MET LP Flashcards
Besides excess vitamin D, name and explain which vitamin can cause hypercalcaemia if intake is in excess? [1]
excessive vit A:
- acts on the bone to stimulate osteoclastic resorption, and inhibit osteoblastic formation and in the situations of dehydration or renal failur
What diabetic complication are gliflozins contraindicated in? [1]
It is contraindicated in active foot disease such as skin ulceration with a possible increased risk of toe amputation
What is the treatment protocol for a patient with Addison’s if they are vomiting? [1]
A person with Addisons’ who vomits should take IM hydrocortisone until vomiting stops: this prevents an Addisonian crisis
Name 4 antibodies found in DMT1 [4]
How can you distinguish between AKI and dehydration? [1]
Urea:Creatitine Ratio:
In dehydration: urea that is proportionally higher than the rise in creatinine
(although both have an increase in urea and creatitine)
How do you treat haemolytic uraemic syndrome? [1]
There is no role for antibiotics in the treatment of haemolytic uraemic syndrome unless indicted my preceding diarrhoeal infection
- if not preceded by diarrhoeal infection: treatment is supportive, with fluids, blood transfusions and dialysis as required
Name a drug that is phosphate binder used to treat bone disease of CKD [1]
Sevelamer is a non-calcium based phosphate binder that treats hyperphosphataemia in patients with CKD mineral bone disease
Which drug is used to treat ascites:
- initially [1]
- if patient has ascitic protein < 15 g/l [1]
Initially: spironolactone
if patient has ascitic protein < 15 g/l: ciprofloxacin
*
All patients who are diagnosed with CKD should be prescribed what drug / drug class? [1]
Statins
Which drug class is prescribed for diabetes inspidus? [1]
V2 Receptor agonist
How can you tell if a cause of AKI is pre-renal? [1]
Responds to fluid challenge
Why does Goodpastures syndrome present with haemoptysis? [1]
Type IV collagen is also found in the alveoli, so causes pulmonary haem.
Also presents with nose bleeds
Describe the pattern and source of the deposits in Goodpastures syndrome [1]
IgG deposits in linear fashion
What is one of the most common causes of acute tubular necrosis? [1]
Haemorrhage
If prescribing fluids, how much K should be generally given? [1]
1mmol/kg/day
E.g. if 60kg patient: 6 mmol/kg/day
Which type of GN is associated with renal transplants? [1]
Focal sclerosis glomerulosclerosis
Why does a patient presenting with nephrotic syndrome have a high risk of VTE? [1]
Loss of anti-thrombin III (which antagonises action of thrombin, so get unopposed action of thrombin)
Name three main complications of nephrotic syndrome [3]
Hyperlipidaemia
Infection (loss of IgG)
VTE
What is the most common cause of haemolytic uraemic syndrome? [1]
E. coli
What is important to account for when initiating treatment for chronic CKD? [1]
Iron deficiency can cause patients to fail to respond to EPO therapy
What is a key indicator that a patient is suffering from H.U.S? [2]
Blood diarrhoea and AKI symptoms
Investigations discover she has H. pylori.
What is the next step? [1]
You need to be off PPIs for two weeks before endoscopy so triple therapy would start afterwards
Which disease is commonly associated with primary sclerosing cholangitis? [1]
Name three raised markers that would indicate PSC [3]
Ulcerative colitis
Raised ALP; ANCA; bilirubin
Name two AEs of amlodopine [2]
Headaches
Foot swelling
Name risks of prescribing testosterone for a patient with low testorone? [3]
What follow up would you conduct to ameliorate for this? [1]
Increases the risk of:
* prostate cancer
* secondary polycythaemia - increases risk of DVT and VE
* Aggression
Conduct a yearly PSA for the prostate risk
What is the first line treatment for PCOS? [1]
What other drug should be considered [1]
1st line: Weight loss
Consider: metformin
The Rotterdam criteria are used for making a diagnosis of polycystic ovarian syndrome. A diagnosis requires at least two of the three key features: [3]
Oligoovulation or anovulation, presenting with irregular or absent menstrual periods
Hyperandrogenism, characterised by hirsutism and acne
Polycystic ovaries on ultrasound (or ovarian volume of more than 10cm3)
It is important to remember that only having one of these three features does not meet the criteria for a diagnosis. As many as 20% of reproductive age women have multiple small cysts on their ovaries. Unless they also have anovulation or hyperandrogenism, they do not have polycystic ovarian syndrome.
