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Year 3 Medicine > MedEd Mock 2022 > Flashcards

MedEd Mock 2022 Flashcards

1
Q

What is the first step in the management of query septic arthritis?

A

Needle aspiration and fluid culture

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2
Q

What are the characteristics of a basal cell carcinoma?

A
  • Pearly white
  • Rolled edges
  • Telangectasia
  • Waxy appearance
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3
Q

What are the next steps if basal cell carcinoma is identified in GP setting?

A

If considered low risk, routine referral to dermatology and consultation with dermatology specialists

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4
Q

What is a Coombs test?

A

A test to screen for haemolytic anaemia

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5
Q

How can cholangiocarcinoma and pancreatic cancer be differentiated?

A

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

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6
Q

What is a common cause of cholangiocarcinoma?

A

Primary sclerosing cholangitis

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7
Q

What is the difference between Conn’s syndrome and Phaeochromocytoma?

A

Conn’s syndrome is hyperaldosteronism, phaeochromocytoma is primary hyperadrenalism (hyper-adrenaline)

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8
Q

What are the investigations for phaeochromocytoma?

A
  • 24 hour urine metanephines and catecholamines
  • Plasma catecholamines
  • Serum free metanephines
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9
Q

What is the management of phaeochromocytoma?

A
  1. Alpha blocker eg. phenoxybenzamine
  2. Beta blocker eg. atenolol, propranolol
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10
Q

What is the management of paracetamol overdose?

A

IV N-acetyl cysteine

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11
Q

What does a lead pipe appearance on barium enema indicate?

A

Ulcerative colitis

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12
Q

What is the management of ulcerative colitis?

A

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
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13
Q

What is the management of crohn’s?

A

Induce remission

  • IV prednisolone

Maintain remission

  • Azathioprine
  • Inflixumab
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14
Q

What is the Cushing’s triad?

A
  • Bradycardia
  • Wide pulse pressure
  • Cheyne-Stokes breathing
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15
Q

What are the scoring systems for alcoholism?

A

CAGE= diagnosis of alcoholism

CIWA-Ar= severity of alcohol withdrawal

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16
Q

What is the first line management of someone presenting with alcohol withdrawal?

A

Benzodiazepines

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17
Q

Why is anti-tTG preferred over anti-EMA antobody testing for coeliac disease?

A

Because anti-tTG is cheaper and is more sensitive, although less specific

Anti-EMA (endomysial) should be done if anti-tTG is unavailable

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18
Q

What should patients be told before getting an anti-tTG test?

A

They need to be eating a gluten containing diet for at least 6 weeks before the test

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19
Q

What is the first line management of temporal arteritis?

A

IV methylprednisolone, treatment should not be delayed for investigations

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20
Q

What is the first line imaging for achalasia?

A

Upper GI endoscopy followed by manometry or barium swallow

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21
Q

What is anti-Mi2 associated with?

A

Dermatomyositis

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22
Q

What is anti-Ro associated with?

A

Sjorgen’s syndrome (as well as anti-La)

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23
Q

What is anti-Scl70 associated with?

A

Diffuse cutaneous systemic sclerosis

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24
Q

What are anti-centromere antibodies associated with?

A

Limited cutaneous systemic sclerosis

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25
Q

What is the presentation of c.diff?

A

Watery diarrhoea following long period of hospitalisation/ antibiotic therapy which is commonly green but may be bloody in nature

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26
Q

What is the Rigler sign on x-ray?

A

A sign for pneumoperitoneum

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27
Q

What is the sail sign on x-ray?

A

Left lower lobe collapse

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28
Q

What is the Dome sign on x-ray?

A

A thoracic x-ray which shows air under the diaphragm as a result of ruptured gastric ulcer

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29
Q

What is the presentation of Motor Neuron disease?

A

A combination of upper and lower motor neuron signs, commonly with wasting of the tongue

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30
Q

What are the two acute conditions to consider if a patient presents with abdominal pain that radiates to the back?

A
  • Acute pancreatitis
  • Abdominal aortic aneurysm (rupture)
  • (Aortic dissection if the patient describes a tearing pain)
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31
Q

What is the management of asthma?

A
32
Q

How are COPD and asthma distinguished via spirometry?

A

Both will have an FEV1/FVC ratio <70% as they’re obstructive

  • Asthma will show bronchodilator reversibility
  • COPD will not show bronchodilator reversibility
33
Q

How is heart failure diagnosed via x-ray?

A
  • Alveolar oedema (bat wing distribution)
  • B (Kerley) lines
  • Cardiomegaly
  • Dilated upper lobe vessels
  • Effusion (pulmonary)
34
Q

Why would Rigler’s sign be unlikely to see on chest x-ray?

A

Because it’s largely seen on abdominal x-ray

35
Q

What is the CURB-65 score for pneumonia?

A
  • 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

36
Q

What score is used for pneumonia in a GP setting?

A

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

37
Q

What are the upper vs lower motor neuron symptoms?

A

Upper motor neuron

  • Hyperreflexia
  • Rigidity
  • Spasticity
  • Clonus
  • Up going plantar reflex

Lower motor neuron

  • Hyporeflexia
  • Hypotonia
  • Muscle wasting
38
Q

Which two conditions are characteristically epigastric/ abdominal pain that radiates to the back?

