Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > Med > Flashcards

Med Flashcards

1
Q

polycythemia

A

increase in the number of red blood cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Co-trimoxazole

A

is a combination of trimethoprim and sulfamethoxazole and is in a class of medications called sulfonamides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Loss of kidney function leads to

A

reduced excretion of phosphate and low production of activated vitamin D. Calcium then falls which leads to secondary hyperparathyroidism, which maintains calcium but at the expense of raised phosphate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dressler’s syndrome

A

is pericarditis that occurs two to six weeks after, commonly, anterior myocardial infarction or heart surgery.
It thought to be due to an autoimmune response to myocardial antigens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pericarditis 4 clinical criteria

A

The diagnosis is confirmed in the presence of at least 2 of the 4 clinical criteria: typical chest pain, pericardial friction rub, widespread ST elevation, and pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Absolute contraindications to the use of the oral contraceptive pill include:

A 
Cancer of the breast and genitalia
End stage liver disease
Previous or present history of thromboembolism
Cardiac abnormalities
Congenital hyperlipidaemia, and
Undiagnosed abnormal uterine bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pericarditis The key findings on history

A

constant, pleuritic central chest pain that is worse in the recumbent position and radiates to one or both trapezius ridges
Almost all patients report relief of pain with sitting up or leaning forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Asplenic patients should receive

A

Pneumovax immunisation and it should be repeated every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which medication is commonly associated with new onset of diabetes after transplantation (NODAT)

A

tacrolimus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

QT prolongation also seen with

A

Hypocalcaemia
Hypokalaemia
Type 1a antiarrhythmic drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The mnemonic for remembering the symptoms of hypercalcaemia is

A

stones, bones, groans, thrones and psychiatric overtones. Breaking this down we get:
Stones (renal)
Bones (bone pain)
Groans (abdominal pain, nausea and vomiting)
Thrones (polyuria)
Psychiatric overtones (confusion and cognitive dysfunction, depression, anxiety, insomnia, coma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Amiloride

A

Epithelial Na Channel antagonists

K+ sparing diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Goodpasture’s syndrome

A

is an autoimmune condition in which antibodies (anti-GBM) are produced against type 4 collagen in the lungs and glomeruli. It tends to cause a more nephritic state in the kidneys, and can also present with haemoptysis secondary to pulmonary haemorrhage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

IgA nephropathy

A

is also likely to present more towards the nephritic end of the spectrum, particularly with macroscopic haematuria in a young person following an upper respiratory tract infection. The renal biopsy in this disease (although not always necessary) would show mesangial proliferation and matrix accumulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

heart failure: first line drugs

A

ACE-inhibitor and a beta-blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

heart failure: second line drugs

A

aldosterone antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

heart failure: third line drugs

A

should be initiated by a specialist. Options include ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

new diagnosis of cirrhosis

A

doing an upper endoscopy to check for varices
For people in whom no oesophageal varices have been detected, offer surveillance using upper gastrointestinal endoscopy every 3 years.
liver ultrasound every 6 months (+/- alpha-feto protein) to check for hepatocellular cancer
Calculate the Model for End‑Stage Liver Disease (MELD) score every 6 months for people with compensated cirrhosis.
Consider using a MELD score of 12 or more as an indicator that the person is at high risk of complications of cirrhosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Moderate asthma

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

severe asthma

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

life threatening asthma

A 
PEFR < 33% best or predicted
Oxygen sats < 92%
'Normal' pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Near-fatal asthma

A

a raised pC02 and/or requiring mechanical ventilation with raised inflation pressures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Acute respiratory distress syndrome is a complication of

A

acute pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Causes of Hyperlactataemia

A

Type A - Reduced Tissue Oxygen Delivery
Ex. Ischaemia, severe asthma, shock, HF (hypoperfusion)

Type B1 - Underlying Disease
Ex liver failure, cancer, endogenous b2 stimulation ex phaechromocytoma
Pyruvate dehydrogenase deficiency ex sepsis, thiamine deficiency

Type B2 - Drugs & Toxins
Metformin (biguanides)
Exogenous b stimulation
Linezolid, cyanide