What is the management for oesophageal varices if terlipressin and antibiotics does not work? [1]
Sengstaken-Blakemore tube if uncontrolled haemorrhage
What is the management if Sengstaken-Blakemore tube cannot manage uncontrolled haemorrhage of variceal haem.? [1]
Transjugular Intrahepatic Portosystemic Shunt (TIPSS):
connects the hepatic vein to the portal vein
The Truelove and Witts’ severity index is recommended by NICE when assessing the severity of ulcerative colitis in adults. Ulcerative colitis is classified as ‘severe’ in which instances? [5]
TRUElove and Witt’s
when the patient has blood in their stool, or is passing more than 6 stools per day plus at least one of the following features:
- T - Temp > 37.8
- R - Rate > 90
- U - (Uh)naemia Hb < 105
- E - ESR >30
First episode of C. difficile infection:
Oral [] is the first line antibiotic for use in patients with C. difficile infection
second-line therapy: oral []
third-line therapy: oral [] +/- IV []
Oral vancomycin is the first line antibiotic for use in patients with C. difficile infection
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole
Which one of the following findings on biopsy would be most consistent with a diagnosis of gastric adenocarcinoma?
Columnar metaplasia
Histiocytic infiltration
Paneth cell metaplasia
Giant cell granulomas
Signet ring cells
Which one of the following findings on biopsy would be most consistent with a diagnosis of gastric adenocarcinoma?
Columnar metaplasia
Histiocytic infiltration
Paneth cell metaplasia
Giant cell granulomas
Signet ring cells
If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates then oral [] are added
If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates then oral corticosteroids are added
Avoid [] when patient is already on clopidogrel?
for revision: avoid omeprazole/esomeprazole when pt already on clopidogrel (use lansoprazole instead)
Ciprofloxacin.
Delafloxacin.
Levofloxacin.
Moxifloxacin
These are all examples of quinolones. Treatment for which pathology are they conintradicated in and why? [1]
Epilepsy:
Quinolones may lower the seizure threshold and may trigger seizures. Levofloxacin is contraindicated in patients with a history of epilepsy and, as with other quinolones, should be used with extreme caution in patients predisposed to seizures, or concomitant treatment with active substances that lower the cerebral seizure threshold, such as theophylline:
Name an antibiotic that causes cholestasis [1]
Co-amoxiclav is a well recognised cause of cholestasis
Co-amoxiclav causing cholestasis would cause which deranged LFTs [3]
Raised ALP
Raised bilirubin
Raised yGT
Name a cause of Cushing’s symptoms, that is not due to corticosteroid excess [3]
pseudo-Cushing’s syndrome, which has different causes:
- depression
- HIV infection
- excess alcohol consumption.
What are the clinic [1] and ABPM [1] BP targets for DMT2 patients? [2]
T2DM blood pressure targets are the same as non-T2DM. If < 80 years:
clinic reading: < 140 / 90
ABPM / HBPM:< 135 / 85
PPIs cause what electrolyte imbalances? [2]
Hyponatraemia
Hypomagnesia
Describe a method, that is not looking at specific antibodies, that you can distinguish between DMT1, DMT2 & MODY [1]
Measuring C-peptide levels (result of the cleavage of proinsulin into insulin):
DMT1: low (there’s basically no insulin in type 1 the C-peptide would be low)
DMT2: C-peptide remains in the normal range
MODY: C-peptide levels will be normal or high, given that insulin is still being produced.
A 33-year-old man was admitted to the surgical ward due to an exacerbation of Crohn’s disease. He presented with a perianal abscess that has been surgically drained. An MRI confirms a complex perianal fistula.
In addition to an antibiotic and a biologic, what other management would be indicated?
Lidocaine gel
Rectal mesalazine
Seton placement
Surgical resection
Topical glyceryl trinitrate
A 33-year-old man was admitted to the surgical ward due to an exacerbation of Crohn’s disease. He presented with a perianal abscess that has been surgically drained. An MRI confirms a complex perianal fistula.
In addition to an antibiotic and a biologic, what other management would be indicated?
Seton placement
A seton is a piece of surgical thread that is run through the fistula to allow continuous drainage while the fistula is healing. This ensures that the fistula doesn’t heal containing pus within, which would result in further abscess formation.
