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MSRA > Medicine > Flashcards

Medicine Flashcards

1
Q

When to give O2 in MI

A

If sats <94%

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2
Q

Mx of Ramsay Hunt

A

oral aciclovir and corticosteroids are usually given

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3
Q

Obstructive vs restrictive pul function test

A

Obstructive
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced

Restrictive
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased

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4
Q

Examples of obstructive vs restrictive

A

Restrictive
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders

Obs
Asthma
BE
COPD

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5
Q

To who are pneumococcal vaccinations offered to

A

65 years and those with:
Spleen
Resp disease- Asthma is only included if ‘it requires the use of oral steroids at a dose sufficient to act as a significant immunosuppressant’

chronic heart disease

chronic kidney disease (at stages 4 and 5, nephrotic syndrome, kidney transplantation)

chronic liver disease

immunosuppression (either due to disease or treatment). This includes patients with any stage of HIV infection

cochlear implants

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6
Q

Who is influenza vaccine offered to

A

chronic respiratory disease

chronic heart disease

chronic kidney disease (at stages 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation)
chronic liver disease: cirrhosis, biliary atresia, chronic hepatitis

chronic neurological disease: (e.g. Stroke/TIAs)

diabetes mellitus (including diet controlled)

immunosuppression due to disease or treatment (e.g. HIV)

asplenia or splenic dysfunction

pregnant women

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7
Q

Other than abx what increases risk of C diff

A

PPI

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8
Q

Third nerve palsy

A

Down and out
ptosis
‘down and out’ eye
dilated, fixed pupil

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9
Q

IV and VI palsy

A

IV- vertical diplopia

VI - horizontal diplopia

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10
Q

Anaphylaxis doses

A

6 months
100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)

6 months - 6 years
150 micrograms (0.15 ml 1 in 1,000)

6-12 years
300 micrograms (0.3ml 1 in 1,000)

Adult and child > 12 years
500 micrograms (0.5ml 1 in 1,000)

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11
Q

Drugs causing torsades

A

Antiarrhythmics (e.g. amiodarone, sotalol)

Antibiotics (e.g. erythromycin, clarithromycin, ciprofloxacin)

Psychotropic drugs (e.g. serotonin reuptake inhibitors, tricyclic antidepressants, neuroleptic agents)

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12
Q

Hereditary haemorrhagic telangiectasia SX

A

epistaxis

telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)

visceral lesions

family history

2/4

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13
Q

CT head in <1hr

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

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14
Q

CT head <8 hrs

A

some loss of consciousness or amnesia since the injury:
age 65 years or older

any history of bleeding or clotting disorders including anticogulants

dangerous mechanism of injury

more than 30 minutes’ retrograde amnesia of events immediately before the head injury

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15
Q

What can accentuate digoxin toxicity

A

HypoK

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16
Q

Long term prophylaxis for cluster headaches and acute tx

A

Verapamil- proph

Sumatriptan is used as an acute rescue therapy (along with high-flow oxygen)

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17
Q

Step ladder for asthma

A

1- SABA
2- SABA + low-dose inhaled corticosteroid (ICS)

3- SABA + low-dose ICS + leukotriene receptor antagonist (LTRA)

4- SABA + low-dose ICS + long-acting beta agonist (LABA)
Continue LTRA depending on patient’s response to LTRA

5- Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS

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18
Q

UTI tx

A

NICE recommend trimethoprim or nitrofurantoin for 3 days
send a urine culture if:
aged > 65 years
visible or non-visible haematuria

Men - 7 days

Preg- nitro then amoxicillin
7 days
Culture

Catheter- 7 days
Do not treat asymptomatic

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19
Q

Step down of asthma

A

step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids

3 months

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20
Q

Mx of Addisons with intercurrent illness

A

glucocorticoid dose should be doubled, with the fludrocortisone dose staying the same

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21
Q

Reactive arthritis sx

A

typically develops within 4 weeks of initial infection - symptoms generally last around 4-6 months

arthritis is typically an asymmetrical oligoarthritis of lower limbs
dactylitis

symptoms of urethritis

conjunctivitis (seen in 10-30%)
anterior uveitis

circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica

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22
Q

Who qualifies for FITT testing

A

with an abdominal mass

with a change in bowel habit

with iron-deficiency anaemia, or

aged 40 and over with unexplained weight loss and abdominal pain, or

aged under 50 with rectal bleeding and either of the following unexplained symptoms:
abdominal pain
weight loss, or

aged 50 and over with any of the following unexplained symptoms:
rectal bleeding
abdominal pain
weight loss, or

aged 60 and over with anaemia even in the absence of iron deficiency

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23
Q

Cavitating lesion in CXR in alcoholic

A

Klebsiella

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24
Q

SE of thyroxine therapy

A

hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation

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25
Q

What reduces levo absorption

A

Iron and CaCO3

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26
Q

Where Pagets affects

A

Paget’s disease of the bone generally affects the skull, spine/pelvis, and long bones of the lower extremities

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27
Q

Tx of bradycardia

A

IV atropine

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28
Q

Pagets Mx

A

Bisphosphonates

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29
Q

Somatisation disorder vs conversion

A

Somatisation disorder
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results

Conversion
typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms

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30
Q

Asthma classification

A

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

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

Life threatening
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

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31
Q

Cauda Equina sx

A

low back pain
bilateral sciatica
present in around 50% of cases
reduced sensation/pins-and-needles in the perianal area
decreased anal tone
it is good practice to check anal tone in patients with new-onset back pain
however, studies show this has poor sensitivity and specificity for CES
urinary dysfunction

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32
Q

When to sync DC cardiovert

A

tachycardia and signs of shock, syncope, myocardial ischaemia or heart failure should receive up to 3 synchronised DC shocks

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33
Q

Mx of TIA

A

be given aspirin 300 mg immediately unless contraindicated
clopidogrel (initial dose 300 mg followed by 75 mg od) + aspirin (initial dose 300 mg followed by 75 mg od for 21 days) followed by monotherapy with clopidogrel 75 mg od

assessed urgently within 24 hours by a stroke specialist clinician

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34
Q

Argyll-Robertson pupil.

A

Accommodate but do not respond to light

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35
Q

?PMR no response to steroids

A

Stop steroids consider alternative

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36
Q

RA mx

A

Rheumatoid arthritis: initial management is conventional DMARD monotherapy (usually methotrexate), often with short-term bridging corticosteroid

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37
Q

VWD biochem

A

Prolonged bleeding Normal plt and PT
Prolonged APTT

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38
Q

Acute haemolytic reaction sx

A

Fever, abdo pain, hypotension

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39
Q

GLliclazie MOA

A

bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cell causing release of insulin

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40
Q

When can you have sildenafil after having an MI

A

6 months

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41
Q

Driving after TIA

A

Can drive if symptom free after 1 month- no need to inform DVLA

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42
Q

Internuclear ophthalmoplegia

A

Lesion of the medial longitudinal fasciculus (MLF), a tract that allows conjugate eye movement.