Type B3 - Inborn Errors of Metabolism
Ex Enzyme deficiencies - e.g. pyruvate dehydrogenase deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Indications for a temporary pacemaker

A

symptomatic/haemodynamically unstable bradycardia, not responding to atropine
post-ANTERIOR MI: type 2 or complete heart block*
trifascicular block prior to surgery
*post-INFERIOR MI complete heart block is common and can be managed conservatively if asymptomatic and haemodynamically stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The most common organism causing infective exacerbations of COPD is

A

Haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

infective exacerbations of COPD treatment

A

oral antibiotics first-line: amoxicillin or clarithromycin or doxycycline.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Phaeochromocytoma typically present symptomatically with a triad of

A

sweating, headaches, and palpitations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Rheumatic fever is caused by

A

group A Streptococcus species (GAS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

mitral stenosis features

A 
mid-late diastolic murmur (best heard in expiration)
loud S1, opening snap
low volume pulse
malar flush
atrial fibrillation
the normal cross sectional area of the mitral valve is 4-6 sq cm. A 'tight' mitral stenosis implies a cross sectional area of < 1 sq cm
Chest x-ray
left atrial enlargement may be seen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

QRISK2

A

10-year cardiovascular risk) score.

Statins should be given to patients with a 10-year cardiovascular risk >= 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Bifascicular block

A

combination of RBBB with left anterior or posterior hemiblock
e.g. RBBB with left axis deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Trifascicular block

A

features of bifascicular block as above + 1st-degree heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Wolf-Parkinson-White syndrome ECG

A

short PR interval, a delta wave and QRS prolongation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

second degree heart block Mobitz type 1 ECG

A

increasing PR intervals until there is a P wave without a QRS complex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

second degree heart block Mobitz type 2 ECG

A

there is P wave to QRS ratio of 2:1 or 3:1.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Brugada syndrome

A

ST segment elevation in leads V1 to V3.
Brugada syndrome is a rare but serious condition that affects the way electrical signals pass through the heart.

It can cause the heart to beat dangerously fast. These unusually fast heartbeats – known as an arrhythmia – can sometimes be life threatening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Autoimmune hepatitis

A

Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)
Features
may present with signs of chronic liver disease
acute hepatitis: fever, jaundice etc (only 25% present in this way)
amenorrhoea (common)
ANA/SMA/LKM1 antibodies, raised IgG levels
liver biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis
Management
steroids, other immunosuppressants e.g. azathioprine
liver transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

INR 5.0-8.0

No bleeding

A

Withhold 1 or 2 doses of warfarin

Reduce subsequent maintenance dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

INR 5.0-8.0

Minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

INR > 8.0

No bleeding

A

Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

INR > 8.0

Minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Major bleeding

A

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Primary biliary cholangitis - the M rule

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Aplastic anaemia

A

is a rare, potentially life-threatening failure of haemopoiesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Sideroblastic anaemia

A

are a group of blood disorders in which the body has enough iron but is unable to use it to make hemoglobin, which carries oxygen in the blood. As a result, iron accumulates in the mitochondria of red blood cells, giving a ringed appearance to the nucleus (ringed sideroblast)
Sideroblastic anaemia usually causes a microcytic anaemia with raised serum iron levels..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Ferritin is

A

an acute phase reactant and therefore raised in states of chronic inflammation,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

reactive thrombocytosis

A

platelets are raised due to presence of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Charcot’s cholangitis triad

A

fever, jaundice and right upper quadrant pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

CHA2DS2-VASc score

A

management of atrial fibrillation
suggested anticoagulation strategy based on the score:
0 No treatment
1 Males: Consider anticoagulation
Females: No treatment (this is because their score of 1 is only reached due to their gender)
2 or more Offer anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

CHA2DS2-VASc score what each letter mean

A 
C	Congestive heart failure	1
H	Hypertension (or treated hypertension)	1
A2	Age >= 75 years	2
Age 65-74 years	1
D	Diabetes	1
S2	Prior Stroke or TIA	2
V	Vascular disease (including ischaemic heart disease and peripheral arterial disease)	1
S	Sex (female)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

indication for anticoagulation.

A

valvular heart disease, in combination with AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

HASBLED scoring system.