What is the best measure of acute liver failure? [1]
the best measure of acute liver failure is the international normalised ratio (INR).
If a Crohn’s patient has had an ileocacel resection, why may diarrhoea occur? [1]
Name a drug that can treat this [1]
The patient most likely has a diagnosis of bile acid malabsorption as a complication of the ileocecal resection.
Treat using: Cholestyramine - bile acid sequestrant with the potential to control diarrhoea induced by bile acid malabsorption.
A 24-year-old man is reviewed in the gastroenterology clinic following a recent admission for a suspected first episode of ulcerative colitis. Colonoscopy during the admission had found moderate proctitis and the patient was started on first-line topical therapy to induce remission. Following review, it is decided to prescribe the patient medication to maintain remission.
What medication should be prescribed?
Intravenous ciclosporin
Oral azathioprine
Oral prednisolone
Topical mesalazine
Topical prednisolone
What medication should be prescribed?
Intravenous ciclosporin
Oral azathioprine
Oral prednisolone
Topical mesalazine
Topical prednisolone
A topical (rectal) aminosalicylate +/- an oral aminosalicylate is used first-line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis
Whic therapeutic drugs cause cholestasis? [5]
combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
Why is prothrombin a better measure of acute liver failure than albumin? [1]
has a shorter half-life than albumin
How do you calculate serum osmolality? [1]
2 * Na+ + glucose + urea
What are the first line options for diabetic neuropathy? [4]
first-line options include
amitriptyline (a tricyclic antidepressant, TCA), gabapentin (an anticonvulsant), and pregabalin (another anticonvulsant) or duloxetine
Name a 5 AEs of Pioglitazone [5]
ELBOW
E Edema(fluid retention)
L Liver impairment
B Bladder Cancer
O Osteoporosis
W Weight gain
Name a haematological side effect of Azathioprine prescription? [1]
thrombocytopenia
What does this chest x-ray show?
Hiatus hernia
Free gas under the diaphragm
Right basal atelectasis
Right basal consolidation
Right sided pneumothorax
The chest x-ray shows a hiatus hernia which can be seen as a retrocardiac air-fluid level.
Hiatus hernia refers to the herniation of a part of the abdominal viscera through the oesophageal aperture of the diaphragm. The vast majority of hiatus hernias involve only the herniation of a part of the gastric cardia through the muscular hiatal aperture of the diaphragm.
Blood glucose targets for DMT1 patients are’
[] mmol/l on waking and
[] mmol/l before meals at other times of the day
Blood glucose targets
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
What are the serum markers of type 1 auto-immune hepatitis? [3]
Type 1 autoimmune hepatitis:
Antinuclear antibodies
anti-smooth muscle antibodies
raised IgG levels
Additionally, it is more common in young females.
Name 5 drugs that cause gynecomastia [5]
spironolactone (most common drug cause)
cimetidine (H2 antagnosit)
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids
Which part of the body is diverticular disease most likely [95%] to occur? [1]
Sigmoid colon
Sulphasalazine may be used to treat UC.
Name a haematological SE of this treatment [1] and describe how this may present on blood smear [1]
Sulphasalazine may cause haemolytic anaemia
this can present withHeinz bodies
Sulphasalazine Heinz body
Achalasia is associated with which type of oesophageal cancer? [1]
Name a significant risk factor for this cancer [1]
Squamous cell cancer
Smoking
What is pneumonic for remembering the factors that influence Child-Pugh score? [5]
ABCDE
A - albumin
B - bilirubin
C - clotting
D - distention (ascites)
E - encephalopathy
Which LFT is NOT useful in determining severity of liver cirrhosis? [1]
ALT
(not included in Child-Pugh Score)
During the first stage of De Quervain’s thyroiditis, what is the clinical presentation of a patient? [5]
- initial hyperthyroidism
- painful goitre
- globally reduced uptake of iodine-131
- raised ESR & CRP
Thyrotoxicosis can lead to which cardiac pathologies [2]
Thyrotoxicosis can lead to high output cardiac failure & atrial fibrillation
When treating dyspepsia, what are the two management options? [2]
What happens if one doesn’t work/ [1]
NICE guidelines state:
‘Offer one of the following strategies to manage uninvestigated dyspepsia symptoms, depending on clinical judgement:
- Prescribe a full-dose proton pump inhibitor (PPI) for 1 month
- Test for Helicobacter pylori infection if the person’s status is not known or uncertain. If the person tests positive for H. pylori infection, prescribe first-line eradication therapy.
