MedEd Mock 2022 Flashcards
What is the first step in the management of query septic arthritis?
Needle aspiration and fluid culture
What are the characteristics of a basal cell carcinoma?
- Pearly white
- Rolled edges
- Telangectasia
- Waxy appearance
What are the next steps if basal cell carcinoma is identified in GP setting?
If considered low risk, routine referral to dermatology and consultation with dermatology specialists
What is a Coombs test?
A test to screen for haemolytic anaemia
How can cholangiocarcinoma and pancreatic cancer be differentiated?
Clinically and biochemically they’re very similar, CT-MRI and MRCP can distinguish
Pancreatic cancer is much more common, so if a question asks the most likely cause of an obstructive biliary cancer Pancreatic > Cholangiocarcinoma
What is a common cause of cholangiocarcinoma?
Primary sclerosing cholangitis
What is the difference between Conn’s syndrome and Phaeochromocytoma?
Conn’s syndrome is hyperaldosteronism, phaeochromocytoma is primary hyperadrenalism (hyper-adrenaline)
What are the investigations for phaeochromocytoma?
- 24 hour urine metanephines and catecholamines
- Plasma catecholamines
- Serum free metanephines
What is the management of phaeochromocytoma?
- Alpha blocker eg. phenoxybenzamine
- Beta blocker eg. atenolol, propranolol
What is the management of paracetamol overdose?
IV N-acetyl cysteine
What does a lead pipe appearance on barium enema indicate?
Ulcerative colitis
What is the management of ulcerative colitis?
Induce remission
- Oral/ topical Mesalazine (5-ASA)
- Oral beclomethasone
Maintain remission
- Azathioprine
- Inflixumab (TNF-alpha inhibitor)
Can add
- Vedolizumab (integrin blocker)
- Ciclosporin (reduces T-cell activation)
If all unsuccessful
- Total colectomy
What is the management of crohn’s?
Induce remission
- IV prednisolone
Maintain remission
- Azathioprine
- Inflixumab
What is the Cushing’s triad?
- Bradycardia
- Wide pulse pressure
- Cheyne-Stokes breathing
What are the scoring systems for alcoholism?
CAGE= diagnosis of alcoholism
CIWA-Ar= severity of alcohol withdrawal
What is the first line management of someone presenting with alcohol withdrawal?
Benzodiazepines
Why is anti-tTG preferred over anti-EMA antobody testing for coeliac disease?
Because anti-tTG is cheaper and is more sensitive, although less specific
Anti-EMA (endomysial) should be done if anti-tTG is unavailable
What should patients be told before getting an anti-tTG test?
They need to be eating a gluten containing diet for at least 6 weeks before the test
What is the first line management of temporal arteritis?
IV methylprednisolone, treatment should not be delayed for investigations
What is the first line imaging for achalasia?
Upper GI endoscopy followed by manometry or barium swallow
What is anti-Mi2 associated with?
Dermatomyositis
What is anti-Ro associated with?
Sjorgen’s syndrome (as well as anti-La)
What is anti-Scl70 associated with?
Diffuse cutaneous systemic sclerosis
What are anti-centromere antibodies associated with?
Limited cutaneous systemic sclerosis
What is the presentation of c.diff?
Watery diarrhoea following long period of hospitalisation/ antibiotic therapy which is commonly green but may be bloody in nature
What is the Rigler sign on x-ray?
A sign for pneumoperitoneum
What is the sail sign on x-ray?
Left lower lobe collapse
What is the Dome sign on x-ray?
A thoracic x-ray which shows air under the diaphragm as a result of ruptured gastric ulcer
What is the presentation of Motor Neuron disease?
A combination of upper and lower motor neuron signs, commonly with wasting of the tongue
What are the two acute conditions to consider if a patient presents with abdominal pain that radiates to the back?
- Acute pancreatitis
- Abdominal aortic aneurysm (rupture)
- (Aortic dissection if the patient describes a tearing pain)
What is the management of asthma?
How are COPD and asthma distinguished via spirometry?
Both will have an FEV1/FVC ratio <70% as they’re obstructive
- Asthma will show bronchodilator reversibility
- COPD will not show bronchodilator reversibility
How is heart failure diagnosed via x-ray?
- Alveolar oedema (bat wing distribution)
- B (Kerley) lines
- Cardiomegaly
- Dilated upper lobe vessels
- Effusion (pulmonary)
Why would Rigler’s sign be unlikely to see on chest x-ray?
Because it’s largely seen on abdominal x-ray
What is the CURB-65 score for pneumonia?
- Confusion
- Urea >7 mmol/L
- Resp rate >30
- Blood pressure systolic <90, diastolic <60
- Age >= 65
A score of >=3 indicates urgent admission to hospital
What score is used for pneumonia in a GP setting?
CRB-65, urea needs to be sent off to the lab to interpret and therefore in the acute setting it is omitted
Score >=3 indicates urgent admission to hospital
What are the upper vs lower motor neuron symptoms?
