = upper resp system
277
What imaging is typical for suspected pulmonary fibrosis?
HRCT - high resolution CT
278
How can sleep apnea contribute to heart failure?
Sleep apnea increases pulmonary hypertension leads to Right Heart Strain
279
Mnemonic for acute treatment of APO?
LMNOP
Lasix
Morphine to vasodilate
Nitrate to vasodilate
Oxygen
Position
280
How might ascites impact frusemide mode of delivery?
Fluid around gut will impact oral frusemide intake, better to give IV.
281
How does CKD alter frusemide treatment?
Less frusemide is getting to the Loop of Henle due to nephron damage, so more frusemide is needed to have the same effect.
282
Mnemonic for long-term heart failure drugs?
BASS
Beta Blockers
ACEi/ARB
Spironolactone
SGLT2 inhibitors
283
What are the two broad types of pleural effusion? List some causes of each.
Exudative (inflammatory) and Transudative (oncotic - edema).
Exudate - pneumonia, cancer, TB.
Transudative - heart failure, liver failure, kidney failure.
284
Why does a pleural effusion being bilateral help refine the diagnosis?
A bilateral effusion is more likely to be due to a systemic illness like heart failure as opposed to an infection like pneumonia which will cause pleural effusion on one side.
285
Amlodipine is what class of drug? Which site does it act on?
A Calcium channel blocker, dihydropiridine (vessel selective).
Think AmloDiVas
Amlodipine, dihydropyridine, vasculature
286
What is the path of CSF in the brain?
LIT AF
Lateral ventricles
Interventricular foramen
Third ventricle
Cerebral aqueduct
Fourth ventricle
Eventually into subarachnoid space
287
How is syncope defined?
Transient loss of consciousness due to transient cerebral hypoperfusion that is rapid onset, very brief and leads to a quick and complete recovery.
288
What is the main alternate DDx for a syncopal episode? How could you tell them apart?
seizure - do not recover quickly - due to post-ictal phase. Often tired and sore after. Event tends to last longer than syncope.
289
What are the major causes of cardiac syncope?
Anything that reduces CO can do it, but typically the two main culprits are arrythmias and structural issues like valve problems.
290
Does syncope cause jerks?
It can! Jerks can follow from brain hypoxia, so jerks are not just for seizures.
291
What is a significant postural BP change and why would you check Heart rate when checking postural BP?
A change of 20 in systolic or 10 in diastolic.
People SHOULD become tachycardic on standing, but people with autonomic dysfunction (like diabetics) may not have this tachycardia.
292
Comparing BP in both arms is useful to assess for?
Aortic Dissection
293
What are the two scans used for detection of PE's?
CTPA and VQ scan
294
What is the typical non-pharmalogical treatment for 3rd degree heart block?
Pacemaker
295
At what GCS should you intubate?
If GCS 8, intubate
296
Pinpoint pupils is typically a sign of what? What about dilated pupils?
Pinpoint - opiod overdose
Dilated - raised ICP
297
Which cranial nerves control taste?
Anterior 2/3 - facial
Posterior 1/3 - glossopharyngeal
298
In diabetic nueropathy, which sensation and reflexes are the first to go?
Foot sensation and achilles reflex
299
Do cranial nerves crossover?
Only cranial nerve 4
300
Which infection can cause Bells Palsy?
Shingles - Herpes Zoster infection of cranial nerve 7
301
'Hip drop' can be due to a palsy of the ________ nerve or due to weakness of the _______ muscle (ON THE CONTRALATERAL SIDE).
The _______ sign is a test for hip drop.
Superior gluteal.
Gluteus medius.
Trendelenburg.
302
How does renal artery stenosis impact BP (physiology)?
By narrowing the renal artery, less blood flow reaches each nephron. The Juxtaglomerulosa and Macula densa cells detect these changes (low BP by juxta cells and low NaCl by Macula Densa) and cause the release of renin. Renin causes BP rise (largely through production of ANGII - which causes aldosterone release from adrenals and mass vasoconstriction to raise BP). This has no affect on kidneys themselves as no amount of BP raising will increase flow through the stenotic artery - vicious cycle of massive hypertension.
303
What are the 5 impacts of ANG2?
systemic vasoconstriction especially the efferent arteriole
upregulates Na/H transport in proximal tube
promotes ADH creation
aldosterone release
SNS activated leading to more vasoconstriction, more renin and more CO.
304
What is pre-eclampsia?
HTN in pregnancy. Dangerous
305
What height should BP be measured at?
At the same height as the heart
306
What are the values for HTN?
140/90 generally
307
List 6 causes of secondary hypertension (not including pharmalogical agents).
Hyperthyroidism
Hyperaldosteronism
Hyperreninism
Hypercortisolemia
Renal artery stenosis/renal damage
Obstructive sleep apnea
308
Which investigation will reveal kidney damage the earliest?
Urine test - proteinuria comes before creatinine.
309
Flash acute pulmonary edema is commonly cause by _____ ______ ______.
Renal artery stenosis
310
Beta Blockers aren't really used for hypertension alone, but they are often used for other cardiovascular pathologies. List 3.
AF
Ischemic Heart Disease
Heart Failure
311
Name two unique side effects of thiazide diuretics (as compared to other diuretics).
- hyponatremia
- gout risk (uric acid increase).
312
ACEi drugs typically reduce renal function due to dilation of the efferent arteriole, so less blood is filtered. This is clinically acceptable, except when the renal function drop is huge. What condition commonly causes this huge drop in function following ACEi/ARB use?
Renal stenosis
313
How should you manage hypertension in the context of ischemic stroke?
Don't try to lower BP - need the BP high to get blood to brain, lowering BP risks new infarct.
314
What is a give away clinical presentation for Addison's?
Hyperpigmentation, especially in gums.
315
Tryptan/tryptase is a test for ______.
Anaphylaxis
316
Compare the uses of a fine bore vs wide bore tube (NG).
Fine - feeding
Wide - drainage
317
Why does lactate rise?
Ischemia or Necrosis.
318
What is the most specific test for Rheumatoid arthritis?
Anti-CCP (cyclic citrullinated peptide). Rheumatoid factor is + in many conditions.
319
Chronic disease gives what type of anemia?
Normocytic
320
What is the biggest worry for Guillian Barre syndrome?
Respiratory depression
321
What are the 5 main causes of hand joint pain? Which is correctable? Which has a rash?
OA, RA, gout, SLE (correctable), psoriatic arthritis (rash).
322
Tx for syphilis?
IM penicillin
323
Gentamycin is toxic to which two organ systems?
Ototoxicity and nephrotoxicity
324
Which class of antibiotics causes tendinopathy?
Fluroquinolones
325
What is the definitive treatment for Necrotizing fascitis?
Fasciotomy
326
What are the main 2 organisms implicated in infective endocarditis?
Staph aureus and strep viridans
327
What is the treatment for APO?
POND mnemonic:
P - position
O - Oxygen
N - nitrates
D - diuretic (furosemide).
328
In simple terms, how does the vestibulo-ocular reflex occur and which cranial nerves does it involve?
Movement of the head/body is detected by hair cells in the semicircular canals due to movement of the fluid inside. This signal travels down the 8th cranial nerve and is integrated into the brainstem, especially via the nucleus of Cahal in the medial longitudinal fasiculus. This leads. to communication to the cranial nerves controlling the eye movements in both eyes to move eyes according to head movement - normal nystagmus.
329
Which two muscles muffle the sound from inside a person's own head and which cranial nerves control these muscles?
Tensor Tympani (trigeminal 5.3)
Stapedius (seventh - facial)
330
On an ECG what qualifies as an elongated PR interval?
Larger than one big square - FROM THE START OF THE P WAVE, not the end
331
How do you establish LVH on ECG?
Deepest S wave height in V1 or 2 added to tallest R wave in V5 or 6.
332
Mobitz type 2 can progress to which dangerous pathologies?
3rd degree heart block or asystole
333
A really bad PE may show which patterns on an ECG?
S1 Q3 T3 (the numbers are the leads - limb leads)
Tall (S), present (Q), inverted (T) respectively.
334
What are the typical ECG findings for pericarditis and what is the best treatment?
'WIDESPREAD' ST elevation (giveaway word) and PR depression. Treat with NSAIDS, it is all that works.
335
What does hypokalemia do to an ECG?
Shallow T wave (unlike huge T wave in hyperkalemia) followed by U wave.
336
Common side effects of asthma SABA's?
tachycardia, restlessness, shakes. All just adrenergic stuff.
337
How can asthma cause both an alkalosis and an acidosis?
Initially it can cause an alkalosis as the patient is hyperventilating, but as they begin to tire out and decompensate, the CO2 will build up causing an acidosis.
338
Aside from Heart Failure, chronic disease of which two other major organs can cause bilateral leg edema?
Liver - albumin loss (can't make it)
Kidney - albumin loss via proteinuria and RAAS fluid gathering.
339
How can rheumatic heart disease cause both mitral stenosis and regurgitation?
As a child - REGURG
As an adult - STENOSIS
340
Which two hand signs indicate infective endocarditis?
Janeway's lesions and Osler nodes.
341
What is the typical gross cause of an S4 heart sound?
Pressure raise due to cardiac stiffening.
342
How is IBD diagnosed?
You must see it, need colonoscopy/gastroscopy.
343
Mnemonic for multiple myeloma symptoms?
CRAB
C - calcium (hyper)
R - renal damage (due to paraproteins)
A - anemia
B - bone lytic lesions
344
A stroke in which location could cause a vertical nystagmus?
Brainstem
345
A stroke in which location could cause a horizontal nystagmus?
Cerebellum
346
What are Heberden's nodes?
Osteophytes in OA that can be seen clinically, not just on X ray
347
What is otorrhea?
Discharge from the ears
348
Explain Rinne's and Weber's tests. What would an eardrum perforation cause in regards to these tests?
Weber - middle of forehead. Lateralises any pathology but cannot specify nature of deficit.
Rinne - bone vs air. If bone > air - conductive. If air > bone, normal or sensory loss if pathology present from Weber.
Perforation can cause conductive hearing loss (due to eroding ossicles).
349
What is the chordae tympani?
The branch of the facial nerve that passes amongst the ossicles to provide taste to anterior 2/3 of tongue.
350
MOA of carbimazole?
Thyroid peroxidase inhibitor - stops TPO from iodinating tyrosine residues on thyroglobulin.
351
How could you localise which ear you are looking at just from the eardrum?
The malleus points upward anteriorly.
352
The main tracts of the spine I need to know are located where in the spine?
Ventral motor - ventral
dorsal medial sensory - dorsal
anterolateral spinothalamic tract - anterolateral direction, think next to ventral motor
Corticospinal tract - true lateral, above spinothalamic
353
Collapsing carotid pulse is typical of which murmur?
Aortic regurg - think blood is there i systole to form pulse but pulse rapidly drops due to low diastolic pressure as blood re-enters heart.
354
What is a murmur 'grade'?
Loudness - not a measure of severity
355
Late peaking systolic murmur is typical of which murmur?
Aortic stenosis - mirror of early systolic murmur - doesn't get going till after it should.
356
Explain the waves of the JVP and which murmurs could louden each wave type.
a and v wave - atrial wave and ventricular wave.
Atrial wave - right atrium contracts, strengthened by greater volume in atria during atrial contraction - tricuspid stenosis
Ventricular wave - right ventricle contracts, strengthened by greater volume in atria during ventricle contraction - tricuspid regurg.
357
How does inspiration/expiration impact loudness of mitral regurg?
Expiration makes it louder (heart closer to chest wall), inspiration makes it softer.
358
Do all pneumothoraxes cause trachael deviation away from impacted side?
No, only tension pneumothorax. Pleural effusion will push trachea away though.
359
The vast majority of chronic cough cases is caused by which 3 conditions?
COPD, asthma, post-nasal drip
360
What is the main clinical examination sign to look for in lung cancer?
clubbing
361
How could you tell if a sputum sample was dodgy?
Similar to urine sample - presence of squamous cells and if it looks too much like saliva and not sputum
362
When should you conduct spirometry?
when patient is WELL - establishes baseline
363
If they use steroids, what obstructive airway disease is most likely?
ASTHMA, not COPD
364
Features of COPD on CXR?
Hyperinflated chest and relatively smaller heart
365
Can smokers be on O2 supplementation at home?
No - it could blow up
366
What is the most common iatrogenic cause of venous dilatation?
Anti HTN drugs - cause more venous stasis
367
What are some causes of edema due to increased tissue permeability?
SEPSIS, burns and trauma as well
368
hypoalbuminemia can be due to which two broad systems?
Renal - losing albumin
Liver - not making albumin
369
Name 4 causes of lymphatic based edema.
- cancer
- parasites
- surgical intervention eg. mastectomy
- myxedema due to hypothyroid
370
How can edema be linked to thyroid disease?
Myxedema due to extreme hypothyroidism
371
Frothy urine is indicative of what?
Albumin in urine - proteinuria
372
Easy bruising can be a sign of which system failure?
Liver - not making coagulation factors
373
What molecule does the body naturally use to breakdown clots?
Plasminogen/Plasmin
374
Unilateral leg edema suggests what kind of issue in comparison to bilateral?
Unilateral suggests it's a mechanical/local obstruction rather than a systemic issue.
375
Name 2 causes of non-pitting edema
- lymphedema
- myxedema
376
Which heart murmur can be diagnosed without auscultation and why?
Tricuspid Regurg -
can diagnose with prominent v waves, pulsatile liver and leg edema
377
What is the relationship between BNP and heart failure?
BNP is produced by the left ventricle in response to volume overload and is therefore a great test for heart failure. High BNP suggests HF. In a way BNP works to oppose the effects of RAAS
378
Which LFT enzymes indicate liver damage and which indicate biliary obstruction? Of the two liver ones, which is specific to the liver? Which is higher in liver disease?
The transaminases (AST and ALT) are for the liver and ALP and GGT are for the biliary tree. ALT is specific to the liver, AST is made in many places. ALT is higher than AST in most liver diseases EXCEPT alcohol damage which causes AST to be greater.
379
What is the most important Ix finding for haemachromatosis?
Transferrin Saturation is high
380
Aside from the GIT, where else is ALP made?
Bones
381
What clinical finding indicates haemachromatosis?
Bronze skin
382
An isolated raised bilirubin with no other abnormal LFTs is likely to be due to?
Haemolysis - cause of bilirubin release before liver.
383
Name 3 clinical signs of chronic alcohol abuse.
- Dupuytrens contracture
- parotidomegaly
- peripheral neuropathy
384
HCC can only be caused by which two things?
Hep B or Cirrhosis
385
Why might antibiotics be regularly given for ascites?
Spontaneous bacterial peritonitis is a risk with ascites
386
What is the most serious and red flag complication of chronic liver disease?
Varices - need regular scopes
387
Name one surgical and one medical prophylactic treatment for esophageal varices?
Banding and non-selective B blocker like propanolol
388
Explain hepatorenal syndrome.
Patients with liver damage have splanchnic vasodilation due to portal hypertension, causing low perfusion and thus activation of RAAS. The overactivation of RAAS causes an AKI due to renal artery vasoconstriction by ANG2.
389
Do both deep and superficial veins cause DVTs? Which DVTs are most likely to progress to PEs?
Typically only deep veins cause DVTs.
Proximal DVTs tend to become PEs (those at/above the popliteal region).
390
What is polycythemia?
Too many RBCs
391
An elevated JVP, loud P2 over the pulmonary valve and RV heave are consistent with?
PE!!!- Pulm hypertension leading to right heart strain and building preload.
392
What is the only reason you would use thrombolysis for a PE?
If it was a huge PE causing haemodynamic instability (hypotension)
393
When are SGLT2s contraindicated?
Low eGFR
394
Which hormones does somatostatin suppress?
TSH, insulin, GH, CCK
395
which consumed macromolecules induce CCK release?
Fat and protein
396
Mallory Bodies are present in which disease?
Liver damage
397
Which 4 factors will cause a rightward shift in O2:Hb association and what does this mean?
Increased CO2, H+, BPG, Temp will all cause O2 to fall off Hb easier
398
Run through the physiology of alcohol damage to the liver.
- chronic alcohol
- normal alcohol dehydrogenase pathway saturated
- cytochrome and peroxisomes recruited
- ROS made in excess
- Fat synthesis and oxidative stress occur
- inflammation
- stellate cells cause scarring of space of disse - impede liver function
399
describe the timeline of optic neuritis
SUDDEN vision loss - often colour goes first
400
What does a HbeAg positive mean on serology?
Hep B is currently replicating in the host
401
Distribution of chickenpox rash?
All over except palms and feet soles
402
What is primary sclerosing cholangitis?
Scarring of the biliary tree due to inflammation secondary to IBD.
403
How does PTH impact the kidneys?
Decrease phosphate resorption to increase free calcium
404
What Ix MUST be done if septic arthritis is suspected?
Arthrocentesis
405
tenderness on palpation of costophrenic angles typically relates to a pathology of which system?
renal
406
What might a CXR show with a peptic ulcer?
If perforated - pneumoperitoneum pushing up diaphragm
407
What will an untreated small bowel obstruction progress to?
Perforation
408
Name 2 causes of low MCV anemia.
iron deficiency and thalassemia
409
What are the two divisions of macrocytic anemia?
Megaloblastic (B12/folate deficiency - will have hypersegmented neutrophils) or non-megaloblastic.
410
Name 2 causes of haemolysis
Infection eg. malaria and sickle cell disease
411
List 3 causes of non-haemolytic normocytic anemia.
- bleeding
- low EPO from CKD
- anemia of chronic disease
412
What supplement is recommended during treatment with methotrexate?
folate
413
A pulsatile liver is related to which type of murmur?
Tricuspid
414
Which anti-HTN can you NOT use during APO?
Beta blocker
415
Which murmurs are louder on expiration and which on inspiration? (mnemonic)
lEft is louder on Expiration
rIght is louder on inspiration
416
How would aortic stenosis impact BP?
Lowers it - less blood escaping heart
417
Sudden cardiac death in young, fit people may be due to which type of cardiomyopathy? Which clinical sign may be heard (provided they're not dead)
Hypertrophic Obstructive cardiomyopathy
S4 gallop
418
'electrical alternans' is med school codeword for what condition?
Cardiac tamponade
419
The P mitrale and P pulmonale P wave findings for atrial dilation are relevant to which ECG lead?
usually lead II
420
If there is an ECG qn on an exam and the vignette is post surgery, what should you be looking for?
PE
S1Q3T3
421
Name 1 Antibiotic for TB
Rifampicin
422
Which antibiotic class is gentamycin and name 2 side effects
aminoglycosides
Ototoxicity and nephrotoxicity
423
What is an easy trick to establish whether something is metabolic or respiratory on ABG?
If the pH and bicarb are going the SAME direction it is METABOLIC.
If they're going different directions, it's RESPIRATORY.
424
Compare BPPV, labyrinthitis and acoustic neuroma in terms of vertigo and accompanying symptoms.
BPPV - brief episodes regularly, no impact on hearing.
Labyrinthitis - prior URTI, really bad vertigo for weeks. Hearing loss. Sudden.
Neuroma - may not even notice vertigo due to slow growing nature. Hearing loss.
425
Stroke in the posterior circulation can cause which type of nystagmus?
Horizontal (cerebellar)
426
name the classes that accompany these suffixes:
- flozin
- gliptin
- tide
flozin - SGLT2 inhibitors
gliptin - DPP4 inhibitors
tide - GLP1 analogues
427
Why is high K+ in DKA misleading?
DKA causes acidosis, so the cells swap their K+ to take in H+ to try and mediate this but it gets to an extreme point where the cells are now potassium deficient - dangerous.
428
Compare venous and arterial ulcers.
Venous - poorly demarcated and shallow
arterial - well demarcated and deep
429
Low Hb + high urea should ring alarm bells for what?
Upper GI bleed - loss of Hb due to bleeding but blood is being digested and metabolised into urea
430
Compare medical vs surgical treatment of esophageal varices?
Medical. -non-selective b blocker like propanolol
surgical - banding
431
How can gastric vs duodenal ulcers be separated on history?
Worse with food - gastric
better with food - duodenal
432
List the haemorrhoid stages.
1 - internal
2- prolapse with spontaneous retraction
3 - prolapse with mechanical retraction
4 - prolapse with no retraction possible
433
Name 2 buzz phrases for ascites?
Shifting dullness, fluid thrill
434
What is the most common complication of gallstones?
pancreatitis
435
Which glucose channel does insulin upregulate?
GLUT4
436
How can liver damage impact platelet and glucose levels?
makes both low
437
Name 2 mineral based pathologies that can cause liver failure
Wilsons - copper
haemachromatosis - iron
438
What is the role of prostaglandins in kidney function?
PGE causes dilation (no matter where it is). In this case the dilation is of the afferent arteriole (this is part of the autoregulation). NSAIDS stop PGE production hence afferent vasoconstriction.
439
Compare urination frequency and volume in diabetes and in UTIs
Frequency AND volume up - diabetes
Frequency up but volume down - UTI
440
Explain diabetes insipidus and the two sites that can cause it.