If one doesn’t work: swap to other treatment
What is the first line treatment for newly diagnosed DMT1 patients? [1]
In newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be a basal–bolus using twice‑daily insulin detemir
The basal insulin can be twice‑daily insulin detemir or once-daily insulin glargine or insulin detemir
A patient presents with symptoms of an overactive bladder.
What is the first choice drug treatment? [1]
What treatment is offered if the first choice is contrindicated? [1]
First choice: Oxybutynin
Second choice: Mirabegron
Following catheterisation for acute urinary retention secondary to a lower urinary tract infection, the patient’s post-void bladder volume is recorded.
What is the acceptable upper limit of residual urine in patients < 65 years old?
20ml
50ml
100ml
500ml
800ml
Following catheterisation for acute urinary retention secondary to a lower urinary tract infection, the patient’s post-void bladder volume is recorded.
What is the acceptable upper limit of residual urine in patients < 65 years old?
20ml
50ml
100ml
500ml
800ml
Name three causes of increased erythrocyte lifespan [3]
- Splenectomy (think - Coealic Disease)
- B12 and folate deficiences
- IDA
What is the primary cause of primary hyperaldosteronism? [1]
Bilateral idiopathic adrenal hyperplasia
What is important to consider about primary hyperaldosteronism?
Textbooks: hypokalaemic
Life: can be normokalaemic
What is the name of CKD treatment that stimulates EPO? [1]
What checks should occur before this treatment is given? [1
darbepoetin alfa
Other causes of anaemia (such as iron deficiency) should be checked and corrected prior to therapy with erythropoietin
What treatment is given for Crohn’s patients who develop a perianal fistula? [1]
Oral metronidazole
What is gallstone ileus? [1]
Where a gall stone enters the small intestines;
Lodges at the **ileocaecal valves; **
Causes small bowel obstruction and air in biliary tree
What is Classic Rigler’s Triad of gallstone ileus?
Classic Rigler’s Triad - Air in bile ducts, gallstone visible outside gallbladder and small bowel obstruction :
Long term PPI can cause hypomagnesia. What symptoms would this cause? [1]
Muscle ache
Which diabetic drug has an increased risk of leg ulcers and amputation? [1]
canagliflozin and the increased risk of leg ulcers and amputation, with a potential class effect across the SGLT-2 inhibitors.
You diagnose a patient with active AIH.
What is the two step treatment regime? [1]
How long does treatment for AIH need to occur to prevent relapse? [1]
1st line: prednisolone
2nd line: aziothropine
Continue treatment for 2 years
Describe treatment regime for oesophogeal strictures [2]
PPI
Balloon dilatation following benign biospy
State the two subclassifications of chronic (3month+) prostatitis [2]
Chronic prostatitis may be sub-divided into:
Chronic prostatitis or chronic pelvic pain syndrome (no infection)
Chronic bacterial prostatitis (infection)
How do you treat acute bacterial prostatis? [1]
Clinical Knowledge Summaries currently recommend a 14-day course of a quinolone
consider screening for sexually transmitted infections
A 72-year-old man is diagnosed with prostate cancer and goserelin (Zoladex) is prescribed. Which one of the following is it most important to co-prescribe for the first three weeks of treatment?
Tamoxifen
Lansoprazole
Allopurinol
Cyproterone acetate
Tamsulosin
A 72-year-old man is diagnosed with prostate cancer and goserelin (Zoladex) is prescribed. Which one of the following is it most important to co-prescribe for the first three weeks of treatment?
Tamoxifen
Lansoprazole
Allopurinol
Cyproterone acetate
Tamsulosin
Anti-androgen treatment such as cyproterone acetate should be co-prescribed when starting gonadorelin analogues due to the risk of tumour flare. This phenomenon is secondary to initial stimulation of luteinising hormone release by the pituitary gland resulting in increased testosterone levels.
The BNF advises starting cyproterone acetate 3 days before the gonadorelin analogue.
What would treatment be for suspected epididymo-orchitis? [2]
IM ceftriaxone
Oral doxycycline
State two causes of periureteric fat stranding [2]
Caused by kidney inflammation:
* uteric calculi
* pyelonephritis
[] is the investigation of choice for varicose veins/chronic venous disease?