This results in impairment of adduction of the ipsilateral eye. The contralateral eye abducts, however with nystagmus

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43
Q

IgA nephropathy vs post strep GN

A

IgA
1-2 days after URTI

PS GN
1-2 weeks after URTI

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44
Q

UC vs Crohns

A

UC- Continuous
Mucosal
Bloody
PSC
Uveitis
Pseudopolyps
Crypt Abcesses

Crohns
Skip lesion
Obstruction, fistulas
All layers
Goblet cells
Gallstones

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45
Q

Antiphospholipid mx during pregnancy

A

Aspirin and LMWH

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46
Q

Grading of COPD severity

A

FEV1
>80 mild
50-79 mod
30-49 Severe
<30 Very severe

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47
Q

MG symptoms

A

Other symptoms may include extraocular muscle weakness or ptosis
Dysphagia with liquids as well as solids
Tiredness with activity

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48
Q

Mx of TB

A

Initial phase - first 2 months (RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Continuation phase - next 4 months
Rifampicin
Isoniazid

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49
Q

Homonymous quadrantanopia lesion location

A

PITS (Parietal-Inferior, Temporal-Superior)

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50
Q

standard HbA1c target in type 2 diabetes

A

48

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51
Q

Cause of gynaecomastia

A

spironolactone (most common drug cause)
cimetidine
digoxin
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

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52
Q

Medical mx of ascites secondary to liver cirrhosis

A

Spironolactone

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53
Q

Pathogen associated with GBS

A

C jejeuni

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54
Q

Miller Fisher syndrome

A

associated with ophthalmoplegia, areflexia and ataxia. The eye muscles are typically affected first
usually presents as a descending paralysis rather than ascending as seen in other forms of Guillain-Barre syndrome

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55
Q

Persistant ST elevation post MI with no chest pain

A

Left ventricular aneurysm

Thrombus may form within the aneurysm increasing the risk of stroke. Patients are therefore anticoagulated.

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56
Q

Dressler syndrome

A

2-6 weeks following a MI.

fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.

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57
Q

Hypotension, pul oedema and early-to-mid systolic murmur post MI

A

Acute mitral regurgitation

More common with infero-posterior infarction and may be due to ischaemia or rupture of the papillary muscle.

Patients are treated with vasodilator therapy but often require emergency surgical repair.

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58
Q

Impaired fasting and glucose tolerance

A

Fasting - 6.1- 7

Tolerance - 7.8-11.1

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59
Q

Timing of PE treatment

A

Provoked 3 months
Unprovoked 6 months

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60
Q

IBS symptoms

A

altered stool passage (straining, urgency, incomplete evacuation)
abdominal bloating (more common in women than men), distension, tension or hardness
symptoms made worse by eating
passage of mucus

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61
Q

Measures risk of stroke in someone with AF

A

CHADVASC2

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62
Q

ACE exam results

A

/100
<82 dementia

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63
Q

HUS sx and mx

A

bloody diarrhoea- E coli
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia

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64
Q

What does MND not affect

A

doesn’t affect external ocular muscles
no cerebellar signs
abdominal reflexes are usually preserved and sphincter dysfunction if present is a late feature

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65
Q

CHADVASC score

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, TIA or thromboembolism 2
V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1
S Sex (female) 1

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66
Q

Lyme disease

A

Bulls eye
Painless

headache
lethargy
fever
arthralgia

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67
Q

ECG for pericarditis

A

PR depression
Saddle ST elevation

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68
Q

Rhabdomyolysis biochem

A

How Ca
High P, K, urea, CK
Metabolic acidosis

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69
Q

Glipitins MOA

A

Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1

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70
Q

What alters urea breath test

A

no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

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71
Q

Giardiasis sx

A

Ongoing diarrhoea, lethargy, bloating, flatulence, steatorrhoea, weight loss +/- recent travel

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72
Q

Amoebiasis sx

A

often asymptomatic, but when symptoms do occur it will often present with dysentery (severe diarrhoea with blood and mucous).

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73
Q

CI to triptans

A

Ischaemic heart disease

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74
Q

When should you stop taking PPI before OGD

A

2 weeks

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75
Q

Most common extra intestinal manifestation to IBD

A

Arthritis

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76
Q

Painful vs non panful genital ulcer

A

Non painful- Treponema

Painful- H ducreyi - chancroid

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77
Q

Mx of AF

A

< 48 hours: rate or rhythm control
≥ 48 hours or uncertain (e.g. patient not sure when symptoms started): rate control

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78
Q

Abx for meningitis

A

3 months - 50 years: BNF recommends cefotaxime (or ceftriaxone)
> 50 years: BNF recommends cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin) for adults

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79
Q

Confirming HTN dx

A

using ABPM to confirm a diagnosis of hypertension, two measurements per hour are taken during the persons waking hours. The average value of at least 14 measurements are then used to confirm a diagnosis of hypertension

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80
Q

Black blisters, foul smelling

A

C perfirneges

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81
Q

Mx of suspected TIA

A

If on anticoagulants or who have a bleeding disorder should have urgent imaging to exclude haemorrhage.

Other patients should be given 300mg of aspirin immediately then assessed by a specialist within 24 hours.

Aspirin + clop for 21 days 75mg
Long term clopi

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82
Q

What extra medication should a patient with Addisons be prescribed

A

Patients with Addison’s should be given a hydrocortisone injection kit for adrenal crises

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83
Q

Mx if T2DM

A

Metformin - add sulfonylurea if HF

MR metformin if GI symptoms
If not tolerated

If HF or CVD or CVD risks- sulfonylurea mono

If not DPP4(gliptin), pio, or sulfonulyrea

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84
Q

Mx of COPD

A

SABA or SAMA

No asthmatic features/features suggesting steroid responsiveness
+ (LABA) + (LAMA)
if already taking a SAMA, discontinue and switch to a SABA

Asthmatic features/features suggesting steroid responsiveness
LABA + inhaled corticosteroid (ICS)

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85
Q

Asthmatic features of COPD

A

previous diagnosis of asthma or atopy
a higher blood eosinophil count
substantial variation in FEV1 over time (at least 400 ml)
substantial diurnal variation in peak expiratory flow (at least 20%)

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86
Q

Angina mx

A

Beta blocker/CCB - verapamil or diltiazem

still symptomatic after monotherapy with a beta-blocker add a calcium channel blocker and vice versa

If unable to tolerate CCB
a long-acting nitrate
ivabradine
nicorandil
ranolazine

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87
Q

Confirming food allergies

A

Skin prick test

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88
Q

Tests prior to starting TB treatment

A

U+E
LFT
Vision
FBC

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89
Q

Reversal of dabigatran

A

Idraarucizumab

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90
Q

Microprolactinoma mx

A

Bromocriptine /cabergoline
Surgery if medical not tolerated

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91
Q

Uhthoff’s phenomenon vs Lhermitte’s syndrome

A

Uhthoff’s phenomenon: worsening of vision following rise in body temperature

Lhermitte’s syndrome: paraesthesiae in limbs on neck flexion

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92
Q

Diarrheoa with clopi post stroke

A

Change to aspirin

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93
Q

Ix for NAFLD

A

enhanced liver fibrosis (ELF) testing is recommended to aid diagnosis of liver fibrosis

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94
Q

Mx of cervical myopathy

A

Cervical decompression surgery

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95
Q

Tx of UTI third trimester

A

Amox/cef

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96
Q

Needle stick injury - from hep B +ve

A

give an accelerated course of the hepatitis B vaccine + hepatitis B immune globulin.