Issue with ADH function leading to symptoms of diabetes (peeing a lot and thirsty) without actually having anything to do with sugars. Can be neuro (not enough ADH made) or renal (shit ADH receptors).
441
Name 3 causes of post-renal obstruction.
- stones
- cancer
- BPH
442
Which scan is best for renal stones?
CTKUB non contrast
443
If, on commencement of an anti-HTN drug, a person's HTN skyrocketed, what would you expect?
Renal artery stenosis
444
What is sterile pyuria and what does it commonly indicate?
WCC high in urine but no organisms.
Indicates STI - gonnorhea or chlamydia
445
How does PTH impact phosphate levels?
PTH promotes kidneys to excrete phosphate whilst keeping calcium.
446
The immediate treatment for hyperkaemia is ______.
CALCIUM (calcium gluconate).
447
Compare the causes of the following in the urine:
- red cell casts -
- white cell casts -
- brown cell casts -
- fatty casts -
red - nephritic syndrome
white - pyelonephritis
brown - acute tubular necrosis
fat - nephrotic syndrome
448
What is the typical vignette for minimal change disease?
Nephrotic syndrome in a child, often with allergies
449
Compare the 3 causes of rapidly progressing glomerulonephritis - how could you differentiate them?
SLE - classic SLE features
Goodpastures (haemoptysis)
Granulomatosis with polyangitis (vasculitis, ANCA +, ENT bleeding)
450
Name a buzzword for both the histological and CT findings of idiopathic pulmonary fibrosis.
histo: fibroblastic focus
CT: honeycombing
451
Mnemonics for causes of upper lobe and lower lobe fibrosis:
Lower: RASIM
Rheumatoid arthritis
Asbestosis
Scleroderma
Idiopathic pulmonary fibrosis
Methotrexate (and other drugs)
Upper: SATS
Silicosis
Ank spon
Tb
Sarcoidosis
452
What is rhinophyma?
big nose due to alcohol abuse
453
Which anti-htn should you avoid in variant angina?
B blocker
454
What is shown here?
Bleeding peptic ulcer
455
What is shown in the following CXR?
Acute Gastric Dilatation
456
What is shown in the following CXR?
Hiatus Hernia
457
Which medical intervention is shown here and what is the diagnosis?
Barium swallow - achalasia
458
What is shown in this CXR?
Pneumothorax - left lung TOO clear - no signs of tissue, just air. Consolidated white area near heart is collapsed lung.
459
These two CXRs show two different severities of which condition?
Pneumoperitoneum
460
This scan shows an _____ _____ with _____ ______.
Extradural hematoma with midline shift
461
This scan shows what?
Apple core sign - bowel cancer growing around and into the lumen of the bowel, constricting the bowel.
462
What is shown in this scan?
Coffee bean appearance = volvulus.
Pointing toward the sigmoid area so it's a sigmoid volvulus (as opposed to caecal).
463
What is shown in this scan?
Haemopneumothorax with subcut emphysema (trauma) as well as a potential pneumomediastinum
464
What is shown in this scan?
A kidney stone with mild subsequent hydronephrosis
465
What is shown in this scan?
Diverticulitis - gas filled (black) outpouchings of bowel alongside areas of thickened bowel walls (inflammation)
466
What does this ECG show?
First degree heart block
467
What does this ECG show?
Inferior STEMI
468
What does this ECG show?
LVH
469
What does this ECG show?
Mobitz 2
470
What does this ECG show?
Mobitz 1
471
What does this ECG show?
Ventricular pacing (pacing spikes + widened QRS)
472
What does this ECG show?
Dual chamber pacing
473
What does this ECG show?
Hyperkalemia - abnormally peaked T wave
474
What does this ECG show?
Hyperkalemia - worsening - bizarre peaks
475
What does this ECG show?
Severe hyperkalemia - sine wave appearance
476
What does this ECG show?
LBBB - WillaM
477
What does this ECG show?
Severe PE - S1Q3T3
478
What does this ECG show?
Pericarditis - widespread ST elevation, PR depression
479
What does this ECG show?
Hypokalemia - flattened T wave and presence of U wave
480
What does this ECG show?
Sinus arrhythmia
481
Which 2 molecules carry triglycerides around the body?
VLDL and Chylomicrons
482
Tenderness to palpation at the costophrenic angles relates to what organ system?
Renal/urogenital
483
List 4 causes of normocytic anaemia.
- lack of EPO
- anaemia of chronic disease
- haemolysis
- acute bleeding
484
P mitrale and P pulmonale ECG signs are located in which lead?
lead II
485
Salbutamol can cause which electrolyte disturbance?
hypokalemia
486
What causes a Mallory Weiss tear?
High pressure due to coughing or vomiting, alcohol too
487
what is the approximate urine cut off level to classify oliguria
0.5ml per kg per hour or less
488
Which type of dialysis can be done at home?
Peritoneal dialysis can be done at home. Haemodialysis directly involves the blood so really has to be done at hospital.
489
What are the 3 key cytokines that cause inflammation?
TNF-a, IL-1, IL-6
490
Best way to remember catalase and coagulase test for gram positive cocci differentiation?
First split is staph vs strep, 'catalase' is alphabetically before 'coagulase' so it's the first test.
Coagulase is next up and it differentiates staph aureus (+) from all other staph species.
491
What are the main 2 regulatory cytokines?
TGF-B and IL-10
491
How to remember pharmacodynamics from pharmacokinetics?
pharmacoDynamics - all the D words. what DRUG DOES to body.
491
What are the broad targets of Th1, Th2 and Th17 cells?
1- intracellular
2- parasites
17 - extracellular
492
Mnemonic for hypersensitivities?
ACID
Allergy
Cytotoxic
Immune
Delayed
493
What levels do the 3 structures pass through the diaphragm?
8 - IVC
10 - esophagus
12 - aorta
494
What level is the transverse thoracic plane?
T4/5
495
Compare transudate to exudate.
Transudate - think transient fluid. Edema type buildup due to system failure like renal, heart or liver.
Exudate - has cells in it. It's inflammatory. Infection, infarction or cancer.
496
How does digoxin work?
N/K ATPase blocker - keeps Na in cardiomyocyte for longer, Ca stays with Na. Allows for more Ca to build up.
497
Where are B1 and B2 adrenergic receptors located?
B1 - heart (and kidneys)
B2 - lungs
498
How does ezetimibe work?
Stops absorption of gut cholesterol
499
Mnemonic for lower lobe causes of restrictive lung disease?
RASIM (like raisin sort if :))
Rheuamtoid artheritis
Asbestosis
Scleroderma
Idiopathic pulmonary fibrosis
Methotrexate
500
What is fetor?
Smell
501
Which of the big 4 resp pathologies cause absent/reduced breath sounds?
All of them except pneumonia which causes coarse crackles.
502
The rule 'more solid = better vocal resonance' is true for all of the big 4 lung pathologies except for?
Pleural effusion - despite being more solid (liquid) the resonance is reduced, this is because the fluid is sort of acting as a wall stopping the vocal sounds in the lungs.
503
What WBC is dominant in COPD? What about asthma?
COPD - neutrophils that provide the proteases
Asthma - eosinophils
504
The Achilles reflex relates to which spinal level?
S1 and S2.
505
What spinal level does the stomach begin at?
L1
506
Which two molecules stimulate the pancreas to release digestive enzymes? Which of these causes gallbladder contraction?
CCK and Secretin.
CCK acts on gallbladder.
507
Name a common complication of central lung tumours and a common complication of peripheral lung tumours
central - obstruction
peripheral - pleural effusion
508
Where would you find Mallory Denk Bodies?
Liver damage
509
What does Cushing's cause hypertension?
Cortisol has a minor mineralocorticoid reaction - leads to ENaC upregulation.
510
Describe the distribution of T3/4 in different body locations.
T4 is better at circulating so is higher in the blood, it is converted to T3 intracellularly because T3 is better at actually doing the job.
511
Describe the pathophysiology of CAH - congenitial adrenal hyperplasia
Adrenals have horrible response to ACTH, so low cortisol and aldosterone. The latter leads to salt wasting.
Testosterone production is fine.
512
List 6 deficiencies vegans are at risk of.
Iron, Zinc, B12, Vitamin D, calcium and selenium.
513
Which medication can be used to treat symptoms in hyperthyroidism?
Beta Blocker
514
Name one nerve, one bone and one muscle that could be the cause of hip drop.
Nerve - superior gluteal
Bone - greater trochanter of femur
Muscle - gluteus medius
515
How will renal osteodystrophy impact phosphate levels?
Damaged kidneys are unable to seperate Calcium from phosphate, get too much phosphate.
516
Which nerves supply sensation to the foot/toes?
Underside of foot = tibial (follows along from it being a posterior nerve)
Most of foot = superficial fibular
Big toe = deep fibular
517
Which leg compartment does eversion?
Lateral compartment
518
Which fungus commonly causes meningitis?
Cryptococcus
519
Which dermatome is the bottom of the foot?
S1
520
Mnemonic for the tarpal tunnel? (Flexor retinaculum)
Tom Dick And Very Naughty Harry
521
Lewy Bodies are associated with which disease?
Parkinsons
522
Meningitis + rash should raise suspicion of which cause of meningitis?
Neisseria
523
Of the two major motor paths (lateral corticospinal and ventral path) which controls the limbs?
Lateral corticospinal, the ventral path is more for central things like staying standing etc.
524
Down and Out eyes is typical of what pathophysiology?
Raised ICP impeding on CN3
525
Mnemonic for branches of the external carotid.
Seven Loud Femmes Arguing Over PMS
Superior thyroid
Lingual
Facial
Ascending pharyngeal
Occipital
Posterior Auricular
Maxilliary
Superficial temporal
526
Which cranial nerve controls blinking?
Blinking done by orbicularis oculis, muscles of face done by CN7
527
Do cranial nerves control contra- or ipsi- lateral areas.
All control ipsilateral areas aside from CN4 which deccusates.
528
what is celocoxib?
NSAID
529
alpha synucelin is a protein associated with which disease?
Parkinsons
530
Which bacterial cause of meningitis does NOT have a vaccine?
Listeria
531
'Slapped cheek' is caused by which virus?
Parvovirus
532
What is carbidopa?
A medication to treat the side effects of levidopa.
533
What does the embyronic endoderm become?
Resp + gut system
534
Compare the growth of BPH vs prostate cancer and what this means for symptoms/DRE.
BPH - grows peri-urethrally, less likely to feel on DRE but more likely to cause obstructive urological symptoms.
Prostate cancer - grows peripherally, more likely to be felt on DRE.
535
A rash on the palms and soles of the feet should raise a red flag for?
Syphilis
536
A neck of femur fracture could lacerate which nearby artery?
medial circumflex artery
537
Neonatal purulent conjunctivae is often caused by:
gonnorhea
538
Deafness in neonates may be caused by which virus?
CMV
539
What is the blood supply of the ovaries?
Suspensory ligament of ovary
540
The IVC is directly behind which anatomical pouch?
epiploic foramen
541
What is the most serious complication of SGLT2 inhibitors?
euglyceamic ketoacidosis
542
Pheochromocytoma occurs in which cell type?
Chromaffin cells in the adrenal medulla
543
What happens to amylase in pancreatitis?
Amylase RISES - think of inflammation squeezing all the amylase out of the pancreas
544
'Trouble going down stairs' related to an eye pathology is alarm bells for what pathology?
Damage to CN4, typically via trauma.
545
What does the parasympathetic nervous system do to pupil size?
Reduces (constricts) pupils.
Think of sympathetic drugs like MDMA making people's pupils HUGE.
546
When do you stop aspirin for surgery?
You don't.
547
What is the triad of anaesthesia?
Hypnosis, analgesia and paralysis
548
Why might a bowel obstruction be of worry to an anaesthetist?
Risk of aspiration of backed up bowel contents.
549
Which vital sign could show that an endotrachael tube has not been properly inserted?
if O2 sats fall after the tube has been inserted
550
Which common anaesthetic agent does NOT cause respiratory depression?
Ketamine
551
Tramadol impacts which 3 targets?
- serotonin
- opioid
- Noradrenaline
552
Outline the different placement of nicotinic vs muscarinic receptors.
Nicotinic - neuromuscular junction (control skeletal muscle)
Muscarinic - viscera
can think of muscarinic not doing muscles or that you need to move your muscle to get a cigarette (nicotine) to your lips
553
What is the main way to reverse paralytics?
Anti-acetylcholinesterases.
Paralytics function by impairing Ach at the nicotinic receptors. If you stop the breakdown of Ach you by acetylcholinesterases then it can build up and overwhelm the paralysis.
554
What level should a spinal anaesthetic be at?
L3-L4 to miss the L1/2 spine end.
555
What layer is a spinal injected into?
Sub arachnoid space
556
What are some risks with a spinal?
Infection, nerve damage, hypotension, HEMATOMA that compresses spine
557
What molecule can enhance the longevity of local anaesthetics?
Adrenaline
558
Name 3 groups of medications for neuropathic pain.
- tricyclic antidepressants - amytriptyline
- anti convulsants - gabapentin/pregabalin
- SNRIs - duloxetine
559
What is the antidote to opioids?
Naloxone
560
What are the 3 causes of ulcers (cause 95%)
- ischemic (arterial)
- neuropathic
- venous
561
Which ulcer factors are unique to neuropathic ulcers?
Usually painLESS and thus hidden away (eg. on sole of foot) where they worsen because patient cannot feel them.
562
What question could differentiate between leg claudication and critical ischaemia?
Does it occur at rest/at night.
563
What is the main cause of arterial occlusion in the legs and how could you localise where the occlusion is on examination?
Main cause: atherosclerosis
Localise by checking pulses. No pulse = no flow.
564
Sudden leg pain with a white leg probably indicates which condition?
Femoral artery embolic occlusion
565
Which type of shock is 'warm' and which is 'cold'?
Warm - septic - because temperature
Cold - haemorrhagic because losing blood
566
Which medication can be used to dilate tubes in the urogenital system ie. dilate ureter for a stone and dilate urethra for a BPH obstruction?
ALPHA BLOCKERS
-osin drugs
567
Macroscopic haematuria (clots in urine not just pink colour) should ring alarm bells for what?
Urothelial cancer
568
Mnemonic for causes of heamaturia?
PRINTS
Prostate (cancer)
Renal
Infection
Nephritic
Thinners
Stone
569
Dullness to percussion indicates which 2 common lung conditions and how could you differentiate them?
Pleural effusion and pneumonia.
Pleural effusion will have absent breath sounds and pneumonia will have crackles.
570
What are the best ways to investigate pre-renal vs renal vs post-renal.
Pre renal - exam is king
Renal - urine is king
Post renal - imaging is king
571
What is Resonium?
Medication that binds to K+ in diet and causes us to shit it out to prevent hyperkalemia.
572
What are the two pillars of medical treatment for BPH?
Alpha blockers - to relax muscular component of prostate
5a reductase inhibitors - to atrophy glandular component of prostate
573
Compare an incarcerated hernia to a strangled hernia.
Incarcerated - non-reducible hernia
Strangled - ischaemic hernia
574
Acute onset, severe pain in the scrotum with nausea and vomiting should raise alarm bells for?
Torsion
575
What are the two examinations to help differentiate torsion from epididymo-orchitis?
Cremasteric reflex - stroke of inner thing should raise testicles - doesn't happen in torsion.
Lift test - torsion pain is not relieved when testicles are raised
576
What are the 3 main causes of itchy skin?
Eczema, psoriasis and ringworm.
577
Which big 3 factors on examination/Hx seperate psoriasis from eczema?
SCALP ITCH
EAR RASH
JOINT PAIN
= psoriasis
578
Which body areas do eczema and psoriasis target?
FEEP
Flexor Eczema
Extensor Psoriasis
579
A 'yellow crusty' itchy area is likely what condition?
Impetigo - staph aureus skin infection.
580
'Punched out erosions' on the skin are a red flag for what condition?
HSV/VSV infection of the skin
581
Which factors seperate rosacea from other skin conditions?
IT IS NOT ITCHY, NOT SCALEY and DOES NOT SCAR. It is largely linked to sun exposure.
582
What is the main Ddx for rosacea?
Lupus - could come with joint pain
583
A sudden uncontrollable itch, especially on the hands and feet, and spreading to family members is probably which condition?
Scabies
584
What type of lesion should you never partially/punch biopsy?
Pigmented lesions
585
Where are BCCs usually located?
The neck and up
586
Describe a typical BCC under a dermatoscope.
A pearly pink/white lesion with telangiectasia (little red arteries on the lesion).
587
How could you seperate a Squamous cell carcinoma from a BCC with one question?
SqCC are PAINFUL, BCC are not
588
What is the most important pathology to rule out for TLOC?
Stroke
589
Mnemonic for steps in stroke management:
Call BEES
Call code stroke
Bloods x5 (FBE, Coags, LFT, UEC, glucose)
ECG
Examine on the way to scan
Scan - CT non contrast
590
What are the acute treatment options for ischaemic stroke? What are their positives and negatives?
Thrombolysis
- easy
- all vessel sizes
- within 4.5 hrs only
- bleed risk
Clot retrieval
- 6-24 hrs
- needs specialist team
- only large vessels
591
Syncope + headache: think ___
SAH
592
Syncope + chest pain: think ____
ischaemic of heart or arrythmia
593
syncope + dyspnea: think ____
PE
594
What is the relationship between AF and atrial dilation?
AF can either be as a result of atrial dilation (stretch of myocardium causing ectopics) or can itself cause atrial dilation (no proper atrial contraction leads to volume build up in atria and eccentric hypertrophy).
595
What are the CHADS-VASc and HAS-BLED scores?
CHADS VASC - risk of stroke in patient with AF
HAS BLED - risk of bleeding in anticoagulated AF patient
596
Name one physical and one medical treatment for acute supra-ventricular tachycardia.
Physical - valsalva maneouvre
Medical - adenosine
597
What is the end result of heart valve dysfunction?
heart Failure
598
What are the EDV and ESV in a compensating heart?
EDV is greater - more volume to expel
ESV is normal - hence the compensation.
Starling's forces are raising CO to maintain stroke volume.
599
Which medication must be commenced with a mechanical heart valve?
Must be warfarin. DOACs unacceptable.
600
Name two findings on examination unique to aortic regurg.
- collapsing pulse (volume re-entering heart)
- widened pulse pressure (systolic strong by diastolic low due to loss of volume back into heart)
601
What are the two key diagnostic tests for haematological conditions?
Blood film and bone marrow biopsy.
602
List 3 features unique to AML/APML.
- Auer rods in faggot cells
- DIC - disseminated intravascular coagulopathy
- PML RAra mutation
603
Why might leukemia cause elevated LDH and urate?
Tumour lysis syndrome - big for leukemias. Urate will cause AKI.
604
Smear cells are typical of which cancer?
CLL.
605
name a unique treatment for ALL.
L-asparaginase - think - B-ALL is the one in kids because kids plays with BALLS. Kids hate asparagus, so that's their yucky chemo drug.
606
Which leukemias typically cause organomegaly and which typically cause lymphoma-like symptoms?
CML and AML (with M) cause MEGALY.
CLL and ALL (with L) cause LYMPHOMA.
607
Why are bisphosphonates used in myeloma?
To counter bone degradation by bone lytic lesions.
608
What are the 3 'B symptoms'?
fever, night sweats, weight loss. NOT FATIGUE.
609
Compare the lymphadenopathy in infection vs lymphoma.
Infection - painful.
Lymphoma - firm and painless.
610
On histology, lymphocytes with clear white bubbles inside of them are typical of which cancer?
Burkitt Lymphoma
611
What is verapamil?
Cardio selective Ca blocker. Think of it as the opposite of amlodipine.
612
List 4 features of chest pain that would make it LESS likely to be ischaemic.
- sharp
- positional
- pleuritic
- reproducible
613
When to do a stress test and when to do coronary angiogram?
Low risk patient with ischaemia - can do stress test. If high risk, the stress test will just kill them.
614
Which parasite can commonly cause biliary obstruction and how would you test for this?
Ascaris. Check stool for eggs.
615
When do you thrombolyse an NSTEMI?
never.
615
What are Type1 and Type 2 AMIs?
Type 1 = STEMI or NSTEMI
Type 2 = demand ischaemia
616
What is the main contraindication for thrombolysis?
Active bleeding/head trauma
617
Name an endocrine cause for AF
Hyperthyroidism
618
Why would you do an ECHO and CXR for AF?
AF tightly linked with HF, checking for signs of HF or compensation, eg. dilated atria
619
Which medications should be avoided in Wolff Parkinson White?
Anything that targets the AV node, primarily adenosine and cardiac calcium channel blockers.
620
Which is safer in AF, rate or rhythm control?
rate
621
How can obesity impact resp function?
obesity can cause a restrictive lung disease
622
What are the two key investigations for Guillian Barre?
Lumbar Puncture and nerve conduction studies
623
What is myotonic dystrophy and what is a hallmark sign?
