Medicine Flashcards
1
Q
When to give O2 in MI
A
If sats <94%
2
Q
Mx of Ramsay Hunt
A
oral aciclovir and corticosteroids are usually given
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
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
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
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
7
Q
Other than abx what increases risk of C diff
A
PPI
8
Q
Third nerve palsy
A
Down and out
ptosis
‘down and out’ eye
dilated, fixed pupil
9
Q
IV and VI palsy
A
IV- vertical diplopia
VI - horizontal diplopia
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)
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)
12
Q
Hereditary haemorrhagic telangiectasia SX
A
epistaxis
telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
visceral lesions
family history
2/4
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
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
15
Q
What can accentuate digoxin toxicity
A
HypoK
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)
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
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
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
20
Q
Mx of Addisons with intercurrent illness
A
glucocorticoid dose should be doubled, with the fludrocortisone dose staying the same
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
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
23
Q
Cavitating lesion in CXR in alcoholic
A
Klebsiella
24
Q
SE of thyroxine therapy
A
hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation
25
What reduces levo absorption
Iron and CaCO3
26
Where Pagets affects
Paget's disease of the bone generally affects the skull, spine/pelvis, and long bones of the lower extremities
27
Tx of bradycardia
IV atropine
28
Pagets Mx
Bisphosphonates
29
Somatisation disorder vs conversion
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
30
Asthma classification
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
31
Cauda Equina sx
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
32
When to sync DC cardiovert
tachycardia and signs of shock, syncope, myocardial ischaemia or heart failure should receive up to 3 synchronised DC shocks
33
Mx of TIA
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
34
Argyll-Robertson pupil.
Accommodate but do not respond to light
35
?PMR no response to steroids
Stop steroids consider alternative
36
RA mx
Rheumatoid arthritis: initial management is conventional DMARD monotherapy (usually methotrexate), often with short-term bridging corticosteroid
37
VWD biochem
Prolonged bleeding Normal plt and PT
Prolonged APTT
38
Acute haemolytic reaction sx
Fever, abdo pain, hypotension
39
GLliclazie MOA
bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cell causing release of insulin
40
When can you have sildenafil after having an MI
6 months
41
Driving after TIA
Can drive if symptom free after 1 month- no need to inform DVLA
42
Internuclear ophthalmoplegia
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
43
IgA nephropathy vs post strep GN
IgA
1-2 days after URTI
PS GN
1-2 weeks after URTI
44
UC vs Crohns
UC- Continuous
Mucosal
Bloody
PSC
Uveitis
Pseudopolyps
Crypt Abcesses
Crohns
Skip lesion
Obstruction, fistulas
All layers
Goblet cells
Gallstones
45
Antiphospholipid mx during pregnancy
Aspirin and LMWH
46
Grading of COPD severity
FEV1
>80 mild
50-79 mod
30-49 Severe
<30 Very severe
47
MG symptoms
Other symptoms may include extraocular muscle weakness or ptosis
Dysphagia with liquids as well as solids
Tiredness with activity
48
Mx of TB
Initial phase - first 2 months (RIPE)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Continuation phase - next 4 months
Rifampicin
Isoniazid
49
Homonymous quadrantanopia lesion location
PITS (Parietal-Inferior, Temporal-Superior)
50
standard HbA1c target in type 2 diabetes
48
51
Cause of gynaecomastia
spironolactone (most common drug cause)
cimetidine
digoxin
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids
52
Medical mx of ascites secondary to liver cirrhosis
Spironolactone
53
Pathogen associated with GBS
C jejeuni
54
Miller Fisher syndrome
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
55
Persistant ST elevation post MI with no chest pain
Left ventricular aneurysm
Thrombus may form within the aneurysm increasing the risk of stroke. Patients are therefore anticoagulated.
56
Dressler syndrome
2-6 weeks following a MI.
fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.
57
Hypotension, pul oedema and early-to-mid systolic murmur post MI
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.