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97
Q

UC flare management

A

Mild/mod
proctitis
topical (rectal) aminosalicylate:

proctosigmoiditis and left-sided ulcerative colitis
topical (rectal) aminosalicylate

extensive disease
topical (extending past the left-sided colo)
(rectal) aminosalicylate and a high-dose oral aminosalicylate

If first line fails- add oral steroid

Severe- IV steroids

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98
Q

SeverUC classification

A

: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

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99
Q

B thala trait bloods

A

mild hypochromic, microcytic anaemia - microcytosis is characteristically disproportionate to the anaemia
HbA2 raised (> 3.5%)

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100
Q

Adrenaline vs amiodarone in ALS

A

Adrenaline
adrenaline 1 mg as soon as possible for non-shockable rhythms
during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock
repeat adrenaline 1mg every 3-5 minutes whilst ALS continues

amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.
a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered
lidocaine used as an alternative

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101
Q

Most important intervention to reduce flares with Crohns

A

Stop smoking

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102
Q

Rounded opacity in the right upper zone surrounded by a rim of air.

A

Aspergilloma

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103
Q

Granulomatosis with polyangiitis

A

Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Glomerulonephritis
Saddle-shape nose deformity

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104
Q

Prophylaxis of variceal haemorrhage

A

Propanolol

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105
Q

Indications for surgery in bronchiectasis

A

The main 2 indications for bronchiectasis are uncontrollable haemoptysis and localised disease

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106
Q

Degenerative cervical myelopathy

A

Progressive
Pain
Loss of motor function (loss of digital dexterity, preventing simple tasks such
Loss of sensory function causing numbness
Hoffman’s sign

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107
Q

Electrical alternans

A

Alternating QRS amplitude

Seen in cardiac tamponade

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108
Q

Genital wart symptoms and mx

A

small (2 - 5 mm) fleshy protuberances which are slightly pigmented
may bleed or itch

multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy

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109
Q

Weber syndrome

A

ipsilateral CN III palsy and contralateral hemiparesis

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110
Q

Mycoplasma infection sx

A

worsening flu-like symptoms and a dry cough. Erythema multiforme is noted on examination

Abdo pain, hyponatraemia

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111
Q

Hepatic encephalopathy mx

A

Lactulose

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112
Q

Ix for H pylori

A

Urea breath test

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113
Q

Bradycardia with signs of shock

A

Atropine
Transcutaneous pacing

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114
Q

What medication makes clopidogrel less effective

A

Omeprazole

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115
Q

When to stop ACEi with renal function

A

if the creatinine increases by 30% or eGFR falls by 25% or greater.

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116
Q

What can cause a high BNP

A

GFR < 60 ml/min
Sepsis
COPD
Diabetes

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117
Q

Gram neg diplococci on vag swab and mx

A

Gonorrhoea
IM cef

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118
Q

Which extra-intestinal manifestations of Crohn’s disease is related to disease activity?

A

Erythema nodosum

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119
Q

ECG changes after large transfusion of blood

A

HyperK

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120
Q

Drugs causing galactorrhoea

A

metoclopramide, domperidone
Chlorpramzine
haloperidol

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121
Q

Vit B2 deficiency (niacian)

A

Pellagra
dermatitis
diarrhoea
dementia

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122
Q

Vit B9 deficiency

A

Folic acid
Megaloblastic anaemia, deficiency during pregnancy - neural tube defects

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123
Q

Common SE of sulfonylurea

A

hypoglycaemic episodes
weight gain

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124
Q

Small cell carcinoma neuroendocrine disorders

A

ACTH
ADH
Lambert Eaton syndrome

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125
Q

High calcitonin which thyroid cancer

A

Medullary

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126
Q

Recurrent C diff tx

A

A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with oral fidaxomicin

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127
Q

Imaging for suspected fistula in Crohns

A

MRI pelvis

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128
Q

ECG features of WPW

A

short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway

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129
Q

CURB 65 score

A

C Confusion (abbreviated mental test score <= 8/10)
U urea > 7 mmol/L
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years

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130
Q

Pneumocystis jiroveci penumonia mx

A

Cotrim

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131
Q

When should you give cryoprecipitate in bleeding

A

If fibrinogen is low

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132
Q

Types of MND

A

ALS- UMN and LMN
PBP- bulbar
PMA - LMN
PLS - UMN

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133
Q

Rules after pneumonthroax

A

Avoid deep sea diving for life

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134
Q

nuchal rigidity and hyperreflexia A CT head shows bilateral hypodensities in the temporal lobes.

A

Herpes simplex encephalitis

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135
Q

Idiopathic intracranial hypertension

A

Obese, young female with headaches / blurred vision

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136
Q

C diff treatment

A

first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole

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137
Q

Which anti-anginal medication do patients commonly develop tolerance to?

A

SR Isosorbide mononitrate

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138
Q

Pneumonia after influenza

A

Staph aureus

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139
Q

AI hepatitis sx

A

Anti SMA
Anti liver /kidney microsomal
Tender liver
Raised LFTs

Young females
Secondary amennorhoea

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140
Q

PBC vs PSC

A

PBC
Hepatic ducts
AMA
Granuloma

PSC
Extraheptic
Onion skin
UC

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141
Q

Hyperkalaemia ECG

A

Wide QRS
Tented T waves
flattened P wave, prolonged PR interval, ST depression

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142
Q

Mx of Graves

A

propranolol is used to help block the adrenergic effects

carbimazole is started at 40mg and reduced gradually to maintain euthyroidism
typically continued for 12-18 months

Radioiodine treatment
often used in patients who relapse following ATD therapy or are resistant

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143
Q

Mx of hiccups in pall care

A

Chlorpromazine

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144
Q

Mx of SVT in asthmatics

A

Verapamil

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145
Q

Erysipelas affects?

A

Upper dermis and lymphatics

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146
Q

Myelofibrosis sx

A

‘tear-drop’ poikilocytes on blood film

Dry tap

elderly person with symptoms of anaemia e.g. fatigue
massive splenomegaly

hyperplasia of abnormal megakaryocytes
the resultant release of platelet derived growth factor is thought to stimulate fibroblasts
haematopoiesis develops in the liver and spleen

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147
Q

AKI stages

A

1- 1.5-2 or <0.5 urine >6hr
2- 2-3 or <0.5 >12 hrs
3- >3 or <0.3 for >24 hr or anuric

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148
Q

Statin before attempting to conceive

A

Stop statin

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149
Q

Thiazide effects on ca

A

Hypercalcaemia

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150
Q

Tests prior to amiodarone tx

A

TFT
LFT
U+E
CXR

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151
Q

Conditions pre disposing to pericarditis

A

SLE
RA
Post MI

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152
Q

hyper-pigmentation of the palmar creases- endocrine

A

Addisons

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153
Q

Mx of ITP

A

Oral steroids

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154
Q

Sx and mx of Blood product transfusion complications

A

Non-haemolytic febrile reaction- isolated pyrexia
Paracetamol

Minor allergic reaction- Pruritus, urticaria
Antihistamines
Temp stop infusion

Anaphylaxis- Hypotension, dyspnoea, wheezing, angioedema.
Stop, IM adrenaline

Acute haemolytic reaction- Fever, abdominal pain, hypotension
Stop and supportive care