Myotonic dystrophy is a type of muscular dystrophy. Hallmark - atrophy of muscles AND inability to relax muscles once contracted. Classic example: can't release fist when clenched
624
What is the O2 saturation aim for a COPD patient?
88-92%
625
What is pulsus parodoxus and what condition typically causes this?
Fall in BP on inhalation - typical of cardiac tamponade
626
Compare stridor to wheeze.
Stridor - upper resp
Wheeze - lower resp
627
Mnemonic for findings of HF on CXR?
ABCDE
Alveolar edema
B-lines (kerly)
Cardiomegaly (beware AP films)
Dilated pulmonary vessels
Effusions
628
Compare the causes of a bilateral vs one-sided pleural effusion.
Bilateral - more likely to be a systemic (transudative) cause.
Unilateral - more likely to be a local issue like infection.
629
What is the hallmark of myasthenia gravis and what is typically the earliest sign?
Typical: muscle weakness that worsens with use and improves with rest
Earliest sign - typically eye changes like double vision (diplopia) or eyelid sagging (ptosis).
630
What are the 3 major causes of exudative pleural effusion?
Cancer, pneumonia, TB.
631
How does estrogen impact bone density?
Estrogen increases OPG, OPD binds to RANK-L to stop its activation of osteoclasts.
632
What is mupirocin and it’s indications?
Antibiotic used for skin infections, mainly impetigo.
633
Why does liver damage impact platelet level?
Liver makes thrombopoieton which stimulates platelet growth
634
Which initial imaging technique would be indicated in a suspected bowel obstruction?
Erect and supine abdominal films
635
In what ways can the parasympathetic nervous system impact cardiac output?
Only via heart rate not stroke volume
636
Which broad class of drug is contraindicated in heart failure?
Calcium Channel Blockers
637
Name a histological finding in an MI that would appear within 24 hrs of the MI.
Contraction band necrosis
638
'short, rotated leg' is med school code for which pathology?
Neck of Femur fracture
639
'orphan annie eyes' + 'coffee bean cells' are descriptors of which pathology on histology?
Papillary thyroid carcinoma
640
If a patient has TOO much calcitonin, which neoplasm may be responsible and which genetic condition could be at play?
Medullary thyroid carcinoma - ALWAYS THINK M.E.N SYNDROME WITH THESE CASES - look for pheochromocytoma
641
Strengthening which muscles could help to relieve pain from knee osteoarthritis?
Quads, hamstrings and calves.
642
What is the generic name for the osteoporosis drug Prolia?
Denosumab
643
Left homonymous hemianopia could be due to a lesion in which 2 locations?
RIGHT optic tract or RIGHT occipital lobe (eg. optic radiations)
644
A large goiter can impact which nerve?
Recurrent laryngeal
645
Which neonatal/peadiatric infection can cause pancreatitis?
Mumps
646
What are purpura?
Bruises essentially, caused by low platelets.
647
Which medications are involved in a standard induction for anaesthesia? What about maintenance?
Induction - fentanyl for analgesia and propofol for hypnosis.
Maintenance with volatile agents eg. Sevo
648
Which spinal layer does a spinal anaesthetic go in?
sub-arachnoid space
649
What is the most common indication for a fascia iliaca nerve block?
HIP FRACTURES
650
If someone has a gout flare up but also have chronic renal disease, which treatment is best?
Steroids - prednisolone. Can't give NSAIDS due to renal damage.
651
Where is a colle's fracture located?
Wrist fracture
652
What is the Schober test and what is it used for?
The bend and touch your toes test - used to diagnosed spondoarthropathies. ESPECIALLY ANK SPON.
653
How could you differentiate neurogenic claudication from vascular claudication?
Neurogenic claudication (due to spinal stenosis) will not have any of the vascular sequalae, eg. pulses will be normal.
654
Which imaging is best for spinal stenosis?
CT
655
Sudden ischemia is typically due to what?
An embolus (as opposed to a local thrombus that will cause gradual worsening ischemia).
656
What is the best scan for an AAA?
CT
656
Which resuscitation fluid is best for a ruptured AAA?
They are profusely bleeding so blood is needed.
657
A hypovolemic patient with a pulsatile abdominal mass is typical of which pathology?
Ruptured AAA
658
What are the 3 skin sequelae of chronic venous insufficiency?
- varicose eczema
- lipodermatosclerosis
- ulcers
659
A patient presenting with typical renal colic pain with a temperature likely has what pathology? What would be the immediate treatment?
Infected obstructed kidney. Urology need to put in a nephrostomy or a stent in prior to surgery.
660
Macroscopic haematuria should be treated as what until proven otherwise?
Urothelial cancer
661
The most common cause of an SAH is trauma. What is the most common non-traumatic cause?
Aneurysm
662
What is risonium?
Medication that binds to dietary potassium to prevent absorption in hyperkalemics.
663
What investigation must be done in meningitis before a diagnostic lumbar puncture is performed?
CT head to ensure no raised ICP that may lead to coning following a lumbar puncture.
664
What are the 4 pillars of meningitis empiric therapy?
Ceftriaxone, Penicillin, Dexamethasone, Vancomycin (+/-)
665
What is the best imaging for testicular torsion?
Ultrasound with Doppler
666
What is overflow incontinence?
Incontinence due to a full bladder - could be a neurological or obstructive picture.
667
What is the Phalen's test for?
Carpal Tunnel
668
Which surfaces are usually affected by eczema vs psoriasis?
PEEF
Psoriasis is Extensor
Eczema is Flexor
669
Compare skin prick testing to patch testing.
Skin prick - immediate reaction testing type 1 hypersensitivities.
Patch test - delayed reaction (48hrs) testing for Type 4 hypersensitivities
670
What is the most common cause of contact dermatitis?
Nickle
671
Which 3 body areas are uniquely targeted by psoriasis?
Scalp
Ears
Buttcrack
672
What are the 2nd and 3rd line treatments for psoriasis?
2nd - phototherapy
3rd - methotrexate
673
What is permethrin used for?
Topical treatment of Scabies.
674
What is the 'post-exposure' treatment for HepA?
vaccination
675
Actinic (Solar) keratosis is a precursor to which dermatological condition?
squamous cell carcinoma
676
Which melanoma factor directly relates to mortality?
depth
677
What are the 3 broad steps in treatment of melanoma?
1. Check the rest of the skin
2. Excisional (NOT PUNCH) biopsy
3. Wide local excision surgery
678
Which fungus causes ringworm?
Tinea Corporis
679
Mnemonic for steps in suspected stroke?
Call BEES
Call code stroke
Bloods x5 - FBE, UEC, LFT, Coags, Glucose
ECG
Examinations to rule out other causes on the way to:
Scan - CT non contrast
680
What will you see on a CT non contrast for an acute ischemic stroke?
Nothing really. There would be loss of grey matter differentiation about 5 days post stroke.
681
Which type of syncope classically occurs in a crowded area?
Vasovagal
682
What are the two main causes of Long QT syndrome? (aside from medications)
Electrolyte imbalance and genetic pre-disposition
683
Describe the impacts of different murmurs on pressure/volume and heart remodeling.
STENOSIS will cause increased pressure in the prior chamber as the doorway is smaller. - CONCENTRIC HYPERTROPHY
REGURGITATION will cause increased volume as the blood flows back through the door. ECCENTRIC HYPERTROPHY
684
Longer INR, Longer APTT and low fibrinogen represent which pathology?
DIC - disseminated intravascular coagulopathy. Typical of AML.
685
On histo, if there were more WBC than RBCs, what would you be thinking?
haem cancer
686
Smear cells on histo are typical of which pathology?
CLL
687
Monoclonal antibody for lymphoma?
Rituximab
688
Which two main pulmonary pathologies can cause full white out of a lung on CXR - how could you tell them apart?
Collapsed lung - trachea moves toward white
Pleural effusion - trachea moves away from white
689
What shape do the pulmonary arteries form on CT and what pathology should you look for there?
Sideways 'Y' shape.
Look here for PEs.
690
Why does tension pneumothorax actually kill?
It tamponades the IVC.
691
Pneumothorax CXR findings?
DRMT
Diaphragm flattening
Rib splaying
Mediastinal shift
trachael deviation
692
Compare the management of Type A vs B aortic dissection.
Type A - must be surgical due to risk of dissecting heart.
Type B - medical management
693
diplopia and trouble going down the stairs is common for pathology of which cranial nerve?
CN4 Trochlear
694
Dilated pupil, Drooping eyelid and a laterally leaning eye may be indicate of which cranial nerve pathology?
CN3 oculomotor damage
695
Retinoic acid and arsenic are common treatments for which disease?
APML Leukemia
696
What is iloprost?
IV prostacyclin injection to vasodilate fingers in Reynauds
697
What causes the lap belt sign and what organs are at risk?
Typically a MVA causing tightening of the seatbelt around the tummy. Lumbar spine fractures and a huge risk as well as pancreas, liver, kidneys and spleen.
698
Which antibody is unique to scleroderma?
SCL-70
699
Which medication can help maintain the health of bones in myeloma?
Bisphosphonates
700
What are the top 3 differentials for upper GI Bleed?
Varices, ulcers, malignancy.
701
List the 3 broad causes of splenomegaly.
- Portal HTN
- infection eg. EBV
- haematological cancers
702
What are the key imaging techniques for breast cancer?
Mammogram (x-ray) and breast ultrasound
703
Removal of all of the lymph nodes in an area makes the area at risk of _______.
Lymphedema
704
What is Tamoxifen?
A SERM - selective estrogen receptor modulators.
Great drug as it stops the activity on estrogen on breast tissue (a cause of cancer) but acts like estrogen on bone, so less chance of osteoporosis.
705
What is anastrozole?
An Aromatase inhibitor - stops the production of estrogen. Essentially creates early menopause.
706
What is colchicine?
An acute treatment for gout
707
What are the key 3 things to report when describing an ECG?
rate, rhythm, broad/narrow.
708
A broad QRS complex indicates an issue originating where?
The ventricles
709
What are the top 2 electrolytes to check in abnormal heart function?
Potassium and Magnesium
710
Aside from the joints, Ank Spon can commonly affect which two other systems?
Eyes and Lungs
711
What is the span of a normal liver?
12cm
712
Compare a lupus facial rash to a dermatomyositis facial rash.
Lupus tends to spare the naso-labial folds whereas dermatomyositis does not
713
How can scleroderma involve the mouth?
Patients often cannot fully open their mouths
714
Myocarditis secondary to coxsackie B virus is a cause of which cardiomyopathy?
Dilated
715
What is the most common type of cardiomyopathy and which social factors may contribute to its development?
Dilated cardiomyopathy. Alcohol and cocaine may cause it.
716
Sudden death/syncope in athletes may be due to which cardiomyopathy?
Hypertrophic cardiomyopathy
717
Acute pericarditis is often complicated by which pathology?
Pericardial effusion
718
_____ cardiomyopathy is often due to stiffening of the heart due to sarcoidosis, amyloidosis or post radiation fibrosis.
Restrictive
719
How can an NG tube impact acid/base balance?
Can cause metabolic alkalosis due to suctioning out acid from stomach
720
Anaesthetised patients will likely experience which acid/base imbalance?
Respiratory acidosis
721
What level of base excess is relatively severe?
5/-5 or above is severe
722
What is the treatment for MS?
Steroids and Mabs
723
List some complications of chronic steroid use:
insomnia, diabetes, weight gain, immune suppression, osteoporosis.
724
What is anti-phospholipid syndrome and what is the main complication?
Congenital autoimmune illness - MUCH greater risk of clots.
725
Neurodegenerative disorders tend to kill patients via which process?
Respiratory Depression
726
Young stroke patients should be checked for which stroke aetiologies?
Patent foramen ovale and dissected vertebral artery.
727
Severe OA, swelling and damage in a diabetic foot is most likely due to:
Charcot’s foot - diabetic neurogenic arthropathy)
728
What is the common diagnostic tool for pericardial effusion/tamponade?
ECHO
729
What is the emergency treatment for unstable tamponade?
Pericardiocentesis
730
Scarring of the SA node and bouts of tachycardia/bradycardia are symptoms of which pathology?
Sick sinus syndrome. Pacemaker but be careful.
731
List 3 broad infection groups typically responsible for reactive Arthritis?
GIT infections, STIs and parvovirus
732
Which bacteria is typically implicated in Guillian Barre?
Campylobacter
733
What are the two main common side effects of a radical prostatectomy?
Impotence and incontinence
734
Which type of therapy is best to deal with palliative bone mets?
Radiotherapy
735
Why don't prostate cancer bone mets typically raise calcium levels?
Unlike other bone mets, they are typically sclerotic not lytic
736
What are the two main markers for testicular cancer and how can these be used to monitor disease after an orchidectomy?
Beta HCG and alpha fetoprotein - should return to normal with removal of the cancer
737
How may seminomas vs non-seminomas be described on palpation?
Seminoma - slow growing, smooth.
Non-seminoma - fast growing, irregular.
738
Why can testicular cancer cause back pain?
Migration to para-aortic lymph nodes.
739
Compare heamaturia in renal cell carcinoma vs transitional cell carcinoma?
RCC bleeding is rare.
TCC bleeding VERY COMMON - macroscopic haematuria
740
Compare nephrectomy in RCC vs TCC?
RCC often only requires a partial nephrectomy due to local impact.
TCC that spreads up the ureter to the renal pelvis requires a total nephrectomy.
741
Winging of the scapula can be due to a defect in which nerve?
Long thoracic nerve
742
Which two conditions cause 'copious' amounts of sputum?
BRONCHIECTASIS (main one), and COPD
743
What is the link between bronchiectasis and infections?
Infections cause mucus secretion, poor clearance leads to mucus plugging and more infections. Vicious cycle.
744
'Frothy pink sputum' is pathognomonic of which condition (in MCQ not real life)?
Heart failure
745
List cardio, GIT and resp causes of clubbing:
Cardio - endocarditis
GIT - IBD, cirrhosis, celiac
Resp - everything except COPD
746
List 3 paraneoplastic syndromes caused by small cell lung cancer.
- PTPrp
- SIADH (produces ADH)
- ectopic ACTH
747
What is Light's Criteria?
How to determine whether a pleural effusion is transudative or exudative. LDH or protein of aspirate / serum level of over 0.6 means the aspirate is full of LDH and proteins and is therefore an exudate.
748
Surgical treatment for repeated pleural effusions?
Pleurodesis
749
What is biPAP used for?
biPAP, unlike CPAP, works on CO2 as well as oxygen. It is therefore key in treatment of type 2 respiratory failure
750
What are the 3 pillars of acute COPD exacerbation treatment?
Antibiotics, bronchodilators, steroids
751
Antibiotics for 'walking' (atypical) pneumonia?
Think of causes - LCM.
C is chlamydia.
Treat chlamydia with doxy or azithro.
752
Is a low RR in asthma a good thing?
No - low RR indicates decompensation and fatigue - they are in danger, need ICU.
753
Pulmonary hypertension can cause which type of murmur?
Tricuspid murmur
754
What would be part of a stroke workup?
ECG/Holter to check for AF
ECHO to check for clots/atrial dilation
Carotid Doppler
755
Which major circle of willis artery feeds the brainstem?
PCA
756
List 5 causes of peripheral neuropathy.
Diabetes
B12 deficiency
Alcohol
Chemo
Autoimmune
ABCDE
Autoimmune, B12, chemo, diabetes, ETOH
757
What is intussusception?
Intestine telescopes in on itself - common in kids
758
Which major circle of willis artery feeds the cerebellum?
PCA
759
How to clarify what someone means by being dizzy?
Do they mean lightheaded or do they mean the room/floor is spinning (vertigo).
760
List 3 major body systems impacted by methotrexate.
Lungs - ILD
Liver - toxicity
Bone marrow - pancytopenia
ALSO - fertility (teratogenic)
761
What is the worst side effect of poorly controlled celiac?
Lymphoma
762
What is the main electrolyte we care about in refeeding syndrome?
Phosphate (surg of ATP synthesis mops up all the phosphate)
763
How long after a stroke until someone can drive?
4 weeks after neuro deficits stop
764
List 4 causes of liver disease:
NAFLD, alcohol, haemachromotosis, hepatitis.
765
Why might ascites cause dyspnea?
Ascites physically limit chest expansion
766
Does NAFLD cause bilateral edema?
NO - only a fully cirrhotic liver will cause edema
767
What is hepato-renal syndrome and what is the prognosis?
Repeated kidney damage despite fluids due to splanchnic vasodilation. Patient will die without liver transplant.
768
Which IBD can be rectal sparing?
Crohns. UC really isn't ever rectal sparing.
769
Why does weight loss help GORD?
Reduces intra-abdominal pressure
770
Aside from cancer, which other pathology may cause solids but not liquids to be trapped in esophagus?
Osephageal stricture
771
Bruising around the umbilicus is pathognomonic for?
PANCREATITIS. Cullen's sign.
772
List 3 indicators of pancreatitis severity.
WCC raised.
Hypocalcaemia.
Hyperglycemia.
LDH increased.
773
What scan diagnoses cirrhosis?
Fibroscan
774
A raised alpha fetoprotein is indicative of which two diseases?
HCC and testicular cancer
775
Chronic pancreatitis will display which feature on X-ray?
Calcifications
776
What is the main investigation for pancreatic insufficiency?
Feacal elastase
777
A celiac patient presents with a rash, what is the likely diagnosis?
Dermatitis herpetiformis
778
List 3 causes of REALLY high AST/ALT
viral hepatitis
panadol overdose
ischemic liver
779
Antidote for panadol?
NAC - N-acetyl cysteine
780
What is DCR?
Direct Cardioreversion
781
Should steroids be used for stroke/cerebellar haemorrhage?
NO - the increased glucose from steroids will increase cerebral edema. Makes ICP worse
782
Which of the BASS Heart failure drugs cannot be given acutely? Which drug IS used acutely that is not part of BASS?
Beta blocker - decompensated heart needs the HR. Must wait till they have improved to give this (euvolemic).
Frusemide in acute setting.
783
What medication should always be given with prednisolone?
PPI due to ulcer risk
784
Compare the treatment of stable vs unstable VT.
Stable - pharmacological cardio reversion (amiodarone)
Unstable - DCR
785
Mnemonic for acute MI Tx:
MOANA
morphine
Oxygen
Aspirin
Nitrates
Anticoagulants
786
Name two main cardioversion drugs:
Amiodarone and sotalol
787
What is ‘electrical alternans’ on an ECG?
alternating amplitude of QRS pathognomonic of cardiac tamponade
788
What is pulsus paradoxus?
Drop in BP on inspiration associated with cardiac tamponade
789
What are the steps in DKA management?
1. FLUID
2. Insulin once rehydrated (risk of cerebral edema if glucose enters cells whilst patient is still dehydrated)
3. Manage potassium level
4. Address the cause
790
Is Hashimoto’s thyroiditis tender or non-tender?
Non-tender
791
Compare tonic-clonic and absence seizures.
Both are generalised seizures (occur across the entire brain) but tonic-clonic is the classic seizure and lasts around 5 minutes.
Absence seizures last up to 10 seconds and cause the patient to lose awareness, they zone out.
792
Compare an unaware focal seizure to a generalised absence seizure.
Unaware focal - often minutes long and may have stereotypical characteristics like lip smacking, picking, patting etc).
Absence seizures are very short, up to 10 seconds but present very similarly. They may not have the lip smacking etc but may have facial twitch
793
Does syncope cause convulsions?
It can! So don't assume seizure without a careful history. Temporary hypoxia to the brain in syncope can cause convulsions.
794
Which seizure type is most common in children (under 8)?
Absence
795
Which history finding is specific to epilepsy?
Tongue biting
796
What are the 2 major differentials for seizure (not including syncope which doesn't cause true seizure).
1. TIA but loss of consciousness uncommon
2. Pseudoseizure
797
What is a pseudoseizure?
Up to 40 minute long seizure that is psychogenic in origin and fluctuates in intensity for the 40 minutes.
798
What is the initial Ix for seizure and what is the best Ix?
CT head is first to ensure it's not a stroke or bleed.
Then EEG is gold standard.
MRI will show nothing in epilepsy.
799
What does an EEG show in pseudoseizure?
nothing
800
List one medication you could use to treat a seizure whilst it is happening and one long term medication to prophylactically prevent seizure.
Acute - a benzo eg. midazolam
Long term - carbamazapine
801
What is the mechanism behind breastfeeding preventing ovulation?
Breastfeeding promotes prolactin production, prolactin inhibits GnRH so LH and FSH levels are suppressed, preventing ovulation.
802
What is the 'triple test' for a breast lump?
1. History and exam
2. Imaging - ultrasound and mammogram
3. non-excisional biopsy
803
A lump in the breast in a young woman, often found during pregnancy, is likely to be what pathology?
Fibroadenoma.
They are hormonally responsive so often appear in pregnancy.
They may or may not be tender
804
A breast lump that appears over a matter of days and is very painful is likely to be which pathology?
A cyst
805
Odd discharge from the nipple is indicative of which group of breast pathologies?