58
Impaired fasting and glucose tolerance
Fasting - 6.1- 7
Tolerance - 7.8-11.1
59
Timing of PE treatment
Provoked 3 months
Unprovoked 6 months
60
IBS symptoms
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
61
Measures risk of stroke in someone with AF
CHADVASC2
62
ACE exam results
/100
<82 dementia
63
HUS sx and mx
bloody diarrhoea- E coli
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
64
What does MND not affect
doesn't affect external ocular muscles
no cerebellar signs
abdominal reflexes are usually preserved and sphincter dysfunction if present is a late feature
65
CHADVASC score
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
66
Lyme disease
Bulls eye
Painless
headache
lethargy
fever
arthralgia
67
ECG for pericarditis
PR depression
Saddle ST elevation
68
Rhabdomyolysis biochem
How Ca
High P, K, urea, CK
Metabolic acidosis
69
Glipitins MOA
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
70
What alters urea breath test
no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
71
Giardiasis sx
Ongoing diarrhoea, lethargy, bloating, flatulence, steatorrhoea, weight loss +/- recent travel
72
Amoebiasis sx
often asymptomatic, but when symptoms do occur it will often present with dysentery (severe diarrhoea with blood and mucous).
73
CI to triptans
Ischaemic heart disease
74
When should you stop taking PPI before OGD
2 weeks
75
Most common extra intestinal manifestation to IBD
Arthritis
76
Painful vs non panful genital ulcer
Non painful- Treponema
Painful- H ducreyi - chancroid
77
Mx of AF
< 48 hours: rate or rhythm control
≥ 48 hours or uncertain (e.g. patient not sure when symptoms started): rate control
78
Abx for meningitis
3 months - 50 years: BNF recommends cefotaxime (or ceftriaxone)
> 50 years: BNF recommends cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin) for adults
79
Confirming HTN dx
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
80
Black blisters, foul smelling
C perfirneges
81
Mx of suspected TIA
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
82
What extra medication should a patient with Addisons be prescribed
Patients with Addison's should be given a hydrocortisone injection kit for adrenal crises
83
Mx if T2DM
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
84
Mx of COPD
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)
85
Asthmatic features of COPD
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%)
86
Angina mx
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
87
Confirming food allergies
Skin prick test
88
Tests prior to starting TB treatment
U+E
LFT
Vision
FBC
89
Reversal of dabigatran
Idraarucizumab
90
Microprolactinoma mx
Bromocriptine /cabergoline
Surgery if medical not tolerated
91
Uhthoff's phenomenon vs Lhermitte's syndrome
Uhthoff's phenomenon: worsening of vision following rise in body temperature
Lhermitte's syndrome: paraesthesiae in limbs on neck flexion
92
Diarrheoa with clopi post stroke
Change to aspirin
93
Ix for NAFLD
enhanced liver fibrosis (ELF) testing is recommended to aid diagnosis of liver fibrosis
94
Mx of cervical myopathy
Cervical decompression surgery
95
Tx of UTI third trimester
Amox/cef
96
Needle stick injury - from hep B +ve
give an accelerated course of the hepatitis B vaccine + hepatitis B immune globulin.
97
UC flare management
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
98
SeverUC classification
: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
99
B thala trait bloods
mild hypochromic, microcytic anaemia - microcytosis is characteristically disproportionate to the anaemia
HbA2 raised (> 3.5%)
100
Adrenaline vs amiodarone in ALS
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
101
Most important intervention to reduce flares with Crohns
Stop smoking
102
Rounded opacity in the right upper zone surrounded by a rim of air.
Aspergilloma
103
Granulomatosis with polyangiitis
Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Glomerulonephritis
Saddle-shape nose deformity
104
Prophylaxis of variceal haemorrhage
Propanolol
105
Indications for surgery in bronchiectasis
The main 2 indications for bronchiectasis are uncontrollable haemoptysis and localised disease
106
Degenerative cervical myelopathy
Progressive
Pain
Loss of motor function (loss of digital dexterity, preventing simple tasks such
Loss of sensory function causing numbness
Hoffman's sign
107
Electrical alternans
Alternating QRS amplitude
Seen in cardiac tamponade
108
Genital wart symptoms and mx
small (2 - 5 mm) fleshy protuberances which are slightly pigmented
may bleed or itch
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
109
Weber syndrome
ipsilateral CN III palsy and contralateral hemiparesis
110
Mycoplasma infection sx
worsening flu-like symptoms and a dry cough. Erythema multiforme is noted on examination
Abdo pain, hyponatraemia
111
Hepatic encephalopathy mx
Lactulose
112
Ix for H pylori
Urea breath test
113
Bradycardia with signs of shock
Atropine
Transcutaneous pacing
114
What medication makes clopidogrel less effective
Omeprazole
115
When to stop ACEi with renal function
if the creatinine increases by 30% or eGFR falls by 25% or greater.