Venous duplex ultrasound is the investigation of choice for varicose veins/chronic venous disease
[] is the first-line imaging in peripheral artery disease
Duplex ultrasound is the first-line imaging in peripheral artery disease
Name this radiological sign [1]
What does it indicate? [1]
Thumb printing
Indicates ischaemic colitis
Which class of antihypertensive are contraindicated in end-stage chronic liver disease (Childs score C)?
Beta-blockers
Calcium-channel blockers
ACE inhibitors
Diuretics
1 OF 10
Which class of antihypertensive are contraindicated in end-stage chronic liver disease (Childs score C)?
Beta-blockers
Calcium-channel blockers
ACE inhibitors
Diuretics
1 OF 10
Which variables are used in the Child-Pugh score? [5]
Ascites
Bilirubin
INR
Hepatic Enceph
Serum Albumin
What are symptoms of carcinoid syndrome? [4]
- Skin flushing
- Diarrhoea
- Bronchospasm
- Hypotension
A 60-year-old woman with a history of polycythaemia rubra vera presents with abdominal pain and distension. She is found to have ascites and hepatomegaly on examination
This a steriotypical history of what pathology? [1]
hepatic vein thrombosis
What is the name for this sign? [1]
Which form of IBD is it most common in? [1]
Lead pipe / drain pipe colon: more common in UC
normal mucosal architecture is lost, and scarring shortens and narrows the colon, creating the lead pipe appearance seen on radiographs
What is the name for this sign? [1]
Which form of IBD is it most common in? [1]
Kantor’s string sign
More common in Crohns
string sign refers to luminal narrowing as the result of inflammatory edema, irritability, spasms and fibrosi
Patient with known Crohn disease. Which of the following features is shown on this selected post-contrast coronal CT image? [1]
Comb sign
What is the treatment for a patient with Crohn’s disease and:
- perianal abscess? [1]
- perianal fistula? [1]
- perianal abscess: incision and drainage
- perianal fistula: seton placement
(The placement of a seton (suitable for high tract disease) though the fistula attempts to bring together and close the tract, passing out at opening of the perianal skin adjacent to the external opening (Fig. 3))
Describe what is meant by Boerhaave syndrome [1]
Boerhaave syndrome is an oesophageal perforation, it is differentiated from a Mallory-Weiss tear as it is a transmural tear rather than a mucosal tear. It can be associated with haematemesis but this is uncommon.
How do follicular and papillary thyroid carcinomas present histologically? [2]
Follicular: uniform colloid-filled follicles presenting a normal thyroid
Papillary: ground-glass or orphan-annie nuclei with psammoma bodies
What is Plummer-Vinson syndrome caused by? [1]
How does it appear under OGD? []1
What is the clinical triad? [3]
PVS: occurs in long term IDA patients
Disease causing dysphagia, IDA and glossitis
Get an oesophageal web
A mass is found in the most distal part of a rectum. It is confirmed as cancer. What is the name of the procedure that should be used to resect this tumour? [1]
Abdominoperineal resection
What cortisol and aldosterone levels would you expect in Sheehans syndrome? [1]
Cortisol: reduced
Aldosterone: normal
What is the name of this sign? [1]
What pathology does it indicate? [1]
Cullens sign
Cullen’s sign is described as superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. This is also known as peri-umbilical ecchymosis. It is most often recognised as a result of haemorrhagic pancreatitis.
What is the name of this sign? [1]
What pathology does it indicate? [1]
Grey-Turner’s sign
Classically it correlates with severe acute necrotizing pancreatitis
What is the most common fistula that occurs in diverticula disease [1]
Colovescial fistula
Describe the typical presentation of Peutz-Jeghers syndrome [2]
Pigmented lips, hands, soles of feet and face
Leads to SBO & GI bleeds
What is the most common complication of thyroid eye disease? [1]
Exposure keratopathy
- damage to the cornea that occurs primarily from prolonged exposure of the ocular surface to the outside environment.
A patient has bowel perforation secondary to a colonic tumour. What is treatment aim? Via which type of surgery? [1]
End colostomy via a Hartmans procedure
Haemophilus influenzae
Acanthosis nigricans
Achalasia
Plummer-Vinson syndrome
Plummer-Vinson
