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Passmed Mistakes > Mid / High Qs > Flashcards

Mid / High Qs Flashcards

1
Q

What is the most common reason total hip replacements need to be revised?

A

Aseptic loosening of hip replacement

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2
Q

Mx of secondary pneumothorax?

A

> 2cm + 50y+ = Insert chest drain

1-2cm = Aspiration, if this fails chest drain - admit 24hrs

<1cm - O2 + admit for 24hrs

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3
Q

When should you thrombolyse in a PE?

A

When there is haemodynamic instability

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4
Q

Hip fracture surgery - when should pts fully weight bear again?

A

Straight after surgery

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5
Q

Describe garden classification of NOFs

A

The Garden system is one classification system in common use.
Type I: Stable fracture with impaction in valgus
Type II: Complete fracture but undisplaced
Type III: Displaced fracture, usually rotated and angulated, but still has boney contact
Type IV: Complete boney disruption

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6
Q

Mx of NOF - Intracapsular / subcaptial ?

A

Undisplaced = internal fixation (or hemiarthroplastu if unfit)

Displaced = Total hip replacement (or Hemiarthroplasty - if not independent, cognitive impairment / not fit for procedure)

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7
Q

Mx of NOF - extracapsular

A

Extracapsular = subtrochanteric or trochanteric

Stable intertrochanteric = dynamic hip screw
Reverse oblique, transverse or subtrochanteric = intramedullary device

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8
Q

What medication should be avoided bowel obstruction? why?

A

Metoclopramide - has prokinetic properties and can stimulate persistalsis -> can worsen mechanical bowel obstruction and precipitate perforation

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9
Q

NSTEMI Mx?

A
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10
Q

Cluster headaches acute mx? prophylaxis?

A

High flow o2 + Subcut triptans

prophylaxis - Verapamil

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11
Q

ACS mx when should you avoid nitrates / use w caution? what should you give when medically mx instead?

A

PT is hypotensive as it causes widespread vasodilation

Aspirin + Ticagrelor + Fondaparinux

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12
Q

What to do in new onset AF presenting w/in 48h? after 48h?

A

Anticoagulate (heparin) + electrical cardioversion

48h+ - greater risk of clots hence anticoagulate for 3w before cardioversion

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13
Q

Mx of acute pericarditis?

A

Outpatient mx unless 38oC+ Or raised trop

NSAIDs + Colchinie are 1st line

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13
Q

Mx of acute pericarditis?

A

Outpatient mx unless 38oC+ Or raised trop

NSAIDs + Colchinie are 1st line

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14
Q

Acute mx of STEMI?

A

Analgesia
O2
Nitrates
Aspirin + Prasugrel (or clopidogrel if theyre already on a oral anticoagulant)

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15
Q

Acute relapse of MS - mx?

A

High dose oral steroids eg oral methylpred

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16
Q

Mx - fragility fracture in woman over 75?

A

DEXA scan isnt needed to dx osteoporosis - start bisphosphonate therapy

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17
Q

What is the treatment of choice in biliary colic?

A

Elective laparoscopic cholecystectomy

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18
Q

Inguinal hernia mx?

A

Assymptomatic = routine surgical referral

Signs of incarceration / strangulation = urgent surgical referral

Truss = If unfit for surgical referral

Surgery is usually open unless bilateral / recurrent in which case it is laparoscopic

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19
Q

Electrolyte abnormality in prolonged diarrhoea?

A

Met acidosis + hypokalaemia - loss of bicarb excretion from GI tract

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20
Q

Constant back pain + worse on movement + fever and anorexia + disc space narrowing on x-ray - dx? most common cause?

A

Discitis by staph aureus

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21
Q

What are the possible side effects of thyroxine therapy?

A

hyperthyroidism: due to over treatment
reduced bone mineral density -> osteoporosis
worsening of angina
atrial fibrillation

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22
Q

Possible interactions w thyroxine therapy and what to do?

A

Iron + calcium carbonate - reduces absorption of levothyroxine hence give 4 hrs apart

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23
Q

What is Phrens sign? what is positive in? how can you test for this?

A

Lifting scrotal skin from testes reduces pain - seen in epididymoorchitis -> urine void first sample for NAAT

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24
Q

What are the causes of normal anion gap met acidosis?

A

ABCD R

Addisons
Bicarb loss - eg diarhoea
Chloride
Drugs
R - renal tubular acidosis (High Cl and Low Bicarb)

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25
Q

What are the possible paraneoplastic features seen in each of the following lung cancers:
Small cell
Squamous cell
Adenocarcinoma

A

Small cell - excess ACTH, ADH and Lamert-Eaton syndrome

Squamous cell - PTH related protein -> hypercalcemia, hyperthyroidism to ectopic TSH

Adenocarcinoma - Gynaecomastia (most common in non-smokers)

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26
Q

Vomiting + Fever + Severe abdo pain relieved by leaning forward -> dx?

A

Acute pancreatitis

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27
Q

1st line mx of osteoarthritis?

A

Osteoarthritis - paracetamol + topical NSAIDs (if knee/hand) first-line

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28
Q

Which causes of CKD do not show small kidneys on USS?

A

CKD due to ADPKD or early stage diabetic nephropathy

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29
Q

When giving fibrinolysis to STEMI pts what should you do after?

A

ECG 60-90 mins post fibrinolysis to check if ST changes have resolved - if not suggests persistent ischaemia hence PCI needs to be considered

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30
Q

What are some absolute CI for laparoscopic surgery?