116
What can cause a high BNP
GFR < 60 ml/min
Sepsis
COPD
Diabetes
117
Gram neg diplococci on vag swab and mx
Gonorrhoea
IM cef
118
Which extra-intestinal manifestations of Crohn's disease is related to disease activity?
Erythema nodosum
119
ECG changes after large transfusion of blood
HyperK
120
Drugs causing galactorrhoea
metoclopramide, domperidone
Chlorpramzine
haloperidol
121
Vit B2 deficiency (niacian)
Pellagra
dermatitis
diarrhoea
dementia
122
Vit B9 deficiency
Folic acid
Megaloblastic anaemia, deficiency during pregnancy - neural tube defects
123
Common SE of sulfonylurea
hypoglycaemic episodes
weight gain
124
Small cell carcinoma neuroendocrine disorders
ACTH
ADH
Lambert Eaton syndrome
125
High calcitonin which thyroid cancer
Medullary
126
Recurrent C diff tx
A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with oral fidaxomicin
127
Imaging for suspected fistula in Crohns
MRI pelvis
128
ECG features of WPW
short PR interval
wide QRS complexes with a slurred upstroke - 'delta wave'
left axis deviation if right-sided accessory pathway
129
CURB 65 score
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
130
Pneumocystis jiroveci penumonia mx
Cotrim
131
When should you give cryoprecipitate in bleeding
If fibrinogen is low
132
Types of MND
ALS- UMN and LMN
PBP- bulbar
PMA - LMN
PLS - UMN
133
Rules after pneumonthroax
Avoid deep sea diving for life
134
nuchal rigidity and hyperreflexia A CT head shows bilateral hypodensities in the temporal lobes.
Herpes simplex encephalitis
135
Idiopathic intracranial hypertension
Obese, young female with headaches / blurred vision
136
C diff treatment
first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole
137
Which anti-anginal medication do patients commonly develop tolerance to?
SR Isosorbide mononitrate
138
Pneumonia after influenza
Staph aureus
139
AI hepatitis sx
Anti SMA
Anti liver /kidney microsomal
Tender liver
Raised LFTs
Young females
Secondary amennorhoea
140
PBC vs PSC
PBC
Hepatic ducts
AMA
Granuloma
PSC
Extraheptic
Onion skin
UC
141
Hyperkalaemia ECG
Wide QRS
Tented T waves
flattened P wave, prolonged PR interval, ST depression
142
Mx of Graves
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
143
Mx of hiccups in pall care
Chlorpromazine
144
Mx of SVT in asthmatics
Verapamil
145
Erysipelas affects?
Upper dermis and lymphatics
146
Myelofibrosis sx
'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
147
AKI stages
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
148
Statin before attempting to conceive
Stop statin
149
Thiazide effects on ca
Hypercalcaemia
150
Tests prior to amiodarone tx
TFT
LFT
U+E
CXR
151
Conditions pre disposing to pericarditis
SLE
RA
Post MI
152
hyper-pigmentation of the palmar creases- endocrine
Addisons
153
Mx of ITP
Oral steroids
154
Sx and mx of Blood product transfusion complications
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
155
What would over estimate Hba1c
Splenectomy
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
156
Tx of legionella
Macrolides
157
Laxative for IBS
Ispahula husk
158
Mx nausea of migraine
Metoclopramide
159
Mx of nausea from chemo
Ondansetron
160
Most affected site in Crohns
Ileum
161
Marker to be checked after Heb B immunisation
Anti HBs
162
Thrombolysis and thrombectomy timings
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
163
Presents with hemiparesis, pul oedema, ST elevation
Left ventricular thromboembolism
Persistent ST elevation after previous MI, is very suggestive of a left ventricle aneurysm.