Transfusion-associated circulatory overload - Pulmonary oedema, hypertension
Stop, consider diuretics

Transfusion-related acute lung injury (TRALI)- Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension
Stop, O2 care

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155
Q

What would over estimate Hba1c

A

Splenectomy
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia

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156
Q

Tx of legionella

A

Macrolides

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157
Q

Laxative for IBS

A

Ispahula husk

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158
Q

Mx nausea of migraine

A

Metoclopramide

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159
Q

Mx of nausea from chemo

A

Ondansetron

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160
Q

Most affected site in Crohns

A

Ileum

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161
Q

Marker to be checked after Heb B immunisation

A

Anti HBs

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162
Q

Thrombolysis and thrombectomy timings

A

Thrombectomy in 6 hours and thrombolysis- <4.5 hrs if proximal anterior

or
thrombectomy -who were last known to be well between 6 hours and 24 hours previously (including wake-up strokes):
confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA

Thrombolysis- <4.5 hrs
BP <185/110

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163
Q

Presents with hemiparesis, pul oedema, ST elevation

A

Left ventricular thromboembolism

Persistent ST elevation after previous MI, is very suggestive of a left ventricle aneurysm.

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164
Q

Lights criteria

A

Effusion lactate dehydrogenase (LDH) level greater than 2/3 the upper limit of serum LDH

Pleural fluid LDH divided by serum LDH >0.6

Pleural fluid protein divided by serum protein >0.5

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165
Q

Rash in Lyme disease

A

Erythema migrans

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166
Q

Diagnosis of mycoplasma

A

Serology

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167
Q

Primary/secondary Syphillis sx and mx

A

1- Painless single genital lesion

2- A non-itchy rash appears, usually on the palms and soles of the feet, buccal ulcers

IM Benzathine penicillin

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168
Q

Imaging for stroke

A

Non contrast CT head

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169
Q

Types of seizures

A

Focal seizures-
these start in a specific area, on one side of the brain
the level of awareness can vary in focal seizures. The terms focal aware (previously termed ‘simple partial’), focal impaired awareness (previously termed ‘complex partial’)

General
tonic-clonic (grand mal)
tonic
clonic
typical absence (petit mal)
atonic

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170
Q

Define status evilepticus

A

a single seizure lasting >5 minutes, or
>= 2 seizures within a 5-minute period without the person returning to normal between them

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171
Q

Important cause of SE to rule out first

A

Hypoglycaemia and hypoxia

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172
Q

Mx of SE

A

Prehospital setting PR diazepam or buccal midazolam may be given
in hospital IV lorazepam is generally used. This may be repeated once after 5-10minutes

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173
Q

Medical management of acromegaly

A

Octreotide

174
Q

Mx of prostatis

A

Cipro

175
Q

Painful blisters and ulcers that have appeared on his glans mx

A

Aciclovir

176
Q

Mx of AF

A

< 48 hours: rate or rhythm control
≥ 48 hours or uncertain (e.g. patient not sure when symptoms started): rate control
if considered for long-term rhythm control, delay cardioversion until they have been maintained on therapeutic anticoagulation for a minimum of 3 weeks

177
Q

Anti epileptic most associated with weight gain

A

Sodium valproate

178
Q

BV in pregnancy

A

Metronidazole

179
Q

Hypertensive 66yo DM

A

Ramipril

180
Q

Mx of monomorphic tachy, QRS wide, normotensive

A

Amiodarone

181
Q

Mx of bacterial meningitis

A

Def and dex (dex improves nerd outcomes such as deafness)

182
Q

How long can you not drive for after unprovoked seizure with normal imaging and EEG

A

6 months

183
Q

Driving rules with syncope

A

simple faint: no restriction
single episode, explained and treated: 4 weeks off
single episode, unexplained: 6 months off
two or more episodes: 12 months off

184
Q

Which group should be offered HPV vaccine for first time

A

Boys and girls 12-13

185
Q

Mefloquine SE

A

Neuropsychiatric disturbance

Contraindicated in epilepsy

186
Q

Conduction issues in inferior vs anterior MI

A

Inferior- AV

Anterior- BBB

187
Q

Tx of trigeminal neuralgia

A

Carbamazepine

188
Q

When should bupropion not be prescribed

A

In patients with epilepsy.

189
Q

Mx of campylobacter

A

Clarithromycin

190
Q

Symptomatic UTI in catheterised patients

A

Change catheter and Abx 7d

191
Q

MSRA +ve skin tx

A

Nasal mupriocin
Chlorhexidine for skin

192
Q

New onset diabetes and WL in elder ix

A

CT for pancreatic cancer

193
Q

Crises in sickle cell

A

Thrombotic
Painful crises or vaso-occlusive crises
precipitated by infection, dehydration, deoxygenation

Acute chest
vaso-occlusion within the pulmonary microvasculature → infarction in the lung parenchyma
dyspnoea, chest pain, pulmonary infiltrates on chest x-ray, low pO2

Aplastic crises
caused by infection with parvovirus
sudden fall in haemoglobin
Reduced reticulocyte count

Sequestration crises
sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia
associated with an increased reticulocyte count

194
Q

Pregnant, clue cells on swab tx?

A

Metronidazole BD 7d

195
Q

Prophylaxis of oesophageal vatical bleeding

A

Propanolol

196
Q

How many tetanus shots for lifelong protection

A

5

197
Q

Chronic diabetic nephropathy on USS

A

Large/normal sized kidneys on ultrasound whereas most patients with chronic kidney disease have bilateral small kidneys

198
Q

How often should Sickle cell patients receive the pneumococcal polysaccharide vaccine

A

5 years

199
Q

Left ventricular free wall rupture sx

A

1-2 weeks afterwards. Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy are required.

200
Q

Pericarditis vs Dressler

A

Pericarditis is early
Dressler >2w

201
Q

Negative prognostic factors for lymphoma

A

The presence of B symptoms (night sweats, weight loss and fever)
Male gender
Being aged >45 years old at diagnosis
High WCC, low Hb, high ESR or low blood albumin

202
Q

Medical mx of ascites

A

Spiro

203
Q

ABG triad for chronic CO2 retention:

A

Normal pH
High pCO2
High HCO3

204
Q

Mx of Phaeochromocytoma

A

PHenoxybenzamine

205
Q

management of delirium in palliative care patients

A

oral haloperidol

206
Q

Diabetes diagnosis

A

Diabetes meliitus diagnosis: fasting > 7.0, random > 11.1 - if asymptomatic need two readings

207
Q

Calculation of alcohol units

A

Alcohol units = volume (ml) * ABV / 1,000

208
Q

What BP should people stop driving at

A

If consistently above 180 systolic or 100 diastolic

209
Q

Levodopa SE

A

dry mouth
anorexia
palpitations
postural hypotension
psychosis

dyskinesias at peak dose: dystonia, chorea and athetosis (involuntary writhing movements)

210
Q

Patient hypertensive on acei, CCB and thiazide like diuretic, what next

A

Spiro if K <4.5
If >4.5- a/b blocker

211
Q

When to investigate haematuria in 2WW

A

Aged >= 45 years AND:
unexplained visible haematuria without urinary tract infection, or
visible haematuria that persists or recurs after successful treatment of urinary tract infection

Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test

212
Q

One day following a thrombolysed inferior myocardial infarction a 72-year-old man develops signs of left ventricular failure. His blood pressure drops to 100/70mmHg. On examination he has a new early-to-mid systolic murmur.