A

consider whether warfarinisation is in the best interests of the patient
There are no formal rules on how we act on the HAS-BLED score although a score of >= 3 indicates a ‘high risk’ of bleeding, defined as intracranial haemorrhage, hospitalisation, haemoglobin decrease >2 g/L, and/or transfusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

HASBLED scoring system.

A

H Hypertension, uncontrolled, systolic BP > 160 mmHg 1
A Abnormal renal function (dialysis or creatinine > 200)
Or
Abnormal liver function (cirrhosis, bilirubin > 2 times normal, ALT/AST/ALP > 3 times normal 1 for any renal abnormalities

1 for any liver abnormalities
S Stroke, history of 1
B Bleeding, history of bleeding or tendency to bleed 1
L Labile INRs (unstable/high INRs, time in therapeutic range < 60%) 1
E Elderly (> 65 years) 1
D Drugs Predisposing to Bleeding (Antiplatelet agents, NSAIDs)
Or
Alcohol Use (>8 drinks/week) 1 for drugs

1 for alcoho

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

widened mediastinum on x-ray is sign of

A

aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

prescribing an angiotensin converting enzyme (ACE) inhibitor to all patients with chronic kidney disease (CKD) who have

A

raised albumin:creatinine ratio
urinary ACR or 70mg/mmol or more

Lipid-lowering therapy with a statin is also recommended for all patients with CKD for the primary or secondary prevention of cardiovascular disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

management of hyperkalaemia is as follows:

A

f K+ > 6.5 mmol/l or if there are ECG changes:

Administer calcium gluconate 10% 10-20ml by slow IV injection titrated to ECG response
Give 10 U Actrapid in 50 ml of 50% glucose over 10-15 minutes
Consider use of nebulised salbutamol
Consider correcting acidosis with sodium bicarbonate infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Cerebral oedema - can occur if

A

sodium levels rapidly decrease, as seen in rapid diabetic ketoacidosis correction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

rapid correction of hyponatraemia can lead to

A

Central pontine demyelination

The hyponatraemia should be corrected at a rate of 6 to 12mmol/L in the first 24. With rapid correction fluids shifts can cause damage to myelin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Causes of hyperkalaemia:

A 
acute kidney injury
drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin**
metabolic acidosis
Addison's disease
rhabdomyolysis
massive blood transfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

A common endocrine complication of small cell lung cancer is

A

SIADH

The syndrome of inappropriate ADH secretion (SIADH) is characterised by hyponatraemia secondary to the dilutional effects of excessive water retention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Causes of predominantly hypercholesterolaemia

A

nephrotic syndrome
cholestasis
hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

The initial management of hypercalcaemia

A

is rehydration with normal saline, typically 3-4 litres/day. Following rehydration bisphosphonates may be used. They typically take 2-3 days to work with maximal effect being seen at 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Warfarin mechanism of action

A

is an oral anticoagulant which inhibits epoxide reductase preventing the reduction of vitamin K to its active hydroquinone form, which in turn acts as a cofactor in the carboxylation of clotting factor II, VII, IX and X (mnemonic = 1972) and protein C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

warfarin indications

A

ndications
venous thromboembolism: target INR = 2.5, if recurrent 3.5
atrial fibrillation, target INR = 2.5
mechanical heart valves, target INR depends on the valve type and location. Mitral valves generally require a higher INR than aortic valves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Factors that may potentiate warfarin

A

liver disease
P450 enzyme inhibitors, e.g.: amiodarone, ciprofloxacin
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

warfarin

A

haemorrhage
teratogenic, although can be used in breastfeeding mothers
skin necrosis: when warfarin is first started biosynthesis of protein C is reduced. This results in a temporary procoagulant state after initially starting warfarin, normally avoided by concurrent heparin administration. Thrombosis may occur in venules leading to skin necrosis
purple toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Any of the following features in a person aged 0-24 years should prompt a very urgent full blood count (within 48 hours) to investigate for leukaemia:

A 
Pallor
Persistent fatigue
Unexplained fever
Unexplained persistent infections
Generalised lymphadenopathy
Persistent or unexplained bone pain
Unexplained bruising
Unexplained bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

first-line antibiotic in the treatment of syphilis is:

A

intramuscular benzathine penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