164
Lights criteria
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
165
Rash in Lyme disease
Erythema migrans
166
Diagnosis of mycoplasma
Serology
167
Primary/secondary Syphillis sx and mx
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
168
Imaging for stroke
Non contrast CT head
169
Types of seizures
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
170
Define status evilepticus
a single seizure lasting >5 minutes, or
>= 2 seizures within a 5-minute period without the person returning to normal between them
171
Important cause of SE to rule out first
Hypoglycaemia and hypoxia
172
Mx of SE
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
173
Medical management of acromegaly
Octreotide
174
Mx of prostatis
Cipro
175
Painful blisters and ulcers that have appeared on his glans mx
Aciclovir
176
Mx of AF
< 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
Anti epileptic most associated with weight gain
Sodium valproate
178
BV in pregnancy
Metronidazole
179
Hypertensive 66yo DM
Ramipril
180
Mx of monomorphic tachy, QRS wide, normotensive
Amiodarone
181
Mx of bacterial meningitis
Def and dex (dex improves nerd outcomes such as deafness)
182
How long can you not drive for after unprovoked seizure with normal imaging and EEG
6 months
183
Driving rules with syncope
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
Which group should be offered HPV vaccine for first time
Boys and girls 12-13
185
Mefloquine SE
Neuropsychiatric disturbance
Contraindicated in epilepsy
186
Conduction issues in inferior vs anterior MI
Inferior- AV
Anterior- BBB
187
Tx of trigeminal neuralgia
Carbamazepine
188
When should bupropion not be prescribed
In patients with epilepsy.
189
Mx of campylobacter
Clarithromycin
190
Symptomatic UTI in catheterised patients
Change catheter and Abx 7d
191
MSRA +ve skin tx
Nasal mupriocin
Chlorhexidine for skin
192
New onset diabetes and WL in elder ix
CT for pancreatic cancer
193
Crises in sickle cell
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
Pregnant, clue cells on swab tx?
Metronidazole BD 7d
195
Prophylaxis of oesophageal vatical bleeding
Propanolol
196
How many tetanus shots for lifelong protection
5
197
Chronic diabetic nephropathy on USS
Large/normal sized kidneys on ultrasound whereas most patients with chronic kidney disease have bilateral small kidneys
198
How often should Sickle cell patients receive the pneumococcal polysaccharide vaccine
5 years
199
Left ventricular free wall rupture sx
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
Pericarditis vs Dressler
Pericarditis is early
Dressler >2w
201
Negative prognostic factors for lymphoma
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
Medical mx of ascites
Spiro
203
ABG triad for chronic CO2 retention:
Normal pH
High pCO2
High HCO3
204
Mx of Phaeochromocytoma
PHenoxybenzamine
205
management of delirium in palliative care patients
oral haloperidol
206
Diabetes diagnosis
Diabetes meliitus diagnosis: fasting > 7.0, random > 11.1 - if asymptomatic need two readings
207
Calculation of alcohol units
Alcohol units = volume (ml) * ABV / 1,000
208
What BP should people stop driving at
If consistently above 180 systolic or 100 diastolic
209
Levodopa SE
dry mouth
anorexia
palpitations
postural hypotension
psychosis
dyskinesias at peak dose: dystonia, chorea and athetosis (involuntary writhing movements)
210
Patient hypertensive on acei, CCB and thiazide like diuretic, what next
Spiro if K <4.5
If >4.5- a/b blocker
211
When to investigate haematuria in 2WW
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
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.
This patient has developed acute mitral regurgitation secondary to papillary muscle rupture.
213
Abx for neutropenic sepsis
Tazocin
214
Mechanisms of renal transplant rejection
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
Witnessed cardiac arrest
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
Anti emetic causing hyperprolactinaemia
Prochlorperazine
217
What must be treated prior to thrombolysis
Hypertension (>185/110 mmHg)
With labetalol
218
Anti Hbs levels after Hep B vaccine and mx
>100 good response - - booster in 5 yrs
10-100 suboptimal- 1 further dose
<10 Non responder- testing for infection, further 3 doses
219
Leptospirosis sx
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
When should statins be started in T1DM
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
Best method of assessing response to Hep C treatment
Viral load
222
AF and HF tx
Digoxin
223
Absolute CI to thrombolysis
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
Diabetic med CI in HF
Pioglitazone
225
Kaposi Sarcoma
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
Features of thyroid storm
fever > 38.5ºC
tachycardia
confusion and agitation
nausea and vomiting
hypertension
heart failure
abnormal liver function test - jaundice may be seen clinically
227
Murmur in AR
Early diastolic
On the RIGHT
228
Carbogeline/bromocriptide SE
pulmonary, retroperitoneal and cardiac fibrosis.
229
Travellers diarrhoe non bloody organism
Enterotoxigenic E. coli
230
Measure of disease activity in rheumatoid arthritis
DAS28
231
Hba1c pre diabetes
42-47
Discuss diet and exercise
232
eGFR variables
CAGE - Creatinine, Age, Gender, Ethnicity
233
Maintaining remission in Crohns
azathioprine or mercaptopurine
234
How frequently can you give adrenaline in anaphylaxis
5 mins
235
What neuropathic pain medication should you avoid in BPH
Amitriptyline
236
FAST alcohol questionnaire
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
Levels of obesity
BMI 30-35 Obese
35-40 clinically obese
>40 Morbidly
238
Hypokalaemia and pH
Inversely related
i.e in Cushings- causes hypokalaemia which causes metabolic alkalosis
239
Practical Mx of animal bites
Thorough washout and dressing only
Abx
240
NFM 2 sx
Bilateral acoustic neuromas (vestibular schwannomas)
other benign neurological tumours and lens opacities.
241
Indications for placing a chest tube in pleural infection:
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
Change in levothyroxine in pregnancy
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
Which vaccine are CI in immunocompromised patients
Vaccinations Make BRIT Yellow
Varicella
measles, mumps, rubella (MMR)
BCG
oral rotavirus,oral polio
influenza (intranasal)
oral typhoid
yellow fever
244
Gower sign
Seen in Duchenne muscular dystrophy, when a child used their arms to aid standing from a squat
245
Mx of complex fistula in Crohns
MRI
Oral metronidazole if sx
Draining seton
246
Maintaining remission in UC
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
Mx of salmonella
Cipro
248
TV vs BV
TV green
Strawberry cervix
249
Treatment offered to close contacts of meningitis patients
Oral ciprofloxacin or rifampicin is used as prophylaxis for contacts of patients with meningococcal meningitis
250
Abx for shigella
Cipro
251
Abxx for otits media, externa, peridontal abscess and gingivitis
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
Mx of acute pyelonephritis
Broad-spectrum cephalosporin or quinolone
253
Peutz-Jeghers syndrome
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
Valproate SE
teratogenic
P450 inhibitor
gastrointestinal: nausea
increased appetite and weight gain
alopecia: regrowth may be curly
ataxia
tremor
hepatotoxicity
255
NYHA classification
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
seminoma vs non seminoma tumor markers
Seminoma - bhcg
NS- High AFP , bhcg
257
Screening test for PCKD
US abdomen
258
Facial swelling after starting on ACS treatment
Angiooedema 2' to ACEi
259
Mx of CML
Imatinib
260
Resolution of DKA
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
261
Diagnosis of DKA
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
Adverse effects of PPIs
hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections
263
Behcet's syndrome
painful mouth sores, genital sores, and eye inflammation.
venous thromboembolism due to the inflammation of the blood vessels
264
Opioids able to be used in impaired renal function
Oxycodone
Buprenorphine
265
Prolactin in acromegaly
raised prolactin in 1/3 of cases → galactorrhoea
266
What else do you need to test for with TTG
IgA levels
As if IgA def- false negative
267
Chlamydia in pregnancy tx
Azithromycin, erythromycin or amoxicillin
268
Acoustic neuroma sx
cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
269
What is the latest time that HIV post-exposure prophylaxis may be given
72 hrs
270
Steroid therapy on bloods
neutrophilia
271
Dx and mx of SBO
hydrogen breath test
Management
correction of the underlying disorder
antibiotic therapy:rifaximin
272
Mx of Lyme disease
14-21d Doxycycline
Amox if CI
273
Mx of intracranial and visceral nausea
Cyclizine
274
Mx of toxoplasmosis
If immunocompetent- nothing
If compromised
pyrimethamine plus sulphadiazine for at least 6 weeks
275
Features of HONK
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
DIC features
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
277
Combination antiplatelet and anticoagulant therapy
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
Mx of asthma after IV steroids given
IV MgSO4
then aminophylline
279
Organism causing IECOPD
H influenza
280
Indication for cardiac resynchronicsation therapy
left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms
On maximal medical therapy
281
Mx of STEMI
Aspirin 300mg
PCI within 120mins
If no- thrombolysis
282
Mx of NSTEMI/UA
Aspirin
Fonda if no immediate PCI
GRACE score
>3%
PCI
Pras/tica
<3%
Ticagrelor
283
Bupropion MOA
Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
284
Adenosine SE
chest pain
bronchospasm
transient flushing
285
Subclinical hypothyroidism dx and mx
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
ABs in Graves
TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)
287
Marker in diagnosing anaphylaxis
Serum tryptase
288
Prophylaxis of migraine but has asthma
Topirmate
289
A crescent sign on CXR, previous TB
Aspergillosis
290
Test for strep vs glandular
Anti strep titre
Monospot
291
Varenicline MOA
a nicotinic receptor partial agonist
should be started 1 week before the patients target date to stop
292
Bronchiectasis sx
Large amounts of purulent sputum
Chest x-ray shows numerous parallel line shadows.
293
Quadrantopia causes
Upper- pituitary
Lower- craniopharingoma
294
Macula sparing homonymous hemianopia
Occipital cortex
294
Most commonly inherited thombophillia
Factor V Leiden
295
Raised ALP in the presence of normal LFT's
Bone mets
Pagets
296
Resp mx in a1at def
surgery: lung volume reduction surgery, lung transplantation
297
Factors favouring true epileptic seizures
tongue biting
raised serum prolactin*
298
MODY features
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
BRCA cancers
Breast and ovarian
BRCA2 Prostate men
300
Symptomatic stable angina on a calcium channel blocker but with a contraindication to a beta-blocker, the next line treatment ?
long-acting nitrate, ivabradine, nicorandil or ranolazine
301
Mx of rabies
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
Mx of both B12 and folate def
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
Sx and mx of Wilson's
low serum copper and a reduced serum caeruloplasmin.
Hepatitis, kayser fleishcer rings,
Blue nails
Chorea, dementia
Penicillamine
304
Nicorandil SE
Anal ulceration
305
Ascites and low ascitic fluid protein (<15 g/L) mx
Oral cipro
306
Third nerve palsy
Ptosis, down and out, mydraisis
Due to compression of para
307
Abx prophylaxis in COPD
Azithromycin
308
Which oesophageal cancer is related to achalasia
SCC
309
Chemo toxicity SE
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
Mx of bells palsy
Oral pred <72 hrs and artificial tears
311
India ink
Cryptococcal
312
Anticoagulation post AF ablation
Continue anticoagulation long term
313
Cryoprecipitate contains
factor VIII, fibrinogen, von Willebrand factor and factor XIII
314
When to refer for dyspepsia urgently
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
Non urgent endoscopy referrals
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
Mx of genital herpes in this trimester of pregnancy
Acyclovir until delivery- C section
317
Mx of primary hyperaldosteronism
Spironolactone
318
Which vaccines should be avoided on azathioprine
Live
BRIT
MMR, BCG, rotavirus, influenza, typhoid, yellow
319
Thorax mass in MG
Thymoma
320
Mx of bloating and vomiting after eating in T1DM
Metoclopramide
321
ACS treatment causing worsening MG
Beta blocker
322
Meds exacerbating MG
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
323
GRACE score components
Arrest
Heart rate/BP
ECG
Age
Renal function
Trops
324
Blood monitoring with statin
LFT at baseline, 3 months and 12 months
325
Diarrhoea acid base disturbance
Normal anion gap metabolic acidosis
326
When to add diabetic drug to patient
If Hba1c >58
327
DM on triple therapy but hba1c 62
Swap med for GLP1
328
Lymphoma associated with coeliac
Enteropathy associated T cell lymphoma