A

This patient has developed acute mitral regurgitation secondary to papillary muscle rupture.

213
Q

Abx for neutropenic sepsis

A

Tazocin

214
Q

Mechanisms of renal transplant rejection

A

Hyperacute rejection (minutes to hours)
due to pre-existing antibodies against ABO or HLA antigens
an example of a type II hypersensitivity reaction
leads to widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ
no treatment is possible and the graft must be removed

Acute graft failure (< 6 months)
usually due to mismatched HLA. Cell-mediated (cytotoxic T cells)
usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria
other causes include cytomegalovirus infection
may be reversible with steroids and immunosuppressants

Causes of chronic graft failure (> 6 months)
both antibody and cell-mediated mechanisms cause fibrosis to the transplanted kidney (chronic allograft nephropathy)

215
Q

Witnessed cardiac arrest

A

if the cardiac arrested is witnessed in a monitored patient (e.g. in a coronary care unit) then the 2015 guidelines recommend ‘up to three quick successive (stacked) shocks’, rather than 1 shock followed by CPR

216
Q

Anti emetic causing hyperprolactinaemia

A

Prochlorperazine

217
Q

What must be treated prior to thrombolysis

A

Hypertension (>185/110 mmHg)
With labetalol

218
Q

Anti Hbs levels after Hep B vaccine and mx

A

> 100 good response - - booster in 5 yrs

10-100 suboptimal- 1 further dose

<10 Non responder- testing for infection, further 3 doses

219
Q

Leptospirosis sx

A

Flu-like symptoms
subconjunctival suffusion (redness)/haemorrhage

second immune phase may lead to more severe disease (Weil’s disease)
acute kidney injury (seen in 50% of patients)
hepatitis: jaundice, hepatomegaly

220
Q

When should statins be started in T1DM

A

Individuals with type 1 diabetes who do not have established cardiovascular disease (CVD) risk factors should be offered atorvastatin 20 mg for primary prevention of CVD if they are:
Older than 40 years of age
Have had diabetes for more than 10 years
Have established nephropathy
Have other CVD risk factors (such as obesity and hypertension)

221
Q

Best method of assessing response to Hep C treatment

A

Viral load

222
Q

AF and HF tx

A

Digoxin

223
Q

Absolute CI 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

224
Q

Diabetic med CI in HF

A

Pioglitazone

225
Q

Kaposi Sarcoma

A

caused by HHV-8 (human herpes virus 8)
presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)

radiotherapy + resection

226
Q

Features of thyroid storm

A

fever > 38.5ºC
tachycardia
confusion and agitation
nausea and vomiting
hypertension
heart failure
abnormal liver function test - jaundice may be seen clinically

227
Q

Murmur in AR

A

Early diastolic

On the RIGHT

228
Q

Carbogeline/bromocriptide SE

A

pulmonary, retroperitoneal and cardiac fibrosis.

229
Q

Travellers diarrhoe non bloody organism

A

Enterotoxigenic E. coli

230
Q

Measure of disease activity in rheumatoid arthritis

A

DAS28

231
Q

Hba1c pre diabetes

A

42-47
Discuss diet and exercise

232
Q

eGFR variables

A

CAGE - Creatinine, Age, Gender, Ethnicity

233
Q

Maintaining remission in Crohns

A

azathioprine or mercaptopurine

234
Q

How frequently can you give adrenaline in anaphylaxis

A

5 mins

235
Q

What neuropathic pain medication should you avoid in BPH

A

Amitriptyline

236
Q

FAST alcohol questionnaire

A

The FAST (Fast Alcohol Screening Test) questionnaire is a brief screening tool for alcohol misuse, which consists of four questions. The first question focuses on hazardous drinking and if the patient scores 3 or more points, there is no need to ask the remaining three questions as this already indicates possible alcohol misuse

237
Q

Levels of obesity

A

BMI 30-35 Obese
35-40 clinically obese
>40 Morbidly

238
Q

Hypokalaemia and pH

A

Inversely related

i.e in Cushings- causes hypokalaemia which causes metabolic alkalosis

239
Q

Practical Mx of animal bites

A

Thorough washout and dressing only

Abx

240
Q

NFM 2 sx

A

Bilateral acoustic neuromas (vestibular schwannomas)
other benign neurological tumours and lens opacities.

241
Q

Indications for placing a chest tube in pleural infection:

A

Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage.
The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage.
Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage.

242
Q

Change in levothyroxine in pregnancy

A

omen with established hypothyroidism who become pregnant should have their dose increased by at least 25-50 micrograms levothyroxine due to the increased demands of pregnancy

243
Q

Which vaccine are CI in immunocompromised patients

A

Vaccinations Make BRIT Yellow

Varicella
measles, mumps, rubella (MMR)
BCG
oral rotavirus,oral polio
influenza (intranasal)
oral typhoid
yellow fever

244
Q

Gower sign

A

Seen in Duchenne muscular dystrophy, when a child used their arms to aid standing from a squat

245
Q

Mx of complex fistula in Crohns

A

MRI
Oral metronidazole if sx
Draining seton

246
Q

Maintaining remission in UC

A

proctitis and proctosigmoiditis
topical (rectal) aminosalicylate alone (daily or intermittent) or
an oral aminosalicylate plus a topical (rectal) aminosalicylate (daily or intermittent)

left-sided and extensive ulcerative colitis
low maintenance dose of an oral aminosalicylate

247
Q

Mx of salmonella

A

Cipro

248
Q

TV vs BV

A

TV green
Strawberry cervix

249
Q

Treatment offered to close contacts of meningitis patients

A

Oral ciprofloxacin or rifampicin is used as prophylaxis for contacts of patients with meningococcal meningitis

250
Q

Abx for shigella

A

Cipro

251
Q

Abxx for otits media, externa, peridontal abscess and gingivitis

A

Otitis media Amoxicillin (erythromycin if penicillin-allergic)

Otitis externa- if severe Flucloxacillin (erythromycin if penicillin-allergic)

Periapical or periodontal abscess Amoxicillin

Gingivitis: acute necrotising ulcerative
Metronidazole

252
Q

Mx of acute pyelonephritis

A

Broad-spectrum cephalosporin or quinolone

253
Q

Peutz-Jeghers syndrome

A

autosomal dominant

Features
hamartomatous polyps in the gastronintestinal tract (mainly small bowel)
small bowel obstruction is a common presenting complaint, often due to intussusception
gastrointestinal bleeding
pigmented lesions on lips, oral mucosa, face, palms and soles

254
Q

Valproate SE

A

teratogenic
P450 inhibitor
gastrointestinal: nausea
increased appetite and weight gain
alopecia: regrowth may be curly
ataxia
tremor
hepatotoxicity

255
Q

NYHA classification

A

NYHA Class I
no symptoms

NYHA Class II
mild symptoms
slight limitation of physical activity:

NYHA Class III
moderate symptoms
marked limitation of physical activity: comfortable at rest