Ductal pathology
806
Nipple retraction/dimpling is suspicious of which pathology?
Breast cancer (peu d'orange sign)
807
Which type of breast cancer is the most common?
Ductal adenocarcinoma of no specific type
808
What is a classic sign of breast cancer on mammogram?
Micro-calcifications
809
Which spinal column is checked by the Babinski reflex?
corticospinal tract
810
'saddle anaesthesia' is typical of which pathology?
Cauda equina
811
What is the most immediate course of action to take if you suspect urinary retnetion?
Catheter
812
List pathologies that could cause cauda equina compression in each of these layers: extradural, intradural but extramedullary, intramedullary.
extradural - abscess, bone/disc degeneration, metastatic tumour.
intradural but extramedullary - meningioma
intramedullary - glioma
813
Urinary incontinence is typical of which pathology?
Cauda equina. Though very late spinal compression will also present this way.
814
What is the most common bacteria that causes an epidural abscess?
Staph aureus
815
What is the treatment for spinal abscess?
Surgical drainage and broad spectrum antibiotics
816
A raised ICP associated with a astrocytoma should be treated with what drug?
steroids - though steroids are contraindicated in many other causes of raised ICP
817
Histology of a GBM will show which classic feature?
Pallisading necrosis
818
How do brain tumours tend to initially present?
With the raised ICP symptoms - especially headache and seizure, also drowsiness
819
New seizures in adult patients should always be treated as ______?
Brain cancer
820
Large 'swirls' on histo is typical of which pathology?
Meningioma
821
What spinal level is the umbilicus? (give both dermatome and physical level)
T10 supplies the umbilicus dermatome but the actual level is around L3-4.
822
List the 3 nerves of the hip joint
Femoral nerve, obturator nerve and superior gluteal nerve.
823
Which LFT is commonly raised in various bone pathologies?
ALP
824
What lifestyle change is KEY in hip osteoarthritis?
Weight loss
825
Compare the abdo x-ray findings of a distal vs proximal bowel obstruction.
Distal - most of the bowel will be dilated as it's all backed up.
Proximal - most of the bowel will be normal
826
What is Riggler's sign?
Two distinct gas bubbles where the gastric bubble is on X ray - one is the gastric bubble but the other is evidence of pneumoperitoneum.
827
What are the three major causes of colitis, how would you differentiate them?
The 3 I's.
Inflammation - will be in context of IBD etc or in a young patient with new IBD.
Ischemia - flexures targeted as they are watershed areas
Infection
828
What is the KEY question to ask when a patient presents with macroscopic haematuria?
Painful or painless?
Painless = TCC
painful = likely to be a stone.
829
A young person with hypertension should really be screened for?
Renal artery stenosis
830
Tx for a post-op wound infection?
Drainage and Abx
831
What are the antibiotics used for acute pyelonephritis associated with hospitalisation?
Ampicillin/Amoxicillin with gentamycin or cipro.
832
If a patient needs Piptaz but has a penicillin allergy what would you give instead?
Cipro (PA cover) and vanc
833
What is the anticoagulation duration for DVT/PE?
3 months
834
What is the main treatment goal of osteoporosis?
Reduce fracture risk
835
List, in order, the treatment options for estrogen related osteoporosis.
1. SERM eg. tamoxifen
2. Bisphosphonates
3. Denosumab
836
What is the most worrying side effect of bisphosphonates?
Osteonecrosis of the jaw
837
Why are bisphosphonates dangerous in CKD?
CKD leads to poor reabsorption of calcium leading to hypocalceamia (and secondary hyperparathyroidism), if bisphosphonates stop osteoclast activity there is a severe risk of hypocalcaeamia
838
What is secondary hyperparathyroidism?
Hypocalcemia with origins outside the parathyroid gland, typically renal disease. PTH is high in secondary hyperparathyroidism.
839
Fluffy consolidation around a joint or bone on X-ray in a young person with unilateral bone pain is likely to be?
Osteosarcoma
840
What are 3 surgical options for improving spinal canal stenosis?
Laminectomy, discectomy, vertebrectomy.
841
What are aperients?
Laxatives
842
What are hectic fevers and what pathology are they assoicated with?
Great swings in temperature - associated with abscesses
843
How will X-rays appear in infective knee pain eg. SA or OM
Totally normal until 1-2 weeks after the infection
844
What is the biggest risk of lowering glucose too fast in DKA?
Cerebral edema - low glucose in blood but maintained glucose in brain will cause water to move into the brain
845
What is the best imaging for a knee effusion?
Ultrasound
846
What colour aspirate is normal from a knee?
Translucent clear/yellow liquid
847
What is celecoxib and why would you use it?
A COX-2 selective NSAID. It has a lower risk of peptic ulcers (so good for long term) but can still cause renal damage like all NSAIDS
848
Which acute analgesia would you use for RA and which 3 medications would you use in the long term?
Acute - celecoxib
Long: methotrexate, folic acid, prednisolone.
849
List 7 side effects of methotrexate.
- hair loss
- liver toxicity
- leucopenia
- thrombocytopenia
- GI toxicity
- ILD
- pneumonitis
- NOTE - doesnt directly cause renal damage but is renally cleared so need to be careful
850
Which Mab would you start for RA if methotrexate was not enough?
A TNF Mab - infliximab or adalimumab
851
What are the 3 pillars of osteoporosis management?
Bisphosphonates, Vit D and Denosumab
852
How can steroids or NSAIDS cause pernicious anaemia?
Steroids and NSAIDS can cause gastritis if used for long enough. Gastritis will lead to poor functioning/release of intrinsic factor which will lead to a B12 deficiency and anaemia.
853
What are the 3 mainstays of acute gout treatment and what is a long term drug for gout?
Colchicine, NSAIDS and prednisolone.
Long term - allopurinol (never in acute setting as it can make it worse).
854
What does ferritin tend to do in infection/inflammation?
It goes up - body stores iron away in an effort to sequester it from potential iron-loving bacteria
855
Name the rash that can occur in celiac
dermatitis herpetiformis
856
Which infection classically causes Guillian Barre?
Campylobacter
857
Which two broad groups of infections tend to cause reactive arthritis?
GIT infections and STIs (and parvovirus)
858
What is a key modifiable factor for OA?
WEIGHT. Especially for knee OA.
859
What are the 4 key features of Giant cell Arteritis?
- scalp tenderness
- jaw pain
- new onset headache
- visual change
860
A patient with Giant Cell Arteritis with proximal shoulder/neck pain is likely to also have which 'sister' pathology?
Polymyalgia rheumatica
861
What is the key acute treatment for GCA?
Steroids
862
Gold standard for GCA diagnosis?
Temporal artery biopsy
863
Red aspirate from a joint indicates what? What about cloudy yellow/white aspirate?
Red - haemoarthrosis (trauma)
Cloudy - infection
864
Which set of symptoms is classic for GPA - granulomatosis with polyangitis?
Saddle nose/epistaxis
865
Dermatophytic fungal infections predispose to which bacterial infections?
Cellulitis
866
Burns patients risk which major pathogen?
Pseudomonas aurigenosa
867
What is the typical gas gangrene/nec fasc organism?
Strep Pyogenes
868
Compare spinal involvement in RA vs OA.
RA spinal involvement is rare.
OA spinal involvement very common
869
Are all RA sufferers sero-positive?
No, around 50% of RA patients are both anti-CCP and rheumatoid factor negative.
870
What is a worrying side effect of hydroxychloroquine as a DMARD?
Eye toxicity
871
What do the O and [ / ] symbols mean on an audiogram?
O = air conduction
[ / ] = bone conduction (straight like bones)
872
Which organisms tend to cause otitis externa and what is the Tx of choice?
Pseudmonas is the main one and Staph aureus.
Ciprofloxacin drops +/- steroids are a good first line
873
Why is it imperative to do a cranial nerve exam on otitis externa patients?
MALIGNANT OTITIS EXTERNA
- where otitis externa spreads to skull base and starts impacting cranial nerves
874
A neonate who has had a cold and been holding his ear whilst crying non-stop suddenly stops crying and is quite well aside from occasionally rubbing his ear and having ear discharge on his pillow. What is the diagnosis?
Otitis media with relief due to perforation.
875
Which group of organisms tend to cause otitis media?
Resp/pharyngeal organisms
876
Compare the pain caused by wiggling a patients ear in otitis externa vs media.
Externa - wiggling will cause pain
media - no pain
877
What is the typical antibiotic for otitis media?
Amoxicillin/augmentin
878
What is the only antibiotic eardrop appropriate for a perforation?
Ciprofloxacin - the rest are ototoxic
879
What is glue ear and what is the treatment?
An otitis media infection with effusion - pressure buildup.
Treatment is GROMMETS.
880
What is a cholesteatoma?
In the context of perforation, the outer ear's squamous epithelium may grow into the middle ear causing PAINLESS OTORRHEA. Can burrow into brain so must be treated
881
What is the treatment for cholesteatoma?
Tympanoplasty +/- mastoidectomy
882
Unilateral ear pain with normal otoscopy is _______ until proven otherwise.
Head/neck cancer.
Due to involvement of cranial nerves which pass near ear.
883
How can otitis media cause facial palsy?
CN7 the facial nerve travels through the ear (think chordae tympani)
884
Ear pain with crusty lesions in ear canal and facial palsy is very suspicious for ____.
VZV (Ramsey Hunt if it impacts the facial nerve)
885
What is the treatment for Ramsey Hunt?
- steroids
- valcyclovir
- TAPE EYE SHUT !!!! - risk corneal damage if it cannot blink
886
Which gland does the facial nerve pierce?
Parotid
887
Vertigo for around a minute with no hearing involvement is typical of ____?
BPPV
888
What is the treatment for BPPV?
Epley maneouvre
889
Vertigo following illness is suspicious of?
Vestibular neuritis
890
Episodes of vertigo lasting hours with nausea and vomiting and tinnitus is typical of _______.
Meniere's disease
891
If you suspected Meniere's, which other diagnosis would you want to rule out and how would you do it?
Rule out acoustic neuroma. MRI.
892
If a growth moves on swallowing it is most likely related to which organ?
Thyroid
893
Compare leukoplakia and erythroplakia. What are they and what do they indicate in terms of future progression?
Leukoplakia - 'white plaques' - in mouth. pre-malignant for squamous cell carcinoma.
Erythroplakia - red plaques in mouth. MUCH worse. 50% chance of squamous cell progression.
894
Compare tonsillitis to peritonsilar abscess (quinsy).
Tonsillitis usually bilateral. Abx.
Quinsy one-sided and usually pushes tonsil forward or back. Can cause airway obstruction, very dangerous.
895
How could you differentiate EBV from tonsillitis?
EBV is more systemic with widespread lymphadenopathy as well as hepatosplenomegaly.
896
What is Ludwig's angina and what typically causes it?
Dental abscess (typically due to dental work) that may push airway shut - can't be sedated or go to imaging. Need tracheostomy.
897
24/7 hoarse voice even without prior strain is suspicious for?
Laryngeal cancer (SqCC)
898
Progressive dysphagia is suspicious for?
cancer
899
Key acute medications for upper airway obstruction?
Dexamethasone (ENTs Vitamin D) and adrenaline
900
What type of epithelia is in the upper resp tract?
Until the lungs, all of the upper resp tract (nose included) is pesudo-stratified columnar epithelium.
Remember the resp system is the opposite to the GIT where upper GIT is all squamous until columnar stomach. Inverse is resp.
901
Persistent and chronic middle ear effusions despite antibiotics are ____ until proven otherwise.
Nasal tumours
902
Name 3 signs of a skull base fracture.
- racoon eyes
- CSF leak from nose or ear
- blood behind eardrum
- subconjunctival haemorrhage
903
What is a septal hematoma?
Collection of blood (due to trauma) in the nasal mucosa. Can cut off blood supply to nose causing cartilage necrosis so must be drained in ED.
904
What is rhinitis medicamentosa?
Overuse of anti-mucus sprays leading to addiction/resistance.
905
List 3 causes of peripheral vertigo and 3 causes of central vertigo.
Peripheral: BPPV, labyrinthitis, Meniere's, vestibular neuritis.
Central: vestibular migraine, stroke, MS.
Acoustic neuroma is more of a central one too.
906
What is the Dix Hallpike maneouvre?
A technique used to elicit rotational nystagmus in BPPV
907
RAPD can be caused by which two broad conditions?
Optic nerve pathology (eg. MS lesion) or ischemic retina.
908
What is the name of the colour blind test?
Ishihara test
909
An absent red reflex on fundoscopy of children is suspicious for?
Retinoblastoma
910
What is the easiest clinical way to detect refractory error (need for glasses)
Use of pinhole
911
What are cataracts and how do you treat them?
Lens opacity.
Take the lens out and put a new one in.
912
What is glaucoma and what are the two broad types?
Glaucoma = raised intra-occular pressure.
Primary open angle glaucoma
OR
acute closed angle glaucoma (emergency)
913
What is the key descriptor on history of primary open angle glaucoma?
Slow loss of peripheral vision.
914
What is the key descriptor of acute closed angle glaucoma on history?
Sudden visual loss often with 'rainbows' in eyes.
915
What are the two types of diabetic retinopathy and how do they appear on fundoscopy?
Non-proliferative - micro aneurysms (little red dots) and exudate (small cotton wool spots).
Proliferative - looks FUCKED. Like how you'd expect a tumour of the eye to look (though it's not a tumour. New vessels forming all over the place in haphazard nets, hence 'proliferative'
916
Name the key history finding and key fundoscopy finding of macular degeneration.
history - loss of central vision
fundoscopy - huge pale spot over macula like a cloud, can be full of dense cotton wool spots
917
Which medication treats macular degeneration?
Endothelial growth factor inhibitor
918
What are the 3 key signs of cranial nerve 3 pathology?
1. ptosis
2. 'down and out'
3. blown pupil
919
What is the most common cause of cranial nerve 3 palsy?
Aneurysm
920
What two descriptors of history/inspection indicate cranial nerve 4 pathology?
- trouble walking down stairs
- head tilt
921
What is the most common cause of cranial nerve 4 palsy?
Trauma
922
What is a macular 'cherry red spot' indicative of?
Retinal artery occlusion - must check carotids
923
If fundoscopy looks out of focus/blocked off/curtained - that is suspicous for _____.
Retinal detachment
924
Sudden blindness after partying = ?
Methanol
925
Which eye pathology may be the cause of visual loss in a person who wears contacts?
Microbial keratitis
926
Why might a beta-blocker be prescribed for ascites or varices?
Non-cardiac selective beta blockers are useful in HF/Liver failure to reduce fluid buildup (in this case reducing portal hypertension)
927
What is the key initial medication for a gastric bleed?
PPI
928
What is octreotide and what is it used for in terms of gastro pathologies?
A somatostatin analogue used for osephageal varices
929
What is the first medication to give in hyperkalemia?
Calcium
930
What demographic of patient commonly experience cardiac tamponade?
Post cardiac surgery patients
931
What is a Urine ETG?
test for ethanol metabolism - checks if someone has been drinking
932
Mnemonic for Child Pugh score?
ABCDE
Albumin, bilirubin, coagulopathy, distension and encephalopathy.
Remember by first 3 being measurable and latter 2 being clinical.
933
What are CPE?
Carbapenamase producing enterobacteriacae.
934
Why is urea important in a gastric bleed?
Digested blood from upper GI bleed is metabolised into urea. Will be high if bleeding into gut
935
List 3 common manifestations of autonomic dysfunction:
1. Erectile dysfunction
2. Postural BP drop
3. gastroparesis
936
How does pancreatic insufficiency affect bowel movements?
DIARRHEA !!!!!
Textbook steatorrhea is good for exams but rarely happens in real life
937
Pancreatic back pain is usually described as ____.
Sharp
938
Do you empirically treat a suspected H.pylori infection?
No, you may as well wait for serology to come back before you give antibiotics in case you give the patient C.diff.
939
How would you know if someone was 'fluid responsive'?
HR drop with IV fluid
940
Which drug forces an asthma attack during respiratory function tests?
Mannitol
941
What are DLCO and lung volume tests?
DLCO helps seperate obstructive causes of respiratory pathology (eg. separates emphysema from asthma).
Lung volumes is useful in restrictive lung disease.
942
What causes a Mallory-Weiss tear?
Increased abdo pressure - often due to vomiting.
943
What is the key electrolyte in re-feeding syndome?
Phosphate
944
What are the 3 steps for any upper GI bleed management?
1. PPI (IV)
2. Metaclopramide (empty gut)
3. Gastroscopy
945
What are the 3 intervention options for a gastric ulcer on gastroscopy?
1. Adrenaline injection
2. Burn it
3. Cut it
946
List 1 conservative and 1 surgical management for osephageal varices.
- octreotide
- banding on gastroscopy
947
What are the 2 key pathologies to monitor long term in liver failure?
Varices and HCC
948
What are the 2 key treatments for hepatic encephalopathy and how do they work?
Lactulose - laxative that forces ammonia in gut out through stool rather than being absorbed
Rifaximin - antibiotic for ammonia producing gut bacteria
949
Where are the different types of beta receptors located?
B1 - heart and kidneys
B2 - lungs
950
Name 2 non-cardiac selective beta blockers.
PCI (mnemonic)
Propanolol, Carvidelol Isn't
(Isn't cardiac selective
951
How long is DAPT continued after an MI?
1 year on aspirin and second agent, then just aspirin forever
952
Best diagnostic tool for myocarditis?
MRI
953
What are the Heart Failure chest X-ray findings?
ABCDE
Alveolar edema
B-lines
Cardiomegaly
dilated pulmonary vessels
Effusions (pleural)
954
What is TVD?
Triple vessel disease
955
Fun way to remember axis?
If 1 and avF are making a diamond together = eg. 1 is up and avF is down, then that is left because you wear a diamond on your left hand
956
What is adjuvant chemo for?
Chemo after surgical removal to mop up any micro-mets
957
What is the timeframe for febrile neutropenia post-chemo?
Around 7-10 days - the lifespan of a neutrophil.
958
What are 3 clinical signs of aortic regurg?
1. collapsing pulse in the carotids
2. widened pulse pressure
3. S3 sound due to volume buildup
959
What is a PPM?
Permanent pacemaker
960
Which examination might be done in suspected Wernicke's encephalopathy (aside from a GIT exam)
Cranial nerves - as often eye nerves are impacted.
961
Name 4 causes of normocytic normochromic anemia.
- haemolysis
- acute bleed
- anemia of chronic disease
- renal disease with low EPO
962
A slow rising pulse in the carotids is indicative of with pathology?
Aortic stenosis
963
What are the 2 broad causes of pernicious anemia?
- poor intrinsic factor function/release in stomach
OR
- poor B12 absorption in ileum
964
What is typically the first sign of anemia?
tachycardia
965
What are the long term Heart Failure drugs?
BASS
Beta Blocker (not acutely)
ACEi/ARB
SGLT2 inhibitor
Spironolactone
(add frusemide acutely)
966
Aortic stenosis in young people is suspicious for which congenital issue?
Bicuspid aortic valve
967
How will you know if you have diuresed too much?
Creatinine will rise
968
What is the criteria for ST elevation on an ECG?
1mm in all leads except anterior leads which are 2/2.5 mm (women, men)
969
Scleroderma can cause which suite of complications?
CREST(OR)
Calcinosis
Reynauds
Esophageal dysmotility
Sclerodactyly
Telangiectasia
(Oxygen - ILD)
(R - renal damage)
970
leukonychia is a sign of?
Low albumin
971
What is an 'escape beat'?
Backup conduction (eg. Purkinje's) causing ventricular contraction
972
What are the 3 ECG findings of a STEMI?
- ST elevation
- reciprocal T wave inversion
- Q waves
973
Which IV medication lowers ICP?
Mannitol
974
What is type 3C diabetes and how is it managed?
Pancreatic insufficiency - managed the same as Type 1
975
How does diabetes insipidus impact urine?
Lack of ADH function leads to less water being re-absorbed. So urine is high in volume and very dilute.
976
How does diabetes insipidus impact serum sodium?
Water is being peed out so blood is concentrated - get a hypernatremia.
977
Treatment for neurogenic diabetes insipidus?
Exogenous ADH - desmopressin
978
What is the concern in regards to non-functioning pituitary macroadenomas?
Mass effect.
Non-functioning means they are not hormonally active.
979
What is the main complication of pituitary surgery that endocrinologists manage?
Diabetes insipidus
980
Name 3 long-acting insulins.
Optisulin, levemir, toujeo
981
If ketones are high (above 2) which would be the easiest next investigation to order?
ABG to check blood pH
982
What is the Type 2 equivalent of DKA and which is more dangerous?
HHS Hyperosmolar Hyperglycemic state - more dangerous than DKA as it is slow to resolve and usually occurs in already co-morbid patients
983
Which tests are most useful in diabetes inspidius?
Urines. More useful than bloods.
984
Very thirsty + peeing lots - should ring alarm bells for what condition?
Diabetes
985
What is the most common side effect of metformin and what is the major contraindication?
