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Muhesh Final Year from Passmed > Medicine > Flashcards

Medicine Flashcards

1
Q

What is the cushing’s reflex?

A

Hypertension and Bradycardia (Usually Hypertension and Tachycardia go hand in hand)

Raised ICP

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2
Q

Migraine Treatment:

Acute

Prophylaxis

A

Acute: Triptan + NSAID/ Triptan + Paracetomal (5 HT Agonists)

Prophylaxis: Topiramate or propranolol (5 HT Antagonists)

Propranolol - Avoid if patients are asthmatic or have heart block etc.

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3
Q

Treatment resistant Migraine Treatment

A

5-8 Weeks acupuncture

Gabapentin

Menstrual Migraine - Zolpitriptain and Frovatriptan

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4
Q

Hypertension Treatment Pathway

<55 year old

>55 year old / black people

A

<55 year old

i) ACE-i and ARB
ii) CCB
iii) Thiazides
iv) Spironolactone / High-dose thiazide diuretic
v) Alpha/ Beta Blocker

>55 year old / Black

i) CCB
ii) Thiazides
iii) Spironolactone / High-dose thiazide diuretic
iv) Alpha/ Beta Blocker

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5
Q

Stages of hypertension

A

1) Clinic- 140/90 mmHg

Home - 130/85 mmHg

2) Clinic - 160/100 mmHg

Home - 150/95 mmHg

Severe Hypertension) Clinic - 180 mmHg

BP - 110mmHg

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6
Q
A
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7
Q

Risks of dialysis

Four main ones and ions responsible

A

Calcium Related (and phosphate)

Circulatory Disease

Cardiovascular Siease

Cerebrovascular disease

Peripheral Vascular Disease

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8
Q

Phosphate target in:

Normal Patient

And Renal Patients

What is the risk?

A

Normal patient: 1.0-1.1

Renal patient: 1.7

Severe promoter of cardiovascular disease

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9
Q

Polycystic kidney disease mutations

Disease relation?

Proteins effected?

Predominant types of mutation?

A

Disease relations -

Berry aneurysms (PKD1 +PKD2)

liver cysts

diverticular disease

Aortic disease

Adrenal Disease

Proteins: Polycystin 1 and Polycistin 2

Mutations:

Most inherited

15% Mutations sporadic / mosaicim

85% Mutations inherited

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10
Q

Which mutation confers worse prognostically for PKD?

What type of mutaton confers worse progonstically?

A

PKD1!! - ESRF by the 40s

PKD2 - ESRF by the 60s

Deletions are worse than point mutations

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11
Q

Which drug has shown benefit in reducing growth of polycystc kidneys?

Mechanism?

Side effects?

A

Tolvaptan

Downregulates cAMP pathway leading to reduction in cyst size.

Side effects: Thirst, Polyuria, Dysuria, Dehydration

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12
Q

What phenotypic characteristics of PKD confer worse diagnosis?

A

Male

Hypertension

Deletion

Urological complications

Multiple Cysts

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13
Q

Causes of hypertrichosis? (4)

A

Drugs - minoxidil, cyclosporin, diazoxide

Congenital hypertrichosis

Porphyria Cutanea Tarda

Anorexea Nervosa

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14
Q

Hepatitis E is associated with which food products?

Type of virus?

Particularly at risk group?

A

Seafood

Pork

Hep E is a RNA hepevirus

20% mortality in pregnant women

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15
Q

Ciclosporin

MOA?

Side Effects?

Indications

A

Calcinuein inhibitor preventing IL2 mediated T Cell proliferation

Side Effects - Everything goes up.

Fluid retention, hyperkaemia, IGT, Gingival hyperplasia, Hypertrichosis, hyperlipidaemia.

Hepatotoxic

Indications - Transplant, RA, psoriasis, UC, pure red cell aplasia

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16
Q

Drug causes of hyperkalaemia

A

Potassium sparing diuretics, Ace-i, ARBs, ciclosporin, heparin

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17
Q

Watery eye

Swelling of the medial canthus

Dx

Mx

A

dacryocystitis - lacrimal sac infection

Mx - systemic abx (not topical),

If accompanied by periorbital cellulitis - Iv Abx too

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18
Q

Inflamed breast appearance?

A

Inflammatory breast cancer

Where cancerous cells block lymph drainage resulting in an inflamed breast appearance

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19
Q

Two examples of loop diuretics

Where do they act

On what do they act

SEs

A

Frusemide, bumetanide

Act on ascending limb

Block the Na, K, Cl transporter

SEs - hypotension, hyponatraemia, hypokalamia, hypocholoraemia alkalosis, hypocalcaemia, ototoxic, gout hyperglygaemia

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20
Q

Hyperemesis Gravidarum criteria

A

5% Pre Pregnancy Weight Loss

AND

Dehydration

AND

Electrolyte Imbalance

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21
Q

What is ABCD2?

What are the scoring points?

What is the scoring threshold plus intervention?

A

ABCD2 is the prognostic scoring algorithm for determining stroke following TIA

ABCD2

A ge - >60 Years 1 point

B - BP >140/90 mmHg 1 point

C - Unilateral weakness - 2 points

Speech disturbance - 1 point

D - Duration of symptoms

>60 minutes - 2 points

10-59 minutes - 1 point

Patient has diabetes - 1 point

Scoring threshold:

3 or less - Specialist assessment within 1 week of symptom onset

>4 - 300mg Aspirin daily

assessment within 24 hours

optimising of risk factors

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22
Q

Which antiplatelet therapy for stroke?

A

CHANCE Study- Shows greatest risk reduction in high risk TIA patients was seen in aspirin + clopidogrel

Then clopidogrel

Then aspirin + dypirimadole

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23
Q

Most common organism implicated in dog and cat bites?

Which antibiotic therapy?

If not tolerated?

A

Pasteurella Multocida

Antibiotic;

Co-Amoxiclav

Doxy + Met

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24
Q

What GFR level do you:

review metformin

stop metformin

Contrast studies- what do you do with metformin

A

Review:

< 45 ml/min

Stop:

<30 ml/min

Metformin should be stopped on day of contrast study and for 48 hours after

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25
Q

Hypokalaemic Metabolic Alkalosis =

______ Syndroem

A

Cushing’s Syondrome:

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26
Q

Alendronate Advice?

A

30 minutes before breakfast with plenty of water and sit up right for at least 30 minutes after

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27
Q

First line for trigeminal neuralgia

A

Carbamezapine

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28
Q

Positive tests in asthma:

FENO (what is measured and positive test)

Spirometry

A

FENO:

all 3 NOs is measured but iNOS rises (produced by inflammatory cells)

Adults >40 parts per billion

Children > 35 parts per billion

Spirometry:

Reversibility testing

Adults - 12% + improvement of FEV1 and 200ml increase in volume

Children - 12% + improvement of FEV1

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29
Q

Which drug should be given after every other blood unit?

A

Furosemide

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30
Q

Dehydration

Osmolality >320 mosmol/kg

Hyperglycaemia >30 mmol/L

A

Hyperosmolar Hyperglyacemic State

Key differentating factors from DKA :

Hyperglycaemia is more pronounced in HHS

No acidosis in HHS

Ketones are less than 3 in HHS

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31
Q

Acetycholine Accumulation:

Causes

Symptoms

Management

A

Causes:

Acetylcholinesterase Inhibitors

Organophosphate insecticide poisoning

Symptoms:

SLUD - Salivation, lcarimation, urination, diarrhoea

Hypotension

Bradycardia

Miosis

Muscle Fasciculations

Mx:

Atropine

?Pralidoxime

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32
Q

Which disease warrants pre operative cervical spine radiographs?

Why?

A

Rheumatoid Arthritis

Atlantoaxial subluxation is a complication and due to airway manipulation can cause SC compression

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33
Q

Rheumatoid Arthritis Extra Ocular:

ROODII AF

A

Resp: PF, PE, Pulmonary nodules, Bronchiolotis Oblietrans, Pleurisy

Ocular: Keratoconjunctivitis, Episcleritis, Scleritis, Ulceration, Keratitis, Chloroquine, retinopathy

Osteoporosis

Depression

IHD

Infections

Amyloidosis

Felty’s Syndrome ( RA + Splenomegaly + Neutropenia)

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34
Q

Causes of horner’s syndrome?

Central - 5, preganglionic - 4, postganglionic 4

A

Central:

Anhidrosis of face, arm and trunk

Causes - Stroke, Syringomyelia, Multiple Sclerosis, Tumour, Encephalitis

Pre-Ganglionic Lesions:

Anhidrosis of the face

Causes - Pancoast’s Tumour, Thyroidectomy, Trauma, Cervical Rib

Post-Ganglionic Lesions

No Anhidrosis

Causes - carotid artery - Disseciton, aneurysm, Cluster headache, Cavernous Sinsus thrombosis

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35
Q

Ototoxic Drugs

A

Aminoglycosides - Gentamicin

Furosemide

Aspirin

Cisplatin, Carboplatin

Chlorhexidine (Direct Contact)

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36
Q

Replacement of normal bone by vascular spongy bone ( in the ear )

A

Otosclerosis

Age of onset - 20-40 yo

Features: Conductive deafness, tinnitus, flamingo tinge of Tympanic membrane, FH

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37
Q

Metabolic Acidosis

Elevated Anion Gap

Elevated Serum Ketone Levels

Normal/Low Glucose Concentrations

Management?

A

Alcoholic Ketoacidosis

Mx - Saline + Thiamine.

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38
Q

Digoxin:

MOA

Indications

Toxicity + Management

A

MOA - Cardiac glycoside decreasing conduction through AVN and increases contractility due to Na/K ATPase pump inhibition

Indications - AF and Atrial flutter (rate control)

Symptomatic relief in HF

Toxicity - >1.5 mcg/l

Features - Unwell, lethargic, N&V, yellow - green vision, arrhythmias, gynaecomastia

Toxicity is incurred due to - hypokalaemia and other electrolyte disturbacnes (low Mg, High Ca, high Na), renal failure, hypoalbumin, hypothermia, hypothyroid and other drugs ( amiodarone, quinidine, verapamil, spironolactone)

Management - Digibind, correct arrhythmias, monitor potassium

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39
Q

Treatment of ischaemic stroke

A

Thrombolysis if <4.5 hours and no contraindications

300 mg Aspirin Daily for 2 weeks

75 mg daily clopidogrel long term

Statin if cholesterol is >3.5 mmol/l

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40
Q

Cavitating pneumonia:

Alcoholics and diabetics

A

Klebsiella Pneumoniae

  • Upper lobe bilateral cavitating opacities, empyema red currant jelly sputum
  • Gram Negative, non motile, encapsulated, facultative anaerobid, rod shaped, lactose - fermenting
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41
Q

Red scaly patches on sun-exposed areas

Dx

Mx

A

Bowen’s Disease or SCC in situ

5% malginant risk

Mx:

Topical 5 FUC, Imiquimod

Cryotherapy

Excision

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42
Q

Therapeutic Drug Monitoring

Lithium

Ciclosporin

Digoxin

Phenytoin

A

Lithium

12 hours post dose. Range 0.4-1.0 mmol/l

Digoxin

6 hours post dose

Ciclosporin and Phenytoin

Trough doses. Phenytoin - not routinely done

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43
Q

Contraindications to lung cancer surgery?

7

A

i) General health

ii) IIIb or IV (metastases)

iii) FEV1 <1.5 Litres

iv) Malignant pleural effusion

v) Tumour in peri-hilar region

vi) Vocal cord paralysis

vii) SVC obstruction

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44
Q

Criteria for HHT Diagnosis

Inheritance Pattern

A

HHT is an AD condition

Possible HHT: 2 of 4

Definite HHT: 3 of 4

Criteria:

Epistaxis

Telangiectases

Visceral Lesions - AVMs, GI telangiectasia

FH - First degree relative with HHT

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45
Q

Oxford/Bamford Stroke classification system?

A

Criteria:

1) Unilateral hemiparesis/hemisensory loss of face, arm or leg
2) homonymous hemianopia
3) Higher Cognitive dysunfction

TACI - All criteria present

PACI - 2 of 3 criteria present

LACS - 1 of: Unliateral weakness/ sensory deficit, Pure sensory, Ataxis Hemiparesis

PCI - Presents with 1 of following - Cerebellar/ brainstem syndrome, loss of consciousness, homonymous hemianopia

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46
Q

What are the two medullary occlusion snydromes ?

Describe deficits and differentiating features

A

PICA Infarct

- Contralteral loss of pain and temp sensation in body

  • Ipislateral - Pain and temp sensory loss in face

Ipsilateral - Cerebellar deficits, Hornery Syndrome

Vertigo, nystagmus, hoarseness, trouble swallowinw

Anterior Spinal Artery Infarct

  • Contralateral - hemiparesis, tactile and kinsethetic defects

Tongue deviates to side of lesion

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47
Q

PUO in context of a patient with haematuria, loin pain, abdo mass?

A

RCC

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48
Q

Indicatiosn for steroid treatmentin sarcoidosis

A

Stage 2 / 3 CXR - + Moderate, severe or progressive symptoms. ( if asymptomatic then no treatment required)

Hypercalcaemia

Eye, heart or neuro involvement

Parenchymal lung disease

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49
Q

Acute angle closure glaucoma

Features

Mx

A

Rise in IOP due to impairment of aqueous flow

Fx - Pain, Reduced vision, Mydriasis causes pain, red eye, haloes, non-recative pupil, corneal oedema,

Mx - Reduce aqueous secretion (Acetazolamide) and Induce pupillary constriction ( Pilocarpine)

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50
Q

Two Liver classifiaction systems?

Try to detail criteria

A

Child - Pugh :

BAAPE

  • Bilirubin, Albumin, PT, Encephalopathy, Ascites

<7 = A, 7-9 = B, >9 = C

MELD

  • Bilirbuiin, Creatinine, INR
  • provides 3 month mortality. >40 = 71.3% mortality

Lower the score the better

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51
Q

Visual Field Defects

Bitemporal Hemianopias - When upper quadrants are worse than lower and vice versa?

Homonymous quadrantanopias - Causes?

Homonymous Hemianopias - Causes?

A

Bitemporal Hemianopias -

If compression is inferior to the optic chiasm then the upper quadrants are more effected - pituitary tumour

If compression is superior to the optic chiasm then the lower quadrants are more effected - Craniophayingioma

Homonymous quadrantanopias - Mostly caused by Occipital lobe lesions. Also caused by parietal (Inferior quadrantanopias) and temporal (superior quadrantanopias)

Homonymous Hemianopias - Macula sparing - Definitely occipital cortex.