Upper motor neuron
- Hyperreflexia
- Rigidity
- Spasticity
- Clonus
- Up going plantar reflex
Lower motor neuron
- Hyporeflexia
- Hypotonia
- Muscle wasting
Which two conditions are characteristically epigastric/ abdominal pain that radiates to the back?
- Pancreatitis
- Abdominal aortic aneurysm
What is the management of asthma?
- Low dose ICS (+ SABA for symptom control)
- Low does ICS + LTRA (+ SABA)
- Low dose ICS (+ LTRA if it was working) + LABA (+ SABA)
- Low dose ICS (+ LTRA if it was working) + MART
- Medium dose ICS + all the rest
- High dose ICS + all the rest
How are COPD and asthma distinguished on spirometry?
Both will show an obstructive pattern (FEV1/ FVC <70)
- Asthma will have bronchodilator reversibility
- COPD will not have bronchodilator reversibility
Where does HSV lie dormant?
In the ganglia of local neurons
Which cardiomyopathies displace the apex beat?
Dilated cardiomyopathy
Which parameters are raised in tumour lysis syndrome?
- Uric acid
- K+
- PO43-
- (Ca2+ decreased due to formation of calcium phosphate crystals)
How does tumour lysis syndrome present clinically?
Raised uric acid
- Gout
Raised K+
- Palpitations
- Muscle weakness
- Nausea and vomiting
Raised PO43-
- Muscle pain
Decreased Ca2+
- CATS go numb
What is the management of a pneumothorax?
Primary
- <2cm scan and send home, review in 2-4 weeks
- >2cm fine needle aspiration and if unsuccessful chest drain
Secondary
- <2cm fine needle aspiration
- >2cm chest drain
What constitutes hospital acquired pneumonia?
Pneumonia after 48 hours spent in hospital
What is MRSA resistant to?
- All the -cillins
- Cephalosporins
What can MRSA be treated with?
Vancomycin
What can C.diff be treated with?
- Oral vancomycin
- Oral metronidazole
What would explain a cause of seizure post DKA management?
Fluid overload leading to cerebral oedema
What is primary hyperparathyroidism?
Hyper production of PTH from the parathyroid glands, leading to increased PTH, increased Ca2+ and low PO43-
What is secondary hyperparathyroidism?
Hyper production of PTH as a result of low Ca2+ levels, therefore bloods will show high PTH, low (/normal) Ca2+ and high (/normal) PO43-
What is tertiary hyperparathyroidism?
Chronically low Ca2+ leading to secondary hyperparathyroidism, until eventually the parathyroid glad becomes hyperplastic and PTH levels massively increase
Blood result
- PTH very high
- Ca2+ normal or slightly raised
- PO43- raised
What is the moa of cinacalcet?
Increases sensitivity of Ca2+ receptors on the parathyroid gland, making them more receptive to Ca2+ negative feedback
What is the definitive management of hyperparathyroidism?
Surgery to remove the parathyroid gland
What is the marker for medullary thyroid cancer?
Raised calcitonin as it’s produced by the parafollicular cells in the medulla
What is the first line treatment of cardiac tamponade?
Pericardiocentesis
Where is pericardiocentesis performed?
Between the xiphisternum and left costal margin with the needle pointing towards the axilla
What is Beck’s triad?
- Muffled heart sounds
- Raised JVP
- Hypotension
What is the difference between open and closed angle glaucoma?
Closed angle glaucoma is due to a reduced irido-corneal angle leading to reduced drainage and sudden increase in intra-ocular pressure
Open angle glaucome is due to reduced drainage of the trabecular network
Both are hereditory
What is the management of open angle glaucoma?
- Topical prostaglandin analogues (increase humour drainage)
- Latanoprost drops
- Travoprost drops
- Bimatoprost drops - Beta blockers
What is the management of closed angle glaucoma?
- Carbonic anhydrase inhibitors (-zolamide)
- Beta blockers
- Alpha-2 agonists
What is seen on an ABG of Conn’s syndrome?
Metabolic alkalosis
What is the management of hepatic encephalopathy?
Oral lactulose, rifaximin
How can variceal bleeding increase the risk of hepatic encephalopathy?
Increased digestion of the blood in the gut and therefore increased metabolism of protein by gut bacteria, leading to increased production of NH3
What is the traid of ascending cholangitis?
- Right upper quadrant pain
- Rigors/ fever
- Jaundice
What is the management of ascending cholangitis?
- IV fluids if needed
- Piperacillin
- Tazobactam
What is the cut off for mammogram vs ultrasound?
>35 should be given a mammogram
What is the management of acute urinary retention?
Catheterisation
Which arteries supply the visual field pathways?
What is visual agnosia?
Inability to recognise objects/ people/ things
What is Ramsay Hunt syndrome?
A shingles infection of the facial nerve that can cause hearing loss in the affected ear, unilateral facial paralysis and a rash
What is diclofenac?
An NSAID
What is the tram tracking sign?
A sign on histology characteristic of membranoproliferative glomerulonephritis
What is the antobody involved in Goodpastures Syndrome?
Anti-GBM (anti-collagen IV)