Side effect - GI upset - diarrhea
contraindication - renal damage (eGFR under 30 especially)
986
Pancreatitis is a contraindication for which diabetic drugs?
Anything that works on the incretin system: DPP4 inhibitors and GLP1 analogues
987
What are the main 2 concerns regarding sulphonylureas?
- hypoglycemic episodes
- weight gain
988
What is an insulin sliding scale?
Essentially just PRN rapid insulin on top of basal-bolus insulin to keep sugars under control
989
Compare aortic stenosis and aortic sclerosis on examination (3).
Stenosis radiates to the carotids whereas sclerosis doesn't.
Stenosis lowers BP but sclerosis does not.
Stenosis causes a slow rising pulse, sclerosis does not.
990
Which types of heart block require a PPM?
symptomatic mobitz 2 and third degree heart block
991
Best investigation for endocarditis?
ECHO (blood cultures good too - 3 sets).
992
How does pancreatitis impact white blood cells and how does this reflect disease progression?
Acute pancreatitis causes a leukocytosis, especially a neutrophilia.
These neutrophils are involved in pre-mature activation of trypsinogen, causing the pancreas to essentially digest itself in acute pancreatitis.
993
How does prolactin impact periods?
Prolactin causes oligomennorhea or amenorrhea. Oligomenorrhea is common with functional pituitary macroadenomas that produce prolcatin (prolactinomas).
Prolactin inhibits GnRH thus stopping LH and FSH production thus inhibiting ovulation.
This makes sense in context - prolactin promotes lactation and lactation indicates to the body that someone is still nursing a child with reduced ability to grow a new one.
994
How does glucose impact growth hormone and how can this principle be used to diagnose a key endocrine pathology?
Glucose inhibits release of Growth Hormone. As such, an oral glucose tolerance test can be used to diagnose acromegaly as growth hormone levels will not reduce.
995
Which medication MUST be given following neurosurgical correction of Cushing's disease?
Must give steroids - typically dexamethasone, because native ACTH producers have been asleep for so long due to adenoma that they need time to wake up and steroids will stop patient from entering iatrogenic Addison's.
Can take 3-18 months.
996
When should you cease a patient's basal insulin?
Never (at least not without endo input). Kept even for surgery.
997
Why is IV insulin given with dextrose.
Insulin is a limitless drug and if given straight into the blood it can easily turn hyperglycemic blood into a hypo - so glucose (dextrose) is given to offset that risk.
998
Does slow resp rate following an asthma attack mean the asthma has resolved?
No, it can mean the patient is fatigued and decompensating. ICU admission is needed at this time.
999
How may blood pH change over the course of a severe asthma attack?
Initially alkalotic as hyperventilation will cause CO2 to reduce rapidly.
As the patient decompensates the CO2 will build up leading to acidosis.
1000
A body rash is _____ until proven otherwise.
Anaphylaxis
1001
Which two medications 'drive' K+ into cells.
INSULIN (key one) and salbutamol - hence why salbutamol may cause hypokalemia.
1002
Why is infection a common precipitant of DKA?
Infection raises cortisol levels in the body leading to greater gluconeogenesis.
1003
What is the main diagnostic tool for myeloma?
Bone Marrow Biopsy (and blood film to an extent).
1004
What is the number 1 oncological emergency? What is the treatment?
Febrile neutropenia, 7-10 days after chemo.
Do blood cultures then antibiotics (piptaz) within 30 minutes over fever onset.
1005
Back pain that is not responsive to opioids is suspicious for?
Spinal compression, especially if history of cancer as boney mets are common.
1006
What is the first immediate treatment given for suspected spinal compression?
Steroids
1007
What is the treatment for cardiac tamponade that is cause haemodynamic instability?
Pericardiocentesis
1008
SVC obstruction can occur due to which type of cancer and what are the symptoms?
Any thoracic/ENT cancer but typically lung cancer.
FACIAL swelling is a key feature, also get dyspnea etc.
1009
Treatment for SVC obstruction?
Stent it
1010
A right sided, ventricularly paced heart is likely to show which ECG abnormality?
Left Bundle Branch Block - electricity is coming in from right heart, makes the ECG thing the left sided conduction is just way shitter than the right, looks like LBBB.
1011
What are Heberden's nodes?
Osteophytes of the hands typical of osteoarthritis
1012
What is the process that causes oesophagitis?
Acid reflux
1013
Which pulmonary edema medication is contraindicated if the patient is hypotensive?
Nitrates
1014
What is factitious hypothyroidism?
Use of thyroxine when not prescribed
1015
What is Terlipressin used for?
to stop bleeding osephageal varies
1016
Compare morning stiffness in inflammatory vs mechanical joint pain.
Can occur in both but tends to be brief in osteoarthritis but takes hours of movement to disappear in inflammatory conditions and pain will return on rest.
1017
Is swelling more typical of an inflammatory or mechanical joint pathology?
Inflammatory
1018
Compare the efficacy of paracetamol in inflammatory vs mechanical joint pain.
Paracetamol is shit in inflammatory, works well in mechanical.
1019
Name four potential macroscopic changes to the hands in Rheumatoid arthritis?
- Rheumatoid nodules (if seropositive)
- Swan neck deformity
- Ulnar deviation
- boutenniere deformity
1020
Name 4 pathologies that accompany rheumatoid arthritis in non-joint related systems and 1 pathology that often accompanies rheumatoid arthritis in the hands.
- scleritis (red eye)
- ILD/pulm fibrosis
- pleural effusion
- pericardial effusion
hands: reynauds
1021
Which broad rheum category does psoriatic arthritis fit into? Which other diseases are in this categroy?
Spondyloarthropathies.
Includes AnkSpon, Reactive arthritis and enteropathic arthritis.
1022
Aside from the joint pain and the skin changes, which feature is common and unique in psoriatic arthritis patients?
Impacts on nails - nail pitting and onycholysis
1023
What is the most sensitive antibody for lupus and what is the most specific antibody for lupus?
Sensitive - ANA: 98% will have it positive
Specific: dsDNA
1024
What is the genotype associated with ankspon?
HLAB27
1025
How might lupus impact an FBE?
expect anemia due to anemia of chronic disease, NSAID use (bleed) or methotrexate usage
1026
What is the mnemonic for remembering the impacts of reactive arthritis?
Can't see, can't pee, can't climb a tree.
See - conjunctivitis
Pee - urethritis
Tree - arthritis
1027
What demographic of patients experience enteropathic artheritis?
IBD patients
1028
Does joint pain + fever always mean septic arthritis?
In an exam yes, in real life, no. Gout can cause fever.
1029
What is the key clinical test for ank spon?
Schober's test
1030
Does a low serum uric acid exclude gout?
No, uric acid may just be being used up in gout area. High uric acid in serum is pretty specific for gout though.
1031
The back pain in ank spon is often in the _______ area.
Sacro-iliac
1032
Does a clear X-ray rule out a pelvic fracture?
no, they are often missed
1033
What is the best imaging for a suspected epidural abscess?
MRI
1034
What is indomethacin?
NSAID
1035
What are the best first imaging requests for a suspected bowel obstruction?
Erect and supine abdo films
1036
Why may someone with ascites experience tachypnea and hypernatremia?
Fluid is trapped in the portal system, so relatively hypovolemic systemically. Requires greater cardiac output and causes more concentrated sodium
1037
How does hepatic encephalopathy impact sleep?
It can reverse the sleep cycle
1038
What does an air bronchogram show?
Consolidation
1039
Broadly, what are the treatment paths for a stable arrhythmia vs an unstable arrhythmia?
stable - can do medical management, if reversion is required try amiodarone and sotalol.
unstable - need DCR - shock the arrhythmia
1040
A broad QRS indicates a problem originating in the ______.
Ventricles
1041
How does magnesium help the heart?
stabilises cardiac membranes
1042
A young person entering ventricular tachycardia is very suspicious for?
Wolff-Parkinson white
1043
What is the treatment for Wolff-Parkinson White?
ablation
1044
List 3 medications for overloaded AF?
The two classic AF drugs: rate control (BB) and anticoagulation (DOAC) + a diuretic for the fluid
1045
What type of ECHO is used to check for cardiac clots in AF?
TOE
1046
A post-op arrhythmia is typically due to ______.
Electrolyte derangement
1047
Any bradyarrhythmia on ECG should be checked for _______.
inferior ischemia
1048
What are the aggressive treatment strategies for bradyarrhythmias and tachyarrhythmias?
brady - PPM
tachy - shock
1049
Which IV drug could you give for a bradyarrhythmia?
atropine
1050
Why does reciprocal inversion happen in ischemia?
due to blockage of coronary artery, the other arteries will try and provide collateral flow to the hypoxic areas and in doing so will themselves become hypoxic leading to a sort of angina in their area hence the ST depression
1051
Which medication is a common cause of myositis?
statin
1052
ANCA is a test for which group of pathologies?
Vasculitis not including large vessel. Mostly used for small vessel vasculitis.
1053
Snuffbox pain is typical of which pathology?
scaphoid fracture
1054
Thenar wasting is typical of which pathology?
Carpal tunnel
1055
How do most systemic autoimmune diseases damage the kidneys?
Immune complexes damage the glomerulus causing nephritis.
1056
What are the big 4 ANA positive diseases?
SLE
Scleroderma
Sjrogen's
Myositis
1057
What is the typical myositis joint distribution?
typically proximal joints are affected rather than distal joints. So they have trouble getting up but are good once they're up
1058
What is the gold standard diagnostic tool for myositis?
muscle biopsy
1059
How does ankspon impact the lungs?
stiffness in axial skeleton restricts expansion alongside autoimmune ILD
1060
What is fecal calprotectin used for?
Marker of inflammation in the gut
1061
What is the classic Atrial fibrillation rate control drug?
Metoprolol
1062
What are the four key features of a diabetes PVD assessment?
- pulses
- ulcers
- cap refill
- hair growth
1063
What is the target for rituximab?
CD20 on B cells
1064
myositis + eyelid rash is suspicious for?
dermatomyositis
1065
mouth ulcers are associated with which autoimmune disease?
lupus
1066
List the 3 major causes of rapidly progressing glomerulonephritis.
SLE, Anti-GBM and GPA
1067
What is the main difference between TB granulomas and granulomas from granulomatosis with polyangitis?
TB is caseating, GPA is non-caseating
1068
Which spinal level controls the knee reflex?
L4 - L4 kick the door
1069
Which spinal level controls the achilles reflex?
S1+S2 buckle your shoe
1070
What is CPPD?
Pseudogout. Post-op knee pain is almost 100% of the time pseudogout
1071
Why might prostate cancer raise ALP?
Boney mets - prostate cancer loves bone
1072
A huge PSA is indicative of which pathology?
prostate cancer.
BPH/prostatitis will raise PSH but only modestly
1073
Compare the fracture risk from prostate cancer boney mets vs myeloma boney mets.
lower fracture risk in prostate boney mets as the lesions are sclerotic rather than lytic in myeloma
1074
STEMI criteria on ECG?
- 1mm ST elevation in all leads except anteriorseptal leads which are 2mm
- new LBBB
1075
Mnemonic for broad treatment of STEMI or NSTEMI
BOATMAN
(think you have a heart attack and go to meet the boatman Charon)
Beta Blockera (within 24 hrs if not contraindicated)
Oxygen
Aspirin
Trigelcor/clopidigrel
Morphine
Anticoagulation
Nitrates
1076
What is pulsus paradoxus?
Drop in BP on inhalation typical of cardiac tamponade
1077
Aspects of fluid overload management?
- fluid restriction
- daily weights
- fluid balance chart
- diuretics
- UEC to monitor diuretic use
- address cause
1078
Repeated pleural effusions or non-resolving pleural effusions may require which surgical intervention?
Decortication (VATS)
1079
Bactrim in cancer patients is typically prescribed as prophylaxis for which condition?
PJP
1080
What are the 3 findings on ECG for STEMI/NSTEMI?
- ST elevation/depression
- Q waves
- T wave inversion
1081
COPD findings on CXR?
- hyperinflated
- flattened diaphragm
1082
Sharp or shooting pain in the face should be highly suspicious for?
trigeminal neuralgia
1083
What is pulmonary-renal syndrome and which two conditions often present this way?
Pulmonary haemorrhage + glomerulonephritis
Findings of haemoptysis/epistaxis alongside signs of renal damage (swelling, itch, nausea etc) though haematuria may be occult.
Typically Anti-GBM or GPA
1084
If a type 1 diabetic was having a hypo episode and they were unconscious with no IV access, what might be a suitable first intervention?
Glucagon injection
1085
Glomerulonephritis in pulmonary-renal syndromes may often cause which gross change to the urine?
Nothing, urine may look totally normal despite microscopic haematuria. Would need urinalysis to be sure.
1086
Compare the RBCs from glomerulonephritis versus bladder/urothelial sources.
Bleeding through the glomerulus knocks RBCs out of shape so they are dismorphic. Urothelial RBCs are just regular RBCs
1087
What is anti-phospholipid syndrome and what is the classic exam description?
A female with signs of lupus that is presenting with a PE or DVT that has had miscarriages in the past.
1088
'Vibrating tools' are a very med school exam cause of which two conditions?
Reynauds and carpal tunnel
1089
Bisphosphonates should be avoided in patients who experience which common condition?
Reflux/dysphagia as bisphosphonates cause osephagitis
1090
Compare calcitriol to colecalciferol.
Calcitriol is already activated form, usually given CKD patients.
Colecaliferol is the inactive form.
1091
Does renal damage contraindicate bisphosphonates?
yes, they are eGFR dependant
1092
What are the 3 arms of myeloma diagnosis?
- blood smear
- protein electrophoresis
- bone marrow biopsy
1093
What are the 3 tests looking for Cushing's syndrome?
- saliva cortisol (midnight)
- 24 hr urine cortisol
- dexmeth suppression test
1094
Use of denosumab may cause which effect in CKD patients? (excluding osteonecrosis and atypical fractures).
hypocalcemia
1095
Why might longstanding RA impact anaesthetics?
Long standing RA may erode C1/C2 - impairing things like head tilt.
1096
Pain in the knee that does not show any pathology on examination may be referred pain from the ___.
hip
1097
What are the 4 key signs of base of skull fracture?
- racoon eyes
- csf leak
- haemotympanum
- battle's sign (mastoid bruising)
1098
Thoracic back pain is a red flag for?
Aortic Dissection - thoracic (between the scapula) back pain is really uncommon aside from this.
1099
Which ECG conduction change is common in PEs?
new RBBB
1100
Patella dislocation is a common cause of _______ on aspiration.
haemarthrosis
1101
Which IBD is more likely to cause bleeding?
UC but both can
1102
Acute anal bleeding, diarhhea and pain in the abdomen should be a red flag for _______. ___ is a common risk factor.
Acute mesenteric ischemia
AF
1103
What are the 3 main extraintestinal manifestations of IBD?
- eyes - uveitis
- skin - pyoderma
- joints - enteropathic arthritis
1104
Which 3 substances may be poorly absorbed in Crohns due to damage of the terminal ileum?
- ADEK vitamins
- b12
- bile salts
1105
The poor bile salt reabsorption in Crohns may lead to what other pathology?
gallstones due to imbalance
1106
Peri-anal fistulas are pathognemonic for?
crohns
1107
Which IBD raises the cancer risk more?
both do but especially UC
1108
What is a phase reactant ? Name two positive ones and one negative.
body substances that alter in periods of inflammation or infection.
positive - platelets and ferritin
negative - albumin
1109
What is primary sclerosing cholangitis?
damage to the biliary system due to IBD that causes a cholestatic picture. bili ALP and GGT all up.
1110
Is a colonoscopy still done in an IBD patient currently experiencing a bleeding flare?
no, perforation risk. Do flexible sigmoidoscopy instead
1111
What are the ‘big ticket’ items when it comes to side effects of steroid use?
immune suppression
Osteoporosis
hyperglycaemia
1112
What can pancreatitis do to the lungs?
ARDS
1113
Broad steps in removal of a pancreatic gallstone?
Ultrasound and then ERCP
1114
How could you tell the difference between a mechanical vs non-mechanical bowel obstruction on x-Ray?
Lack of transition point in non-mechanical
1115
‘Mid-dilated irregular pupil’ is a phrase that indicates which pathology?
Closed angle glaucoma
1116
A cherry red spot on fundoscopy indicates what pathology?
Central retinal artery occlusion
1117
Watching TV in a dark room with sudden painful change in vision in one eye is a classic scenario for which condition?
Closed Angle glaucoma
1118
How bad is the pain in retinal detachment?
Painless. - often asked in exams
1119
‘Cell and flare’ is a phrase that indicates which eye pathology?
Anterior uveitis
1120
A FOOSH is more likely to cause ____ in young patients and _____ in old patients.
Young: scaphoid fracture
Old: Colles fracture
1121
Tachycardia, dryness, confusion, facial flush and visual changes are all components of which drug related syndrome?
Anti-cholinergic syndrome
1122
Which are two major differentials for loss of consciousness aside from syncope/TLOC?
Seizure
Brain injury - bleed, stroke etc
1123
Absence of a prodrome, loss of consciousness when supine and short duration are features of which type of syncope?
Cardiogenic
1124
What is the typical cutoff value for high blood pressure?
140/90
1125
What is the best investigation for renal artery stenosis?
Renal Artery Doppler
1126
What is often the first urinalysis evidence of renal damage?
Proteinuria (ever before change in eGFR)
1127
What is the blood test used to check for anaphylaxis?
Tryptan
1128
What are the ABCs of shock resus?
A - airway - airway support
B - breathing - supplemental O2 or mechanical ventilation
C - cardiovascular - need 2 large bore IV cannulae, give IV crystalloid bolus (has come up on exam before)
TREAT CAUSE
+/- ICU inotropes
1129
90% of chronic cough is due to which 3 conditions?
COPD, asthma and post-nasal drip
1130
What is the key investigation for ILD?
High Resolution CT
1131
Is wheeze or stridor more dangerous?
Stridor - requires intervention, often an emergency.
1132
Which 3 clinical features may indicate an infective exacerbation of COPD?
More sputum, change in sputum colour, fever.
1133
What are the 4 broad causes of peripheral edema?
Increased capillary permeability
Decreased oncotic pressure
Increased hydrostatic pressure
Lymphatic obstruction
1134
What are the 2 causes of non-pitting edema?
Lymphatic obstruction OR myxedema (hypothyroidism)
1135
A pulsatile liver is classicaly causes by which murmur?
tricuspid regurg
1136
What is the relationship between AST and ALT in the following:
1. Chronic Liver disease except alcoholic
2. Alcoholic liver disease
3. Cirrhosis
1. Chronic liver disease ALT>AST (think of damaged liver cells releasing ALT).
2. Alcoholic (AST - A Shot Thanks)
AST>ALT
3. Cirrhosis - liver cells now dead, can't properly make ALT but AST made in other places.
AST>ALT
1137
List 4 ultrasound findings that may be found in a cirrhotic liver.
- nodular liver
- dilated portal vein
- retrograde flow through portal vein
- patent umbilical vein (ligamentum teres)
1138
Bronze skin is typical of which condition?
Haemachromatosis
1139
4 ways to treat ascites?
DRAT
Diuretic
Restriction - fluid and salt
Antibiotics for SBP
Tap if needed
1140
Which coagulation factor is not made in the liver?
8
1141
A 'slow growing' and 'smooth' testicular lump is typical of which testicular neoplasm?
Seminoma
1142
Winging of the scapula is often a pathology of which nerve?
Long thoracic nerve
1143
Pulmonary hypertension can cause which type of murmur?
Tricuspid murmur
1144
What are some signs of cerebellar dysfunction?
DANISH
Disdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
1145
Rectal sparing is typical of which type of IBD?
Crohns
1146
How does hiatus hernia impact reflux?
Worsens/causes reflux
1147
How do you manage a totally occluded carotid?
Not much you can do except protect the other patent carotid.
Thrombolysis and endarterectomy both not done in total occlusion.
1148
Why is a PPI used in long term steroid use?
Steroids cause ulcers
1149
What is domperidone?
Antiemetic and prokinetic with a similar MOA to metaclopramide.
1150
3x histo findings for coeliac?
villous atrophy, lymphocytic infiltration, goblet cell hyperplasia
1151
Which BSL level is considered a hypo for a diabetic?
Under 4.0
1152
Do all septic patients have fever?
no. Cold sepsis.
1153
What are the 2 main seeding mechanisms for endocarditis?
IVDU or tooth infection
1154
Kernig's sign and Brudzinski's sign are both signs of?
meningitis
1155
Which antibiotics are used 'above' the diaphragm and 'below' the diaphragm for anaerobes?
Penicillins above the diaphragm
Metronidazole below the diaphragm
1156
What is the mainstay of treatment for cholangitis?
ERCP
1157
Best imaging technique to visualise infective endocarditis?
TOE , but maybe a TTE initially
1158
2 most common causes of CKD?
Hypertension and Diabetes
1159
What are the two criteria (only one must be met) for an AKI?
Creatinine rise of over 1.5x baseline over 2 days
Urine output less than 0.5kl per kg per hr for 6 hrs
1160
Steps in post-renal AKI management?