, some common factors indicating severe pancreatitis include:

A 
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

Note that the actual amylase level is not of prognostic value.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Hepatocellular carcinoma Diagnosis

A

CT/ MRI (usually both) are the imaging modalities of choice
a-fetoprotein is elevated in almost all cases
Biopsy should be avoided as it seeds tumours cells through a resection plane.
In cases of diagnostic doubt serial CT and αFP measurements are the preferred strategy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

main risk factor for Cholangiocarcinoma

A

Primary sclerosing cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Mitral stenosis

A

mid-late diastolic murmur heard loudest in expiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Mitral valve prolapse

A

mid-systolic murmur heard loudest in expiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Tricuspid stenosis

A

mid/late diastolic murmur heard loudest in inspiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Aortic stenosis

A

ejection systolic murmur heard loudest in expiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Pulmonary stenosis

A

It is an ejection systolic murmur, heard loudest in inspiration. It is associated with dyspnoea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

breast Fibroadenoma

A

Common in women under the age of 30 years

Often described as ‘breast mice’ due as they are discrete, non-tender, highly mobile lumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Fibroadenosis (fibrocystic disease, benign mammary dysplasia)

A

Most common in middle-aged women

‘Lumpy’ breasts which may be painful. Symptoms may worsen prior to menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Breast cancer

A

Characteristically a hard, irregular lump. There may be associated nipple inversion or skin tethering

Paget’s disease of the breast - intraductal carcinoma associated with a reddening and thickening (may resemble eczematous changes) of the nipple/areola

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Mammary duct ectasia

A

Dilatation of the large breast ducts
Most common around the menopause
May present with a tender lump around the areola +/- a green nipple discharge
If ruptures may cause local inflammation, sometimes referred to as ‘plasma cell mastitis’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Duct papilloma

A

Local areas of epithelial proliferation in large mammary ducts
Hyperplastic lesions rather than malignant or premalignant
May present with blood stained discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Fat necrosis

A

More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted

84
Q

Breast abscess

A

More common in lactating women

Red, hot tender swelling

85
Q

4 indications for haemodylasis

A

1- refractory hyperkalaemia
2- uraemia
3- fluid overload causing pulmonary oedema
4-metabolic acidosis

86
Q

Light’s criteria

A

exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

87
Q

Spontaneous bacterial peritonitis: most common organism found on ascitic fluid culture is

A

are gram-negative enteric bacteria. E coli is by far the most common followed by Klebsiella.

88
Q

Spontaneous bacterial peritonitis (SBP) diagnosis

A

paracentesis: neutrophil count > 250 cells/ul

89
Q

Spontaneous bacterial peritonitis (SBP) management

A

intravenous cefotaxime is usually given

90
Q

Antibiotic prophylaxis should be given to patients with ascites if:

A

patients who have had an episode of SBP
patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’

91
Q

Allergic bronchopulmonary aspergillosis

A

results from an allergy to Aspergillus spores. In the exam questions often give a history of bronchiectasis and eosinophilia.

92
Q

Allergic bronchopulmonary aspergillosis features

A

bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
bronchiectasis (proximal)

93
Q

Allergic bronchopulmonary aspergillosis Investigations

A

eosinophilia
flitting CXR changes
positive radioallergosorbent (RAST) test to Aspergillus
positive IgG precipitins (not as positive as in aspergilloma)
raised IgE

94
Q

Allergic bronchopulmonary aspergillosis management

A

oral glucocorticoids

itraconazole is sometimes introduced as a second-line agent

95
Q

ACE-inhibitors should be avoided in patients with

A

in hypertrophic obstructive cardiomyopathy (HOCM) with left ventricular outflow tract (LVOT) obstruction. ACE inhibitors can reduce afterload which may worsen the LVOT gradient.

96
Q

Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins
HOCM management

A 
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*
97
Q

HOCM drugs to avoid

A

nitrates
ACE-inhibitors
inotropes

98
Q

Adenosine is contraindicated in

A

asthmatics, use Ca channel blocker instead

99
Q

Defects in humeral immunity, makes you susceptible to:

A

‘Encapsulated organisms’

  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Neisseria meningitis
100
Q

Breast screening ages

A

women aged 50 to 70
Women over 70 can self-refer.
breast cancer screening every 3 years.