NYHA Class IV
severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity

256
Q

seminoma vs non seminoma tumor markers

A

Seminoma - bhcg

NS- High AFP , bhcg

257
Q

Screening test for PCKD

A

US abdomen

258
Q

Facial swelling after starting on ACS treatment

A

Angiooedema 2’ to ACEi

259
Q

Mx of CML

A

Imatinib

260
Q

Resolution of DKA

A

pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L

261
Q

Diagnosis of DKA

A

Key points
glucose > 11 mmol/l or known diabetes mellitus
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick

262
Q

Adverse effects of PPIs

A

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

263
Q

Behcet’s syndrome

A

painful mouth sores, genital sores, and eye inflammation.
venous thromboembolism due to the inflammation of the blood vessels

264
Q

Opioids able to be used in impaired renal function

A

Oxycodone
Buprenorphine

265
Q

Prolactin in acromegaly

A

raised prolactin in 1/3 of cases → galactorrhoea

266
Q

What else do you need to test for with TTG

A

IgA levels
As if IgA def- false negative

267
Q

Chlamydia in pregnancy tx

A

Azithromycin, erythromycin or amoxicillin

268
Q

Acoustic neuroma sx

A

cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy

269
Q

What is the latest time that HIV post-exposure prophylaxis may be given

A

72 hrs

270
Q

Steroid therapy on bloods

A

neutrophilia

271
Q

Dx and mx of SBO

A

hydrogen breath test

Management
correction of the underlying disorder
antibiotic therapy:rifaximin

272
Q

Mx of Lyme disease

A

14-21d Doxycycline

Amox if CI

273
Q

Mx of intracranial and visceral nausea

A

Cyclizine

274
Q

Mx of toxoplasmosis

A

If immunocompetent- nothing

If compromised
pyrimethamine plus sulphadiazine for at least 6 weeks

275
Q

Features of HONK

A

hypovolaemia
marked hyperglycaemia (>30 mmol/L)
significantly raised serum osmolarity (> 320 mosmol/kg)
can be calculated by: 2 * Na+ + glucose + urea
no significant hyperketonaemia (<3 mmol/L)
no significant acidosis

276
Q

DIC features

A

↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products

277
Q

Combination antiplatelet and anticoagulant therapy

A

If stable CVD - anticoagulant monotherapy is given without the addition of antiplatelets

If post PCI- generally patients are given triple therapy (2 antiplatelets + 1 anticoagulant) for 4 weeks-6 months after the event and dual therapy (1 antiplatelet + 1 anticoagulant) to complete 12 months

278
Q

Mx of asthma after IV steroids given

A

IV MgSO4
then aminophylline

279
Q

Organism causing IECOPD

A

H influenza

280
Q

Indication for cardiac resynchronicsation therapy

A

left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms
On maximal medical therapy

281
Q

Mx of STEMI

A

Aspirin 300mg
PCI within 120mins

If no- thrombolysis

282
Q

Mx of NSTEMI/UA

A

Aspirin
Fonda if no immediate PCI

GRACE score
>3%
PCI
Pras/tica

<3%
Ticagrelor

283
Q

Bupropion MOA

A

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

284
Q

Adenosine SE

A

chest pain
bronchospasm
transient flushing

285
Q

Subclinical hypothyroidism dx and mx

A

TSH raised but T3, T4 normal
no obvious symptoms

consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart

if < 65 years consider offering a 6-month trial of levothyroxine if:
the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart,and
there are symptoms of hypothyroidism

286
Q

ABs in Graves

A

TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)

287
Q

Marker in diagnosing anaphylaxis

A

Serum tryptase

288
Q

Prophylaxis of migraine but has asthma

A

Topirmate

289
Q

A crescent sign on CXR, previous TB

A

Aspergillosis

290
Q

Test for strep vs glandular

A

Anti strep titre
Monospot

291
Q

Varenicline MOA

A

a nicotinic receptor partial agonist

should be started 1 week before the patients target date to stop

292
Q

Bronchiectasis sx

A

Large amounts of purulent sputum
Chest x-ray shows numerous parallel line shadows.

293
Q

Quadrantopia causes

A

Upper- pituitary
Lower- craniopharingoma

294
Q

Macula sparing homonymous hemianopia

A

Occipital cortex

294
Q

Most commonly inherited thombophillia

A

Factor V Leiden

295
Q

Raised ALP in the presence of normal LFT’s

A

Bone mets
Pagets

296
Q

Resp mx in a1at def

A

surgery: lung volume reduction surgery, lung transplantation

297
Q

Factors favouring true epileptic seizures

A

tongue biting
raised serum prolactin*

298
Q

MODY features

A

development of type 2 diabetes mellitus in patients younger than 25 years old. In this condition, C-peptide remains in the normal range and beta-cell antibodies are negative.

299
Q

BRCA cancers

A

Breast and ovarian

BRCA2 Prostate men

300
Q

Symptomatic stable angina on a calcium channel blocker but with a contraindication to a beta-blocker, the next line treatment ?

A

long-acting nitrate, ivabradine, nicorandil or ranolazine

301
Q

Mx of rabies

A

if an individual is already immunised then 2 further doses of vaccine should be given
if not previously immunised then human rabies immunoglobulin (HRIG) should be given along with a full course of vaccination.

302
Q

Mx of both B12 and folate def

A

n patients with both vitamin B12 and folate deficiencies, the vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of spinal cord

if no neurological involvement 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months

303
Q

Sx and mx of Wilson’s

A

low serum copper and a reduced serum caeruloplasmin.

Hepatitis, kayser fleishcer rings,
Blue nails
Chorea, dementia

Penicillamine

304
Q

Nicorandil SE

A

Anal ulceration

305
Q

Ascites and low ascitic fluid protein (<15 g/L) mx

A

Oral cipro

306
Q

Third nerve palsy

A

Ptosis, down and out, mydraisis
Due to compression of para

307
Q

Abx prophylaxis in COPD

A

Azithromycin

308
Q

Which oesophageal cancer is related to achalasia

A

SCC

309
Q

Chemo toxicity SE

A

Asparagine- neurotoxicty

Cisplatin- oto/nephro

Vincristine- peiperhal neuropathy
Vinblastine- myelosupression

Bleomycin- pul fibrosis

Doxorubicin- cardiotoxic

Cyclophosphamide- Nephro/bladder toxic
Haemorrhagic cystitis

Methotrexate- nephrotoxic, myelosupression

310
Q

Mx of bells palsy

A

Oral pred <72 hrs and artificial tears

311
Q

India ink

A

Cryptococcal

312
Q

Anticoagulation post AF ablation

A

Continue anticoagulation long term

313
Q

Cryoprecipitate contains

A

factor VIII, fibrinogen, von Willebrand factor and factor XIII

314
Q

When to refer for dyspepsia urgently

A

All patients who’ve got dysphagia

All patients who’ve got an upper abdominal mass consistent with stomach cancer

Patients aged >= 55 years who’ve got weight loss, AND any of the following:
upper abdominal pain
reflux
dyspepsia

315
Q

Non urgent endoscopy referrals

A

Patients with haematemesis

Patients aged >= 55 years who’ve got:
treatment-resistant dyspepsia or
upper abdominal pain with low haemoglobin levels or
raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain

316
Q

Mx of genital herpes in this trimester of pregnancy

A

Acyclovir until delivery- C section

317
Q

Mx of primary hyperaldosteronism

A

Spironolactone

318
Q

Which vaccines should be avoided on azathioprine

A

Live
BRIT
MMR, BCG, rotavirus, influenza, typhoid, yellow

319
Q

Thorax mass in MG

A

Thymoma

320
Q

Mx of bloating and vomiting after eating in T1DM

A

Metoclopramide

321
Q

ACS treatment causing worsening MG

A

Beta blocker

322
Q

Meds exacerbating MG

A

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

323
Q

GRACE score components

A

Arrest
Heart rate/BP
ECG
Age
Renal function
Trops

324
Q

Blood monitoring with statin

A

LFT at baseline, 3 months and 12 months

325
Q

Diarrhoea acid base disturbance

A

Normal anion gap metabolic acidosis

326
Q

When to add diabetic drug to patient

A

If Hba1c >58

327
Q

DM on triple therapy but hba1c 62

A

Swap med for GLP1

328
Q

Lymphoma associated with coeliac

A

Enteropathy associated T cell lymphoma

329
Q

Warfarin: management of high INR

A

Major bleeding- stop, give IV vit k and PCC

INR >8 minor bleeding
IV vit K
Restart warfarin <5

INR >8 no bleeding
Oral Vit K

INR 5-8 minor bleeding
IV Vit K

INR 5-8 no bleeding
Withhold warfarin 1/2 doses

330
Q

Dx of MS

A

MRI with contrast

331
Q

Anaphylaxis, 2x doses of IM adrenaline, low BP

A

Refractory anaphylaxis

respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline

Adrenaline infusion

332
Q

Diabetic medications

A

Sulfonylureas (gli-)
Thiazolidinediones (-glitazone)
DPP-4 inhibitors (-gliptin): lipton tea is as bad as PeePee (i hate lipton tea)
SGLT2 inhibitors (-flozin): flossing between TWO teeth
GLp-1 agonists (dulaGLutide, exenatide, semaGLutide (ozempic), liraGLutide):

333
Q

Longest incubation period for gastroenteritis

A

Giardiasis

334
Q

Driving post ACS, CABG, pacemaker ICD

A

ACS- 4 weeks
1 if post PCI

CABG- 4 weeks

Pacemaker- 1 week

ICD- ventricular- 6m ,proph 1m

335
Q

Trigger for cluster headaches

A

Alcohol

336
Q

Tricep reflex root

A

C7-8

337
Q

ATN vs pre renal urinary sodium

A

ATN- high Na
low osmolality

Pre renal- low Na
High osmolality

338
Q

What is the most effective single step to reduce the incidence of MRSA?

A

Hand hygiene

339
Q

Organism in CAPD-related peritonitis

A

Staph epidermidis
Staphylococcus aureus

340
Q

Blood film of coeliac

A

Hyposplenism

target cells
Howell-Jolly bodies
Pappenheimer bodies

341
Q

Silicosis sx

A

Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes

342
Q

Most common presentation of posterior circulation stroke

A

Coordination difficulties

343
Q

IDA vs ACD

A

TIBC high in IDA
Low in ACD

344
Q

No. units to drink in a week

A

men and women should drink no more than 14 units of alcohol per week
they advise ‘if you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more’

345
Q

Adrenaline doses for anaphylaxis

A

<6m 100-150mcg
6m-6y 150mcg
6-12y 300mcg
>12y 500mcg

346
Q

C peptide in T1DM

A

Low

347
Q

Acute interstitial nephritis

A

‘allergy’-type reaction
raised urinary WCC and eosinophils, alongside impaired renal function

348
Q

Medication causing reduced hypo awareness

A

Beta blockers

349
Q

PTH in primary hyperparathyroid

A

Can be normal or high

350
Q

Lacunar, partial and total anterior infarct

A

Total- 3/3
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction

Partial 2/3

Lacunar 1/3

351
Q

Mx of wounds- tetanus

A

If vaccination history is incomplete or unknown
reinforcing dose of vaccine, regardless of the wound severity
for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago
if tetanus prone wound: reinforcing dose of vaccine
high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin

Patient has had a full course of tetanus vaccines, with the last dose < 10 years ago
no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

352
Q

Neuropathic pain mx

A

amitriptyline, duloxetine, gabapentin or pregabalin
if the first-line drug treatment does not work try one of the other 3 drugs
in contrast to standard analgesics, drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added

353
Q

Diagnosis of PSC

A

MRCP (beady) or ERCP

354
Q

Intravenous drug user is brought to the emergency department with back pain, bilateral leg weakness and fever. Ix?

A

MRI whole spine

355
Q

AMT and 4AT scoring

A

AMT- lower
<3 severe cognitive impairment

4AT - higher scoring-delirium

356
Q

Monitoring for haemochromatosis

A

Ferritin and transferrin saturation

357
Q

Mx of a patient with AF + an acute stroke (not haemorrhagic)

A

Aspirin then Start anticoagulation with a DOAC after 2 weeks

358
Q

Post thrombotic syndrome

A

20-50% of patients following deep vein thrombosis (DVT) and typically presents with symptoms including leg heaviness, aching, pruritis, and oedema that improves with elevation (such as overnight).

varicose veins and skin changes

359
Q

Which veins are damaged in subdural

A

Bridging veins

360
Q

Test useful after patient has had anaphylaxis

A

RAST

361
Q

When to refer someone with anginga to cardio for PCI /CABG

A

NICE guidelines suggest that if a patient requires a third anti-anginal they should be referred for consideration of a more definitive intervention (PCI or CABG)

362
Q

Rectal diazepam dosing

A

10mg

363
Q

Meds for spasticity for MS

A

Baclofen and gabapentin

364
Q

Mx of status epiliticus

A

Lorazepam 2x every 5 mins
4mg

Then phenytoin
Then intubate

365
Q

P mitrale and p pulmonale

A

P mitrale- bifid- mitral stenosis

P pulmonale- increased

366
Q

Murmur associated with PKD

A

Mitral valve prolapse

367
Q

Lymphogranuloma venereum sx

A

Chlamydia trachomatis. Typically infection comprises of three stages
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis

368
Q

HSP

A

IgA vasculitis, is a small vessel vasculitis characterised by palpable purpura, arthritis or arthralgia, abdominal pain and renal involvement. It often follows an upper respiratory tract infection and is most common in children.

369
Q

Sarcoidosis sx

A

acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
ocular: uveitis
skin: lupus pernio
hypercalcaemia:

370
Q

S3 and S4

A

S3 (third heart sound) is considered normal if < 30 years old
caused by diastolic filling of the ventricle

S4 (fourth heart sound)
may be heard in aortic stenosis, HOCM, hypertension

371
Q

Diabetic vs alcoholic ketoacidosis

A

Alcoholic- low or normal glucose

372
Q

SE of excess B6

A

Peripheral neuropathy

373
Q

Migraine meds that should be avoided in preg

A

Toprimate and triptans

374
Q

Pharmacological cardioversion of AF

A

flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease or
amiodarone if there is evidence of structural heart disease.’