- try to catheter
- CTKUB
- Urology referral
1161
Which drug is most closely related to nephrogenic diabetes inspidius?
Lithium
1162
What is the relative serum sodium concentration in diabetes inspidius?
HIGH (ADH not functioning, not resorbing water, pee it all out, sodium in blood concentrates
1163
Does use of synthetic ADH (desmopressin) help in central or nephrogenic diabetes insipidus?
Helps in central - replaces shit ADH made/not made by pituitary.
Useless in nephrogenic as problem is with kidney, not ADH.
1164
How would you seperate diabetes insipidus from a psychogenic cause of polydypsia?
Water Deprivation test - what does it do to urine.
If urine returns to normal = psychogenic.
1165
What are the type 1 diabetes antibodies?
Anti-GAD and anti-islet cell
1166
What is the biggest risk of SIADH?
hyponatremia
1167
splenomegaly in the absence of hepatomegaly is suspicious for?
infection eg. EBV or haem malignancy
1168
thick and thin blood smear is a test for which disease?
malaria
1169
What are the four broad causes of anemia?
1. Non-production (aregenerative)
2. destruction (haemolysis)
3. Loss (bleeding)
4. Sequestration
1170
A-regenerative anemia is broadly due to one of which two factors?
Bone Marrow issue (broken factory)
OR
iron/b12/folate deficiency - no building blocks
1170
If you clinically suspect blood loss but there is no evidence of bleeding, where should you check?
occult bowel bleed
1171
What is one test that could immediately tell you if an anemia was productive or non-productive?
Reticulocytes
1172
'beefy red tongue' is often associated with _____ deficiency.
B12, but also iron or folate deficiency.
1173
petechiae are evidence of ______.
thrombocytopneia
1174
List four investigations that would be ordered in establishing the cause of a severe anemia.
FBE --> Iron studies --> blood smear ---> bone marrow biopsy
1175
We usually transfuse blood in stable patients at a Hb from __ to __.
70-80
1176
What is a significant level of unintentional weight loss?
more than 10% of body mass over 6 months
1177
What are B symptoms?
Weight loss, fever, night sweats
1178
How does refeeding syndrome work?
With already low electrolyte levels, the reintroduction of insulin into the system (following eating) forces potassium (and phosphate) into cells, resulting in dangerously low levels of ions in the serum
1179
If gel electrophoresis shows a largely monoclonal population, what should be your primary differential?
B cell cancer
1180
What is SPEP/UPEP in the context of myeloma diagnosis?
Serum + urine protein electrophoresis
1181
Is bone marrow transplant used in myeloma?
yes. Autologous transplant is done often to relieve symptoms but is NOT curative.
An allograft is the only way to cure the disease but is not safe for majority of patients.
1182
What is the key factor that decides if a patient with a fall is likely to have an intra-cranial haemorrhage?
use of anti-coagulants
1183
Why is extreme tachycardia a risk (eg. from AF or SVT) (3 key reasons)
- heart not well perfused (less time in diastole
- heart not pumping properly - fluid buildup
- stasis of blood - clot risk
1184
Why can people get pins and needles in hands/feet during hyperventilation?
Low CO2, leads to reduced pH, H+ swaps with K+, relative serum hypokalemia gives pins and needles
1185
Compare the LOSS and LESS mnemonics for OA/RA
LOSS
L - loss of joint space
O - osteophytes
S - subchondral sclerosis
S - subchondral cysts
LESS
L - loss of joint space
E - erosions
S - soft tissue swelling
S - soft bones (osteopenia)
1186
Why are allopurinol and azathioprine not used together? What is the exception?
risk of bone marrow suppression (the allopurinol makes the DMARD work too well)
Exception is Crohns.
1187
Where is the back pain of an aortic dissection classicly located?
Thoracic - inbetween scapula
1188
In a med school exam, tachycardia while asleep = ______.
Sinus arrythmia
1189
'tinkling bowel sounds' is med school lingo for which condition?
small bowel obstruction
1190
The iliac crests align with which vertebral level?
L4
1191
Interventional treatment for haemachromatosis?
venesection (literally bleed them)
1192
Why does an NSTEMI cause subendocardial damage?
Think of it like a watershed of the heart. Flow is still present in an NSTEMI it is just reduced, so there is enough flow to supply the areas closest to the artery. The thinner, farther away areas closer to the endocardium are hit the hardest - so they are damaged.
As opposed to a STEMI where all areas are damaged.
1193
Explain the Ankle Brachial Index.
Reduced BP in feet compared to systemically due to atherosclerosis of peripheral vessels in PVD
1194
Explain your 10 leaf tree for dysphagia.
Dysphagia - split into oropharynx and oesophagus.
Oropharynx causes: x4
- stroke
- Parkinson's
- Zenkers
- cancer
Oesophagus split into motility or blockage.
Blockage: x3
- cancer
- stricture
-oesophagitis
Motility: x3
- achalasia
- scleroderma
- oesophagael spasm
1195
Why do a CT scan for myasthenia?
To check for thymoma - a common cause of myasthenia
1196
What is the meaning of 'coryzal' symptoms?
URTI symptoms
1197
Best imaging for suspected aortic dissection?
CT aortogram. (MRI is actually best but may take ages)
1198
Should you give aspirin immediately in a suspected stroke?
no, may be haemorrhagic
1199
What is the thrombolysis window for a stroke?
4.5 hrs
1200
Restless less syndrome is associated with which deficiency?
Iron
1201
What are the 5 P's of ischemic limb?
- pallor
- pulseless
- painful
- polar (cold)
- parasthesia
1202
Range of temp for 'low-grade fever'?
37.5-37.9
1203
Which disease is a major contraindication to testosterone replacement therapy?
prostate cancer
1204
Why does supplemental testosterone reduce sperm count?
testosterone negative feedback onto LH/FSH levels - responsible for sperm production
1205
Neuropathic arthropathy is also known as __________?
Charcot's foot
1206
If an ulcer can be probed to the bone this is equivalent to a diagnosis of _______.
osteomyelitis
1207
What is pseudohyponatremia in diabetes?
conc. of sodium looks low due to glucose sucking out the water from cells and diluting the blood.
1208
What is the cornerstone of T2DM management?
weight loss
1209
which key hormone varies in level when comparing primary Addisons to secondary Addisons?
Aldosterone.
Primary Addisons = adrenals shit. Low in both cortisol and aldosterone production.
Secondary Addisons = pituitary shit. Only low in cortisol, aldosterone fine because it's tropic hormone is ANG2, not ACTH.
1210
A renin:aldosterone ratio is a key test in which cause of hypertension?
Conn's syndrome (hyperaldosteronism)
1211
Describe the impact on 'cup' size in glaucoma.
On fundoscopy, the regular cup and optic disc will turn into a large, swollen optic disc with large cup (inner circle), lines may be blurred.
1212
If CN3, 4 and 6 are all impacted as well as facial sensation, where is the damage likely to be?
Cavernous sinus - where CN 3, 4, 5 and 6 run through.
1213
What is the ulnar nerve paradox?
The closer the damage of the ulnar nerve is to the wrist, the worse the claw hand.
'closer to the paw, the worse the claw'
1214
Absence seizures classicly affect which demographic?
Kids/teenagers
1215
What is the main provoking factor for seizure?
sleep deprivation
1216
Compare macula sparing vs non-sparing homonimous hemianopias.
Macula sparing = occipital lobe issue. Alternate vascular supply to area that integrates information from macula, so unharmed during stroke to occipital lobe.
Non-macula sparing = optic tract lesion. Complete homonimous hemianopia
1217
A stroke that causes an inability to write, count and tell left from right, as well as homonimous hemianopia is likely to be in which area?
Dominant parietal lobe
1218
How long should a post-stroke patient be on anti-platelets?
DAPT - for 3 weeks.
Then aspirin for life.
1219
What are the two main neuromuscular diseases and how could you tell them apart from other neurological conditions like stroke?
myasthenia and MND.
These two have NO sensory findings.
1220
Wolff Parkinson White in combo with AF is a situation wherein which drug class is absolutely contraindicated?
Anything that works on the AV node (Adenosine, Verapamil) due to risk of 1:1 conduction pathway. Eventual V fib.
1221
What is a typical side effect of amlodipine that you might see on cardiovascular examination?
peripheral edema
1222
A new LBBB is equivalent to a ____ until proven otherwise.
STEMI
1223
What is the timeframe to thrombolyse an NSTEMI.
WE NEVER THROMBOLYSE AN NSTEMI
1224
A young person with hypertension and hypokalemia is suspicious for?
Conn's syndrome
1225
Why is SAH more common in people with polycystic kidney disease?
It is a connective tissue disease, so aneurysms are more likely.
1226
Which aspect of iron studies is most important?
Ferritin
1227
Anemic men is highly suspicious of ______.
GIT bleed
1228
If a neutrophil has more than 2-3 lobes it is described as ______. What causes this?
megaloblastic.
Caused by B12/folate deficiency.
1229
What is the most common cause of megaloblastic anaemia?
Pernicious anaemia (autoimmune)
1230
What is the best marker for haemolysis? What are some other markers?
best: LDH
others: haptoglobin, Hb, reticulocytes, unconjugated bilirubin
1231
What is haptoglobin?
molecule made in liver to mop up free Hb, as free Hb is toxic to kidney. Low haptoglobin = high free Hb (or liver disease).
1232
Primary polycythemia is due to which mutation?
JAK2 mutation
1233
How does secondary polycythemia differ from primary on FBE?
Secondary only raises Hb, primary raises Hb, WCC and platelets.
1234
What is the most common cause of secondary polycythemia?
hypoxia --> mass EPO release
1235
If Hb, WCC and platelets are all high. What are the two main possible culprits?
polycythemia
OR
Bone marrow cancer
1236
Mnemonic for CML?
Please Carry My Leukeamia KIT.
Philadelphia
C
M
L
Kinase
Imatinib
Tyrosine
1237
Mnemonic for APML?
LISP ARMADA (L15P Armada)
L (the L of APML)
IS = 15 (chromosome)
P
A
Retinoic acid
M
Arsenic
D- DIC
A - Auer Rods
1238
Lump in neck + pain drinking alcohol is med school code for which disease?
Hodgkins Lymphoma
1239
How are heparin and clexane measured?
heparin via APTT
clexane via factor Xa levels
1240
What is von Willebrand's factor?
Joins factor 8 to platelets to allow clot formation on platelet plug
1241
Which conditions often cause anterior uveitis?
IBD, reactive arthritis and ank spon (so really just link to spondyloarthropathies)
1242
what is the acute treatment for anterior uveitis?
Steroid drops
dilatory eye drops - either with a catecholmine or an anti-muscarinic, often atropine.
1243
What important finding may you find on cranial nerve exam for someone with optic neuritis?
RAPD
1244
What are the 3 C’s of Addison’s Treatment?
cortisone (hydrocortisone)
crystalloid (rehydrate)
carbs (glucose)
1245
Why does testosterone replacement therapy reduce fertility?
Testosterone negative feedback on LH/FSH - less sperm maturation.
1246
A nuclear thyroid scan is best reserved for _____.
Thyrotoxicosis (hyperthyroidism)
1247
which 3 conditions raise ALT over AST?
viral hepatitis, acute liver ischaemia and panadol overdose
1248
A left homonimous hemianopia could be due to a ___ sided occipital lobe stroke
Right
1249
A lesion in the temporal lobe may impact the ____ aspect of the optic tract, causing a ____ quadrantanopia.
Conversely, a lesion of the parietal lobe may impact the ____ aspect of the optic tract, causing a _____ quadrantanopia.
Temporal - outer - superior quadrantanopia
Parietal - inner - inferior quadrantanopia
THINK of it like this - the more lateral optic radiation relates to the most lateral lobe (the temporal lobe)
1250
Treatment for retinal detachment?
Emergency surgery
1251
Orbital fractures tend to fracture the ____ wall or the ____floor. These respectively carry risks of bleeding into the ____ and ____ sinuses.
Medial wall - ethmoid sinus
Orbital floor - maxillary sinus
1252
Eye ‘floaters’ and ‘flashes’ are often a type of prodrome for which eye emergency?
Retinal detachment
1253
Optic disc cupping is a key feature of which condition?
Glaucoma - increase in optic cup size
1254
What is the acute management for asthma (mnemonic)?
POSS
Pred
oxygen
SABA
SAMA (ipratropium)
1255
What is a common long-term treatment strategy for asthma?
Symbicort (steroid + laba), oral fluticasone and PRN Saba
1256
What is the suffix for anti-muscarinics?
-tropium
1257
Short term treatment for COPD exacerbation?
(SOAP)
SABA
OXYGEN
ANTIBIOTICS
PRED
1258
Which antibiotics are used in an infective exacerbation of COPD?
BenPen IV and oral doxy
1259
2 common side effects of anti-muscarinics?
dry mouth and constipation
1260
What triple drug therapy is available for long term COPD treatment?
LABA/LAMA/steroid combo.
1261
Tiotropium is what kind of medication?
LAMA
1262
Mnemonic for long term management of COPD?
(Steroids) = mnemonic
SABA
transplant
endobronchial valve
rehab - pulmonary
oxygen
immunisations
drugs (triple LAMA/LABA/steroids combo)
smoking cessation
1263
What would be 3 clinical indicators that an infective exacerbation of COPD was occuring?
- more SOB
- more sputum
- discoloured sputum
1264
What is empyema?
Infection in a cavity, often the pleura
1265
What is the relative protein level of transudate vs exudate?
Transudate is low in protein compared to exudate/serum, it is also low in LDH.
Light's criteria
1266
large unilateral pleural effusions tend to be due to either ____ or______.
cancer or infections
1267
Where does an ICC insert to drain pleural fluid?
5th intercostal space in the mid-axillary line
1268
What does it mean if an ICC does not 'swing'?
ICC's should swing, that is the fluid should move up and down the drain on respiration/cough. If it doesn't it is either in the wrong place or it is blocked.
1269
If you drained a pleural empyema and found reduced glucose and a reduced pH, what would you suspect?
anaerobic bacteria eating glucose and making lactic acid.
1270
Pleural calcium plaques are often due to _____ exposure.
asbestos
1271
Immunotoxicity due to immunotherapy is treated with ______.
steroids
1272
Following a full neuro exam, what 3 things should be done for a patient with suspected spinal cord compression?
MRI, analgesia, steroids
1273
What are the definitive options for oncological spinal cord compression?
surgical decompression + radiation
1274
What is the time period for antibiotics for febrile neutropenia?
within 30 minutes
1275
Why might myeloma make someone delirious?
Bone mets leading to hypercalcemia, psychic moans
1276
Which medication could you consider in someone with hypercalcemia secondary to myeloma?
bisphosphonates
1277
Why might tumour lysis syndrome cause death?
cells lysing releases potassium, can cause hyperkalemia
1278
Which cancers tend to cause SVC obstruction?
lung and lymphoma
1279
Compare lung cancers on histo
glandular - adenocarcinoma
pink - squamous cell
purple - small cell
1280
Name one genetic cause of COPD
alpha-1 anti trypsin disease
1281
Why may INR be low in cholestasis?
Cholestasis means bile cannot enter the GIT, so fat soluble vitamins, including vitamin K may not be absorbed.
1282
List the 3 major causes of cirrhosis, 3 genetic causes and 3 autoimmune causes.
big 3: hep B, Hep c, alcohol (honorable mention to NASH)
genetic: wilsons, haemachromatosis and alpha 1 anti-trypsin
Autoimmune: autoimmune hepatitis, PSC, PBC
1283
What are the 2 key follow ups for cirrhosis long term?
HCC - ultrasound
Varices - gastroscopy
1284
Tx for haemachromatosis?
Venesection
1285
AST>ALT typically suggests _____.
cirrhosis - think of ALT being the most liver specific enzyme, if liver is dead, the other areas of the body can still make AST (this isn't how it actually is just a good way to think of it).
1286
HCC can occur in cirrhosis of any cause, but only appears in the absence of cirrhosis due to _______.
HBV
1287
Mnemonic for signs of liver decompensation?
CRAYON
C - coagulopathy
R - renal
A - ascites
Y - yellow
O - osephageal varices
N - nuts - encephalopathy - is actually sign of total hepatic failure
1288
What are the 3 extra-intestinal manifestations of IBD?
Skin (pyoderma)
Joints (enteropathic arthritis)
eyes - uveitis
1289
Ascites with a low protein count is likely due to ______.
Portal HTN (transudate)
1290
What is the main risk in ascites?
spontaneous bacterial periotonitis
1291
5 key things found on ultrasound for cirrhosis?
- nodular liver
- large spleen
- dilated portal vein
- reversal of flow in portal vein
- patent umbilical vein due to recannulisation of ligamentum teres
1292
Why are NSAIDS and ACEi contraindicated in ascites?
ascites inherently risks kidneys due to hepatorenal syndrome, so will get double/triple whammy if use those medications
1293
What test could reveal ACTIVE HCV?
PCR, a serum will only tell you if it has been in the body before, not if it is there right now
1294
Macular degeneration tends to show which key finding on fundoscopy, and which aspect of vision tend to be impacted the most?
Drusen - giant yellow cloud over macula
CENTRAL VISION - because it is the macula that is damaged
1295
Treatment for proliferative vs non-proliferative diabetic retinopathy?
proliferative - anti-VEGF
non-proliferative - BSL control
1296
Cherry red spot is typical of which eye pathology?
central retinal artery occlusion
1297
What are the 2 criteria for CKD (must meet one).
- eGFR below 60 for 2 years
- proteinuria or haeamaturia for 3 months
1298
Mnemonic for complications of CKD?
Bone COMA
- Bone - renal osteodystrophy
- Cardiovascular disease
- oedema
- metabolic acidosis
- Anemia
1299
2 types of dialysis and where you might use each?
peritoneal - at home
haemodialysis - in hopsital via fistula
1300
Why do NSAIDS carry a risk of AKI?
they inhibit vasodilation of the afferent arteriole due to inhibiting prostaglandins
1301
List a cause of post-renal AKI in men, women and both (1 each).
Men - BPH/prostate cancer
Women - pelvic cancer
Both - stones
1302
Why might bisphosphonates cause AKI?
They can cause acute tubular necrosis (just like gentamycin)
1303
What are the two criteria for AKI? (one must be met)
Urine output of less than 0.5ml/kg/hr for 6 hrs
1.5x creatinine rise for 7 days
1304
Mnemonic for acute treatment of hyperkalemia?
DISC
Dextrose + Insulin
Salbutamol
Calcium Gluconate
1305
Long term Tx for hyperkalemia?
Risonium
1306
How could you monitor progression of AKI?
URINE - need catheter
1307
A unique feature of CKD on histo is ________.
Thyroidisation.
Wherein the slide looks like thyroid follicles
1308
Which respiratory conditions are worse during sleep?
All of them.
1309
What are the diagnostic criteria for OSA?
More than 5 apnea episodes per hour during sleep (severe is over 30) as per the Epworth Sleep scale.
1310
Narcolepsy is a deficiency in the neurotransmitter ______ and can be treated with _______.
Orexin
Modafinil
1311
Nuchal rigidity is the medical term for ______?
neck stiffness
1312
An acoustic neuroma may present with which 3 findings on cranial nerve exam?
facial nerve palsy
tinnitus
ipsilateral sensorineural loss
1313
Why are lumbar punctures contraindicated in cranial masses?
Cranial masses typically cause raised ICP, so there is a risk of herniation
1314
What are the 3 golden features of migraine (if 2/3 are present, 90% chance it is a migraine).
- nausea
- photophobia
- disability
1315
What is the main differential for a migraine and how could you seperate these on history?
TIA,TIA comes on suddenly, migraine builds over around 5 minutes
1316
What are medication overuse headaches?
headaches due to frequent headache treatment, especially opiods. Causes increase in pain receptors
1317
ED treatment of migraine?
fluid and largactil (chlormazapine)
1318
Papilledema + 6th nerve palsy without any findings on imaging but a high opening pressure on LP is likely to be?
Idiopathic intracranial hypertension
1319
Which condition has a sentinel bleed and how does this present?
SAH - often have a similar but less severe headache a few days or weeks prior to the real main SAH.
1320
why might an SAH patient have photophobia and neck stiffness?
Meningism due to blood pushing on the meninges
1321
Why might a SAH patient have a blown pupil?
aneurysm impacting CN3
1322
If CT is clear but you're clinically convinced it is a SAH, what is your next step?
LP for xanthochromia
1323
how would you look for a cranial aneurysm?
Cerebral angiogram
1324
Post-SAH BP aim?
110-140 systolic, high enough to perfuse but low enough to not cause further rupture
1325
Definitive Tx of SAH?
surgery (clip aneurysm) or endovascular coiling (more common)
1326
Mnemonic for tx for raised ICP?
Surgeons Loosen my brain
Surgery
Lift head
mannitol - diurese
Breath - hyperventilation will reduced CO2 leading to vasoconstriction of the brain vessels
1327
what are the two common neuro causes of foot drop and how could you seperate them on exam?