101
Q

Cervical cancer screening age

A

Cervical screening is offered to women aged 25 to 64 to check the health of cells in the cervix. It is offered every 3 years for those aged 26 to 49, and every 5 years from the ages of 50 to 64.

102
Q

Colorectal cancer screening age

A

Everyone aged 60 to 74 is offered a bowel cancer screening home test kit every 2 years.

If you’re 75 or over, you can ask for a kit every 2 years by phoning the free bowel cancer screening helpline

103
Q

HLA for Ankylosing spondylitis, Reactive arthritis, colitic arthritis, psoriatic
arthritis:

A

HLA-B27

104
Q

HLA for Coeliac disease

A

DQ2 & DQ8

105
Q

HLA for type 1 diabetes

A

DQ8 & DQ2

106
Q

HLA for MS

A

DQ6

107
Q

HLA for rheumatoid arthritis

A

DR4

108
Q

HLA for Cw6

A

HLA-Cw6

109
Q

Truelove and Witts score

A

Severity Index for Ulcerative Colitis

110
Q

Child- Pugh T Score – Child A

A

score less than 7

10 year life expectancy is 70%

111
Q

Child- Pugh T Score – Child B

A

score 7-9

5 year life expectancy is 50%

112
Q

Child- Pugh T Score — Child C

A

score more than 9

1 year life expectancy is 50%

113
Q

crohns first line drug to induce remission

A

glucocorticoids

114
Q

crohns first line drug to maintain remission

A

stopping smoking is a priority

azathioprine or mercaptopurine is used first-line to maintain remission

115
Q

Anal fissures are

A

longitudinal or elliptical tears of the squamous lining of the distal anal canal. If present for less than 6 weeks they are defined as acute, and chronic if present for more than 6 weeks.

116
Q

Adult patients outside of ICU with suspected infection are identified as being at heightened risk of mortality if they have quickSOFA (qSOFA) score meeting

A

> = 2 of the following criteria:
respiratory rate of 22/min or greater,
altered mentation, or
systolic blood pressure of 100mmHg or less

117
Q

Contraindications to thrombolysis

A 
active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
severe hypertension
118
Q

American Society of Anaesthesiologists (ASA) classification

A

assessment tool to stratify risk for patients undergoing surgery.

119
Q

ASA I

A

A normal healthy patient

Healthy, non-smoking, no or minimal alcohol use

120
Q

ASA II

A

A patient with mild systemic disease

Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (BMI 30 - 40), well-controlled Diabetes Mellitus/Hypertension, mild lung disease

121
Q

ASA III

A

A patient with severe systemic disease

Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled Diabetes Mellitus/Hypertension, COPD, morbid obesity (BMI > 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, End-Stage Renal Disease (ESRD) undergoing regularly scheduled dialysis, history (>3 months) of Myocardial infarction, Cerebrovascular accidents

122
Q

ASA IV

A

A patient with severe systemic disease that is a constant threat to life

Examples include (but not limited to): recent (< 3 months) of Myocardial infarction, Cerebrovascular accidents, ongoing cardiac ischaemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis

123
Q

ASA V

A

A moribund patient who is not expected to survive without the operation

Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intra-cranial bleed with mass effect, ischaemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

124
Q

ASA VI

A

A declared brain-dead patient whose organs are being removed for donor purposes

125
Q

Subclavian steal syndrome

A

characteristically presents with posterior circulation symptoms, such as dizziness and vertigo, during exertion of an arm. There is subclavian artery steno-occlusive disease proximal to the origin of the vertebral artery and is associated with flow reversal in the vertebral artery. Management involves percutaneous transluminal angioplasty or a stent

126
Q

Blood films: typical pictures

Hyposplenism e.g. post-splenectomy, coeliac disease (occurs in around 30% of coeliac patients)

A 
target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes
127
Q

Blood films: typical pictures

Iron-deficiency anaemia

A

target cells
‘pencil’ poikilocytes
if combined with B12/folate deficiency a ‘dimorphic’ film occurs with mixed microcytic and macrocytic cells

128
Q

Blood films: typical pictures

Myelofibrosis

A

‘tear-drop’ poikilocytes

129
Q

Blood films: typical pictures

Intravascular haemolysis

A

schistocytes

130
Q

Blood films: typical pictures

Megaloblastic anaemia

A

hypersegmented neutrophils

131
Q

Heinz bodies

A

are large inclusion bodies within the RBCs composed of denatured haemoglobin, and are associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency.

