medicine 2

Question 1

emergency treatment for anaphylaxis?

Answer 1

IV hydrocortisone and adrenaline

Question 2

RCHOP drugs

Answer 2

Rituximab, cyclophosphamide, vincristine, doxorubicin and prednisolone

Question 3

Poor prognostic factors for ALL:

Answer 3

Presentation <2 or >10

B or T cell surface markers

WCC>20 at diagnosis

Question 4

Poor prognostic factors for HL:

Answer 4

B symptoms
Age >45
Wcc> 15
hb <10.5
albumin <40
lymphocytes <600
male

Question 5

Blood film findings:

Answer 5

Howell-Jolly –> hyposplenic conditions e.g. megaloblastic anaemia, post splenectomy

Heinz –> G6PD deficiency

Shistocytes –> metallic heart valves or haemolytic anaemia

Rouleaux –> MM + other inflammatory conditions, alongside raised ESR

Question 6

Drugs that induce thrombocytopenia:

Answer 6

aspirin, heparin, diuretics, quinine, sulfonamides, thiazide diuretics

Question 7

Things that can induce a sickle cell crisis:

Answer 7

Infection
Hypoxia
Dehydration

Question 8

Management of SCD:

Answer 8

1. hydroxycarbamide –> increases fetal Hb which can’t sickle
2. exchange transfusion if severe anaemia
3. vaccinations and abx, to avoid infections as this can precipitate vaso-occlusive crises

Question 9

Investigation findings in DIC:

Answer 9

Thrombocytopenia
PT increased
D-dimer increased
Fibrinogen decreased

Question 10

Presentation of tumour lysis syndrome:

Answer 10

~2 days post high dose chemo for leukaemia or lymphoma.
Oliguria, abdo pain and weakness.
High potassium, phospahte and urea.
Low calcium.
AKI

Question 11

Presentation of sideroblastic anaemia:

Answer 11

Microcytic anaemia refractory to iron therapy, with abnormally high serum ferritin and iron.

Question 12

Hereditary causes of haemolytic anaemia:

Answer 12

Sickle cell
Thalassaemia
G6PD deficiency
Hereditary spherocytosis

Question 13

Causes of a prolonged PT:

Answer 13

DIC
Vit K deficiency (2,5,7,10)
Chronic Liver Disease

Question 14

Causes of a prolonged APTT:

Answer 14

DIC
Haemophilia A+B
VWB Disease

Question 15

Drugs that may enhance the effect of warfarin, and therefore need lower dosing / monitoring of it:

Answer 15

Alcohol
Amiodarone
Antibiotics
SSRIs + SNRIs
Aspirin
Clopidogrel

Question 16

Drugs that may reduce the effect of warfarin, and therefore need higher dosing /monitoring of it:

Answer 16

St John’s Wort
Rifampicin
Carbamazepine
Phenytoin

Question 17

When is serum ferritin increased?

Answer 17

Acute phase protein increased in inflammatory states, CKD, liver disease and malignancy.

Question 18

Drug causes of urticaria:

Answer 18

aspirin
penicillin
opiates
NSAIDs

Question 19

Erythroderma definition and causes:

Answer 19

When the body is covered 95% by a rash of any kind.

Eczema, psoriasis, lymphoma, leukaemia, idiopathic

Question 20

Features of raised ICP:

Answer 20

papilloedema
headache
n+v
temp loss of vision
reduced consciousness
Cushings reflex

Question 21

qSOFA

Answer 21

‘Quick’ SOFA score is used for patients with an infection - if >/= 2, they have a heightened risk of mortality.

RR >22
SBP <100
Altered mentation

Question 22

Sepsis and septic shock definition:

Answer 22

Sepsis = life threatening organ dysfunction caused by a dysregulated host response to infection.

Septic shock = a more severe form of sepsis in which circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone.

Question 23

Indications for splenectomy:

Answer 23

Devascularised spleen

Hilar vascular injuries.

Uncontrolled splenic bleeding

Question 24

Drug causes of pancreatitis:

Answer 24

Sodium valproate, mesalazine, azathioprine, bendro, furosemide, steroids, pentamidine

Question 25

Early complications of orthopaedic surgery:

Answer 25

DVT, PE, intrarticular sepsis, leg length discrepancy