329
Warfarin: management of high INR
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
Dx of MS
MRI with contrast
331
Anaphylaxis, 2x doses of IM adrenaline, low BP
Refractory anaphylaxis
respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline
Adrenaline infusion
332
Diabetic medications
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
Longest incubation period for gastroenteritis
Giardiasis
334
Driving post ACS, CABG, pacemaker ICD
ACS- 4 weeks
1 if post PCI
CABG- 4 weeks
Pacemaker- 1 week
ICD- ventricular- 6m ,proph 1m
335
Trigger for cluster headaches
Alcohol
336
Tricep reflex root
C7-8
337
ATN vs pre renal urinary sodium
ATN- high Na
low osmolality
Pre renal- low Na
High osmolality
338
What is the most effective single step to reduce the incidence of MRSA?
Hand hygiene
339
Organism in CAPD-related peritonitis
Staph epidermidis
Staphylococcus aureus
340
Blood film of coeliac
Hyposplenism
target cells
Howell-Jolly bodies
Pappenheimer bodies
341
Silicosis sx
Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes
342
Most common presentation of posterior circulation stroke
Coordination difficulties
343
IDA vs ACD
TIBC high in IDA
Low in ACD
344
No. units to drink in a week
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
Adrenaline doses for anaphylaxis
<6m 100-150mcg
6m-6y 150mcg
6-12y 300mcg
>12y 500mcg
346
C peptide in T1DM
Low
347
Acute interstitial nephritis
'allergy'-type reaction
raised urinary WCC and eosinophils, alongside impaired renal function
348
Medication causing reduced hypo awareness
Beta blockers
349
PTH in primary hyperparathyroid
Can be normal or high
350
Lacunar, partial and total anterior infarct
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
Mx of wounds- tetanus
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
Neuropathic pain mx
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
Diagnosis of PSC
MRCP (beady) or ERCP
354
Intravenous drug user is brought to the emergency department with back pain, bilateral leg weakness and fever. Ix?
MRI whole spine
355
AMT and 4AT scoring
AMT- lower
<3 severe cognitive impairment
4AT - higher scoring-delirium
356
Monitoring for haemochromatosis
Ferritin and transferrin saturation
357
Mx of a patient with AF + an acute stroke (not haemorrhagic)
Aspirin then Start anticoagulation with a DOAC after 2 weeks
358
Post thrombotic syndrome
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
Which veins are damaged in subdural
Bridging veins
360
Test useful after patient has had anaphylaxis
RAST
361
When to refer someone with anginga to cardio for PCI /CABG
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
Rectal diazepam dosing
10mg
363
Meds for spasticity for MS
Baclofen and gabapentin
364
Mx of status epiliticus
Lorazepam 2x every 5 mins
4mg
Then phenytoin
Then intubate
365
P mitrale and p pulmonale
P mitrale- bifid- mitral stenosis
P pulmonale- increased
366
Murmur associated with PKD
Mitral valve prolapse
367
Lymphogranuloma venereum sx
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
HSP
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
Sarcoidosis sx
acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
ocular: uveitis
skin: lupus pernio
hypercalcaemia:
370
S3 and S4
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
Diabetic vs alcoholic ketoacidosis
Alcoholic- low or normal glucose
372
SE of excess B6
Peripheral neuropathy
373
Migraine meds that should be avoided in preg
Toprimate and triptans
374
Pharmacological cardioversion of AF
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
Asthma diagnosis in adults
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
Asthma diagnosis in 5-16 and <5
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
Testing for HIV
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
Cytotoxic agent causing hypomagnesia
Cisplatin
379
Most affected site in UC
Rectum
380
Scoring to identify patients with a pulmonary embolism that can be managed as outpatients
PESI
381
Broca vs Wernickes area
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
HPV for genital warts
HPV 6 +11
383
Virus causing Kaposi sarcoma
HHV8
384
Cells seen in AML and CLL
AML- auer rods
CLL- smear
385
Which sedative agent can you not prescribe in PD
Haloperidol
386
Timing of skin prick vs skin patch
Prick- after 15 mins
Patch- 48 hrs
386
Enchephaltis CT findings
prominent swelling and increased signal of the brain on MRI
CT head identifies hypodensity
387
Which med should be given before fibrinolysis for a STEMI
antithrombin drug eg fondaparinux
388
CKD staging if GFR 65 but normal creatinine and urine dip
No CKD
If kidney tests are normal, there is no CKD
389
DLB vs PD
Parkinson's disease dementia the tremor, bradykinesia, and rigidity will develop before dementia. In DLB, the opposite is true
390
Anti emetic in PD
Domperidone
391
Alpha-1 antitrypsin deficiency on spirometry
Obstructive picture
392
Following a cholecystectomy pt complains that she has experienced chronic diarrhoea which seems to float in the toilet. Meds to help?