132
Q

GCS score eyes

A

eyes don’t open - 1
eyes open to pain -2
eyes open to speech- 3
eyes open spontaneously-4

133
Q

GCS score verbal

A 
No verbal response -1
inappropriate sounds- 2
inappropriate words- 3
confused -4 
oriented- 5
134
Q

GCS score motor

A 
no response- 1
extension- 2
abnormal flexion- 3
normal flexion-4 
localises pain -5
obeys command-6
135
Q

Ankle:brachial pressure index (ABPI) >1.3

A

High- usually calcified blood vessel (incompressible)

136
Q

ABPI 0.92-1.3

A

NORMAL

137
Q

ABPI 0.5-0.9

A

intermittent claudication

lifestyle, medical then surgery

138
Q

ABPI < 0.5

A

severe arterial disease: rest pain, ulceration, gangrene

—> urgent referral to vascular surgeon

139
Q

normal urine output

A

0.5ml/kg/h

140
Q

Wilson’s disease investigation

A

Low ceruloplasmin & high urinary copper

definite diagnosis is obtained by liver biopsy

141
Q

Abdominal aortic aneursym <3 cm

A

Normal - No further action

142
Q

Abdominal aortic aneursym 3-4.4 cm

A

Rescan every 12 months

143
Q

Abdominal aortic aneursym 4.4-5.4 cm

A

Rescan every 3 months

144
Q

Abdominal aortic aneursym >= 5.5 cm

A

Refer within 2 weeks to vascular surgery for probable intervention
Only found in 1 per 1,000 screened patients

145
Q

Stage 1 hypertension

A

clinic blood pressure ranging from 140/90 mmHg to 159/99 mmHg and subsequent ambulatory or home blood pressure monitoring average ranging from 135/85 mmHg to 149/94 mmHg

146
Q

Stage 2 hypertension

A

clinic blood pressure ranging from 160/100 mmHg to 179/119 mmHg and subsequent ambulatory or home blood pressure monitoring average 150/95 mmHg or higher

147
Q

Stage 3 hypertension

A

This is defined as a clinic systolic blood pressure 180mm Hg or higher or clinic diastolic blood pressure 120 mmHg or higher.

148
Q

Accelerated or malignant hypertension is defined as

A

a blood pressure of 180/120 mmHg or greater, in combination with signs of papilloedema or retinal haemorrhages on fundoscopy.

149
Q

Gallstone ileus

A

This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.

Abdominal pain, distension and vomiting are seen.

150
Q

Cholangiocarcinoma

A

Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss. A palpable mass in the right upper quadrant (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen

151
Q

In patients who are not currently bleeding or about to undergo a procedure, platelet transfusion should be performed if platelets fall below

A

0 x 109/L, however, there are certain conditions in which the use of platelet transfusion is associated with increased risk of death. One of these is thrombotic thrombocytopenic purpura, which should be treated with corticosteroids or other immunomodulatory medications

152
Q

clinically significant bleeding (World Health organisation bleeding grade 2- e.g. haematemesis, melaena, prolonged epistaxis) - Offer platelet transfusions to patients with a platelet count of

A

platelet count of <30 x 10 9

153
Q

for patients with severe bleeding (World Health organisation bleeding grades 3&4), or bleeding at critical sites, such as the CNS.
Platelet thresholds for transfusion are higher

A

maximum < 100 x 10 9

154
Q

Platelet transfusion for thrombocytopenia before surgery/ an invasive procedure. Aim for plt levels of:

A

> 50×109/L for most patients
50-75×109/L if high risk of bleeding
100×109/L if surgery at critical site

155
Q

For example, do not perform platelet transfusion for any of the following conditions:

A

Chronic bone marrow failure
Autoimmune thrombocytopenia
Heparin-induced thrombocytopenia, or
Thrombotic thrombocytopenic purpura.