- L5 radiculopathy
- fibular nerve issue
seperate via foot inversion. THIS MAKES SENSE. the fibular nerve splits into two, in this case the foot drop is an issue with the deep fibular nerve which does foot dorsiflexion, it has nothing to do with inversion. Inversion is done by the tibial nerve, so absence of inversion must be a higher issue that is affecting multiple nerves - L5 radiculopathy.
1328
Broadly, proximal muscle weakness is more indicative of _____ whereas distal muscle weakness is more indicative of ______.
proximal - myopathy
distal - neuropathy
1329
A pathology in the anterior horn of the spine typically present with?
fasiculations
1330
Brisk reflexes + muscle atrophy is alarm bells for which condition?
mixed UMN + LMN = MND.
1331
Muscle weakness with either ptosis or diplopia is a classic presentation of?
myasthenia gravis
1332
What is the pathophysiology of myasthenia?
autoimmune - antibodies target Ach receptor on post-synaptic muscle terminal. Clog up the receptors.
1333
What blood test might reveal myasthenia?
autoantibodies: anti-Ach receptor and anti-MUSK
1334
Aside from bloods, what tests should be done for suspected myasthenia?
CT to check for thymoma
nerve conduction studies (EMG)
1335
List 4 classic findings for a patient with myotonic dystrophy.
- unable to relax muscles (eg. can't release clenched fist)
- frontal baldness
- ptosis
- facial/neck muscle wasting
1336
Muscle weakness with no sensory change indicates what kind of issue, and how would you further split this issue into potential categories?
weakness without sensory change = neuromuscular pathology.
is it in the spine - MND
is it between the nerve and muscle - myasthenia
is it in the muscle - muscular dystrophy, myositis, statin myalgia
1337
Which feature could easily seperate MND from myasthenia?
MND never involves the eyes
1338
What is the best way to diagnose Parkinson's?
Give a levodopa challenge and see if they improve
1339
Parikinson's tends to be slow, more unilateral and responds well to dopamine. If a Parkinson-like presentation was fast, symmetrical or non-responsive to dopamine, what else could you consider.
Parkinson plus syndromes:
- vascular parkinsons (stroke affecting substantia nigra)
- Lewy Body dementia
1340
list 8 non-motor features of Parkinsons
- anxiety/depression
- sleeping disorder - kick in sleep
- erectile dysfunction
- loss of smell (anosmia)
- orthostatic hypotension
- urinary issues
- constipation
1341
Cogwheel rigidity and shuffling gait are typical of:
Parkinson's
1342
Treatment for Parkinson's?
Levodopa with peripheral dopamine converter like Carbidopa or Benseraside
1343
What is Rotigotine?
dopamine patch, useful when ain drug has to be ceased for reasons like surgery
1344
What is important to tell patients regarding dopamine treatment?
it treats the motor symptoms but not the mental symptoms and it does not stop disease progression, it may wear off
1345
What is a key non-pharmacological treatment for Parkinson's?
rehab with physio, helps to prevent pneumonia and pressure sores
1346
what allied health may be involved for a Parkinson's patient?
physio for rehab
OT for aids, sleep hygiene
SPEECH PATH - for speaking and swallowing - KEY
psych - for mood
1347
Plaques in the spine in MS are medcially called:
transverse myelitis (demyelination)
1348
Which 3 investigations are key for MS?
- MRI spine
- MRI brain
- LP for oligoclonal bands
1349
monoclonals may reactivate which dangerous virus?
JCV
1350
How is Lambert-Eaton different to myasthenia and what is its typical cause
Lambert Eaton can be overcome with increased movement as opposed to the fatiguable weakness in myasthenia. Lambert Eaton tends to be paraneoplastic.
1351
Name 3 Grave's specific findings for hyperthyroidism.
- exopthalmos
- pre-tibial myxedema
- thyroid acropachy (clubbing)
1352
1/3 of eyebrows missing is a classic feature of:
hypothyroidism
1353
All connective tissue diseases are capable of causing which 3 conditions?
Reynauds, ILD, arthritis
1354
What are the time limits for definitive ischemic stroke treatment.
within 4.5 hrs - thrombolysis
within 24 hrs - clot retrieval
1355
what are the 3 broad causes of ischemic stroke that need investigation following a stroke.
cardioembolic - ECG, ECHO, Halter
carotid - doppler
watershed - hypotension
1356
what are the 2 major risks factors that need to be kept in mind immediately following an ischemic stroke?
- haemorrhagic transformation
- aspiration pneumonia
- bonus points - reinfarct
1357
Which antibiotic may cause a prolonged QT interval?
macrolides
1358
Why must tetracyclines be taken sitting up?
osephagitis risk
1359
Which two antibiotic classes are used for anaerobes? (think of the diaphragm)
penicillins above the diaphragm
metranidazole below
1360
Which common analgesia agent can cause serotonin syndrome?
tramadol
1361
azathioprine may cause _____ and _______.
pancreatitis and pancytopenia
1362
How is clexane monitored?
anti factor 10a levels
1363
Why does clopidogrel cause 'less' bleeding than aspirin?
still an anti-platelet but does not carry the risk of peptic ulcer due to its MOA.
1364
what is indomethacin?
NSAID
1365
Why are COX-2 inhibitors sometimes preferred for long term NSAID use?
less risk of ulcer, but still carries renal risk and cvd risk
1366
why does sepsis cause death?
persistent hypotension causes systemic hypoxia
1367
What are the 4 SIRS criteria?
all the t words and wcc.
Tachycardia
Tachypnea
Temperature
WCC raised
1368
Timeline for antibiotics in sepsis?
within an hour
1369
Ampicillin is great for targeting which group of bacteria?
enterococcus
1370
After how long do post-surgical infections tend to arise?
about a week
1371
What is shingles and does it need antibiotics?
RE-ACTIVATION of latent VZV (they must have been exposed before), it may need Abx if there is a secondary infection
1372
List 3 encapsulated bacteria.
the 3 that cause meningitis; Hib, N.menin, strep pneumoniae
1373
How often should IV cannulas be replaced?
every 2-3 days
1374
Compare bacterial causes of vomiting with no diarrhea, watery diarrhea and bloody diarrhea.
vomiting alone - Staph aurues and bacillus ceres food poisoning
watery diarrhea - vibrio (the water bug gives watery diarrhea), ETEC, giardia
bloody - shigella, EHEC, campylobacter, salmonella
1375
What is the magic CD4 count for AIDS defining illnesses to start appearing?
200
1376
Aspergillus is famously associated with which group of patients?
lung transplant
1377
Negative pressure room respiratory isolation is used for which disease?
TB
1378
Why does lactate go up in DKA?
hypovolemia due to polyuria leads to hypoperfusion
1379
Ideally, when should BSLs be checked at home?
before meals and before bed
1380
4 pillars of DKA management?
1. rehydrate - 1L of 0.9% NaCl via a large bore IV over 30 mins.
2. slow K, monitor every 3 hrs
3. actrapid insulin, (if insulin given IV should be accompanied with dextrose)
4. find precipitant - AMI, infection or stress
1381
2 actions of metformin?
- reduces liver gluconeogenesis
- increases peripheral insulin sensitivity
1382
Which diabetic medications should be avoided if a patient has pancreatitis?
DPP4 and GLP1
1383
When should SGLT2s be stopped and restarted RE surgery?
stopped 3 days before, restarted when the patient has returned to normal eating and drinking
1384
If 3 hyperglycemic diabetic drugs fail to control HbA1c what is the next step?
insulin
1385
equation to quickly calculate a person's osmolality?
2xNa + glucose
1386
What is the treatment for HHS and what is the BSL aim?
aggressive rehydration,
aim BSL 15-20 over first 24hrs
1387
Steps in hypoglycemia management?
- oral quick carbs if conscious (eg. juice or jelly beans)
- if not awake, IV 50% dextrose via cubital vein OR glucagon IM
- long acting carbs - eg. sandwich or long dextrose infusion
- recheck every 30 mins
- find cause
1388
Which hormone suppresses prolcatin?
dopamine
1389
If the pituitary stalk is compressed, which pituitary product is the first to rise?
prolactin. Due to no dopamine being able to make it through stalk, so it cannot inhibit prolactin.
1390
Which pituitary hormone may cause galactorrhea?
galactorrhea = lactation.
done by prolactin
1391
Is there a definitive medical management for prolactinomas?
yes, dopamine agonists will reduce size of prolactinomas. eg. cabergoline
1392
Which two hormones control GH levels?
GHRH - positive
somatostatin - negative
1393
How is acromegaly diagnosed?
oral glucose tolerance test as glucose SHOULD inhibit GH.
1394
Which surgery can be done on pituitary masses? eg. for acromegaly
transphenoidal hypohysectomy
1395
Which 3 tests can be used to diagnose Cushing's syndrome and which common blood test would you monitor regularly?
- midnight salivary cortisol
- 24 hr urine cortisol
- dexamethasone suppression test
monitor UEC for hypokalemia due to mineralocorticoid action of cortisol
1396
Compare the level of aldosterone and cortisol in primary vs secondary adrenal insufficiency.
primary - shit cortisol and aldosterone
secondary (pituitary) - just shit cortisol
1397
How does primary adrenal insufficiency impact potassium levels?
causes hyperkalemia due to absence of aldosterone
1398
Best test to diagnose primary adrenal insufficiency?
synacthen test - synthetic ACTH given and see what it does to cortisol
1399
What is the acute treatment of an Addison's crisis?
CCC, crystalloid, carbs, cortisone.
- rehydrate, give glucose, and give replacement hydrocortisone
1400
What medications should Addison's patients be on long term?
hydrocortisone and fludrocortisone
1401
Best test for Conn's syndrome?
aldosterone:renin ratio
1402
1 medical and 1 surgical treatment of Conn's syndrome?
medical - spironolactone
surgical - remove the adrenal gland
1403
Which 3 areas should you check if suspect MEN syndrome?
pheochromocytoma in adrenals, parathyroid hyperplasia and thyroid tumour.
1404
Masses in which 2 organs should never be biopsied, but rather taken out as a whole?
testicle and adrenal gland
1405
what is the medical treatment for pheochromocytoma until surgery can be performed?
alpha blockers
1406
A patient with every fucking endocrine mishap is likely to have?
polyglandular autoimmune syndrome (PAS)
1407
At what point should you do a nuclear scan for hypothyroidism?
never, unecessary unless lump
1408
What is thyrotoxicosis?
hyperthyroidism
1409
List 3 causes of thyrotoxicosis.
- Graves
- toxic nodular goitre
- too much iodine - eg. contrast or naturopathic medicine
1410
Which other organ will be the same colour as a normal thyroid on nuclear scan?
salivary glands
1411
compare causes of homogenous vs heterogenous darkening of thyroid on nuclear scan
homogenous - Graves - increased uptake across the entire thyroid
heterogenous - nodule
1412
List 3 long term treatment options for hyperthyroidism.
1. medical management with carbimazole
2. iodine radioactive ablation
3. surgical removal - only for malignancy or cosmetic
1413
How long will it take to see change in TSH following treatment for thyroid?
at least 6 weeks, no point in checking sooner
1414
When is thyroid ultrasound appropriate?
only if there is a lump/goitre
1415
Thyroid cancer masses are often _____, _____, and _____.
solitary, 'cold' and solid.
1416
is a hypoechoic thyroid nodule worrisome?
yes, no echo on ultrasound means it is solid, could be cancer.
1417
What are the 3 big risks in a thyroidectomy/hemithyroidectomy.
1. parathyroid damage
2. recurrent laryngeal damage
3. ENT bleeding
for the top 2, hemithyroid is ideal.
1418
If thyroid cancer is present and has inflammed lymph nodes, what is the next step.
NEEDS a total thyroidectomy with radio ablation afterwards, a hemithyroid is not acceptable.
1419
Which molecule can be measured after a total thyroidectomy + ablation to see if all of the cancer is gone?
thyroglobulin. Can't use this in hemithyroid because you'll still have half a thyroid to make thyroglobulin.
1420
What is subacute thyroiditis and what is a giveaway that an exam wants you to consider this?
subacute thyroiditis = deranged TFTs following illness, typically URTI. Resolves in 6 weeks.
exam giveaway - they will give CRP/ESR
1421
What imaging should be used for a retro-sternal thyroid mass?
ultrasound won't work because it won't penetrate the bone, need to do CT.
1422
Does radioactive iodine treatment of a hot nodule cause ablation?
no, will localise to the nodule. Rest of the thyroid is functionally asleep so won't take up iodine.
1423
What is the one key feature that defines all forms of androgen deficiency?
low testosterone
1424
Compare LH/FSH in primary vs secondary androgen deficiency.
primary - LH/FSH high
secondary - low
1425
What is Klinefelter's and is it primary or secondary?
primary androgen deficiency due to XXY chromosome pattern
1426
Why is testosterone replacement dangerous in terms of clots? Which blood value would you monitor?
like estrogen, it is prothrombotic. Due to stimulating EPO, leads to mild polycythemia increasing blood viscosity.
Monitor haematocrit
1427
What is the classic med school contraindication for testosterone replacement therapy?
Can you think of any others?
PROSTATE CANCER
others: desire to have a child, OSA.
1428
Why does testosterone replacement therapy reduce fertility?
negative feedback on LH/FSH axis, FSH needed for Sertoli cells to nurture sperm
1429
JAK2 mutation is linked to which disease?
primary polycythemia
1430
What is malignant otitis externa?
a complication of otitis externa in immunocompromised patients that leads to a base of skull osteomyelitis
1431
What is 'glue ear' and how would you treat it?
OME - otitis media with effusions
- grommets
- steroids
- abx
1432
vestibular neuritis typically causes which type of nystagmus?
rotational
1433
What are the 4 major causes of anaemia?
non-production
loss
destruction
sequestration
1434
How could you further split up non-productive anaemia?
- lack of haemotinic factors
- bone marrow pathology
- low EPO
1435
How can hypothyroidism impact MCV?
MCV raised - hypothyroidism can cause a macrocytic, non-megaloblastic anaemia
1436
A blood film with too many WBC in a med school exam is probably _______.
leukemia, especially CML
1437
What is hydroxocobalamin?
B12
1438
One pharmacological and non-pharmacological treatment for B12 deficiency?
- dietician referral
- hydroxocobalamin IM
1439
Anaemia with jaundice should raise alarm bells for?
haemolysis
1440
Mnemonic for 5 key causes of haemolysis?
Good God Man Save Her
Gilbert's - not technically haemolysis but similar
G6PD deficiency
Malaria
Sickle cell
Hypersplenism eg. EBV
1441
3 key Ix to check for presence of haemolysis? + 2 Ix to check for the cause of haemolysis.
- LDH
- haptoglobin
- unconjugated bilirubin
check: Coomb's test and blood film
1442
What is a spherocyte?
a dysmorphic type of red blood cell that indicates hereditary/autoimmune haemolysis. Looks like a perfect red circle with no white in middle like a RBC should have.
1443
Which food to avoid if you have G6PD deficiency?
legumes (beans)
1444
Explain HCT and RDW.
HCT - concentration of cells in the blood, will go down in anaemia.
RDW - how different the cells are in shape. The higher the RDW the more variation in RBC size - not good.
1445
Iron deficiency has which classic finding on blood film?
pencil cells
1446
Name the next best test for each of these in the context of aneamia:
- low mcv
- normal mcv
- high mcv
low mcv - ferritin
normal mcv - reticulocytes
high mcv - b12/folate
1447
What is the ferritin level in anaemia of chronic disease?
high (unlike true iron deficiency, as body is sequestering iron due to perceived threat)
1448
What do iron studies show in thalassemia?
fuck all, totally normal
1449
Name 4 major causes of iron deficiency.
- poor intake - diet
- bleeding
- malabsorption eg. coeliac
- sequestration eg. anaemia of chronic disease
1450
A middle aged man with anaemia should promptly receive which two tests?
colonoscopy and faecal occult blood test
1451
what is the antidote of dabigatran?
idarucizumab
1452
Why is desmopressin (DDAVP) used in bleeding disorders?
it increases the amount of factor 8 and von willebrands in the blood so increases clotting.
1453
DOACs are contraindicated in damage of which key organ?
kidney disease
1454
What would you give to reverse aspirin/clopidogrel?
no direct antidote, would need to do a platelet transfusion
1455
Explain the 3 types of von Willebrand disease.
type 1 - partial vwf deficiency
type 2 - normal vwf level but is is deficient in some way
type 3 - total vwf deficiency
1456
Tx for von Willebrands?
- replace vWF
- desmopressin
1457
What will APTT and INR look like for von Willebrand and haemophilia?
both have normal INR but raised APTT (as factor 8/9 are part of APTT intrinsic pathway)
1458
Which factors are affected in Haemophilia A and B?
A - 8
B - 9
1459
compare the inheritance pattern of haemophilia and von willebrands.
haemophilia - X linked - think alexi romanov
von willebrands - autosomal
1460
What are the key treatments for haemophilia A vs B?
A - give factor 8
B - give prothrombin (contains 2, 9 and 10).
1461
petechiae tend to be due to ________.
thrombocytopenia
1462
Immune thrombocytopenia can be cause by one infectious agent, one group of autoimmune diseases and one lifestyle choice. List them.
EBV
ANA diseases
overintake of quinine
1463
Quinine taken for lupus may cause ______.
bleeding due to thrombocytopenia
1464
What is the KEY component to give someone in DIC?
You need to replace all of their coags but ESPECIALLY FIBRINOGEN. Give crypoprecipitate.
1465
In Australia, fibrinogen is given as part of which drug?
cryoprecipitate
1466
Rigors typically indicate ______.
bacteraemia
1467
Is an isolated vomiting episode with a fever always indicative of a GIT infection?
No. Any infection can cause a vomit due to stress on the brainstem, this is especially true if there is no diarrhoea.
1468
Staph aureus in the urine should always be treated as _______ and therefore you should always check for ______.
bacteraemia
endocarditis
1469
Which imaging technique is commonly used to investigate a PUO?
PET scan
1470
Compare a meningitis headache to a SAH headache.
SAH faster onset, meningitis may be the worst headache they've ever had but it may take hours to reach that point.
1471
What would be easy way to check for raised ICP?
papilledema
1472
2 main causes of viral meningitis?
enterococcus and HSV2
1473
What is vanc for in meningitis?
beta lactam resistant strep pneumoniae
1474
Do hospital workers needed post-exposure prophylaxis for meningitis?
no. Only for close contacts, especially people the patient lives with. Only for Hib or N.meningitidis, not strep.
1475
What extra test would you run on the LP CSF from suspected meningitis?
Test CSF for HSV-1 via PCR
1476
Sepsis can often cause pain in the ______.
thighs
1477
List 6 causes of acute back pain.
- pyelonephritis
- malignancy
- epidural abscess
- slipped disc
- vertebral osteomyelitis
- vertebral fracture
1478
erythema marginatum is a rash most associated with _______?
rheumatic fever
1479
Compare the pharmacological management of valvular vs non-valvular AF.
non-valvular - use DOAC as anticoagulant
valvular (including AF secondary to valve disease like mitral stenosis) - need warfarin
1480
The two definitive treatments for a diseased valve are?
valvuloplasty or replacement
1481
What is the typical management of tricuspid regurg?
can usually be managed just with diuretics
1482
'new heart murmur' is always _______ on exams.
infective endocarditis
1483
dental seeded infective endocarditis tends to be caused by which bacteria?
strep viridans
1484
What are the 2 key investigations for infective endocarditis ?
blood cultures x 3
ECHO
1485
How should antibiotics be given in infective endocarditis?
long term via PICC
1486
Live vaccines should be avoided in _______ patients.
immunocompromised
1487
chronic traveller's diarrhoea is often due to?
a parasite, typically giardia
1488
ICT rapid test and thick and thin blood films are key investigations for?
malaria
1489
Tx for malaria?
chloroquine + artemether-lumafantrine (artemisinin)
1490
3x malaria prophylaxis options?
- doxy , continue for 4 weeks after
- malarone, expensive
- mefloquine, once weekly
1491
An acute fever with a sunburn looking rash in a returned traveller is typical of ?
dengue virus
1492
how could you seperate dengue and malaria on history?
malaria usually takes 4-6 weeks to incubate, dengue is less than 3 weeks, much more acute.
1493
Enteric fever is caused by which bacteria?
salmonella
1494
anal pain in a sexual history suggests?
herpes
1495
3 initial STI investigations for an MSM patient with anal pain would include:
first pass urine, anal swab, throat swab.
1496
Which Ix is most important in newly diagnosed HIV patients to check for their AIDS status?
CD4 count
1497
What is the magic CD4 count number that leads to AIDS defining illnesses?
below 200
1498
What is the most important Ix to monitor the efficacy of treatment in HIV + patients?
viral load
1499
If a HIV viral load is high despite treatment, what is likely the issue and why is this a big problem?
poor medication adherence.
Can lead to HIV resistance
1500
When first diagnosing a patient with HIV it is important to contact which other people?
contact tracing as well as blood/sperm bank donations.