IF the shape of the defect is the same in both eyes then - posterior defect (Occipital lobe, radiation)

If Different - anterior defect (optic tract)

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52
Q

Recurrent Laryngeal nerve palsy vs Superior laryngeal nerve palsy

A

Recurrent - Innervates all intrinsic larynx muscles except cricothyroid. Causes hoarsesness

Superior - Cricothyroid. Damage affects pitch of the voice and the projection of the voice

Look at the image and you can see the course of the superior laryngeal nerve exposes it to traumatic injury whereas the recurrent can be implicated in cardiac, mediastinal and pulmonary pathology.

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53
Q

AntiDiabetic drug

Bind to ATP dependent K+ channel on pancreatic B Cells

Side effects?

A

Sulfonylureas

Increase insulin secretion from B Cells.

Side effects:

Weight gain

hypoglycaemic

Rare - SIADH, BM Suppression

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54
Q

5 HT DRugs

Agonists:

5 HT 1 D

Partial 5 HT1

Antagonists:

5 HT2

5 HT 3

A

5 HT 1 D agonist - Sumitriptan. Acute migraien treatment

Partial 5 HT 1 agnoist - ergotamine

5 HT 2 antagonist - pizitogen ( migraine prophylaxis)

5 HT 2 antagonist - cyproheptadine (diarrhoea control in carcinoid pts)

5 HT 3 antagonists - ondansetron

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55
Q

What do you do if you hae a hypo while driving?

A

Have fast acting glucose.

Move out of drivers seat

Wait un til 45 minutes after the BG is >4.0 mmol/mol

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56
Q

Burns managmenet

Wallace rule?

Parklands formula?

A

Wallace: 9% - head and neck, anterior chest, posterior chest, arm, posterior leg, anterior leg

Parklands: Fluid requirement.

Fluid needed: Total body SA of burns(%) x weight (kg) x 4

Half fluid in first eight hours

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57
Q

Drugs reducing mortality in LVF?

A

ACE-I

ARB

Hydralazine

Nitrates

Beta blockers

Aldosterone Antagonists

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58
Q

What type of visual problem occurs due to open angle glaucoma?

A

Visual Field Defects leading to tunnel vision

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59
Q

Which antihypertensive is safe to give with lithium

A

Amlodipine

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60
Q

Mixed respiratory alkalosis and metabolic acidosis

What overdose?

A

Salicylate

low CO2 and Low pH = Mixed

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61
Q

IV amiodarone vs Synchronised cardioversion

In VT

A

IV amiodarone –> patient is stable

Synchronised cardioversion –> Unstable patient

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62
Q

Polymorphic VT/ Torsades de Pointes treatment

A

IV magnesium

If unstable cardioversion

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63
Q

Diabetes Insipidus + Visual Field defect.

What is the defect?

Likely pathology?

A

Lower bitemporal heminopia

Craniophayngioma

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64
Q

Itchy vesicular skin lesions on extensor surfaces?

A

Dermatitis Herpetiformis

  • Note vesicular so not eczema necessarily.

Associated with coeliac disease

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65
Q

Dapsone

Three uses

A

Dermatitis herpetiformis (Coeliac’s Disease)

Leprosy (with rifampicin and clofimazine)

Granuloma Annulare

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66
Q

TB Drug Side Effects

A

Rifampicin - orange bodily fluids, rash, hepatotoxicity, drug interactions

Isoniazid - peripheral neuropathy, psychosis, hepatotoxicity

Pyrazinamide - arthralgia, gout, hepatotoxicity, nausea

Ethambutol - optic neuritis, rash

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67
Q

Ivabradine

MOA

Indications

SEs

A

MOA: Inhibits If channels (Funny channels) which usually allow a mix of potassium and sodium in and are triggered by hyperpolarisation. The influx of potassium when they are triggered allows depolarisation and spontaneous activation of cardiac myocytes.

Indications: Symptomatic angina relief

Side effects:

  • bright spots in vision (due to iH channels in the retina)
  • blurred vision
  • metabolised by the cyp450 3A4 so inducers and inhibitors alter drug concentration
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68
Q

How long before surgery do you stop the OCP?

A

4 weeks

In some cases for exampel where LA is given tehre is no need to stop it

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69
Q

Special prep for following surgeries:

Thyroid

Parathyroid

Sentinal node

Thoracic Duct

Carcinoid

Colorectal

Thyrotoxicosis

A

Thyroid - Vocal cord check

Parathyroid - Methylene blue to identify gland

Sentinel node - radioactive marker/ dye

Thoracic duct - administer cream

Carcnioid - Octreotide

Colorectal - Bowel perforation

Thyrotoxicosis- lugol’s iodine/medical therapy

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70
Q

Louis Bar Syndrome?

A

Neurological syndrome

- severe ataxia

- telangiectasia

Otherwise known as ataxia tenlangiectasia

Defective ATM Gene - usually responsible for identifying DNA breaks

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71
Q

Describe the following pulses and conditions they’re in:

i) Pulsus paradoxus

ii) Slow Rising
iii) Collapsing
iv) Pulsus Alternans
v) Bisferiens pulse
vi) Jerky pulse

A

i) PUlsus paradoxus: >10mmHg fall in Systolic BP during expiration. (Severe asthma, Cardiac tamponade) Pulse may be absent during inspiration
ii) Slow rising: Aortic Stenosis
iii) Collapsing: Aortic regurgitation, PDA, High output states
iv) Pulsus Alternans: Regular alternation of the force of the pulse. (LVF)
v) Bisferiens pulse: Double Pulse (seen in mixed aortic valve disease)

vi) Jerky pulse: HOCM

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72
Q

4 Types of MND:

Chromosome association

Gene Association

Worst and best prognosis

A

Chromosome - 21

Genes - SOD1, C9orf72, TARDBP, FUS

Primary Lateral Sclerosis -Just UMN signs

Amyotrophic Lateral sclerosis - 50% of patients. SOD1

Progressive Muscular Atrophy - LMN Signs only. Best prognosis

Progressive bulbar palsy - Loss of function of motor brainstem nuclei. Chewing, swallowing, facial muscle dysfunction. Worst prognosis

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73
Q

Drug Name?

Increases GABA Activity

Causes Weight Gain and nausea

OtherSEs?

A

Sodium Valproate (guess you could say alcohol too)

SEs: Alopecia, Pancreatitis, Hepatitis, ataxia, tremor, thrombocytopenia, hyponatraemia teratogenicity

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74
Q

Dry mouth and Raised ALP

A

Primary Biliary Cholangitis

70% have sicca symptoms

Middel aged women

Anti Mitochondrial Antibodies

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75
Q

Weber’s test localises to the contralateral or ipislateral side in sensorineural hearing loss?

A

Localises to the contralateral side because sound

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76
Q

String like narrowed terminal ileum

A

Kantor’s Sign

Crohn’s Disease

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77
Q

Best test to identify bowel perforation?

A

CT Scan

Erect chest x ray also useful

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78
Q

Mx for acne rosacea

A

Mild - Topical Metronidazole

more severe - Oxytetracycline

Laser therapy - prominent telangiectasia

General principles - high factor UV cream, camouflage to disguise redness

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79
Q

Complications of Subarachnoid Haemorrahge and treatment :

3

A

Rebleeding - ICP management, coiling, surgery

Obstructive hydrocephalus - Therapuetic lumbar puncture, decompressive craniectomy

Vasospasm - nimodipine

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80
Q

Mucosal invovlement:

Pemphigus

Pemphigoid

A

Pemphigus!

Pemphigus involves the mucous

Pemphigus - IgG against desmosomal proteins —> Intrapeidermal bullous formation

Pemphigoid - IgG against hemidesmosal proteins –> subepidermal bullous formation

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81
Q

What GCS level warrants CT head within 1 hour of arrival?

A

GCS <13

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82
Q

Immediate management of acute urinary clot retention leading to AKI?

A

Bladder irrigation with three way urethral catheter

Nephrostomies /Suprapubic catheters are second line measures as more invasive

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83
Q
A
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84
Q

Pain on wrist extension/forearm supination when elbow is extended

A

lateral epicondylitis: Tennis elbow

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85
Q

Diffuse haemorrhage of adrenal glands

A

Waterhouse- Friedrichson syndrome

-Patients often septic with profound coaguloapthy

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86
Q

Most common benign (4) and malignant parotid masses (6)

Other causes of parotid swelling (3)?

A

Benign:

Pleomorphic Adenoma (80% of ALL masses)

Warthin’s Tumour (adenolymphoma)

Monomorphic Adenoma, Hemangioma

malignant:

Mucoepidermoid carcinoma (30%), Adenoid, Mixed, Acinic, Adenocarcinoma, Lymphoma

Other:

HIV, Sjogren, Sarcoid

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87
Q

COPD Management?

A

i) SABA/SAMA

ii)

FEV1 >50%

LABA or LAMA

FEV1 <50%

LABA/LAMA + ICS

Oral theophylline

Mucolytics - Carbocysteine

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88
Q

Features of TCA Overdose

Mx

A

Features:

Anticholinergic features

Arrhythmias

Seizures

Metabolic acidosis

coma

Broad complexes, Tachycardia, prolonged QT interval

Management:

IV bicarbonate - for metabolic acidosis

IV lipid emulsion - binds free drugs

Anti arrhythmics not as useful as they prolong depolarisation or prolong QT intervals.

Lidocaine may be helpful

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89
Q

What to do if someone taking the COCP does not stop taking this before their surgery?

What can be offered instead of COCP for these patients?

A

Give them thromboprophylaxis.

If they don’t want to stop contraception then offer the POP until they are mobilised then they cna be switched to COCP

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90
Q

Name some occupational materials that are thought to cause occupational asthma (7)

A

Spray painting, foam moulding (Isocyanates)

Platinum Salts
Soldering Flux Resin

Glutaraldehyde

Flour

Epoxy Resins

Proteolytic Enzymes

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91
Q

i) Colicky pain and post prandial swelling of sumbandibular gland?

ii) Pus leaking from ducts associated with submandibular gland - Cx?

iii) painless slow growing mass in submandibular region

iv) Parotid duct called? Submanidublar duct called?

A

i) Sialolithiasis - 80% occur in the submandibular gland. Sialography - investigation of choice.
ii) Sialadenitis - submandibular abscess
iii) Submandibulat tumour. CT/MRI - to timage and usually FNAd. Most masses are excised anyway
iv) Parotid - Stenton’s duct. Submandibular - warthol’s duct

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92
Q

List of conditions pyoderma gangrenosum is associated with? (7)

Mx

A

Deep red necrotic ulcers

Causes - Idiopathic (50%), IBD (UC ,Crohn’s), RA, SLE, Myeloproliferative disorders, Lymphoma, Monoclonal Gammopathy, Primary Biliary Cirrhosis

Mx - oral steroids, ciclosporin, infliximab

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93
Q

Corneal abrasian

Dx

Mx

A

Dx - Slit lamp investigation with fluorescein shows yellow stained abrasian

Mx - topical antibiotic to prevent bacterial superinfeciton

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94
Q

Treatment for:

i) Massive PE with circulatory failure

ii) Provoked PE

iii) Unprovoked PE

iv) PE in malignancy

A

i) Thrombolysis. Use unfranctionated heparin (measure with APTT)
ii) Provoked PE - 5 days LMWH + 3 months warfarin
iii) Unprovoked PE - 5 days LMWH + 3-6 months Warfarin
iv) Malignancy PE - 6 months LMWH

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95
Q
A
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96
Q

Two most comman causes of bihilar lymphadenopathy

3 Other rarer

A

Sarcoidosis

Tuberculosis

Rarer Causes:

Malignancy, lymphoma

Pneumoconiosis - beryliosis

Fungi - histoplastmocytosis, coccidioidmycosis

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97
Q

New classification for Diabetic Retinopathy

Old classification

A

New:

Mild, Moderate, Severe NPDR

PDR

Mild - >1 microaneurysm

Moderate - microaneurysms, hard exudates, blot haemorrhages, cotton wool spots, venous bleeding, intraretinal microvascular abnormalities

Severe - blot haemorrahges and microaneurysms in 4 quadrants. Venous bleeding in at least 2 quadrants. IRMA in at least 1 quadrant

PDR - Neovascularisation

Old:

Backround - microaneurysms, blot haemorrhages <3, hard exucates

Pre proliferative - cotton wool spots, > 3 blot haemorrhages, venous bleeding, dark haemorrhages

Proliferative - neovascularisation

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98
Q

Cocaine MOA

Side Effects

A

MOA - Blockes dopamine, NA and serotonin

Cardiovascular effects

myocardial infarction. tachycardia, bradycardia, hypertension, QRS widening and QT prolongation, aortic dissection

Neurological effects -

seizures, mydriasis, hypertonia, hyperreflexia

Psychiatric effects -

agitation, psychosis, hallucinations

Others

ischaemic colitis, hyperthermia, metabolic acidosis, rhabdomyolysis

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99
Q

Clinical features of aynkylosing Spondylitis

Examination - what is schober’s test

Radiologically

7 As and 1 C of ankylosing spondylitis

A

HLA B27 association

Night and morning pain in young man

On examination:

Loss of lumbar lordosis

Increased thoracic kyphosis

Reduced lateral flexion

Reduced forward flexion

Schober’s test - Line drawn 10 cm above + 5 cm below. Distance between lines should increase by more than 5 cm when patient bends as far as possible.

Reduces chest expansion

Radiological features

Bamboo spine/ dagger spine

Scroilitis - narrowing/ widening of the joints

Squaring of the vertebral bodies

Enthesopathy, Ossification of ligmaents and tendons

7 As and 1 C of ank spond

Anterior Uveitis

Apical Fibrosis

Aortic Regurgitation

Achilles Tendonitis

AV Node Block

Amyloidosis

Peripheral arthritis

Cauda Equina Syndrome = C

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100
Q

Reduces IL-2 release causing reduction in clonal expansion of T Cells

Indications

Side Effects

A

Ciclosporin

Indications: UC, Red Cell Aplasia, psoriasis, RA, Organ transplantation

SE:

Nephrotoxic

Hepatotoxic

HyperKalaemia

Hypertension

Hypertension

Fluid Retention

Gingival hyperplasia

Hypertrichosis

IGT

Hyperlipidaemia

Increased chance of severe infection

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101
Q

Binds to sodium channels and increases their refractory period

Side Effects:

Acute

Chronic

Dose Monitoring

A

Phenytoin

Side Effects:

Acute - Cerebellar Poisoning ( Dizziness, Diplopia, Ataxia, Nystagmus, Slurred Speech, Confusion, Seizures)

Chronic - Gingival Hyerplasia, hirsutism, drowsiness, megaloblasitc anaemia, peripheral neuropathy, increased vitamin d metabolism (osteomalacia), lymphadenopathy, dyskinesia, drug induced lupus, hepatitis. dupytren’s contracture, fever, rashes (TEN)

Trough monitoring - for dose adjustment, suspected toxicity, non-adherence

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102
Q

Patient with Intracerebral Bleed

Becomes unresponsive

Primary Diagnostic Concern?

A

Obstructive hypercephalus - due to blood in in the ventricles

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103
Q

Antibiotic choice for corneal abrasian in:

Contact Lens Wearer

Non-Contact Lens Wearer

A

Contact lens - Topical Ciprofloxacin

Non contact lens wearer - Topical Erythromycin, Topical sulfecetamide

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104
Q

Levodopa:

Usually given with?

How long does it usually work for?

What side effects?

A

Usually given with - Carbidopa, Benserazide (DOPA Decarboxylase inhibitors)

Usually effective for about 2 years

SIde effects - On and off –> where suddenly there isn’t enough dopamine so symptoms resume. Can be treated with interspersed dopamine analogues.

Dyskinesia

Postural hypotension

Cardiac arrhythmias

Nausea and vomiting

reddish discolouration of urine

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105
Q

Opthalmaplegia, Areflexia, Ataxia

A

Miller- Fisher Syndrome

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106
Q

Statin + Macrolide

A

= Raised CK

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107
Q

Blood test for advanced fibrosis?

A

ELF (Enhanced liver fibrosis) - looks at Hyaluronic Acid, Procollagen III, Metalloproteinase 1 Inhibitor

Algorithmic result determined from the finding

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108
Q

Treatment goals for haemachromatosis

A

Transferrin saturation - <50%

Ferritin - <50 ug/l

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109
Q

Different renal stone treatmetns (5)

A

Extracorporeal shock therapy / Lithotripsy: >2 cm stones

Ureteroscopy : >2 cms stones in pregnant women

Percutaneous nephrolithotomy: complex renal calculi/ stone calculi

Expectant Management: <5mm ureteric calculi

Open: Complex cases

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110
Q

Renal stone prevention:

Calcium Stones

Oxalate Stones

Uric Acid Stones

A

Calcium Stones - High fluids, low protein, thiazide diuretics - increase distal tubular calcium resorption

Oxalate Stones - cholestyramine, pyridoxine - urinary oxalate secretion

Uric Acid Stones - Allopurinal, Oral bicarbonate

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111
Q

Hypokalaemia ECG (5)

Hyperkalaemia ECG

A

Hypokalaemia ECG: U have no pot and no t, but a long PR and a long QT

U Waves

Absent T Waves

Long PR

St Depression

Long QT

Hyperkalaemia ECG:

Peaked T Waves (first sign)

Absent P Waves

Prolonged PR

Conduction block

Sine waves

bradycardia

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112
Q

Treatment for symptomatic bradycardia

A

IV Atropine

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113
Q

Drug causes of pancreatitis (8)

A

azathioprine

mesalazine

didanosine

bendroflumethiazide

furosemide

pentamidine

steroids

sodium valproate

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114
Q

Which COPD patients get antibiotics in exacerbation?

A

NICE - purulent sputum or clinical signs of pneumonia

In reality - all of them get antibiotics

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115
Q

Heart Failure:

1st Line

2nd Line

3rd Line

A

1st Line:

ACE-i + Beta Blocker (bisoprolol or carvedilol)

2nd Line:

Aldosterone Antagonist, ARB or Hydralazine + Nitrate

3rd Line:

Cardiad resynchronisation, Digoxin (particularly if concurrent AF) or Ivabradine (only if HR >75 bpm + LVF <35%)

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116
Q

Regarding extra-colonic manifestations of IBD:

Which are disease activity:

Related

Unrelated

A

Related:

  • Asymmetric arthritis
  • Episcleritis (more common in crohn’s)
  • Erythema nodosum
  • Osteoporosis

Unrelated:

  • Symmetric Arthritis
  • Uveitis (more common in UC)
  • Pyoderma Gangrenosum (Rx oral/iv intermittent pred/ ciclosporin)
  • Clubbing
  • Primary Sclerosing Cholangitis (UC)
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117
Q

Lobar Collapse

X Ray Signs

Causes

A

X Ray signs:

  • Opacification in distribution of lobe
  • Pulling up of rest of lung i.e. horizontal fissure
  • Tracheal deviation to side of collapse
  • raised hemidiaphragm on side of collapse

Causes:

  • Mucous plug in asthma
  • Pneumonia
  • Lung cancer
  • Foreign body
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118
Q

Pneumothorax intevention guidance:

Primary

Secondary

A

Primary:

  • <2 cm rim of air. Consider discharge
  • >2cm rim of air: aspirate then drain if not working

Secondary:

  • >2 cm rim of air: Chest drain
  • 1-2 cm rim of air: Aspiration / chest drain
  • 1 cm : 24 hour oxygen therapy then repeat x ray
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119
Q

Amyloid Deposit in Thyroid Cancer

A

Medullary Thyroid

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120
Q

Statin Dose:

Primary prevention

Secondary prevention

A

Primary - 20 mg OD

Secondar - 80 mg OD

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121
Q

Treatment for acne

3 - and their rough MOA

A

Benzoyl peroxide - bacteriocidal

Adapalene - topical retinoid inhibiting keratinocyte differentiation

Lymecycline - is an antibiotic but in acne is an anti-inflammatory

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122
Q

Hallmark features of dermatofibroma

5

A

Itchy

occurs after insect bite

benign

Well-defined

Dimples inwards when squeezed

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123
Q

Brown, yellow patches on sun exposed areas.

A

Solar Lentigines

  • benign but have malignant potential.

Look for brown spots in between them for malignant conversion

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124
Q

Which type of naevus can resemble malignant melanoma

A

Dysplastic naevus

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125
Q

Difference between Lentigo Maligna and Solar Lentigenes and SSM

A

Lentigo Maligna are more darkly pigmented than solar lentigenes,

  • also usually larger and more irregularly shaped

When distinguishign between LM and SSM:

  • sun exposed more likely to be LM
  • Trunk and limbs - SSM
  • Angiogenesis - SSM

-

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126
Q

Pigmented linear line on nail

(involvement of nail bed)

A

Longitudinal Melanicular

(hutchinsons sign)

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127
Q

Grows faster than BCC, but resembles BCC

A

Amelanotic Melanoma

  • Although these will not be pigmented can be picked up by realising their growth is rapid
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128
Q

Crusted, erythematous, yellow lesion

What does it become

A

Actinic Keratoses

- becomes SCC (1-5% risk over 2 years)

Sun exposed sites , scaly, red, sore, plaque like, keratin

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129
Q

keratocanthoma vs SCC

A

They are similar visually and even histologically

BUT

Keratocanthomas

  • originates from follicular infundibulum
  • appear involuted
  • spontaneously regress
  • faster growing than SCC
  • keratin filled centre
  • retinoids

SCC

  • Metastasise, grow fast
  • firm, flesh toned, sore, painful, bleeds and oozes

Excision is management for both, 5 FUC, imiquimod,

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130
Q

Cranial Nerves effected in Accoustic Neuroma

Investigation of choice

A

CNVII - facial droop

CNV - absent corneal reflex

CNVIII - Deafness, tinnitus

MRI Cerebellopontine angle

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131
Q

cANCA (2)

pANCA (5)

A

cANCA - targets serine proteinase 3

granulomatosis with polyangitis (Wegener’s)

microscopic polyangitis

pANCA - targets MPO

immune crescenteric glomerulonephritis

churg-strauss

primary sclerosing cholangitis

microscopic polyangitis

granulomatosis with polyangitis (wegener’s)

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132
Q

Screening test of choice for Adult polycystic kidney disease

Which gene is associated with worse disease

Which chromosomes?

A

Ultrasound abdomen:

total of 2 cysts from either kidney if <30 yo

2 cysts in each kidney if 31-59 yo

4 cysts in each kidney if >60 yo

ADPKD1 (also more common) is associated with worse disease

ADPKD1- Chr 16

ADPKD2- Chr 4

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133
Q

First time tonic clonic AED for:

Men

Women

A

Men: Valproate

Women: Lamotrigine

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134
Q

Palliative care:

i)Moving from oral morphine to parenteral morphine

ii)from morphine to diamorphine

iii)in CKD alternatives to morphine

iv) codeine/tramadol to morphine

v) oral morphine to oral oxycodone

A

i)Moving from oral morphine to parenteral morphine

Divide oral morphine dose by 2

ii)from oral morphine to diamorphine (SC)

Subcutaneous diamorphine. Divide oral dose by 3

iii)in CKD alternatives to morphine

Buprenorphine, fentanyl, alfentanil

iv) Oral codeine/tramadol to oral morphine

divide by 10

v) oral morphine to oral oxycodone

divide by 1.5-2

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135
Q

Inducing remission in UC:

I) mild to moderate disease

ii) severe disease

iii) distal disease vs proximal disease

A

i ) mild to moderate disease:

Oral aminosalicylate

rectal/topical aminosalicylate

oral beclometasone proprionate

oral prednisolone - second line for inducing remission

ii) severe disease:

IV steroids

iii) distal disease vs proximal disease:

distal disease - rectal medalazine

proximal disease - oral aminosalicylates

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136
Q

Red Man syndrome?

i) What drug

ii) Mechanism

iii) Mx

A

i) Vancomycin
ii) Fast infusion causes vancomycin mediated mast cell degranulation. not anaphylaxis
iii) Stop infusion, wait for resolution, and start again at a slower rate.

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137
Q

Component of CHADS2 VASC scoring

A

C- Congestive Heart Failure

H - Hypertension

A - Age >75 = 2 points, 65-74 = 1 point

D- Diabetes

S2 - Stroke/TIA =2 points

V = Vascular disease

S = Sex being female

Consider anticoagulation in MEN at score of 1

Definitely anticoagulate when score >2

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138
Q

Reflexes: Which nerve correlation

Ankle

Knee

Biceps

Triceps

Brachioradialis

A

Ankle - S1-S2

Knee - L3-L4

Biceps - C5-C6

Triceps - C7-C8

Brachioradialis - C5-C6

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139
Q

Bony Metastases:

Common primaries

Common sites

A

Primaries - Prostate, breast, lung

Sites - Spine, pelvis, ribs, skull, long bones

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140
Q

Variceal Haemorrhage:

Acute treatment (5)

Prophylactic treatment (2)

A

Acute treatment (5)

ABC + fluid / blood resuss

Clotting- FFP + VIt K

Terlipressin

QUinolones

Invasive - Endoscopy + rubber band ligation/ Sengstaken-Blakemore if uncontrolled/ TIPS as a last line

Prophylactic treatment (2)

Propanolol - reduce rebleeding

Endoscopic variceal band ligation - two weekly intervals

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141
Q

Mx of chronic neuropathic pain

First Line

Second Line

Trigeminal Neuralgia

A

First - Amiptryilline, Duloxetine (SSNRI), Pregalabalin, gabapentin

Second- topical capsaicin, tramadol (rescue therapy), pain management

Trigeminal Neuralgia - Carbamezapine

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142
Q

UC + Transverse colon diameter >6 cm =

A

Toxic megacolon

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143
Q

Simon Broome Classification

A

Used to diagnose Familial Hypercholesterolaemia

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144
Q

Eron Classification System

A

For cellulitis

1-4

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145
Q

Serum-ascites albumin gradient

Raised in

What’s normal

A

Ascites caused by Portal Hypertension

<11 g/L normal

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146
Q

Significant smoking history increases lung cancer risk by a factor of ….

Asbestos exposure increases lung cancer …

A

10 - smoking

5 - asbestos

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147
Q

Carbon 13 urea breath test?

Reduced accuracy of test?

A

H Pylori

Reduced accuracy of test?

  • Anti secretory drugs within last 2 weeks
  • Antibiotics within last 4 weeks
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148
Q

Thiazide Diuretics used to treat Hypertension (3)

A

Bendroflumethiazide

Indapamide (1.5mg MR)

Chlorthalidone (12.5-25.0 mg)

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149
Q

Causes of Long QT

2 syndromic

5 Drug

5 other

A

2 syndromic:

Jervelle- Lang- Nielsen Syndrome - (abormal K+ Channel - associated with deafness)

Romano Ward Syndrome -

5 Drug:

TCAs -

Amiodarone

Terfenadine

Chloraquine

Erythromycin

5 other :

Electrolyte- Hypomaganesaeima, Hypokalaemia, Hypocalcaemia

Acute MI

Myocarditis

Hypothermia

SAH

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150
Q

Drugs causing haemolysis in G6PDD>

A

anti-malarials: primaquine

ciprofloxacin

sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas

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151
Q

Acceptable RF change when ACE-I started?

A

25% GFR decrease

30% Creatinine rise

Anymore should prompt investigation

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152
Q

What are medicines associated with the development of idiopathic (iatrogenic) intracranial hypertension? (7)

A

Tetracycline antibiotics

isoretinoin

contraceptives

steroids

levothyroxium

cimetidine

lithium

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153
Q

Blood investigation in wernicke’s encephalopathy?

A

Red Cell Transketolase

- thiamine dependent enzyme so in those with thiamine defficiecny the activity will be negatively impacted

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154
Q

Dermatome:

C6?

T4?

T10?

L1?

L4?

L5?

S1?

A

C6 - Put thumb and first finger together to make a 6 with your left hand. Dorsal thumb and first finger

T4 - Teat Pore. Nipple

T10 - Belly but- TEN. Umbilicus

L1 - L for ligamnet (inguinal) 1 for 1nguinal. Inguinal Ligament

L4 - Down on aall fours. Knee Cap

L5 - Largest of the five. DOrsum of big toe

S1 - Smallest one - Small toe

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155
Q

CVP Reading of <18 mmHg implies:

A

Pulmonary oedema is excluded

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156
Q

EBV Associated malignancies

A

Burkitt’s Lymphoma - starry sky

Nasopharyngeal carcinoma

Hodgkin’s lymphoma -

HIV associated CNS Lymphoma

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157
Q

Dysplasisa in oesophagus during endoscopy?

Metaplasia?

A

Needs treatment!

  • Endoscopic resection/ablation
  • thought to prevent transfromation to adenocarcinoma

3-5 yearly surveillance with endsocopy for metaplasia

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158
Q

IBS Management

1st line

2nd line

A

1st line drugs often depend on presentation:

Constipation - Laxatives, Linaclotide (if constpiation >12 months and laxatives not working)

Pain - anti-spasmodics ( baclofen, mebeverine, dantrolene)

Diarrhoea - loperamide

2nd Line:

TCA> SSRIs

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159
Q

Differentiate between SIADH and Salt Wasting

A

Both have:

> 500 urine osmolality

Hyponatraemia

SIADH - euvolaemic

Salt wasting - Dehydrated

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160
Q

RBBB

Left Axis Deviation

First Degree heart block

/

RBBB

Left Axis Deviation

A

Tri-Fascicular Block

/

Bi-Fascicular Block

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161
Q

Medication to quit smoking?