156
Q

Hypercalcaemia: causes

A

Two conditions account for 90% of cases of hypercalcaemia:

  1. Primary hyperparathyroidism: commonest cause in non-hospitalised patients
  2. Malignancy: the commonest cause in hospitalised patients. This may be due to number of processes, including; bone metastases, myeloma, PTHrP from squamous cell lung cancer
Other causes include
sarcoidosis*
vitamin D intoxication
acromegaly
thyrotoxicosis
Milk-alkali syndrome
drugs: thiazides, calcium containing antacids
dehydration
Addison's disease
Paget's disease of the bone**
157
Q

The Glasgow score is used to identify cases of severe pancreatitis.

A

There is a useful mnemonic that can be used to remember the criteria.

P - PaO2 (< 7.9 kPa).

A - age (>55).

N - neutrophils (white cell count > 15x 109/L).

C - calcium (calcium < 2 mmol/L).

R - renal function (urea > 16 mmol/L).

E - enzymes (lactate dehydrogenase > 600 IU/L).

A - albumin (albumin < 32 g/L).

S - sugar (blood glucose > 10 mmol/L).

3 points and above suggests a high risk for severe pancreatitis.

Discuss (1)
Improve

158
Q

some common factors indicating severe pancreatitis include:

A 
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
159
Q

If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given

A

either oral azathioprine or oral mercaptopurine to maintain remission

160
Q

Inguinal hernia in infants treatment

A

= Urgent surgery

161
Q

Grading of hepatic encephalopathy

A

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma

162
Q

Small cell Lung cancer: paraneoplastic features

A

ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome

163
Q

Squamous cell Lung cancer: paraneoplastic features

A

parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH

164
Q

Adenocarcinoma Lung cancer: paraneoplastic features

A

gynaecomastia

hypertrophic pulmonary osteoarthropathy (HPOA)

165
Q

Statins must be temporarily held when prescribing a

A

macrolides (e.g. erythromycin, clarithromycin)

166
Q

statin contraindications

A

macrolides (e.g. erythromycin, clarithromycin) are an important interaction. Statins should be stopped until patients complete the course
pregnancy

167
Q

Risk factors for Peptic ulcer disease

A

Helicobacter pylori is associated with the majority of peptic ulcers:
95% of duodenal ulcers
75% of gastric ulcers
drugs:
NSAIDs
SSRIs
corticosteroids
bisphosphonates
Zollinger-Ellison syndrome: rare cause characterised by excessive levels of gastrin, usually from a gastrin secreting tumour
the role of alcohol and smoking is not clear

168
Q

Haemophilus influenzae pneumonia is a common cause of pneumonia in patients with

A

COPD.

169
Q

Klebsiella pneumoniae pneumonia is typically associated with

A

alcoholics and diabetics. It causes classic red-currant jelly sputum.

170
Q

Legionella pneumophila pneumonia is classically secondary to

A

to infected air conditioning units.

it is always worth asking about recent travel. It commonly causes hyponatraemia and lymphopenia.

171
Q

Preceding influenza predisposes to ….. pneumonia

A

Staphylococcus aureus pneumonia

172
Q

Ascending cholangitis is a bacterial infection (typically

A

E. coli

173
Q

Most common organism found in central line infections

A

Staphylococcus epidermidis

174
Q

Haemophilus influenzae B can cause

A

periorbital cellulitis, acute epiglottitis, and acute exacerbations of COPD.

175
Q

Staphylococcus aureus causes

A

skin infections (e.g. cellulitis), abscesses, osteomyelitis, toxic shock syndrome.

176
Q

Streptococcus agalactiae may lead to

A

neonatal meningitis and septicaemia.

177
Q

Streptococcus pyogenes is the organism responsible for

A

heumatic fever, erysipelas, impetigo, cellulitis, type 2 necrotizing fasciitis and pharyngitis/tonsillitis.