1501
A lump in the neck following commencement of HIV therapy may be due to which phenomena?
immune reconstitution syndrome
1502
Name one histo finding specific to TB and one gross lung finding specific to TB.
- multinucleated giant cells (Langhan's cells)
- caseating granulomas
1503
Succussion splash is med school lingo for which pathology?
gastric outlet obstruction
1504
Crossed tenderness is med school lingo for which pathology?
acute appendicitis (Rosving's sign)
1505
For AMI, what is the cut-off for PCI and thrombolysis?
PCI is 90 minutes
thrombolysis up to around 12 hrs
1506
Shortening of the leg is typical of?
hip fracture
1507
list the considerations for associated risks of spinal injury (canadian spine rules).
- fast drive
- sixty five
- sense deprive
- side to side (head)
1508
What is the mnemonic for resus cases and which examinations/factors fit into each letter of the mnemonic?
ABCDDEFG
Airway - jaw thrust, chin lift, airway assessment, intubation, talking/awake
Breathing - O2 sats, RR, wheeze, cough, positioning, CXR, ABG
Circulation - BP, HR, perfusion, urine, ECG, fluid resus
Disability - temp, neuro exam, PEARL,
DONT EVER FORGET GLUCOSE
1509
Compare simple vs comminuted fractures.
simple - one break, into 2 pieces.
Comminuted - crushed - many pieces.
1510
List 3 types of common adult fractures
- transverse
- oblique
- spiral
1511
Compare the terms displaced and angulated when it comes to fractures.
displaced - not in line with the rest of the bone (but still parallel)
angulated - in a different angle than the rest of the bone
1512
List the immediate fracture steps in ED and the subsequent steps beyond ED.
ED: examination, analgesia, X-ray, re-align, splint (POP for wrist), re-X-ray.
Further: reduction, immobilisation, ortho referral/fracture clinic, keep the environment healthy.
1513
What position should someone with a suspected hip fracture be kept in ?
supine
1514
What is a potential side effect of a long time spent supine and immobilised, especially in old people?
deconditioning
1515
2 risks of a scaphoid fracture?
- avascular necrosis
- a-union of the bones
1516
Symptoms of fracture?
the hallmarks of inflammation. Pain, swelling, loss of function etc.
1517
Which tendons control flexion of the DIP and PIP ?
DIP - flexor digitorum profundus (think D's together)
PIP - flexor digitorum superficilias
1518
Which tendons control the extensor aspect of the DIP and PIP?
DIP - terminal tendon
PIP - central slip
1519
Which nerve controls the interosseus muscles of the hand?
ulnar
1520
Which major arm nerve does not participate in muscle contraction above the wrist?
radial
1521
A 'small chip' fracture is likely a sign of a pathology relating to a _______ or ________.
tendon or ligament
1522
Name 4 things you would do for every wound laceration in the ED.
1. X ray
2. Abx
3. analgesia
4. tetanus shot
+/- referral for surgical washout
1523
Best antibiotic for animal bite?
augmentin
1524
When is the best time to suture a bite from a human?
never suture a human bite
1525
How should an amputated body part be handled?
do not put it directly on ice.
Wrap it in saline gauze then put it in a plastic bag then put it directly next to ice.
X-ray the amputated limb too
1526
Swelling of one finger is likely to be ________. How serious is this?
Tenosynovitis - surgical emergency.
1527
If there is a risk of avascular necrosis with a NOF break, what would be the definitive management?
hemiarthoplasty - replace the femoral head
1528
If you have a high clinical suspicion of a fracture but it is not evident on XR, what would you do?
CT
1529
40% of anterior shoulder dislocations lead to temporary ________.
axillary nerve dysfunction
1530
What are the Ottawa ankle/foot rules?
ankle - inability to walk + malleolar pain
foot - midfoot pain, 5th metatarsal base pain, inability to walk
1531
What should always be done before a bone reduction?
X RAY
1532
List some of the high risk factors that call for a head CT in the Canadian CT rules.
- over 65
- over 2 episodes of vomiting
- reduced GCS 2 hrs after the event
- suspected skull fracture
mild risks: amnesia before the event of over 30 mins, dangerous mechanism.
1533
What is a total contraindication of reducing a shoulder dislocation in the ED?
if you suspect a fracture
1534
Longer term management for shoulder dislocation?
sling for 2 weeks, re-xray
1535
What is the pathophysiology of a subdural bleed?
tearing of a bridging vein
1536
Compare the colour of sub-dural blood in acute, sub-acute, and chronic bleeds.
acute - white
sub-acute - grey
chronic - same dark colour as CSF
1537
Most common 2 causes of SAH?
- berry aneurysm in anterior circulation
- trauma
1538
Main risk factor for a primary intra-parenchymal brain bleed?
HTN
1539
Which plane shows shoulder dislocations the best?
trans-axillary x-ray
1540
Posterior dislocations are common following ________.
seizures
1541
The patient hearing a 'crack' is warning bells for ______.
fracture
1542
A twisting ankle injury may fracture the ________ alongside a local ankle fracture.
proximal fibula - always CHECK paired bones
1543
How much saline (approx) can you give before you really need to start considering transfusion?
About 2L
1544
A traumatic haemothorax may also be accompanied on CXR by fluffiness in the rest of the lung, these are likely ______.
Contusions
1545
In trauma, tachycardia means _____ unless proven otherwise.
bleeding
1546
Best immediate step for managing a bleeding area?
PRESSURE
1547
What is eFAST?
a quick whole body ultrasound done by the ED bedside in a trauma case
1548
What are the 4 categories of ED investigations to consider?
- bedside
- pathology
- imaging
- microbiology
1549
Shock causes acidosis due to _____.
lactate
1550
When do Q waves appear and what do they indicate?
1-24 hrs after AMI, look for delayed presentation AMI in shocked patient.
1551
Longer term non-pharm management of an AMI?
- admit to cardiac care unit
- cardiac rehab
1552
Does 0.9% saline tend to alter serum osmolality?
no, it is essentially isotonic.
1553
How do diarrhoea and dehydration affect osmolality?
diarrhoea reduced sodium and water, so may look normal osmolality but clinically unwell.
regular dehydration will increase osmolality as water is scarce.
1554
Giving 5% dextrose is the equivalent of giving ______.
Water. It will impact osmolality as it is just water, not salts.
1555
How does intracellular volume change with a high serum sodium and a low serum sodium?
water follows sodium.
If its high, cell volume will decrease.
Low serum sodium - cell volume increase
1556
Low urine sodium with normal levels of sodium should ring alarm bells for which condition and what is a common cause of this condition?
diabetes insipidus, often due to stroke.
1557
Name 4 causes of hyponatremia. 1 psychological, 1 pathology, 2 pharmacological.
1 - psychogenic polydipsia
1 - SIADH
2 - thiazides and SSRIs
1558
What are the steps in the de-escalation loop?
- listen
- agree
- explain
- repeat
1559
List 3 ED sedation options for agitated patients and the aim in this scenario.
- dropiridol, midazolam, olanzipine.
aim is for them to be sedated but rousable
1560
What is the medication used to improve cognition in Alzheimer's and what is an important thing to tell patients?
- Donepezil - Ach-ase inhibitor
- it does not stop disease progression
1561
Name the 2 main features of depression, one of which is required for diagnosis.
- anhedonia
- low mood
1562
What investigation should be done before donepezil?
ECG
1563
A risk in patients taking SSRI + tramadol is?
serotonin syndrome
1564
Inattention is a key aspect of ______.
delirium
1565
Agitated patients require which class of medications and list 3.
anti-psychotics.
Risperdone, Olanzipine, haloperidol
1566
If anti-psychotics are contraindicated, what would you use?
Lorazepam
1567
Benzos should be avoided in which pathology?
delirium
1568
Anti-psychotics should ve avoided in which disease?
Parkinsons
1569
How many doses of anti-psychotics is usually needed for a delirium episode?
usually just 1
1570
Thought disorder + hallucinations/delusions is typical of ______.
Schizophrenia
1571
Is delirium always aggressive and overt?
no, hypoactive delirium is often misdiagnosed as depression.
1572
BPSD is a name for?
dementia
1573
Compare the timeline of dementia vs delirium.
Dementia - slowly progressive without fluctuation.
Delirium - acute, fluctuating.
1574
The double duct sign on CT is an indicator of which pathology?
pancreatic cancer
1575
What is the triple therapy for treatment of h. pylori?
ACE
amoxicillin, clarithromycin, esomeprazole
1576
4 components of a haemolytic screen?
- haptoglobin
- LDH
- unconjugated bilirubin
- reticulocytes
1577
Differing BP between arms is a classic sign of which pathology?
aortic dissection
1578
'S4 gallop' is a typical feature of which cardiomyopathy?
HOCM
1579
Which maneouvres are used to diagnose/treat BPPV?
diagnose - dix hallpike
treat - epley
1580
Which LFT value may be raised in ank spon?
ALP - the bone one
1581
List one pharm and one pathological cause of diabetes insipidus.
- lithium use
- pituitary tumour
1582
List 5 of the criteria for Ranson pancreatitis mortality.
- age
- LDH up
- WCC up
- glucose - up
- hypoglycemia
(also high AST randomly)
1583
Mnemonic for the risks of too-rapid sodium level correction?
High to low your brain will blow (cerebral edema)
Low to high your pons will fry (pons damage).
1584
List 3 pathological causes of SIADH.
- lung cancer - SCLC
- meningitis
- encephalitis
1585
Which scan is the best for lymphoma?
PET
1586
Antidote for paracetamol overdose?
N-acetylcysteine
1587
Mnemonic for the reasons for dialysis?
AEIOU
Acidosis
Electrolyte disturbance
Intoxication
overload
Uremic symptoms
1588
What is Lateral Medullary Syndrome and which subsequent syndrome does it cause?
PCA stroke impacting brainstem.
Causes Horner's syndrome.
1589
When should a carotid endarterectomy be heavily considered?
Beyond 70% stenosis
1590
'pulsating' headache (in a med school exam) rules out which cause of headache and likely refers to which cause of headache?
rules out tension type headache.
likely refers to migraine.
1591
improvement of leg pain by hanging the limb off the side of the bed is the typical scenario for which pathology?
critical limb ischemia
1592
2 long term side effects of bisphosphonates and 1 short term?
2 - osteonecrosis of the jaw and atypical femoral fractures
short - GORD
1593
Teleangiectasia is common in which type of skin cancer?
BCC
1594
What is the pre-cursor to skin SCC?
actinic keratosis
1595
Which monoclonal is commonly given for ulcerative colitis?
infliximab or adalimumab
1596
How to treat raised ICP?
Surgeon Loosen My Brain Sir
- Surgery
- Lift head
- Mannitol
- Breathe - hyperventilate them
+/- Steroids if caused by a mass
1597
3 symptoms of a Zenker's diverticulum?
halitosis, regurgitation, feeling of lump in throat
1598
Which type of eponymous cell is found in Hodgkins Lymphoma?
Reed Sternburg cells
1599
A rash on the hands and feet is typical of ______.
Syphilis
1600
A NOF can lacerate which leg artery?
medial circumflex
1601
An increased amylase is indicative of which condition?
Pancreatitis
1602
Which spinal level is aimed for in a spinal anaesthetic?
L3-5
1603
Which medication can be used a medical management for passing kidney stones?
Alpha blockers - just as in BPH
1604
Which 4 investigations would you order if you suspected testicular cancer?
USS + BCHG + alpha fetoprotein + LDH
1605
A very high BHCG is indicative of which type of testicular cancer?
Choriocarcinoma (remember choroid is the tissue that nurtures the baby in a female, so equate the baby marker (BHCG) with a choroid cancer).
1606
What is the breast triple test?
exam + imaging + biopsy
1607
Headache worst at night or on waking are med school code for which pathology?
brain cancer
1608
Best imaging for septic arthritis?
USS
1609
mnemonic for RA treatment?
CAMP
Celecoxib
Adalimumab
methotrexate
pred as needed
1610
Painless otorrhea should raise alarm bells for which pathology?
cholestotoma
1611
What is the magic neutrophil number for febrile neutropenia?
less than 1.0
1612
Which value is used to measure clexane efficacy?
factor Xa levels
1613
Which ulcer type is most associated with granulation tissue?
Venous
1614
How often is INR checked for warfarin?
4 weekly
1615
What is AVNRT?
the most common type of supraventricular tachycardia, identified by regular tachycardia with no delta waves.
1616
True seizures involve biting of which area of the tongue?
the sides! other types such as a psychogenic seizure may bite other areas such as the front.
1617
Procedural memory is often spared in _______.
Alzheimers
1618
Which type of dementia is best described as a stepwise decline?
vascular - worsens with each stroke
1619
Which type of dementia may have hallucinations?
Lewy Body
1620
What is a definitive intervention for non-proliferative diabetic retinopathy?
laser treatment
1621
A cloudy peritoneal dialysis bag is indicative of?
infection/peritonitis
1622
Seeing 'halos' around lights is typical of which eye pathology?
cataracts
1623
Bouchard nodes, hallux rigidus and Heberden's nodes are found in ____.
osteoarthritis
1624
Do cranial nerve pathologies affect ipsilateral or contralateral sides of the face?
Ipsilateral (aside from CN4 which is the only one to decusate)
1625
Which treatment is best for a person with a Hb below 70 who is symptomatic?
urgent RBC transfusion
1626
Which breast lump is most common in women under 35 and does it cause discharge/lactation?
Fibroadenoma - no it does not.
1627
What is Prehn's sign? What is Prehn's negative?
Prehn's sign = the testicle lift to test torsion.
NEGATIVE - pain unrelieved by lifting which means it is likely torsion. Think of negative being the negative outcome.
1628
Removal of the terminal ileum will likely affect absorption of B12 and which other substance?
bile salts
1629
Which other joint pathology pre-disposes people to septic arthritis?
osteoarthritis
1630
What is a red flag in migraine sufferers that would indicate they need further workup?
increased frequency or severity
1631
A fever 24 hrs after surgery is likely to be due to _______.
common post-op fever due to trauma to body - infections/DVT don't really show up for 3-7 days.
1632
PPI use is a risk factor for hospital acquired _____.
pneumonia - raises apsiration risk
1633
Treatment for epididymo orchitis?
antibiotics and elevation
1634
Which medication class is generally contraindicated in heart failure?
calcium channel blockers
1635
Which score is used to grade liver transplant candidates?
MELD score
1636
Why is electric cardioversion contraindicated for AF that has been present for over 48 hrs?
clot risk
1637
When should a colonoscopy be done for acute diverticulitis?
It shouldnt be done - may perforate the bowel. Just do a CT.
1638
Pain on accomodation with a red, weeping, painful and photophobic eye is typical of which condition?
uveitis
1639
CURB65 is a score for which pathology?
pneumonia severity
1640
Which valvular pathology is often cause by HOCM?
aortic stenosis (functional)
1641
'impaired elasticity and proliferation of connective tissue' describes which cardiomyopathy?
restrictive
1642
Mesalamine (5-ASA) is a long term treatment for which disease?
IBD
1643
'Moth eaten' areas of bone are typical of _______.
lytic lesions
1644
'immature neutrophils' on blood film are typically of which blood cancer?
APML
1645
Can epilepsy cause neuro damage or death?
yes both - neuro damage in status epiliepticus and sudden death can occur
1646
An isolated thrombocytopenia on blood tests may be due to which disease?
immune thrombocytopenia purpura
1647
Which type of dementia may barely affect memory?
fronto-temporal - impacts behaviour
1648
Donepezil is used for?
Alzheimers
1649
Which two medication classes should be avoided in Alzheimers?
benzos and anti-psychotics
1650
Does parkinsons tremor tend to be symmetrical or asymmterical?
asymmetrical
1651
violent sleep thrashing is typical of which disease?
Parkinsons
1652
What is dyskinesia in Parkinsons?
Presence of involuntary movements typical of prolonged dopamine treatment.
1653
Which medications are in symbicort?
budenoside and formetrol
1654
Methacoline is used to diagnose which condition?
Asthma provocation test
1655
Graves histology may show a metaplasia from ____ cells to _____ cells.
from cuboidal to columnar
1656
Phosphate is mostly present as which molecule in the body?
H2PO4
1657
How long can a CVC be left in?
5-21 days
1658
What is the target of ciprofloxacin?
bacterial gyrase
1659
What is the target of metranidazole?
bacterial DNA disruption
1660
A headache triggered by cough or straining is typical of which pathologies?
Those that raise ICP - bleeds and mass lesions.
1661
How does a ruptured AAA impact blood pressure?
Causes hypotension
1662
What size AAA requires surgery (when symptomatic)?
above 5cm
1663
List one surgical and medical treatment for achalasia.
surgical - myotomy
medical - botox
1664
Regular feeling breast lumps in young women are likely to be ____ whereas in middle aged women they're likely to be ______.
young - fibroadenoma
middle aged - fibrocystic disease
1665
What is Paget's disease?
Oozing/red/crusty nipple due to ductal carcinoma in situ
1666
When does mastitis occur?
Red, painful nipple following breastfeeding.
1667
A spinal anaesthetic is used for surgeries below the ______.
Umbilicus
1668
What is the typical pain ladder for post-op analgesia?
paracetamol --> NSAID --> opiod
1669
Which blood test could indicate compartment syndrome?
CK
1670
Which dermatome is the back of the knee?
S2
1671
A kidney stone above ____ in size is unlikely to pass naturally.
7mm
1672
What is the best treatment for a kidney stone between 10 and 20mm?
stent and uretoscopy
1673
Which type of diuretic is a risk factor for calcium renal stones?
loop diuretic
1674
Long, thin, penicl-shaped stools are typical of which cancer?
rectal carcinoma
1675
Why does COPD increase haemorroids risk?
repeated straining from coughing
1676
Diffuse goitre is more descriptive of ______ whereas a painless, rubbery goitre is more typical of ______.
Graves is diffuse.
Hashimotos is rubbery.
1677
Does Graves have Anti-TPO antibodies?
It can, they are quite non-specific.
1678
What is propyluracil?
An alternate to carbimazole used in pregnant women.
1679
A protruding lateral ear is a specific sign of which pathology?
Mastoiditis - due to untreated otitis media. They also have a tender mastoid process.
1680
Which antibiotic is used in mastoiditis?
Cefotaxime
1681
what is the typical cause of a Quinsy?
poorly/untreated tonsilitis
1682
Where is an emergency tracheotomy placed anatomically?
Between the thyroid and cricoid cartilage (cricothyroid ligament).
1683
What is a HINTS exam?
Head Impulse, Nystagmus, Test of Skew - a neuro exam done in vertigo to differentiate peripheral vs central vertigo.
1684
What is the anti-histamine typcically used to treat vertigo?
Promethazine
1685
When is it appropriate to stop the K+ infusion in DKA?
potassium levels over 5.5
1686
When is it appropriate to commence insulin in DKA?
When K+ is above 3.5
1687
Which anatomical feature puts someones at risk of glaucoma?
shallow anterior angle
1688
Comodonal acne is commonly known as?
black and white heads
1689
Female hormonal acne may be controlled by ______ alongside a retinoid and the OCP.
spironelactone
1690
Which type of acne is the most at risk of scarring?
Acne conglobata
1691
What are the first line treatments for osteoporosis?
Bisphosphonates or denosumab
1692
'rolled edges with an ulcerated core' is a description of which skin cancer?
BCC
1693
What is Bowen's disease and which other disease is it often mistaken for?
Pre-malignant squamous cell lesion, often mistaken for psoriasis.
1694
BRAF and MEK inhibitors as well as CTLA-4 and PD-1 inhibitors are all treatments for?
melanoma
1695
How does tamoxifen help osteoporosis?
it doesnt really
1696
Which type of muscle fibre is targeted in sarcopenia?
Type 2 (fast)
1697
what is the initial management of critical limb ischemia?
anti-coag
1698
Which stroke causes hemineglect?
Non-dominant stroke, often impacting parietal lobe. Typically right sided MCA stroke.
1699
Why might hypoxia raise haemoglobin?
Secondary polycythemia - hypoxia causes kidney to make EPO to create more Hb.
1700
How painful are first degree haemorroids?
not very
1701
A 'left parasternal impulse' is a sign of ?
right ventricular strain
1702
Which nerve roots supply the median nerve, ulnar nerve and radial nerve?
Median - C6-T1
Radial - C7 mostly but C5-T1 in reality, al, of brachial plexus.
Ulnar - C8 and T1
1703
What is Beck's triad and which condition does it relate to?
hypotension + elevated JVP + muffled heart sounds - all indicate cardiac tamponade.
1704
Electrical alternans is med school code for which pathology?
tamponade
1705
An old person with pain in the groin and anterior thigh may indicate?
hip pathology
1706
Which skin cancer may have a keratin 'horn'?
squamous cell carcinoma
1707
How does parietal lobe impact vision?
Gives sense of spacial self direction and orientation. This is why damage to this area may cause hemineglect.
1708
Pain in shoulder abduction from 60 to 120 degrees is typical of which pathology?
impingement syndrome
1709