3

A

Given in isolation and not as combination treatment

NRT - Lozenges, Gums etc.

  • cauase nausea and headaches

Bupropion - Dopamine + NE reuptake inhibitor/ nicotinic antagonist

SEs - Seizures, CI - elipepsy, pregnancy, breast feeding

Varenicline - Nicotinic receptor partial agonist

?more effective than bupropion

SE - suicidalility. Commonly - nauseua, headaches, abnormal dreams

CI- mental health issues, pregnancy and breastfeeding

Varenciline

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162
Q

Screening for zollinger ellison syndrome

A

Fasting gastrin levels!

secretin stimulation test

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163
Q

Strep Bovis

What tests do you do?

A

Bloods - usuals + Blood cultures

Echo - if murmur / ?valve vegitation

Colonoscopy - ?Colorectal cancer

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164
Q

Infective endocarditis

Most common

Subacute

Culture negative

A

Most common - S. Aureus

Subacute - Viridans, Bovis?

Culutre negative:

  • Liebman Sacks (SLE)
  • Marantic (Malignancy)
  • 3 Bs - bartonella, Brucella, coxiella burnetti
  • HACEK -Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
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165
Q

Anti-Emetics MOA:

Metoclopramide

Domperidone

Ondansetron

Cyclizine

Prochlorperazine

A

Metoclopramide - Dopamine receptor antagonist / 5 HT3 antagonist/ 5 HT4 agonist

Domperidone - D2 receptor antagonist

Ondansetron - 5 HT3 Antagonist

Cyclizine - anti-histamine

Prochlorperazine - D2 Receptor antagonist (phenothiazine)

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166
Q

Causes of respiratory alkalosis

(6)

A

Anxiety

Salicylate

Pulmonary embolism

Pregnancy

altitude

CNS Disorders (Stroke, SAH, encephalitis)

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167
Q

WPW

5 ECG Features

Explain mechanism

Types?

Mx?

Mx if AF?

A

ECG:

Short PR Interval

Broad QRS

RAD if right accessary

LAD if left accessary

Delta wave - upstroke of QRS complex

WPW caused by a congenital accessory pathway between the atria and the ventricles

- can cause AF to rapidly degeneratie into VF

Three types

A LAD (left accessory) - dominant r wave in v1

B RAD (right accessory) - dominant r wave in v6

C - upright delta waves in v1-4 but negative delta waves in v5-v6

Mx

Medical - Sotalol, Fleicanide, Amiodarone

Interventional - radiofrequency ablation of accessory

Mx if AF - Don’t give sotalol as this can cause progression to VF. Beta blockers increase the refractory period so slowing down the rate but in WPW this is thought to lead to increased conduction through the accessory pathway

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168
Q

Amiodarone

MOA

Monitoring

SEs

A

MOA - Potassium channel blocker (CLASS III Anti-arrhythmic) (minor sodium channel blocker) –> Inhibits repolarisation

Monitoring –> Prior to starting - TFT, U+E, LFT, CXR

6 monthly - TFT, LFT

SEs - Thyroid, hepatotoxic, pulmonary fibrosis, slate-grey appearance, corneal deposits, peripheral neuropathy + myopathy, photosensitiviy.

makes pts bradycardic

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169
Q

Maintenance fluids requirements?

V important card

A

Water - 30 ml/kg/day

Sodium, Potassium Chloride - 1mmol/kg/day

Glucose - 50-100 g/day

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170
Q

Tumour Antigens:

Ca 125

Ca 19 9

Ca 15 3

PSA

AFP

CEA

S- 100

Bombesin

A

Ca 125 - ovary

Ca 19 9 - pancreatic, cholangiocarcinoma

Ca 15 3 - breast

PSA - prostate

AFP - HCC, Teratoma

CEA - CRC

S- 100 - Melanoma, Schwannoma

Bombesin - SCLS, Gastric cancer, neuroblastoma

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171
Q

Peripheral Neuropathy

Which are predominantly:

i) motor (6)

ii) sensory (6)di

A

MOTOR CAUSES:

i) CMT - HMSN
ii) GBS
iii) Poprhyria
iv) Lead poisoning

vI) CIDP - chronic inflammatory demyelinating polyneuropathy

vi) diptheria

Sensory Causes:

i) diabetes
ii) uraemia
iii) leprosy
iv) B12 def.
v) alcoholism
vi) amyloidosis

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172
Q

Inhaled ICS Doses:

Low

Medium

High

A

Low - <400

Medium - 400-800

High - >800

doses all in mcgs.

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173
Q

Which artery supplies AV node?

What is it usually a branch of?

A

Posterior Interventricular Artery

usually a branch of the - RIGHT CORONARY ARTERY ( in a minority of patients the left circumflex artery )

So - clinically:

RCA occlusion causes Inferior MI —> complication can be heartblock as both the AVN and SAN are supplied by the right coronary usuallly

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174
Q

Cerebral oedema after blood transfusion?

A

Dialysis Disequilibrium Syndrome

Diagnosis of exclusion

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175
Q

Inhibits sodium absorption at beginning of DCT?

What channel does it block

Some examples of the drug (3)

SEs

A

Thiazides: Blocks the Na+ Cl- symporter

Drugs: Indapamide, Chlortalidone, Bendroflumethiazide

SEs: Electrolytes: Hypokalaemia and natraemia, hypercalcaemia

dehydration

postural hypotension

gout

IGT

impotence

rare- thrombocytopenia, agranulocytosis, photosensitive rash, pancreatitis

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176
Q

Ptosis and dilated pupil =?

Ptosis and constricted pupil =?

A

Ptosis and mydriasis (dilated pupil) = CN III palsy

Ptosis and meiosis (Constricted pupil) = Horner’s syndrome

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177
Q

In CURB 65 :

All of the values

A

Confusion: 8/10 or less on AMTS

Urea: >7 mmol/L

R: >30 BPM

B: <60 mmHg diastolic

Age: >65

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178
Q

Allergy, Eosinophilia, Medium vessel vasculitis (involvement of renal vessels?)

Condition

Antibody implicated

Drugs that can precipitate disease?

A

Churg Strauss- asthma, eosinophils, sinusitis, mononeuritis multiples, pANCA positive in 70% patients

- pANCA

Leukotriene receptor antagonists can precipitate disease

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179
Q

Erratic blood glucose control

bloating

vomiting

Dx?

Rx?

A

Gastroparesis (in DM)

Rx - metoclopramide, domperidone, erythromycin

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180
Q

Investigating frank haematuria in >45?

A

Cystoscopy

  • Concern is bladder cancer so follows the 2ww pathwya
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181
Q

Chemotherapeutic agents and their SEs?

Cyclophosphamide

Bleomycin

Doxirubicin

MTX

5FUC

6MCU

Cytarabine

Vincblastine

Vincristin

Docetaxel

Cisplatin

Hydroxyurea

A

Cyclophosphamide - haemorrhagic cystitis, myelosuppression, TCC

Bleomycin - lung fibrosis

Doxirubicin - cardiomyopathy

MTX - myelosuppresion, mucositis, liver fibrosis, lung fibrosis

5FUC - myelosuppression, mucositis, dermatitis

6MCU - myelosuppression

Cytarabine, myelosuppression, ataxia

Vincblastine - myelosuppression

Vincristin - peripheral neuropathy, paralytic ileus

Docetaxel - neutropenia

Cisplatin - ototoxicity, peripheral neuropathy, hypomaganasaemia

Hydroxyurea - myelosuppression

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182
Q

Which murmur is associated with collagen defects - Marfan’s, ehler’s danlos?

A

Mitral regurgitation

  • pan systolic
  • soft s1, split s2
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183
Q

Epilepsy and driving

1 seizure

formal diagnosis of epilepsy

withdrawal of AEDs

A

1 seizure - tell DVLA and cant drive for six months

Formal diagnosis - must be seizure free for >12 months

withdrawal of AEDs - shouldn’t drive while withdrawing and until 6 months after final dose

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184
Q

Pointed/ arrowhead t wave inversion in anterior leads?

A

Wellen’s Syndrome

  • represents critical, proximal stenosis of the LAD

(symmetrical often deep t wave inversion, >2mm)

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185
Q

Thyroid nodules + lymphadenopathy?

A

Papillary Carcinoma - undergo lymphatic spread more readily than follicular thyroid cancers

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186
Q

Atrial Flutter

What is the atrial rate?

What does block refer to?

Rx?

A

Atrial rate is normally 300. So the block refers to how many saw tooth p waves versus how many ventricular beats.

This dissociation is caused by AV Block. 2:1 block = 150 bpm (ventricular beats), 3:1 = 100, 4:1 =75

Rx:

Medication used to treat AF

Cardioversion - lower lectricity required

Tricpid valve isthmus ablation

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187
Q

Pericarditis

Signs and symptoms

Causes

ECG Findings

A

Signs and symptoms

Central chest pain, pleuritic

Relieved by sitting forwards

tachypnoea, tachy cardia

pericardial rub

Causes: Virii (Cox), TB, Uraemia, Post MI, Dresslerr’s, CTD, hypothyroidism

ECG Findings - Concave ST elevation. Most specific- PR depression

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188
Q

Epithelioid Histiocytes

A

Histological finding in TB

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189
Q

Common causes of pyogenic liver abscesses

Hydatid disease vs other liver abscess

A

Staph aureus and e coli

hydatid disease - the cyst is walled off and well circumscribed

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190
Q

Adenosine interactions

A

Enhanced by - dipyrimadole

Inhibited by - theophylline

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191
Q

AS

Asymptomatic patient

when to treat?

A

>40 mmHg pressure gradient

LVF

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192
Q

Trichrome stain.

Methenamine silver stain .

Giemsa stain

A

Trichrome stain is for giardiasis.

Methenamine silver stain is for PCP pneumonia.

Giemsa stain is for Cryptococcus neoformans.

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193
Q

Councilman bodies

Epithelioid histiocytes .

Herman’s sign .

Winterbottom’s sign

A

Councilman bodies is something you would see in the liver and is associated with hemorrhagic fevers such as yellow fever.

Epithelioid histiocytes are for tuberculosis infection. These are flattened macrophages which resemble epithelium.

Herman’s sign is a rash found in dengue fever patients.

Winterbottom’s sign is an enlarged lymph node found in patients suspected of African sleeping sickness.

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194
Q

Wegener’s renal biopsy finding?

A

Crescenteric GN

WCC

Wegeners, cANCA, Crescenteric

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195
Q

Surgical treatment of ITP?

A

platelet count threshold level is 80

>80

Nothing , just monitor bleeding

<80 consider IVIG and corticosteroids

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196
Q

Neuropathies

predominantly sensory and autonomic neuropathy

predominantly motor neuropathy

predominantly sensory neuropathy

A

Type 2 diabetes causes predominantly sensory and autonomic neuropathy

Botulism and lead poisoning cause predominantly motor neuropathy

Vitamin B12 deficiency and alcohol cause predominantly sensory neuropathy

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197
Q

Periodic acid schiff positive granules

A

Macrophage inclusions seen in Whipple’s Disease

Tropheryma whippelii

Rx - Co-trimoxazole

malabsorption: diarrhoea, weight loss

large-joint arthralgia

lymphadenopathy

skin: hyperpigmentation and photosensitivity

pleurisy, pericarditis

neurological symptoms (rare): ophthalmoplegia, dementia, seizures, ataxia, myoclonus

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198
Q

Visual field defect in glaucoma?

A

Peripheral visual field loss

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199
Q

Target INR for valves

Mitral

Aortic

A

Mitra- 3;5

Aortic - 3.0

200
Q

Which ECG findings have a risk of potential asystole (4)

Rx

A

complete heart block with broad complex QRS

recent asystole

Mobitz type II AV block

ventricular pause > 3 seconds

Rx - Transvenous pacing (if delay - atropine, adrenaline, transcutaneous pacing)

201
Q

Common drug decreasing absorption of levothyroxine?

A

IRON

202
Q

Nicorandil

MOA

Use

A

Potassion channel activator

Used in angina

203
Q

Angina Algorithm

1st Line

2nd Line

3rd Line

Definitive

A

Angina Algorithm

All given aspirin, statin + GTN

1st Line - CCB (Rate limiting - diltiazen / verapamil) / B BLocker

2nd Line - Both CCB + B Blocker

3rd Line - Nicorandil (K+ Channel activator), Long acting Nitrate, Ranazoline, Ivabradine (Interacts with If channel in SAN –> rate limiting)

Definitive - PCI/ CABG

204
Q

Why are packed red cells irradiated?

A

Depletes blood of T lymphocytes

Effort to prevent GVHD

205
Q

ADenosine

MOA

Use

A

SVT

A1 agonist - reduces cAMP -> causes hyperpolarisation due to potassium eflux

206
Q

eGFR variables

CAGE

A

Creatinine

Age

Gender

Ethnicity

207
Q

ECG Changes for thrombolysis or percutaneous intervention

A

ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR

ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR

New Left bundle branch block

208
Q

Absent corneal reflex…

A

Accoustic neuroma

  • effect 5,7,8
209
Q

Hypercalcaemia management?

A

IV NS + Frusemide if patient is fluid intolerant

followed by bisphosphonates

Calcitonin can be used to quickly rectify and steroids in sarcoid

210
Q
A
211
Q

T1DM

Target BM on:

Waking

Before meals

A

Waking: 5-7

Before meals : 4-7

212
Q

Aortic Coarctation

Features

Associations

A

Features

  • RF Delay
  • Mid Systolic Murmur (listen inbetween clavicles)
  • Apical click from aortic valve

Associations

  • Turner’s
  • Bicuspid
  • Berry aneurysms
  • NF
213
Q

VF/ pVT

When do you give drugs

What drugs?

A

1 mg Adrenaline, 300mg Amiodarone - IV

Drugs to be given after third shock

214
Q

Addisonian Crisis

Features

Mx

A

Features - hypovolaemia, hyponatraemia, hypokalaemia, abdo pain

Mx - 100mg hydrocortisone (6 hourly)

Stat IV NS

start oral steroid after 24 hours/ when patient stabilises

215
Q

Parkinson’s

TRAP?

A

Tremor

Rigidity

Akinesia

Postural instability

216
Q

Triptan adverse effects?

A

Tightness of throat and chest

tingling

heat

heaviness

pressure

217
Q

Why would you have anterior lead and inferior lead ST Elevation?