178
Q

Inguinal hernia

A

Above and medial to pubic tubercle

Strangulation is rare

179
Q

Femoral hernia

A

Below and lateral to the pubic tubercle
More common in women, particularly multiparous ones
High risk of obstruction and strangulation
Surgical repair is required

180
Q

Spigelian hernia

A

Also known as lateral ventral hernia
Rare and seen in older patients
A hernia through the spigelian fascia (the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally)

181
Q

Richter hernia

A

A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect

Richter’s hernia can present with strangulation without symptoms of obstruction

182
Q

Venous thromoboembolism - length of warfarin treatment

A

provoked (e.g. recent surgery): 3 months

unprovoked: 6 months

183
Q

The most common causes of viral meningitis in adults are

A

enteroviruses (Coxsackie B )

184
Q

Ventricular tachycardia contraindicated drug

A

verapamil

185
Q

Mitral valve prolapse complications: mitral regurgitation

A 
Associations
congenital heart disease: PDA, ASD
cardiomyopathy
Turner's syndrome
Marfan's syndrome, Fragile X
osteogenesis imperfecta
pseudoxanthoma elasticum
Wolff-Parkinson White syndrome
long-QT syndrome
Ehlers-Danlos Syndrome
polycystic kidney disease
186
Q

An increase in serum creatinine up to ….. from baseline is acceptable when initiating ACE inhibitor treatment

A

30%

187
Q

Marfan’s syndrome is

A

an autosomal dominant connective tissue disorder.

defect in protein fibrillin-1.

188
Q

The main ECG abnormality seen with hypercalcaemia is

A

shortening of the QT interval

189
Q

Alternating QRS amplitude

A

in pericardial effusion

190
Q

‘Downsloping ST depression with biphasic T waves

A

myocardial ischaemia or digoxin toxicity.

191
Q

Small P waves and QRS widening

A

hyperkalaemia (along with tall-tented T waves).

192
Q

U waves, PR interval elongation, and ST depression

A

hypokalaemia

193
Q

In life-threatening Clostridium difficile infection treatment is with

A

ORAL vancomycin and IV metronidazole

194
Q

False aneurysms (pseudoaneurysm)

A

involve a collection of blood in outer layer only adventitia) which communicates with the lumen; can happen after trauma

195
Q

True aneurysms

A

abnormal dilatations that involve all layers of arterial wall

196
Q

Drugs to avoid in renal failure

A

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

197
Q

Zollinger–Ellison syndrome

A

is a disease in which tumors cause the stomach to produce too much acid, resulting in peptic ulcers. Symptoms include abdominal pain and diarrhea. The syndrome is caused by a gastrinoma, a neuroendocrine tumor that secretes a hormone called gastrin

198
Q

frothy pink sputum may come from

A

pulmonary edema

199
Q

pancytopenia

A

is a condition that occurs when a person has low counts for all three types of blood cells: red blood cells, white blood cells, and platelets

200
Q

Which antihypertensive agent is most appropriate as initial therapy in pheochromocytoma?

A

Alpha blockade using phenoxybenzamine is used in treatment of secondary hypertension in pheochromocytoma. Patients should always be well alpha blocked before commencing any beta blockade.

201
Q

QRISK®3 algorithm calculates a person’s risk of developing a

A

heart attack or stroke over the next 10 years
risk factors
Chronic kidney disease, which now includes stage 3 CKD
Migraine
Corticosteroids
Systemic lupus erythematosus (SLE)
atypical antipsychotics
severe mental illness
erectile dysfunction
a measure of systolic blood pressure variability

202
Q

Thiazide diuretics like bendroflumethiazide are known to cause

A

hypercalcaemia

203
Q

An important side effect of PPIs to be aware of is the potential to increase the risk of

A

Clostridium difficile pseudomembranous colitis.

204
Q

Management of an acute anal fissure (< 1 week)

A

soften stool
dietary advice: high-fibre diet with high fluid intake
bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
lubricants such as petroleum jelly may be tried before defecation
topical anaesthetics
analgesia

205
Q

Management of a chronic anal fissure

A

the above techniques should be continued
topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin

206
Q

Causes of false-negative Mantoux test

A 
immunosuppression (miliary TB, AIDS, steroid therapy)
sarcoidosis
lymphoma
extremes of age
fever
hypoalbuminaemia, anaemia
207
Q

In the 2013 guidelines NICE recommend the following requirements for maintenance fluids:

A

25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis

Medicine (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions