met rogue

Question 1

Ascites

Answer 1

SAAG gradient >11g/L
high
Liver cirrhosis - portal hypertension

Question 2

raises anti-mitochondrial antibodies

raised ALP, GGT

Answer 2

Primary biliary cholangitis

Question 3

T2DM and abnormal LFTSs?

Answer 3

usually non-alcoholic fatty liver disease

check ferritin for haemochromatosis

Question 4

drugs causing long QTc

Answer 4

cardiac
amiodarone
sotalol
1a antiarrythmic

TCAs
SSRIs - citalopram 
methadone
chloroquine 
erythromycin

Question 5

hypothyroid in pregnancy

Answer 5

increase levothyroxine up to 50%

Question 6

Low dose dex - NOT supp

High dose - SUPP

Answer 6

Cushing’s disease

Question 7

Graves

and which antibodies pls

Answer 7

autoimmune attack on thyroid
overactive
TSH receptor stimulating ABs
anti-thyroid peroxidase ABs

Question 8

ABC in IBS?

Answer 8

abdominal pain
bloating
change in bowel habits (diarrhoea/constipation)

Question 9

pharyngeal pouch

Answer 9

dysphagia 
regurgitation 
halitosis - bad breath 
aspiration 
--> surgical repair

Question 10

ADH action

Answer 10

anti-diuretic hormone
increases aquaporins
increases pure water absorbed back to blood 
decreases plasma osmolality 
increases urine osmolality

Question 11

SIADH

Answer 11

inappropriate ADH secretion
–> hyponatraemia
result of dilution / excessive water retention

Question 12

SIADH treatment?

Answer 12

fluid restriction

…

Question 13

Effects of hyponatraemia

Answer 13

cerebral oedema
lethargy
nausea and vomiting
headache/confusion
decreased GCS

Question 14

broad spectrum antibiotics & PPIs can cause?

Answer 14

C difficile infection

Question 15

C difficile

Answer 15

diarrhoea
abdominal pain
raised WCC
severe toxic megacolon

Question 16

C difficile treatment?

Answer 16

oral metronidazole 10-14 days
2nd line - vancomycin
life threatening?
-> mix oral vanc and IV met

Question 17

anaemia diagnosis

& infection?

Answer 17

normally ferritin
ferritin = unreliable indicator of iron levels in infection
use transferrin saturation & TIBC instead

Question 18

differentiate between IBS and IBD in primary care

Answer 18

fecal calprotectin

Question 19

SIADH causes

Answer 19

small cell lung cancer
pancreas, prostate malignancy 
stroke
neuro haemmorhages
TB, pneumonia 
drugs

Question 20

alcoholic ketoacidosis findings

Answer 20

metabolic acidosis 
raised ketones
normal glucose
(raised anion gap)

Question 21

alcoholic ketoacidosis treatment

Answer 21

saline & thiamine infusion

Question 22

C difficile investigation results

Answer 22

C dif toxin = current infection

C dif antigen = past exposure/colonies

Question 23

hyperkalaemia causes?

Answer 23

AKI
metabolic acidosis
Addisons disease 
rhabdomyolysis 
massive blood transfusion 
drugs: 
- ACE inhibitors, ARBs
- potassium sparing diuretics 
- spironolactone 
- heparin
- ciclosporin
- beta blockers maybe?

Question 24

painless obstructive jaundice

palpable gall bladder

Answer 24

think malignancy

• cholangiocarcinoma
• pancreatic cancer

Question 25

Hepatocellular carcinoma causes

Answer 25

liver cirrhosis
chronic hep B/C 
alcohol 
haemochromatosis 
PBC 
...

Question 26

HCC features

Answer 26

late presentation 
cirrhosis/liver failure
jaundice
ascites
RUQ rain 
hepatomegaly/spleno
pruritus
raised AFP - alphafetoprotein

Question 27

hyponatraemia causes? urinary sodium >20mmol/l

Answer 27

diuretics - loop, thiazide
Addisons disease
renal failure
SIADH 
hypothyroid

Question 28

hyponatraemia causes? urinary sodium <20 mmol/l

Answer 28

diarrhoea, vomiting, sweating
burns, rectal adenoma
water excess
 - secondary hyperaldosteronism from heart failure, liver cirrhosis 
- nephrotic syndrome
- IV dextrose
...

Question 29

isolated bilirubin rise

Answer 29

Gilberts syndrome (goes away by self)

Question 30

p-ANCA

Answer 30

primary sclerosing cholangitis

ulcerative colitis/IBD?

Question 31

hyperkalaemia ECG changes

Answer 31

Tall-tented T waves
flat/lost of P waves
wide QRS complex
increased PR interval 
sine wave pattern --> VF

Question 32

severe hyperkalaemia limits

Answer 32

> = 6.5 mmol/L

Question 33

causes of AKI

Answer 33

= STOP
Sepsis, shock
Toxicity 
Obstruction
Parenchymal disease

Question 34

some symptoms of hyperkalaemia

Answer 34

chest pain
palpitations
weakness

Question 35

hyperkalaemia stabilise cardiac membrane

Answer 35

IV calcium gluconate

does NOT lower serum K

Question 36

hyperkalaemia - short term ECF–> ICF shift

Answer 36

insulin/dextrose infusion

nebuliser salbutamol

Question 37

remove K from body

Answer 37

calcium resonium (oral or enema)
loop diuretics
dialysis

Question 38

diarrhoea acid-base disturbance?

Answer 38

normal anion gap metabolic acidosis

Question 39

vomiting acid-base disturbance?

Answer 39

normal anion gap metabolic alkalosis

Question 40

membranous glomerulonephritis findings

Answer 40

• nephrotic/proteinuria
• thick base membrane
• sub-epithelial spikes

Question 41

cause of membranous glomerulonephritis

Answer 41

APA2 antibodies
infection
malignancy
SLE, thyroid, rheumatoid

Question 42

membranous glomerulonephritis treatment

Answer 42

ACEi/ARB - reduce proteinuria
immunosuppression
anticoagulation if high risk

Question 43

anti-GBM disease

Answer 43

autoimmune, against collagen in lungs/glomeruli

• nephritic
• haemoptysis
• linear IgG in basement membrane

Question 44

IgA nephropathy findings

Answer 44

• macroscopic haematuria in young person, post URTI

- renal biopsy = mesangial proliferation, matrix accumulation

Question 45

what is IgA nephropathy

Answer 45

IgA builds up in kidneys - leads to inflammation…?

Question 46

what does aldosterone do?

Answer 46

regulates BP

resorption of Na –> water

Question 47

post ERCP - epigastric pain radiating to the back, nausea, jaundice, vomiting, fever?

Answer 47

acute pancreatitis - common complication of ERCP

Question 48

Sildenafil

Answer 48

Phosphodiesterase type V inhibitors
erectile dysfunction, pulmonary hypertension
vasodilation by increasing cGMP –> relaxes smooth muscle/vessels (corpus cavernosum)