A

Due to complete occlusion of a wrap around LAD

218
Q

Causes of SVT (3)

A

AV nodal re entry tachycardia (AVNRT)

AV re entry tachycardia (AVRT)

Junctional Tachycardia

219
Q
A
220
Q

Subungual Fibromata

Subungual Hyperkeratosis

A

Subungual Fibromata - Tuberous Sclerosis

Subungual Hyperkeratosis - Psoriasis

221
Q

Causes of:

Increased T4

Increased TSH

A

Grave’s

De Quervian’s

Pituitary Adenoma

Poor Compliance with Thyroid meds (TSH goes down days to weeks after consumption)

Total thyroid resistance -

222
Q

GLP 1 Mimetics?

A

Exanetitde (SC), Liraglutide

Good for weight loss

Need to have a significant HBA1C reduction

Good for people not usitable for insulin therapy

223
Q

Kallman Vs Kinefelter?

A

Kallmann - X Linked recessive

Reduced GnrH Secreting neurones in hypothalamus (low SH levels)

- sterility, delayed puberty, anosmia ., hypogonadism.

  • normal/ tall

Kinefelter - 47 XXY

  • delayed/ absent puberty

Tall limbs, hypotonia , gynaecomastia , Cognitive impairment

224
Q

Tumour Lysis Syndrome Biochemical markers

Rx

A

2 of :

Raised- Uric acid, potassium, phosphate

Decreased - calcium

Clinical diagnosis needs 2 of biochemical markers +

Raised serum creatinine

Arrhytmia/ sudden death

Seizure

Mx

- Allopurinol

- Rasburicase

225
Q

Inherited Hyperbilirubinaemias (4)

A

Unconjugated Hyperbilinaemia (Impaired UGT1A1 - bilirubin processor)

  • Crigler Najjar (appear jaundiced)
  • Gilbert

Conjugated Hyperbilinaemia

  • Dubin Johnson
  • Rotor
226
Q

Causes of:

Pulsus parodoxus
Slow-rising/plateau
Collapsing
Pulsus alternans

Bisferins Pulse
‘Jerky’ pulse

A

Pulsus parodoxus

greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration

severe asthma, cardiac tamponade

Slow-rising/plateau

aortic stenosis

Collapsing

aortic regurgitation

patent ductus arteriosus

hyperkinetic (anaemia, thyrotoxic, fever, exercise/pregnancy)

Pulsus alternans

regular alternation of the force of the arterial pulse

severe LVF

Bisferiens pulse

‘double pulse’ - two systolic peaks

mixed aortic valve disease

‘Jerky’ pulse

hypertrophic obstructive cardiomyopathy*

227
Q

Carcinoid Syndrome

- Cardiac Features

- Respiratory Features

-Others

- Ix

-Mx

A

Cardiac Features

  • TIPS - Tricuspid Insufficeincy, Pulmonary Stenosis.

Respiratory Features

Bronchospasm

Others - hypotension, flushing, diarhoea, pellagra, Cuhsing’s

Ix - 5 HIAA, Chromagrin A y

Mx - Octreotide ( Somatostin Analogues). Diarrhoea (Cyproheptadine)

228
Q

IgA Deposition on histology of kidney?

A

IgA Nephropathy - Berger’s Disease (HSP also has IgA positive immunohistochemistry)

Ax - Alcoholic cirrhosis, Coelias, HSP

Mx - steroids / DMARDs dont help

229
Q

Prophylaxis for neutropenic sepsis?

A

Fluoroquinolones

230
Q

Eczema

Immunodeficiecny

thrombocytopenia

A

Wiskott Aldrich Syndrome

-X linked recessive (WASP gene)

Fx:

  • Bacterial infections
  • eczema
  • thromboycytopenia
  • low IgM levels
231
Q

Sulfonylurea

MOA:

SEs:

A

MOA:

increase insulin secretion by binding to ATP Dependent K+ Channel on beta cells

SEs:

Weight gain + Hypos

N+V

SIADH

cholestasis

peripheral neuorpathy

hepatic damage

BM suppression

232
Q
A
233
Q

Rule for bowel diameter

A

369

>3 pathological for Small bowel

>6 pathological for large bowel

>9 pathological for caecum

234
Q

COPD

using inhalers but not effective at reducing breathlessness

FEV1 <50%

FEV1 >50%

A

FEV1 > 50%: LABA or LAMA

FEV1 < 50%: LABA + ICS or LAMA

235
Q

Proximal aortic dissection - Mx?

Descending aortic dissection - Mx?

A

Proximal aortic dissection = Aortic root replacement

Descending aortic dissection = Endovascular treatment

236
Q

Heart Sounds?

S1

S2

S3

S4

A

S1

closure of mitral and tricuspid valves

soft = long PR or mitral regurgitation

loud= mitral stenosis

S2

closure of aortic and pulmonary valves

soft = aortic stenosis

splitting = during inspiration is normal

S3

caused by diastolic filling of the ventricle

considered normal if < 40 years old

heard in left ventricular failure, constrictive pericarditis and mitral regurgitation

S4

atrial contraction against a stiff ventricle

aortic stenosis, HOCM, hypertension

237
Q

Splitting of S2

Inspiration

Expiration

Wide

Fixed

A

Inspiration = can be normal

Expiration= aortic stenosis, HOCM, LBBB

Wide = pulmonary stenosis, RBBB

Fixed = ASD

238
Q

Sickle Cell Disease

Low Hb and High Reticulocytes

Low Hb and Low Reticulocytes

A

Low Hb and High Reticulocytes - Acute sequestration, haemolysis

Low Hb and Low Reticulocytes - Parvovirus

239
Q

Severe hypokalaemia?

Value?

Mx?

A

Value = <2.5/ or if symptomatic (cramps and palpitations etc.)

Mx

Cardiac monitoring

No more than 20 mmol/hour K

If mild Hypokalaemia can give oral potassium

240
Q

Distinguishing between ATN and Pre Renal AKI

Urinary sodium?

Urine: Plasma osmolality?
Urine: Plasma urea?

A

ATN

Urinary sodium - >30 mmol/L

Urine: Plasma osmolality - <1.1
Urine: Plasma urea >10:1

Pre renal AKI

Urinary sodium - <20 mmol/L

Urine: Plasma osmolality >1.5
Urine: Plasma urea <8:1

241
Q

Investiation of CHoice for Liver Cirrhosis

A

Transient Elastography

  • 50 Mhz Wave looking for stiffness of liver

Recommended instead of liver biopsy

Indications

  • Hep C
  • >35 units alcohol per week
  • known alcohol related liver disease
242
Q

Late onset Type 1 Diabetes + Other Autoimmune

A

LADA

  • Latent Autoimune diabetes of adulthood

Anti-GAD antibodies bt just slower process

243
Q

Gold standard for oesophogeal Ca diagnosis>

A

Endoscopy

Not barium anymore

244
Q

Indications for prophylactic antibiotics in SBP (3)

Which antibiotic

A

Indications:

  • previous SBP
  • ascitic fluid albumin level <15 g/L + Child-Pugh Score of >9/ hepatorenal syndrome
  • cirrhosis + ascites with albumin level <15 g/L
245
Q

Normal QT?

Drugs prolonging QT?

Other causes of long QT?

Congental Causes of QT?

A

Normal QT

<430 ms in men <450 ms in women

Drugs prolonging QT

Anti Depressants (TCAs, SSRIs), Anti-arrhythmics (sotalol, amiodarone), Anti Addiction (methadone), Anti malarial (chloroquine), Anti Fungal (terfenadine), Antibiotic (erythromycin), Antipsychotic (Haloperidol)

Other causes of long QT

HypOs - Calcaemia, kalaemia, Magnaesema, MI, Hypothermia, SAH

Congental Causes of QT

Jervell-Lange-Nielsen (deafness), Romano -Ward

246
Q

Fluid bolus volume?

A

500 ml 0.9% saline STAT if no HF

250 ml 0.9% saline STAT if HF

247
Q

What severity index for UC?

One of 2

then one of 4

A

Trueove and Witt’s

Either: Passing >6 stools a day or Blood ins tool

and one of:

>37.8 degrees c

HR >90 bpm

Hb <105 g/L

ESR >30 mmHour

248
Q

Which leads is t wave inversion normal in?

A

III

aVR

VI

249
Q

Degenerative loss of auerbach’s plexus

A

Achalasia

Failure of peristalsis and relaxatio nof the LOS

Middle age people

250
Q

Improvement in mortality with Spironalactone?

A

Only in patients with:

NYHA Class III/ IV

Already talking ACE-I

251
Q

Digoxin in HF

A
  • Only improves symptoms due to inotropic effects

But strongle indicated in people with HF + AF

252
Q

Statins in T1DM?

Dose and indications

A

Atorvostatin 20mg

Indications:

>40 yo

Diabetis for >10 years

Nephropathy

CVD risk factors - hypertension/ obesity

253
Q

Dyspnoea

AF

Haemoptysis

A

Mitral Stenosis

particularly if heart has added sound + diastolic murmur

254
Q

Valve abnormality in takayasu’s arteritis

A

Aortic Regurgitatiopn (20%)

255
Q

Target INRs?

VTE

AF

A

VTE

Single - 2.5

Recurrent - 3.5

AF

2.5

256
Q

MI Sequalae

Infero Posterior infarction + LHF/Pulmonary Oedema + New Systolic Murmur

Acute HF + Pan systolic Murmur

Muffled heart sounds, Raised JVP

persistent ST Elevation + LVF

A

Mitral Regurgitation

Infero Posterior infarction + LHF/Pulmonary Oedema + New Systolic Murmur

Interventricular Septum Rupture

Acute HF + Pan systolic Murmur

Ventricular Free wall rupture

Muffled heart sounds, Raised JVP

Ventricular Aneurysm

persistent ST Elevation + LVF

257
Q

First line anti hypertensive irrespective of age or ethnicity in diabetics?

A

ACE-inhibitors

258
Q

EPO

Failure to respond reasons? (5)

SEs? (7)

A

Failure to respond reasons

Low iron

Low Dose

Infection/Inflammatory disease

Hyperparathyroidism

Aluminium

SEs

Hpyertension –> Enceophalopathy/seizures

Bone pain

Flue symptoms

Cutaneous symptoms

Ab formation against EPO? - red cell aplasia (Darbepoetin negates the risk)

Low iron - increased RBC production

259
Q

Anti Anginal to be avoided in HF?

First line anti-anginal in patients with known HF?

Two sets of two drugs not to combine that are used to treat HF/ Angina?

A

Anti Anginal to be avoided in HF?

Verapamil

First line anti-anginal in patients with known HF?

Atenolol (Beta blockers)

Two sets of two drugs not to combine that are used to treat HF/ Angina?

ACE-i + ARB

Verapamil + Beta Blocker

260
Q

Causes of widened mediastinum ( acute) (5)

A

Thoracic AAA

Lymphoma

Retrosternal Goitre

Teratoma

Thymic tumour

261
Q

Hypoparathyroidism vs Pseudo HypoPTH vs Pseudo Pseudo HypoPTH

Test?

A

Hypoparathyroidism - PTH deficiency (low PTH, low calcium ,high phosphate)

Pseudohypoparathyroidism - GNAS 1 mutation —> abnormal G proteins –> resistance to PTH everywgere. (high PTH, low calcium, high phosphate)

Pseudopseudohypoparathyrodisim - imprinting effect - GNAS1 mutation from father—> selective expression of mutation in everywhere EXCEPT kidney. So normal kidney calcium handling but resistance to PTH in the rest of body. (high PTH, normal calcium, normal phosphate

Urinary - cAMP and phospahte levels used to distinguish between the three (raised in primary hypoPTH. normal in the other 2)

262
Q

Metabolic complication from overadministration of NS?

A

Hypercholoraemic Acidosis

This is because you give them too much chloride relative to sodium —> forms more HCL due to the physiological buffering effect

263
Q

3 Hz oscillations on EEG

A

Absence seizures

Sleep

Narcolepsy

264
Q

Terbanifine toxic to?

A

Liver

  • Check LFTs before and then 4-6 weeks into treatment
265
Q

What does TIPS procedure involve?

A

Connecting the hepatic vein to the portal vein thus bypassing the cirrhotic liver which is causing the hypertension in the portal system

266
Q

Causes of dilated cardiomyopathy?

(3 main)

(7 others)

A

Main causes:

Alohol

Postpartum

Hypertension

Other Causes:

Viruses (Coxsackie, HIV, DIptheria)

Drugs (Doxorubicin)

Inherited

Endocrine (hyperthyroidism)

Infiltrative (Haemachromatosis, Sarcoidosis)

Neuromuscular (Duchenne’s)

Nutritional (Kwashiakor, pellagra (b3), thiamine, selenium)

267
Q

Gastroenteritis:

Typical causes of food poisoning (3)

Gradual (2)

A

Typical - B Cerues, C perfringens, S Aureus

Gradual - Ameobiasis (painful, bloody), Giardiasis

268
Q

Risk factor for?

Nitrosamines

Aflatoxin

Aniline Dyes

Benzene

Cadmiun

A

Nitrosamines - oesophageal and stomach cancer

Aflatoxin - Liver cancer

Aniline Dyes - TCC of bladde

Benzene - leukaemia and lymphoma

Cadmiun - prostate cancer

Vinyl Chloride - Hepatic Angiosarcoma

269
Q

MRSA management

first line

second line

A

First line - Vancomycin/ Teicoplanin

Second line - Linezolid

270
Q

Proteinuria in inflammatory conditions?

Supporting diagnosis?

A

Amyloidosis

Diagnosis:

Rectal Biopsy

Congo Red stain

Serum amyloid precusor scan (SAP Scan)

271
Q

Soil/bird/rat dropping exposure?

A

Histoplasmosis

272
Q

Mx of PCP pnuemonia

Mild/mod

Severe

A

Mild mod - co trimoxazole

Severe - IV Pentamidine

Steroids reduce risk of RF and death

273
Q

Rx for metastatic bone pain? (4)

A

NSAIDs

Opioids
Bisphosphonates

Radiotherapy

274
Q

Neutropenic Sepsis

Prophylaxis

Rx

A

Fluoroqunolone for prophylaxis

Rx:

Tazocin

If no improvement after >48 hours - meropenem +/- vanc

4-6 days no improvement - Investigated for fungi

275
Q

Signet Ring Cells

A

Gastric Carcinoma

  • the more signet ring cells, the worse the prognosis

Also present in other cancers like prostate, bladder, gallbladder

276
Q

Caveat to diagnosing kidney disease in stage 1 and stage 2?

