Medicine

Question 1

CKD

Answer 1

0-
eGFR >60 and no markers kidney damage

1-
eGFR >90 but markers of kidney damage

2-
eGFR 60-90 with markers of kidney damage

3a-
eGFR 45-60 with or without markers

3b-
eGFR 30-45 with or without markers

4-
eGFR 15-30

5-
eGFR <15

Marker-electrolyte dist/proteinuria

Question 2

eGFR variables

Answer 2

CAGE

creatinine
age
gender
ethnicity

factors that affect-
red meat 12 prior
muscle mass
pregnancy

Question 3

diastolic murmur + AF =

Answer 3

?mitral stenosis

Question 4

most common cause nephrotic syndrome children

Answer 4

minimal change disease (75%)

causes-
drugs
hodgkins lymphoma
thymoma
NSAIDs
glandular fever

only proteinurea not haematuria

steroids then cyclophosphamide

1/3 rule - never again/intermittent/frequent relapses

Question 5

paracetamol poisoning best measure of liver failure

Answer 5

PT over ALP/ALT

Question 6

travellers diarrhoea definition

Answer 6

3+ loose stools in 24 hours with or without cramps, fever, nausea, vomiting or blood in the stool

E. coli commonest cause

Question 7

carbimazole monitoring

Answer 7

council on infections after starting die to agranulocytosis

Question 8

T2DM A1c targets

Answer 8

lifestyle management - 48

lifestyle + MF - 48

any BSL lowering drug - 53

Question 9

First line T2DM mangement

Answer 9

if HbA1c >48

assess CVS risk

if low risk –> MF

if high risk –> MF + SGLT-2 inhibitor

trial MR MF if GI upset

If MF contraindicated—–

SGLT-2i if CVD/CCF

DPP-4/pioglitazone/gliclazide

Question 10

SGLT-2 inhibitors

Answer 10

dapa/empagliflozin

should give if
- QRISK >10
- CVD
- CCF

MF should be uptitrated prior to starting

Question 11

second line T2DM management

Answer 11

already on MF
new target is A1c >53

metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea
metformin + SGLT-2 inhibitor (if NICE criteria met)

Question 12

DPP4i

Answer 12

GLIPTINS

sitagliptin

Question 13

Third line T2DM management

Answer 13

aim A1c <53

metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea

consider insulin therapy

Question 14

Fourth line T2DM management

Answer 14

switch one of the drugs to GLP-1 mimetic
GLUTIDES - semaglutide,leraglutide

only continue if >11 and weight loss 3% reduction A1c at 6 months

starting insulin - stop all bar MF

Question 15

most common drug cause gynaecomastia

Answer 15

spironolactone

Question 16

primary biliary cholangitis

Answer 16

middle aged women
9:1 ration women:men

associated
- Sjogrens (80%)
- RA
- systemic sclerosis
- thyroid disease

presents-
fatigue, itch, lethargy, raised ALP, cholestatic jaundice, hyperpigmentation at pressure points.

AMA - antimitochondrial Abs in 98%
raised serum IgM

management-
urodeoxycholic acid
itch–> cholestyramine
liver transplnt if bili >100

20 fold Increase risk HCC

Question 17

ECG normal variants

Answer 17

sinus bradycardia
junctional rhythm
first degree heart block
Mobitz type 1 (Wenckebach phenomenon)

Question 18

pericarditis

Answer 18

pleuritic CP relieved by leaning forwards

widespread ST elevation

PR depression most specific ECG finding

high risk patients with any trop rise/ fever should be inpatients

all get echo

NSAIDs/colchicine 1-2 weeks then tapering

Question 19

haemochromatosis monitoring

Answer 19

ferritin and transferrin saturation

typical bloods results-

transferrin sat >55% in men >50% women
ferritin >500
raised iron
low TIBC/serum transferrin