A
  • Pancreatitis
  • Abdominal aortic aneurysm
39
Q

What is the management of asthma?

A
  1. Low dose ICS (+ SABA for symptom control)
  2. Low does ICS + LTRA (+ SABA)
  3. Low dose ICS (+ LTRA if it was working) + LABA (+ SABA)
  4. Low dose ICS (+ LTRA if it was working) + MART
  5. Medium dose ICS + all the rest
  6. High dose ICS + all the rest
40
Q

How are COPD and asthma distinguished on spirometry?

A

Both will show an obstructive pattern (FEV1/ FVC <70)

  • Asthma will have bronchodilator reversibility
  • COPD will not have bronchodilator reversibility
41
Q

Where does HSV lie dormant?

A

In the ganglia of local neurons

42
Q

Which cardiomyopathies displace the apex beat?

A

Dilated cardiomyopathy

43
Q

Which parameters are raised in tumour lysis syndrome?

A
  • Uric acid
  • K+
  • PO43-
  • (Ca2+ decreased due to formation of calcium phosphate crystals)
44
Q

How does tumour lysis syndrome present clinically?

A

Raised uric acid

  • Gout

Raised K+

  • Palpitations
  • Muscle weakness
  • Nausea and vomiting

Raised PO43-

  • Muscle pain

Decreased Ca2+

  • CATS go numb
45
Q

What is the management of a pneumothorax?

A

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
46
Q

What constitutes hospital acquired pneumonia?

A

Pneumonia after 48 hours spent in hospital

47
Q

What is MRSA resistant to?

A
  • All the -cillins
  • Cephalosporins
48
Q

What can MRSA be treated with?

A

Vancomycin

49
Q

What can C.diff be treated with?

A
  • Oral vancomycin
  • Oral metronidazole
50
Q

What would explain a cause of seizure post DKA management?

A

Fluid overload leading to cerebral oedema

51
Q

What is primary hyperparathyroidism?

A

Hyper production of PTH from the parathyroid glands, leading to increased PTH, increased Ca2+ and low PO43-

52
Q

What is secondary hyperparathyroidism?

A

Hyper production of PTH as a result of low Ca2+ levels, therefore bloods will show high PTH, low (/normal) Ca2+ and high (/normal) PO43-

53
Q

What is tertiary hyperparathyroidism?

A

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
54
Q

What is the moa of cinacalcet?

A

Increases sensitivity of Ca2+ receptors on the parathyroid gland, making them more receptive to Ca2+ negative feedback

55
Q

What is the definitive management of hyperparathyroidism?

A

Surgery to remove the parathyroid gland

56
Q

What is the marker for medullary thyroid cancer?

A

Raised calcitonin as it’s produced by the parafollicular cells in the medulla

57
Q

What is the first line treatment of cardiac tamponade?

A

Pericardiocentesis

58
Q

Where is pericardiocentesis performed?

A

Between the xiphisternum and left costal margin with the needle pointing towards the axilla

59
Q

What is Beck’s triad?

A
  • Muffled heart sounds
  • Raised JVP
  • Hypotension
60
Q

What is the difference between open and closed angle glaucoma?

A

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

61
Q

What is the management of open angle glaucoma?

A
  1. Topical prostaglandin analogues (increase humour drainage)
    - Latanoprost drops
    - Travoprost drops
    - Bimatoprost drops
  2. Beta blockers
62
Q

What is the management of closed angle glaucoma?

A
  1. Carbonic anhydrase inhibitors (-zolamide)
  2. Beta blockers
  3. Alpha-2 agonists
63
Q

What is seen on an ABG of Conn’s syndrome?

A

Metabolic alkalosis

64
Q

What is the management of hepatic encephalopathy?

A

Oral lactulose, rifaximin

65
Q

How can variceal bleeding increase the risk of hepatic encephalopathy?

A

Increased digestion of the blood in the gut and therefore increased metabolism of protein by gut bacteria, leading to increased production of NH3

66
Q

What is the traid of ascending cholangitis?

A
  • Right upper quadrant pain
  • Rigors/ fever
  • Jaundice
67
Q

What is the management of ascending cholangitis?

A
  • IV fluids if needed
  • Piperacillin
  • Tazobactam
68
Q

What is the cut off for mammogram vs ultrasound?

A

>35 should be given a mammogram

69
Q

What is the management of acute urinary retention?

A

Catheterisation

70
Q

Which arteries supply the visual field pathways?

A
71
Q

What is visual agnosia?

A

Inability to recognise objects/ people/ things

72
Q

What is Ramsay Hunt syndrome?

A

A shingles infection of the facial nerve that can cause hearing loss in the affected ear, unilateral facial paralysis and a rash

73
Q

What is diclofenac?

A

An NSAID

74
Q

What is the tram tracking sign?

A

A sign on histology characteristic of membranoproliferative glomerulonephritis

75
Q

What is the antobody involved in Goodpastures Syndrome?

A

Anti-GBM (anti-collagen IV)

Year 3 Medicine (22 decks)

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