A

Normal GFR: >100 ml/min in adults

Stage 1: > 90 ml/min

Stage 2: 60-90 ml/min

Stage 1 and stage 2 need signs of CKD other than eGFR being low

  • Blood tests (Abnormal us and es)
  • Urinalysis ( proteinuria)
277
Q

Mx of migraine during pregnancy:

A

1: Paracetomal
2: Aspirin/Ibruprofen (first and second trimester still okay)

278
Q

Magnesium deficiency in relation to calcium handling

A

Hypocalcaemia

  • due to end organ resistance to PTH
279
Q

DDx for Hypertension with Hypokalaemia

A

Conn’s

Cushing’s

Liddle’s (Dysregulation of eNac channels)

Renal artery stenosis

280
Q

When to stop PPI before OGD

A

2 weeks before

  • Masks pathology
281
Q

Post menopausal lady who has had a fracture

A

Bisphopshonates + calcium supplements

treat as though they have osteoporosis

282
Q

Mutation associated with MODY

Best Rx?

A

Glucokinase, HNF1 Alpha - hepatic nuclear factor alpha

Suflonylureas

283
Q

Which antibiotics when combiend with alcohol produce a disulfiram type reaction?

A

Metronidazole, Cefoperazone ( cephalosporin)

284
Q

Tests for confirming H Pylori Cure?

A

Urea breath test (wait 4 weeks after antibiotics stopped, 2 weeks after PPI stopped)

Stool antigen test

Rapid urease test - Biopsy

Gastric biopsy +/- culture

Not serology - stays positive following eradication

285
Q

Vomiting

Thoracic pain

Subcut Emphysema

A

Boerrhave’s

Mackler triad

286
Q

Monitoring for statins?

A

LFTs at baseline, 3 months and 12 months

287
Q

Patho of Anaemia in RF (6/7)

A

Reduced erythropoiesis:

  • Reduced EPO
  • Uraemic damage to bone marrow

Reduced Fe absorption

N/V due to uraemia

REduced RBC survival

Blood loss due to capillary fragility / Poor platelet function

Stress ulceration –> blood loss

288
Q

Wernicke’s encephalopathy:

CAN OPEN

A

Confusion

Ataxia

Nystagmia

Ophthalmoplegia

Peripheral Neuropathy

289
Q

Hiccups in palliative care

Rx

A

Chlorpormazine

Haloperidol

Gabapentin

Dexamethasone

290
Q

Hypothermia ECG findings (5)

A

Bradycardia

J Wave (hump at end of QRS)

1t degree HB

Long QT

Arrhythmias

291
Q

Mx of surgical MRSA patient

A

Nasil - mupirocin

Skin - clorhexidine

292
Q

CCB use in angina

Monotherapy

Combined therapy

A

Monotherapy - rate limiting like verapimil /diltiazem

Combined therapy (with BB) - Long acting dihydropiridine -> nifedipine

293
Q

AKI Three stages? Creatining and UO

A

1: Cr: 1.5-1.9 x baseling. UO: <0.5/ml/kgh for >6 hours
2: 2.0-2.9 x baseline. UO: <0.5ml/kg/h for >12 hours
3: >3.0 x baseline. UO: <0.3 ml/kh/hour for >24 hours or anuric for >12 hours

294
Q

What is lost in nephrotic syndrome?

What rises

A

Antithromin-III

Protein C

Protein S

Thyroxine binding globulin lost tooo

Fibrinogen levels rise

295
Q

Mesenteric Ischaemia ABG?

A

Metabolic acidosis (low bicarb)

296
Q

2ww endoscopy guidelines

A

Anyone with:

Dysphagia

Upper abdo mass ?Gastric Ca

Over 55 with weight loss ANd:

upper abdo pain

reflux

dyspepsia

297
Q

What are the features of child’s pugh stage 3?

A

Bilirubin >50

Albumiun <28

PT >6

Marked Encephalopathy

Marked Ascites

298
Q

What are the components of the MELD score?

A

MELD - Model for end stage liver disease

Bilirubin

Creatinine

INR

Used to work out 3 month mortality

299
Q

5 cutaneous features of TS

A

Shagreen Patch

Ashleaf spots

Subungual Fibroma

Adenoma sebaceum - butterfly distribution

Cafe au lait spots

300
Q

MOA

Carbibamazole

Propylthiouracil

A

Both:

Block TPO from joining and iodinating TG residues –> reduces thyroid hormone production

PTU ALSO - stops peripheral conversion of T4 to T3 (inhibits 5 de iodinase)

301
Q

PCI Cut off time?

A

120 minutes

if not possible them thrombolysis —> ECG check 90 minutes later —-> no resolution then PCI transfer anyway

302
Q

Type and description of aphasia?

Superior temporal gyrus

Arcuate Fasciculus

Inferior frontal gyrus

A

Wernicke’s (receptive) dysphasia - Superior temporal gyrus. Fluent speach, good repitition but abnormal comprehension ( sentences dont make sense, neologisms)

Conduction (associative) dysphasia - Arcuate Fasciculus. Fluent speech, abnormal comprehension, abnormal repitition. (poor repititon but know that they are making mistakes)

Broca’s (expressive) dysphasia - Inferior frontal gyrus (MCA). Non- fluent speech. normal comprehension, normal reptition. (non fluent, halting, laboured speech)

Global aphasia – comprises all three and is due to large damage

303
Q

Persistent ST ELevation after MI

A

Ventricular aneurysm — thromboembolic stroke risk

304
Q

Srugical choices for oesophageal carcinoma (Four types)

A

Ivor - Lewis (bi incisional)

Right sided thoracotamy and laparatomy –> Laparatomy to mobilise stomach and divide oesophageal hiatus

Right sided thoracotomy to mobilise oesophagus and create an intrathoracic oesophagogastric anastamoses

Mckeown (tri incisional)

Abdominal incision - mobilise stomach and oesophagus and for LN resection

Thoracic incision - remove oesophagus and mediastinal LNs

Cervical incision - cervicogastric anastamosis

Transhiatal resection (distal lesions), left thoraco-abdominal resection

305
Q

Drugs causing photosensitivity

A

APQRST

  • Amiodarone
  • phenytoin
  • Quinidine
  • Retinoids
  • Suphonamides
  • Tetracyclines
306
Q

Cholesterol threshold follliwing stroke?

A

3.5

307
Q

anti-GM1 (ganglioside)

anit-GQ1b

A

anti-GM1 (ganglioside) - GBS

anit-GQ1b - MFS

308
Q

Which ECG lead can q waves be normal?

A

Lead III

309
Q

how do you know which is the a and which is the c wave in JVP?

A

C coincides with carotid! a is just before

310
Q

INsulin regemin of choice

1 and 2

A

1 - Basal bolus with twice daily insulin detemir

2 - Basal bolus with once daily glargine or detemir

Rapid acting insulin analogues before meals

311
Q

When to stop AEDs?

A

>2 year seizure free

Wean over 2-3 months

Wean benzos over longer period of time

312
Q

Constituents of cryoprecipitate

A

Factor VIII

Fibrinogen

VWf

Factor XIII

313
Q

FEV1 COPD Classification

A

80 - >80% MILD

50 - 79-50 MODERATE

30 - 49 - 30 SEVERE

30 - <30 VERY SEVERE

314
Q

Most common complication of meninigitis

A

SNHL

315
Q

1st line treatment for Diabetic Neuropathy

A

1st Amitriptylline

Duloxetine, Gabapentin, pregabalin

Tramadol for rescue

Amitriptylline contraindicated in people at risk of urinary retention

316
Q

Transfusion threshole

A

Without ACS . 70g/L

with ACS . 80 g/L

317
Q
A
318
Q

WHich opioids can you give to renally impaired?

A

Codeine

Alfentanil

Buprenorphine

Fentanyl

319
Q

What is the QT INterval

A

Start of Q —> End of T

Males : <430 ms

Females: <450 ms

320
Q

Smoking in IBD

A

Crohn’s - worsens

UC - thought to improves

Stopping smoking is UCELESS

321
Q

ASD :

left or right BBB

A

ONLY RIGHT

322
Q

Preventing risk of contrast nephropathy

A

Iv fluids for 12 hours pre and post procedure

?Oral N-Acetylcysteine

323
Q

Transfer factor reduce

Transfer coefficeint reduced

Transfer factor reduced

Transfer coefficient normal

A

PULMONARY FIBROSIS

Transfer factor reduce

Transfer coefficeint reduced

CYSTIC FIBROSIS

Transfer factor reduced

Transfer coefficient normal

Transfer coefficient corrects for normal alveolar volume

324
Q

Raised Ferritin

How do you deduce the cause?

A

Transferrin saturation

If this is <45% (females) <50% (males) this effectively excludues both primary (HH) and secondary (transfusions) iron overload

Causes of Normal transferrin saturation + Raised ferritin:

Acute phase response - Inflammation

Alcohol excess

Liver Disease

Renal failure

Malignancy

325
Q

CIx to Sildenafil

What is sildenafil

A

Phosphodiesterae (v) inhibitor

Cix

Taking Nitrates or nicorandil ( due to augmented vasodilatory effects)

Hypotension

Recent stroke / MI

326
Q
A
327
Q

DDx for shin derm lesiosn

A

Erythema nodosum
Pyoderma Gangernosum

Pretibial Myxoedema

Necrobiois Lipioidica Diabeticorum (yellow shiny pale plaques with telangectasia)

Ulcers too..

328
Q

Rx for Acne Rosacea?

A

Mild/Mod - topical metronidazole

Mod/Sev- Oral Oxytetracycline

329
Q

Mx for vitiligo?

A

Camouflage, Make up

Topical steroids - if early

Maybe phototherapy/tacrolimus

330
Q

Drug OD?

Hyperreflexia, myoclonus rigidity

Hyperthermia (ANS excitation)

Altered mental state

A

This is serotonin Syndrome

Drug causes - SSRIs, MAOi, Ecstasy, Amphetamines

Mx

Benzos (like with cocaine)

Maybe Serotonin antagonist - Cyprohetpadine

331
Q

Causes of pyoderma gangrenosum

A

Pyoderma gangernosum - small papule initially then ebgins to ulcerate

Casues include: HIR

Haematological malignancies

IBD , PBC

RA, SLE

Rx - oral steroids and immunosuppresants ( ciclosporin, infliximab)

332
Q

ASutin flint murmur?

A

Aortic regurg

Heard in apex area - mid diastolic murmur

The regrugitant jet from the aortic valve hits the mitral valve cusps

333
Q
A
334
Q

Oral morphine to IV/IM/SC Morphine dose

A

HALF IT

335
Q

First ECG sign of MI?

A

Hyperacute T Waves

336
Q

Why give imms to coeliac patients

A

Functional hyposlenism – need PCV +/- Influenza

337
Q

What other electrolyte may you need to replace in patients with hypocalcaemia?

A

Magnesium

338
Q

Murmur in VSD

A

Pansystolic murmur in triscuspid area

339
Q

What is low in sick euthyroid syndroem

A

Everything (sometims TSH can be normal)

340
Q

Drug induced angiodema - most common cause

A

ACE-I

341
Q

What comes first in shingles

A

The pain and parasthaesie

PRECEDES

the rash

342
Q

Palliative care

Codeine/Tramadol –> morphine –> oxycodone –> diamorphine

10 -3

A

Codeine/Tramadol –> morphine (/10)

morphine–> oxycodone (/1.5-2)

morphine–> diamorphine (/3)

oxycodone –> diamorphine (/1.5)

Codeine/Tramadol –> morphine –> diamorphine

10 - 3

343
Q

Cerebellar Lesions:

Finger nose ataxia

Ataxia

A

Finger nose ataxia - Cerebellar hemisphere

ataxia - Cerebellar vermis

344
Q

CUrrent most common cause of infective endocarditis

A

Staph Aureus

345
Q

Subclinical hypothyroidism:

Mx?

A

<65 trial of levothyroxine

>65 watch and wait

346
Q

layers of the eosphagus

A
347
Q

Structures divided in a midline incision

A

linea alba

transversalis fascia

extraperitoneal fat

peritoneum

348
Q

Incision names:

Under right subcostal margin

Incision in right iliac fossa

Oblique incision in right iliac fossa

Rooftop incision

Trasnverse suprapubic insision

Groin incision

Hockey shape scar

A

Under right subcostal margin - Kocher’s

Incision in right iliac fossa - Lanz

Oblique incision in right iliac fossa - Gridiron

Rooftop incision - Gable

Trasnverse suprapubic insision - Pfannestiel

Groin incision - Mcevedy’s

Hockey shape scar - Rutherford Morrison

349
Q

JONEs criteria

JONES

CAFE PAL

A

2 Major /1 Major2 minor

Major:

J - Joint involvement

O - Carditis

N - Subcutaneous Nodules

E - erythema marginatum

S - Sydenham’s Chorea

C - CRP/ ESR

A - rthyralgia

F - ever

E- ESR

P - Prolonges PR

A - mnsesia

L - eukocytosis

350
Q

Drugs lowerin BNP

A

BAAAD

Beta blockers

Aldosterone antagonise

ACEi

ARB

Diurtetics

351
Q

breakthrough dose of morphine?

A

1/6th regular dose

352
Q

Palliative care management:

respiratory secretion

Bowel obstruction

A

respiratory secretion - Hyoscine Hydrobromide

Bowel obstruction - Hyoscine Butylbromide

353
Q
A
354
Q

Rx for minimal change disease

A

Pred (80% will resolve)

Cyclophosphamide

355
Q

Patho for wilson’s

A

Reduced caeruloplasmin in blood

mutation in ATP7B - ATP7B usually releases copper into the bile or binds it to caeruloplasmin.

The function atp7b is impaired —-> leading to copper deposition aborrhently

356
Q

Abdo pain + peripheral neuropathy

Mx

A

Lead poisoning

Dx - can be confused with Porphyria (Raised ALA, Raised urinary coroporoporphyrinogen)

Mx - Chelating (Penicillamine, Dimercaptosuccinic Acid (DMSA)

357
Q

Diagnosis of Clostridium Difficile

A

Clostridium Difficile Toxin in the stool

358
Q

Copper chelating agents: Give 2

A

Penicillamine

Trientine Hydrochloride

359
Q
A
360
Q

worsening psoriasis

Drugs

Infection

Others

A

Drugs

  • Beta blockers, lithium, alochol, NSAIDS, ACE-is, Infliximab

Infection

Strep- guttate psoriasis

Others

Trauma

361
Q

Bisphosphonaes

Indications

SEs

Advice for taking

A

Indications:

Osteoporosis, Paget’s, Pain form bony met’s, hypercalcaemia

SEs:

Oesphogatitis

AVN of jaw

Atypical stress fractures of femur

Hypocalceamia

Constitutional Sx

tablet swallowed with plenty of water on an empty stomach/ before breakfast. Patient should stand/sit upright for 30 minutes after administration

362
Q

Features of papillodoema

A

Venous engorgement

Loss of venous pulsation

Loss of optic cup

Blurring of optic disc margins

Elevation of optic disc

Paton’s lines - retinal lines cascading from the disc

363
Q

Yellow spots around macula

A

Dry Age reglated maculopathy

(or early as per new classification)

Rx - Beta caroten, Zinc, Vit C, Vit E

(not im smokers due to incr risk of lung cancer)

364
Q

1st line Rx for psoriasis (three in combo)

2nd line

3rd line

Secondary care mx?