375
Q

Asthma diagnosis in adults

A

measure the eosinophil count OR fractional nitric oxide (FeNO)
diagnose asthma, without further investigations, if:
eosinophil is above the reference range
FeNO is ≥ 50 ppb

If asthma is not confirmed by the eosinophil count or FeNO
measure bronchodilator reversibility (BDR) with spirometry

376
Q

Asthma diagnosis in 5-16 and <5

A

First-line investigation NICE
measure the fractional nitric oxide (FeNO)
diagnose asthma if:
FeNO is ≥ 35 ppb

If the FeNO level is not raised, or if FeNO testing is not available:
measure bronchodilator reversibility (BDR) with spirometry

<5
treating with inhaled corticosteroids as per the management guidelines with regular review
if they still have symptoms at age 5 then attempt objective tests

377
Q

Testing for HIV

A

Combination tests (HIV p24 antigen and HIV antibody) are now standard for the diagnosis and screening of HIV

antibody develops 4-6 weeks after infection and the p24 antigen can become positive as soon as 1 week after infection.

378
Q

Cytotoxic agent causing hypomagnesia

A

Cisplatin

379
Q

Most affected site in UC

A

Rectum

380
Q

Scoring to identify patients with a pulmonary embolism that can be managed as outpatients

A

PESI

381
Q

Broca vs Wernickes area

A

Broca- non-fluent or expressive aphasia. Patients have difficulty speaking fluently, and their speech may be limited to a few words at a time.

Wernicke- speech fluent, comprehension abnormal, repetition impaired

382
Q

HPV for genital warts

A

HPV 6 +11

383
Q

Virus causing Kaposi sarcoma

A

HHV8

384
Q

Cells seen in AML and CLL

A

AML- auer rods
CLL- smear

385
Q

Which sedative agent can you not prescribe in PD

A

Haloperidol

386
Q

Timing of skin prick vs skin patch

A

Prick- after 15 mins
Patch- 48 hrs

386
Q

Enchephaltis CT findings

A

prominent swelling and increased signal of the brain on MRI

CT head identifies hypodensity

387
Q

Which med should be given before fibrinolysis for a STEMI

A

antithrombin drug eg fondaparinux

388
Q

CKD staging if GFR 65 but normal creatinine and urine dip

A

No CKD
If kidney tests are normal, there is no CKD

389
Q

DLB vs PD

A

Parkinson’s disease dementia the tremor, bradykinesia, and rigidity will develop before dementia. In DLB, the opposite is true

390
Q

Anti emetic in PD

A

Domperidone

391
Q

Alpha-1 antitrypsin deficiency on spirometry

A

Obstructive picture

392
Q

Following a cholecystectomy pt complains that she has experienced chronic diarrhoea which seems to float in the toilet. Meds to help?

A

Cholestyramine

393
Q

Mx of child with SCD with temp >38

A

Admit urgently

This is because these patients are functionally asplenic and are at high risk of overwhelming sepsis

394
Q

When to scan wells score

A

DVT 2 or more
PE 4 or more
Otherwise D dimer

395
Q

Preg lady cellulitis, pen allergic abx

A

Erythromycin

NOT Clari

396
Q

Man with HTN 145/92 and Q risk of 9%

A

This patient therefore has stage 1 hypertension. As they are < 80 years they should be considered for treatment but as their 10-year cardiovascular risk if < 10% no action is needed.

397
Q

What needs to be monitored with phenytoin infusion

A

Cardiac monitoring

398
Q

Confirming coeliac

A

Jejunal biopsy

399
Q

Neuroleptic malignant syndrome sx

A

NMS typically develops rapidly, usually within the first two weeks of starting an antipsychotic medication

pyrexia
muscle rigidity
autonomic lability

400
Q

Which opioid for neuropathic pain if others have failed

A

Tramadol

401
Q

Asymptomatic hyperuricaemia tx

A

No treatment

402
Q

Myxoedema coma sx

A

confusion and hypothermia, patients may have non-pitting periorbital and leg oedema, reduced respiratory drive, pericardial effusions, anaemia, seizures

403
Q

Double duct sign of MRCP

A

Pancreatic cancer

404
Q

Renal diet for CKD

A

Low K

405
Q

What medication to take with transfusion for beta thalassaemia

A

iron chelation therapy (e.g. desferrioxamine

406
Q

What medication should be avoided in HOCM

A

Acei
Nitrates

407
Q

Vaccines for COPD

A

Annual influenza
Pneumococcal once off

408
Q

B blocker affect on sleep

A

Insomnia

409
Q

Prosthetic heart valve replacement

A

Mechanical valves are typically offered to younger patients (<65 years)

Bioprosthetic aortic valve replacement if >65 or younger patients not wishing to take lifelong anticoagulation

410
Q

Latent TB tx

A

3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)

411
Q

How to induce remission in Crohns

A

glucocorticoids (oral, topical or intravenous) are generally used to induce remission.

412
Q

Symptom control in non-CF bronchiectasis

A

inspiratory muscle training + postural drainage

413
Q

Pulse pressure in raised ICP

A

Wide

414
Q

Alternative to metronidazole for BV

A

Topical clindamycin

415
Q

Diabetic meds to start with bg of HF

A

start metformin, up-titrate; introduce dapagliflozin once metformin tolerance is confirmed.

Slowly up titrate metformin for GI symptoms

416
Q

Ix for GBS

A

lumbar puncture
rise in protein with a normal white blood cell count (albuminocytologic dissociation) - found in 66%

nerve conduction studies may be performed
decreased motor nerve conduction velocity

417
Q

Post-exposure prophylaxis for HIV time

A

4 weeks

418
Q

Which one of the following drugs used in the management of diabetes mellitus is most likely to cause cholestasis?

A

Sulphonylureas

419
Q

CML vs CLL

A

CML- massive spleen

AML - Myelo’blast’
ALL - Lympho’blast’
CML - Granulo’cytosis’
CLL - Lympho’cytosis’

420
Q

Organism causing infection in CF

A

Pseudomonas

421
Q

What is seen on blood film in DIC

A

Schistocytes

422
Q

Dx of acromegaly

A

if a patient is shown to have raised IGF-1 levels, an oral glucose tolerance test (OGTT) with serial GH measurements is suggested to confirm the diagnosis

423
Q

Nephrogenic vs cranial DI

A

Cranial responds to exogenous ADH

424
Q

Mx of PBC

A

Ursodeoxycholic acid

425
Q

Lobar epileptic symtpoms

A

Temporal lobe seizures are associated with aura, lip smacking and clothes plucking.

Occipital seizures are associated with visual abnormalities.

Parietal seizures are associated with sensory abnormalities.

Frontal movement

426
Q

What can falsely lower BNP

A

Ramipril and BB

427
Q

pH in BV and TV

A

Trichomonas vaginalis + bacterial vaginosis are associated with a pH > 4.5

428
Q

Asymptomatic gallstones

A

Asymptomatic gallstones which are located in the gallbladder are common and do not require treatment. However, if stones are present in the common bile duct there is an increased risk of complications such as cholangitis or pancreatitis and surgical management should be considered.

429
Q

Tx for seizure type

A

1st line for all generalised seizures (except absence) = sodium valproate if male, lamotrigine/levetiracetam if female.
1st line for focal seizures: lamotrigine / levetiracetam
1st line for absence: ethosuxamide

Carb is second line for focal

MSRA (11 decks)

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