Cholestyramine
393
Mx of child with SCD with temp >38
Admit urgently
This is because these patients are functionally asplenic and are at high risk of overwhelming sepsis
394
When to scan wells score
DVT 2 or more
PE 4 or more
Otherwise D dimer
395
Preg lady cellulitis, pen allergic abx
Erythromycin
NOT Clari
396
Man with HTN 145/92 and Q risk of 9%
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
What needs to be monitored with phenytoin infusion
Cardiac monitoring
398
Confirming coeliac
Jejunal biopsy
399
Neuroleptic malignant syndrome sx
NMS typically develops rapidly, usually within the first two weeks of starting an antipsychotic medication
pyrexia
muscle rigidity
autonomic lability
400
Which opioid for neuropathic pain if others have failed
Tramadol
401
Asymptomatic hyperuricaemia tx
No treatment
402
Myxoedema coma sx
confusion and hypothermia, patients may have non-pitting periorbital and leg oedema, reduced respiratory drive, pericardial effusions, anaemia, seizures
403
Double duct sign of MRCP
Pancreatic cancer
404
Renal diet for CKD
Low K
405
What medication to take with transfusion for beta thalassaemia
iron chelation therapy (e.g. desferrioxamine
406
What medication should be avoided in HOCM
Acei
Nitrates
407
Vaccines for COPD
Annual influenza
Pneumococcal once off
408
B blocker affect on sleep
Insomnia
409
Prosthetic heart valve replacement
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
Latent TB tx
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)
411
How to induce remission in Crohns
glucocorticoids (oral, topical or intravenous) are generally used to induce remission.
412
Symptom control in non-CF bronchiectasis
inspiratory muscle training + postural drainage
413
Pulse pressure in raised ICP
Wide
414
Alternative to metronidazole for BV
Topical clindamycin
415
Diabetic meds to start with bg of HF
start metformin, up-titrate; introduce dapagliflozin once metformin tolerance is confirmed.
Slowly up titrate metformin for GI symptoms
416
Ix for GBS
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
Post-exposure prophylaxis for HIV time
4 weeks
418
Which one of the following drugs used in the management of diabetes mellitus is most likely to cause cholestasis?
Sulphonylureas
419
CML vs CLL
CML- massive spleen
AML - Myelo'blast'
ALL - Lympho'blast'
CML - Granulo'cytosis'
CLL - Lympho'cytosis'
420
Organism causing infection in CF
Pseudomonas
421
What is seen on blood film in DIC
Schistocytes
422
Dx of acromegaly
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
Nephrogenic vs cranial DI
Cranial responds to exogenous ADH
424
Mx of PBC
Ursodeoxycholic acid
425
Lobar epileptic symtpoms
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
What can falsely lower BNP
Ramipril and BB
427
pH in BV and TV
Trichomonas vaginalis + bacterial vaginosis are associated with a pH > 4.5
428
Asymptomatic gallstones
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
Tx for seizure type
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