A

Emolient + Vit D topical ( calcipotriol) + topical steroid

2nd line - Oral vit d analogue BD (Reduces epidermal proliferation)

3rd - potent corticosteroid / Coal tar (Interferes with DNA synthesis)/

Secondary care

Light therapy - narrow band UV light

PUVA - psorelan + UV light

Methotrexate, Ciclosporin, systemic retinoids

Biologics- Infliximab, Adalimumab, Etanercept, Ustekinumab

365
Q

Respiratory involement of polymyositis/dermatomypositis

A

Respiratory muscle weakness

Fibrosing alveolitis/ Organising pneumonia

366
Q

MOA of the open angle glaucoma treatments

BC

PM

S

BeCause PMS

A

BC - Reduce aqueous production

Beta blockers (Timolol - CI in HF, ASthma), Carbonic anhydrase inhibitors (Dorzolomide - Sulphonamide like reactions)

PM - Increase uveoscleral outflow

Prostacyclin Analogues (latanaprost - pigmentation of iris), Myotics (Pilocarpine - blurring of vision, constriction of iris, headaches)

S - BOTH

Sympathomimetics (a2 adrenergic agonists like brimonidine - Hyperaemia. Avoid with people taking MAOis - hypertensive crisis, TCAs - reduce efficacy of sympathomimemtics)

367
Q

Asprin

Aminoglycosides

Loop diuretics

Quinine

all cuase

A

Bilateral tinnitus -.-

368
Q

Osteomyelitis

Dx tool of choice

A

MRI Scan

369
Q
A
370
Q

DUKE CRITERIA for ?

Pnemonic

Bacterial Endocarditis FIVE PM

A

Major:

B- Blood cultures (2 showing typical orgnaisnms/ 2 +ve 12 hours apart/ one positive with coxiella)

E- Endocarditis (+ve echo, new murmur)

Minor: FIVE PM

Fever >38

Immunological Phenomena - GN, Osler’s Nodes, Rothe Spots, RF +ve

Vascular Phenomena - Arterial emboli, pulmonary infarcts, ICH, Mycotic aneursyms, Conjuctival haemorrhage, Janeway Lesions

Echo - Not definitive but suggestive

P - Predisposition ( Heart/Valve disease, IVDU)

M - Microbiology (Positive but not fulfilling major criteria)

371
Q
A
372
Q

Chemotherapy Regime

R-CHOP (R-CVDP)

BEP

A

R-CHOP

Rituximab

Cyclophosphamide

Vincristine

Doxorubicin

Prednisolone

BEP

Bleomycin

Etoposide

Cisplatin

373
Q
A
374
Q

Principle electrolyte abnormality seen in refeeding syndrome

A

Hypophosphataemia - Because in catabolic state there is a depletion of intracellular phosphate stores and also a reduction in insulin secretion

Upon the reintroduction of carbohydrates —> insulin + increased phosphate influx into cells. Depleting intravascular phosphate levels

Cx- rhabdomyolysis , seizures, arrhythmias etc…

375
Q

The Seven S’s for TPN

A

Prolonged ObStruction

Severe Chron’s

Severe malnutrition

High output fiStula

swallowing impairment - Oesopageal Ca, etc.

Short gut syndrome

Severe pancreatitits

376
Q

Borders of the inferior lumbar triangle

A

Lateral - External oblique

medial - Lat Dorsi

Inferior - crest of ilium

377
Q
A
378
Q

Painful nodule on ear

Elderly

A

Chondrodermatitis nodularis helicis

Conservaitive measures

  • Alleviate pressure on ear

Medical mx

  • cryotherapy
  • Steroids
  • collagen

Sx

  • Removal but high recurrence
379
Q

Achilles tendon rupture

Which abx?

A

Fluroquinolones

380
Q

RBBB

LAD

1st Degree AVN Block

A

Incomplete Tri-fascicular block:

  • In this case the Left anterior fascicle would be blocked (LAD) + the right fascicle (RBBB)

Three fascicles in the heart conducting from AVN to Ventricles:

Two left side

One right side

381
Q

RBBB

RAD

1st degree AVN Block

A

Incomplete Trifascicular Block:

This case would be the Left Posterior fascicle being blocked (RAD) + Right Fascicle (RBBB)

382
Q

RBBB

R/L AD

Complete Heart Block

A

Compelte trifascicular block

R (L Posterior fascicular block) / L (L Anterior Fascicle Block) AD

383
Q

Axis deviation when both Anterior/Posterior L fascicles blocked?

A

No shift

384
Q

Which parts of the bowel are:

Intraperitoneal

Retroperitoneal

Infraperiotenal

A
385
Q
A
386
Q

Treatment for hyperhidrosis

A

1st - Ammonium Chloriude

2nd - Iontophoresis

3rd- botulinum injections

Can have a thoracic sympathectomy but cx include compensatory sweating

387
Q

Diseases MAllasezia Furfur Causes

Rx?

A

Seborrhoeic Dermatitis/ Pitryiasis Versicolor

Rx

Seb Derm:

Scalp - T Gel/ H&S. Topical Ketocanazole

Skin - Topical ketaconazole, Daktacort (Mild steroid + topical antifungal)

Pit Vers

Topical ketaconazole , Oral itraconazole

388
Q

Petechial Rash

Neuro Symptoms

Resp Symptoms

A

Fat embolism

(think about fractures)

Petechial Rash + subconjunctival/oral haemorrahge

Neuro Symptoms - confusion agitation, retinal haemorrhages, fat globules on fundoscopy

Resp Symptoms - temp, tachycardia, dyspnoea

389
Q
A
390
Q

Pityriasis Rosea

Duration of rash

A

HHV 7

Herald Patch

Erythematous, oval scaly patches paralle to lines of langer

Disappears after 4-12 weeks

391
Q

Stroke while on warfarin

Anticoagulation / antiplatelet?

A

Not good idea to co-prescribe antiplatelet + anticoagulant –> greatly increased risk of bleeding

Conflicting evidence

Some say increase INR to therapeutirc range 2.5-3.5 (if Was 2-3 for AF for example)

Passmed says introduce DOAC

392
Q

Kussmaul’s Sign?

What is it

Which disease is it present in most often

A

Paradoxical rise of the JVP with inspiration

Seen more so in Constrictive pericarditis than with Cardiac tamponade.

Whereas with tamponade Pulsus paradoxus is more common ( reduction in bp of more than 20 mmHg with inspiration0

393
Q

Extra skin conditions

Melasma

Pitryasis Alba

Erythrasma

A

Melasma

Dark skin discolouration

Pregnant women or those on hormonal therapies

Pityriasis alba

Children and young adults

Pink scaly patches —> hypopigmentation afterwards

Dark skinned people

Erythrasma

  • brown scaly skin patches
  • DM and obese
394
Q
A
395
Q

Which antibiotic should be avoided with Statin?

Why?

A

Macrolide

P450 inhibitors —> lead to increased plasma level of the statin –> risk of statin related myopathy etc.

396
Q

What does the serum-ascites albumin gradient ACTUALLY tell you?

A

Tells you whether ascites is caused by portal hypertension or something else:

If >1.1g/dl then you’re thinking portal hypertension –> Cirrhosis, Budd chiari, Portal vein thrombosis, liver mets, cardiac ascites

If <1.1g/dl then it’s something else (as the albumin level in the ascitic fluid itself is pretty high) - peritoneal carcinomatosis, tuberculous, pancreatic ascites, nephrotic syndrome

397
Q

Determining pre renal aki/ post renal aki

just based on U and Es

A

Look at the urea and the creatinine:

Multiply urea x 10

If Urea*10 > Creatinine

It is likely to be pre renal uraemia

398
Q

Type of fluid to avoid in stroke patients

A

5% dextrose

Increases risk of cerebral oedema

Stick to NS or other without sugar in it

399
Q

In diabetic

When hands in prayer position inability to fully extend the MCP joints?

A

Cheiloarthropathy

Scleroderma like thickening of the hands

400
Q
A
401
Q

Double right heart border in Mitral Stenosis

A

The more medial line represents left atrial enlargement in these patients which is secondary to a Tight Stenosis

Other CXR Signs

  • Splaying of the carina
  • Raised left main bronchus

Both due to the left atrial enlargement

Furthermore will have cardiomegaly

402
Q

Prokinetic medications

A

Domperidone

Metoclopramide

Erythromycin

403
Q

CI to ear irrigation

A

HO of OM (not OE) in last 6 weeks

PSH ENT

Current OM or OE

Grommets

Tympanic Perf

Altered mental state

Cleft palate

404
Q

Features of Optic Neuritis

A

<visual>

<p>Reduced red discrimination</p>

<p>Central SCotoma</p>

<p>RAPD</p>

<p>Pain worse on eye movements</p>
</visual>

405
Q

DDx of white tongue lesions

A

Oral Candidiasis - Rub off

Lichen Planus - White lace pattern on buccal membrane, will rub off

Oral Leukoplakia - pre-malignant (SCC), need FU, won’t rub off

406
Q

Ophth Option in Open Angle Glaucoma:

If CVD

If Asthmatic

A

Open angle glaucoma - Raised IOP + reduced peripheral vision

First would go for prostacyclin analogue:

Latanaprost (brown staining of iris)

  • Increases Uveoscleral outflow
407
Q

Brown velvety plaques (neck, axilla, groin)

A

Acanthosis Nigricans

  • Due to hyperinsulaemic states
  • Most commonly GI Ca (But any high insulin state will do)
408
Q

Blurry vision and haloes around light (Months to develop)

A

Glaucoma

409
Q

RFs for Cataract

Subtypes of Cataract

A

Rfs:

Systemic -

DM

Steroids

Cong Rubella

Cong - Downs, Myotonic Distrophy

Metabolic - hypoclacaemia, galactosaemia,

Occular

trauma

uveitis

++myopia (short sightedness where image is focused before the retina)

Topical Steroids

Subtypes

Nuclear

Polar

Subcapsular

Dot opacities

410
Q

Koebner phenomeneon seen in..

A

Psoriasis
Lichen Planus

411
Q

Glaucoma RFs:

Hypermetropia

Myopia

Diff between Open/Closed angle

A

Hypermetropia - Acute closed angle glaucoma

Myopia - Open angle glaucoma

The angle : The angle between the iris and the cornea. The trabecular meshwork where the fluid drains through sits near this angle.

In closed angle - the lens/ choroid/ lens zonules appear to move in a rostral direction –> pushing the iris forward with it and obliterate the angle

In open angle- there isn’t such obliteration. Using drugs to improve drainage and reduce secretion is helpful but drastic measures like causing pupillary constriction aren’t necessary

So the Rx for Closed angle makes sense:

Acetozolamide - reduced secretions

Pilocarpine - pupillary constriction and opens up the angle again

412
Q

What happens to the pupil on closed angle glaucome

A

Semi Dilates

Non reactive

413
Q

Monitoring in leflunomide

A

LFT, FBC, BP

AEs:

Diarrhoea

Hypertension

Pneumonitis

Myelosuppresion

Weight loss

Peripheral neuropathy

414
Q

Which usually effects mouth

Pemphigus

Pemphigoid

A

Pemphigus

  • Shear off easily
  • EFfects mouth
  • IgG against intra-epidermal adhesion proteins
  • Bit more of an emergency than pemphigoid

Pemphigoid

  • tense bullae, pruritic
  • mouth usually spared

- IgG and C3 deposition against hemidesmosomes at the dermo-epidermal junction

Dermatitis herpetiformis

  • is like pemphigoid in the sense that it is subepidermal in pathophysiology
  • intensely pruritic

- but it’s IgA deposition

415
Q

Spoon shaped nails

A

Koilonychia

  • IDA
416
Q
A
417
Q

Like taking which drug?

Liddle’s

Bartter’s

Gitelman’s

A

Liddle’s - Amiloride. ENaC in the Collecting Duct’s

Bartter’s - Loop diuretic. NaKCl in the Ascending loop ofh enle. Like loop diuretics will cause hypercalciuria (so used to treat gout)

Gitelman’s - Thiazide Diuretic. NaCl in the Distal convolutred tubule. Like thiazide diuretics will cause hypocalciuria (so cause gout)

Lidoride, Bartoop, Gitiazide

418
Q
A
419
Q

Periarticular Osteopenia

Inflammatory Arthritis

A

More of a pointer to RA

420
Q

Extensively swollen ear canal in OE?

A

Use an ear wick impregnated with Topical antibiotic +/- steroid

421
Q

Which organism tends to colonise plastic implants?

A

Staphylococcus Epidermidis —> usually need to remove the device

422
Q

Drug causes of TEN? (6 in this list)

Rx?

A

Penicillins

Sulphonamides

NSAIDs

Phenytoin

Carbamezapine

Allopurinol

Rx?

- IVIG (used more now)

  • Plasmapheresis
  • Immunosuppresion (cyclosporin, cyclophosphamide)
423
Q

What is mydriasis

What causes mydraisis

A

Mydriasis is a dilated pupil - Dilated pupil think about sympathetic supply taking control

So - CNIII carries with it the parasymtpahtetic fibres —> if this is damaged will cause mydriatic pupil as parasympathetic would cuase pupillary constriction

Other causes –> Holme’s adie pupil, Traumatic iridoplegia, Phaeo (lots of catecholamines), Congenital, Drugs - Sympathomimetics - amphetamines and coke, Anticholinergics - TCAs (reduce PNS effeicacy) , mydriatics (atropine and tropicamide)

424
Q

Cutaneous features of SLE

A

Discoid Rash

Malar rash

Alopecia

Livedo Reticularis

425
Q

Skin prick test or skin patch test

A

Skin prick- Allergens

SKin patch - contact dermatitis

426
Q

Mulder’s Click>?

A

Morton’s Neuroma

One hand tries to hold the neuroma while the other performs metatarsal squeeze

Click might be palpated and heard

427
Q
A
428
Q

HCV up to date treatment

A

PegIFN alfa-2B + Ribavarin +

newer agents such as

bocepravir (protease inhibitor)

sofusbuvir (example of a nucleotide inhibitor)

429
Q
A
430
Q

What acid base abnormality to gitelman’s and barter’s cause?

A

Metabolic Alkalosis

431
Q

Which cancers have response to anti-vegf treatment

A

Lung Cancer

CRC

Renal Cell

E.g. - Bevacizumab

432
Q

What is ceftuximab

What Cancer?

A

Anti-EGFR Antibody

Useful in Colorectal Cancer

433
Q

What is the underlying blood ppicture in hyperchloremic metabolic acidosis

A

This is so termed a Normal anion gap metabolic acidosis

  • Essentially caused by a loss of base (rather than an increase in acid - the other way around is more true for high anion gap metabolic acidosis)
  • There is a saturation of NaCl Channels in the PCT —> this leads to an increased Chloride level in the plasma.
  • Loss of base (Bicarb) is often due to GI causes but can also be due to RTA Type 2 (reduced resorption bicarb at proximal convoluted tubule) or RTA type (failure of H+ secretion at the distal convoluted tubules) –> essentially there is a low serum bicarb level

So:

Normal anion gap metabolic acidosis: High Cl-/ Low HCO3-

Ineffective acid buffering —> leads to acidosis

Causes GI - Base loss ( diarrhoea, fistulae), renal loss ( RTA type 1/2 ) , Drugs like acetazolomide, Addison’s (reduced H+ secretion as this is usually coupled with Na+ resorption in the distal convoluted tubule )

434
Q

What does hepcidin do

What is TIBC

A

Hepcidin is a key regulator of iron management in mammals.

It essentially traps iron within cells such as hepatocytes and macrophages.

Reduced Hepcidin levels seen in - Hereditary Haemachromatosis —> TIBC will be decreased because hepcidin/ transferring already supersaturated —> Transferring saturation will be high following this logic

Increased hepcidin levels seen in - Inflammatory states —> contributes to anaemia of chronic disease

TIBC

Is an indirect measure of the transferrin in blood. Blood is drawn and then it is seen how much iron can be added to it

  • the more iron that can be added the lower the transferrin saturation (IDA)
435
Q

Which drugs can preciptate worsening of psoriasis

A

Alcohol

Beta Blockers

Lithium

Anti Malarials

436
Q

Drugs causing pemphigus vulgaris

A

ACE-i

NSAIDS

L-DOpa

437
Q

Skin blisters:

Desmosomes

Hemidesmosome

A

Desmosomes - Pemphigus Vulgaris (IgG)

Hemidesmokes - Bullous Pemphigoid (IgG +C3)

Dermatitis Herpetiformis (IgA)

438
Q

How and where is bicarb reabsorbed

A

Bicarb:

HCO3-

Reabsorbed in the proximal convoluted tubuel

  • Due Carbonic Anyhdrase
439
Q

Types of eruptions (What causes them)

A

Maculopapular - Generalies erythematomous macules + papules, fever, +Eosinophils

Cause - penicillis, cephalosporins, AEDS

Urticarial: Two types.

I) IgE mediated - penicillins, cephalosporins

ii) Direct mast cell dreganulation - Morphine, NSAIDs, COntrast, Codeine

Eythema Multiforme

  • HSV, Mycoplasma, Drugs
440
Q

pANCA

A

Churg STrauss

Microscopic Polyangitis

Primary Sclerosing Cholangitis

441
Q
A
442
Q

Weber’s test.

Rinnhe’s testW

Patterns

A

Weber - localises to the side with conductive hearing loss

  • or to the unnafected ear in SNHL

Rinnhe’s - positive if there is Conductive hearing loss (if bone conduction (mastoid process) is better than air conduction (just in front of external accoustic meatus) then there is conductive hearing loss)

SNHL - Webers localises to the unaffected ear and rinnhe’s air conduction is better than bone conduction

Conductive hearing loss - Webers localises to the affected ear and on rinnhe’s bone conduction is better than air conduction

443
Q

Monosodium urate monohydrate

A

Gout

444
Q

A reaction to which other drug precludes the use of sulfasalazine

SEs of sulfasalazine

A

Aspirin

SEs:

Oligospermia

SJS

MYelosuppression

Pneumonitis/ Lung fibrosis

445
Q

Options for bradycardia

A

IV atropine

Transvenous Pacing

Alternatives

Transcutaneous pacing

Adrenaline infusion

446
Q

What cup to disc ratio signifies cupping

A

>0.7 dup to disc ratio

447
Q

Fundoscopy features of primary open angle glaucoma

A
  1. Optic Disc Cupping
  2. Optic Disc Pallor
  3. Bayonetting of vessels (vessels appear to disappear and reappear)
  4. Additional features - Cup notching, disc haemorrahges
448
Q

WHat is a trefoil pelvis

Classification of the disease this is associated with

A

Sign of osteogenesis imperfects

Where the acetabulum indents the medial aspect of the femur.

I-IV Classification

I is not enough quantity —-> IV disordered quality but sufficient quantity.

449
Q

What type of cataract is associated with these circumstances:

Elderly

Commonly inherited

Steroid Use

Also present in normal eye

A

Elderly - Nuclear

Commonly inherited - Polar (in visual axis)

Steroid use - Subcapsular (just deep to the capsule of the lens)

Dot opacities - Can be present in normal individuals

450
Q

HLA B5 & Mica 6 allele

Disease association and features

A

Behcet’s Syndrome

  • Young, Male meditarranean
  • repeated genital, oral ulceration and anterior uveitis

Rarer - Thrombophlebitis, arthitits, neuro (asceptic meningitis), GI upset, Erythema nodosum, DVT

Positive skin pathergy test — Needle prick causing ulcer formation

451
Q

Why do ABPI in patients with obvious venous ulcers

What drug improves healing rate in venous ulcers

A

Treatment is with graded compression stockings however these are contraindicated if the patient has concurrent arterial disease.

Venous ulcer - Oral pentoxifylline

452
Q

Short posterior ciliary artery occlusion …

Which arteries supply the choroid

A

Anterior ischaemic optic neuropathy (leads to optic neuropathy) – Temporal arteriries or atherosclerosis

Choroid —> supplied by posterior and anterior choroidal arteries (from ICA and PCA)

453
Q

CRP or ESR raised in SLE?

A

ESR

  • SL-E-SR
454
Q

key numbers in terms of body water and ECF/ ICF split

A

60% composition is water

2/3 ICF

1/3 ECF (3/14 plasma, 10/14 interstitial, 1/14 transcellular)

455
Q

Storage vs voiding symptoms

A

Storage -

Urgency

Nocturia

Frequenzy

Incontinence

Voiding -

Hesitancy

Poorflow

Intermittent flow

Straining

Incomplete emptying

Post micturition Dribbling

456
Q

Consequences of hypophosphataemia (5)

RARSS

A

Rhabdomyolysis

Respiratory Insufficiency

Arrhythmias

Shock

Seizures

457
Q

Calcium Renal stones

Loop Diuretics

Thiazide Diuretics

A

Loop diuretics — cause them as they cause hypercalciuria

Thiazide directs — can prevent them as these increase resorptoion of calcium in the distal convoluted tubule (can cause slight hypercalcaemia)

458
Q
A
459
Q

Serotonin Syndrome

Features

Which drugs implicated

A

Features

  • Tachycardia, nause, hypertension, hyperreflexia, Dilated pupils

Drugs

SSRIs,

Tramadol

MAOis

Triptans

St John’s wart

460
Q

Opiates in CKD? (3)

A

Alfentanil

Fentanyl

Buprenorphine

(AFB)

461
Q
A
462
Q

Involves nasolabial folds

Cheeks

Eyebrows

Nasal Bridge

Scalp

Spares nasolabial folds

Telangiectasia

pustules

A

Seb Derm

Involves nasolabial folds

Cheeks

Eyebrows

Nasal Bridge

Scalp

Acne Rosacea

Spares nasolabial folds

Telangiectasia

pustules

463
Q
A
464
Q

What is RF?

A

IgM antibody reacting with Fc portion of patients own IgG

  • detected using the Rose Waaler test (sheep red cell agglutination)

Latex agglutination test

465
Q

Bowing appearance on x ray

Child

A

Greenstick fracture

466
Q

What is the interstitial space

What radiological feature si expansion of the interspitial space with fluid often known as>

A

In the context of the lung the interstitial space is the space between the alveoli - remember alveoli are extremely thin

Thickened in interstitial lung diseases

When thi interstitial space becomes oedematous - in pulmonary oedema

This is referred to as Kerley Lines (usually b)

  • easily seen just above the costophrenic angles and are usually perpendicular to the lateral pleural surface
467
Q

What does reticular pattern mean on CXR

nodular

Reticular nodular

Alveolar Pattern Vs Interstitial pattern

A

Reticular Pattern

  • lots of lines

Nodular

  • lots of dots

Reticulonodular - bit of both

Alveolar Pattern

  • Fluffy ill defined looking
  • Can be segmental / lobar - think pneumonia
  • Air bronchiograms

Interstitial pattern

  • Reticulonodular looking pattern

With lots of septal lines

468
Q

Mixed stromal and epithelial elements

(Biphasic might be keyword)

Parotid lesion

A

Pleomorphic adenoma of the parotic

469
Q

Meniere’s Disease

Treat an acute attack?

Prophylaxis

A

Acute attack - Prochlorperazine

Prophylaxis - Betahistine

470
Q

Penis

Tight white ring

Orange red lesions - with redder spots on glans and adjacent areas

Itchy and non-well demarcated rash

Well de-marcated erythematous plaque with a ragged white border

A

Lichen Sclerosus - Tight white ring. Topical steroids

Zoon’s balanitis - Orange red lesions - with redder spots on glans and adjacent areas. Plaques are shiny. steroids, circumision, CO2 laser therapy.

Seb Derm - Itchy and non-well demarcated rash. Steroids + antifungals

Circinate Balanitis - Well de-marcated erythematous plaque with a ragged white border.

471
Q

Vascular Surgery/ Fractures

Common complication/prophylactic measure

What do you do

A

Compartment syndrome (re fractures : tibial shaft, supracondylar humerus fractures)

Extensive Deep Fasciotomies

+ Agress fluids to prevent myoglobin causing an AKI

Necrotic muscles should be debrided/?amputation

472
Q

Bowed Bones

Large Head

Thickened Chostocondral Junctions

Cupped/Widened epiphsis

Transverse subcostal sulcus

A

Rickets

473
Q

Why is inversion spared in common peroneal nerve injury?

A

Because:

The tibialis posterior nerve is supplied by the tibial nerve and also assists in inverting the foot

474
Q

Mnemonics for the Vaughan Williams Classifications

SoBe PoCa

Double Quarter Pounder

lettuce, tomato, mayo, pickles

more fries please

A Big dog is scary

A

SoBe PoCa

I: Sodium fast channel blockers

II: Beta Blockers

III: Potassium Channel Blockers

IV: Slow calcium channel bloker

Class IA

Double Quarter Pounder

Disopyramide, Quinine, Procainamide

Class IB

lettuce, tomato, mayo, pickles

Lidocaine, Tocainide, Mexilitine, Phenytoin

Class IC

more fries please

Moricizide, Fleicanide, Propafenone

Class II: No mnemonic but just beta blockers

Class III

A Big dog is scary

Amiodarone, Bretylium, Dofetilide, Ibutilide, Sotalol

Class IV

Calcium channel blockers

not in mnemonic

Class V

Adenosine, Digoxin

475
Q
A
476
Q

What common drug can cause GI haemorrahge in pts taking warfarin

A

NSAIDs

477
Q
A
478
Q

Scleroderma

Face and distal limbs

Trunk and proximal limbs

A

Faec and distal limb = Limited (centromere)

Trunk and proximal limb = Diffuse (SCL-70 (Topoisomerase))

479
Q
A
480
Q

Keratotic Plugs?

A

Sebhorreic Keratosis (Stuck - on wart)

481
Q

Distal fragment:

Posteriorly displaces supracondylar fracture

anteriorly dysplaced supracondylar fracture

A

Posterior - Extension (more common) Gartland classification

Anterior - Flexion

482
Q

Hypopyon:

Normal pupillary reaction

Abnormal pupillary reaciton

A

Normal pupillary reaction - keratitis/ corneal ulcer

Abnormal pupillary reaciton - anterior uveitis

Both will have hyperaemia and photophobia

483
Q

Nerve roots for anal sphincter control

A

S2, S3, S4

Stops shit hitting the floor

484
Q

Inflammation of extensor pollicsis brevis and abductor pollicis longus tendon sheath

A

De quervain’s tenosynovitis

485
Q

Viral labyrinthitis vs Vestibular neuronitis

A

Viral labyrinthitis: Hearing loss, Vertigo, nystagmus and nausea

Vestibular neuronitis - spares hearing

486
Q

What colour can pit vers be?

A

hypo

Pink

brown

487
Q

What is morphoea?

A

Localised scleroderma

488
Q

Emergency management for acute angle closeure glaucoma

A

IV acetazolamide

Meiotic - pilocarpine (muscarinc agonist)

Beta blocker - timolol

Urgent refer to ophth

IV mannitol - if can’t tolerate other meds

Occular massage

Peripheral Laser Iridotomy (APLI)

Anterior Chamber Parcentesis (ACP)

489
Q

Subtypes of BCC? (4)

A

Nodular

Morpheic

Superficial

Pigmented

490
Q

Malignant Melanoma Criteria (3 major) (4 minor)

A

Major :

Change in

i) size
ii) shape
iii) colour

Minor:

Diameter >6mm

Inflamed

Oozing/ Bleeding

Paraesthesia

491
Q

Allergy:

Type 1? - MOA and Examples

II

III

IV

V?

A

I - IgE mediated mast cell degranulation. Atopy and Anaphylaxis

II - Antibody against cell. HA, ITP, Anti GBM, Anti IF, Anti ABO, ASOT, Rheumatic, Pemphigus

III - Antibodies combine in circulation. Serum sickness, SLE, Post strep glomer, EAA

IV - Delayed T Cell. Contact derm, Tuberculosis, GVHD, Scabies, EAA, MS, GBS

V? - Kind of like II But hte distinction is the ABs bind to the receptor on the cell rather than a random antigen - MG, Grave’s, LEMS,

492
Q

What is the pupil like Cavernous Sinus Thrombosis

A

Semi dilated and non reactive

493
Q

Cause of proteinuria in patients with RA

A

Treatment - Gold Penicillamine

AMyloidoisis

494
Q

Indication for nalaxone

A

Respiratory depressopm

495
Q
A
496
Q

What does hypomagnasaemia cause?

A

i) low PTH –> Hypocalcaemia (Mg needed for PTH secretion
ii) PTH resistance (impaired action of calcium at target organs)

497
Q
A

Muhesh Final Year from Passmed (11 decks)

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