A

haemodynamic instability/shock
raised intracranial pressure
acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm)
uncorrected coagulopathy

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31
Q

Ix for compartment syndrome?

A

Intracompartmental pressure measurements

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32
Q

What drug interaction can increase INR of warfarin pts?

A

Metronidazole - inhibits warfarin inhibition

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32
Q

What drug interaction can increase INR of warfarin pts?

A

Metronidazole - inhibits warfarin inhibition

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33
Q

Mx of RCC?

A

Less than 7cm = partial nephrectomy

More than 7cm = radical nephrectomy

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34
Q

testicular bag of worms + on RHS - possible dx?

A

Right sided varicocele unlikely normally however can be caused by malignancy due to compression of renal vein at nutcracker angle (between AA and SMA)

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35
Q

Features of cardiac tamponade?

A

Raised JVP, persistent hypotension and tachycardia despite fluid resus

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36
Q

Common side effect of metoclopramide?

A

Diarrhoea

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37
Q

Suspected PE but delay in imaging - what should you do?

A

Interim treatment dose apixaban + perform scan when possible

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38
Q

Where are metatarsal shaft fractures likely to happen?

A

2nd metatarsal shaft

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39
Q

Mx of mineral bone disease in CKD?

A

1st = Reduce dietary phosphate

2 = phosphate binders

3 = vit d

parathyroidectomy may be needed in some cases

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40
Q

What class of analgesics should be avoided in ACS? Why?

A

NSAIDs - due to interactions w antiplatelets

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41
Q

Which drugs can be used for chemical cardioversion and when?

A

Flecanide - if no structural heart abnormalities

Amiodarone - whenever

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42
Q

Squaring of thumbs - characteristic of which condition?

A

Osteoarthritis of the hand

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43
Q

Conservatively mx NSTEMI - what should be offered?

A

NSTEMI (managed conservatively) antiplatelet choice
aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk

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44
Q

ECG changes in WPW

A

short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway
in the majority of cases, or in a question without qualification, Wolff-Parkinson-White syndrome is associated with left axis deviation
right axis deviation if left-sided accessory pathway

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45
Q

How can you diagnose gout?

A

Check serum urate once inflammation has settled down (should remain high)

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46
Q

Preferred site for primary PCI?

A

Radial artery

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47
Q

Why does HOCM cause sudden death in young athletes?

A

Due to VT

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48
Q

What are the parts of the modified glasgow scale to calculate severity of pancreatitis?

A

PANCREAS

PaO2
Age
Neutrophilia
Calcium
Renal func
Enzymes
Albumin
Sugar

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49
Q

What type of lung cancer can cause a hoarse voice and how?

A

Pancoast tumours due to suppression of recurrent laryngeal nerve

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50
Q

Which drugs can cause SJS?

A

carbamazepine, lamotrigine, allopurinol, sulfonamide, phenobarbital

Phenytoin
Salicylates
Sertraline
Imidazole antifungal agents
Nevirapine

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51
Q

Which drugs can cause SJS?

A

carbamazepine, lamotrigine, allopurinol, sulfonamide, phenobarbital

Phenytoin
Salicylates
Sertraline
Imidazole antifungal agents
Nevirapine

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52
Q

Ix of Haemochromatosis?

A

General public = Transferrin sat > ferritin

Family = Genetic testing (HFE mutation)

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53
Q

How to distinguish between direct and indirect inguinal hernias?

A

Try to reduce hernia by pressing on deep inguinal ring (mid point of inguinal ligament)

If it stops protruding exit is in deep inguinal ring hence indirect

If it still protrudes it is direct

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54
Q

MX of osteoporosis if they cant have alendronate due to GI side effects?

A

Alendronate -> risedronate or etidronate

If bisphosphonates arent tolerated then you can provide them with strontium ranelate or raloxifene

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55
Q

Mx of sexual epididymoorchittis of unknown organism?

A

IM ceftriaxone + oral doxy 10-14d

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56
Q

Painful shoulder abduction 90-120 degrees - dx? how to distinguish from main differential?

A

Subacrominal impingement

Rotator cuff injuries also present w painful arc but differentiate as these show muscle weakness when compared to opposite arm + pain on palpation (painful arc is also usually first 60 deg)

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57
Q

USS of kidneys in chronic diabetic nephropathy?

A

Bilateral large / normal sized kidneys

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58
Q

Parkinsonianism + autonomic features (ED, postural hypotension and atonic bladder) + cerebellar sign - dx?

A

Multiple system atrophy

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59
Q

Mx of antiphospholipid syndrome?

A

Primary thromboprophylaxis - low dose aspirin

Secondary thromboprophylaxis:
- Initial VTE - lifelong warfarin INR 2-3
- Recurrent VTE - lifelong warfarin INR 3-4 (if clots whilst on warfarin consider adding aspirin)
- Arterial thrombosis - lifelong warfarin INR 2-3

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60
Q

Inguinal hernia, pigmented spots on mouth, palms and soles + intussusception @12y - what is likely dx and finding on colonoscopy?

A

Peutz-Jeghers syndrome - associated w hamartomas

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61
Q

Why is hyperphosphataemia in CKD an issue?

A

Can drag Ca from bones -> osteomalacia treat w bisphosphonates

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62
Q

Result of iron studies in haemochromatosis?

A

Raised transferrin saturation and ferritin, with low TIBC, high serum iron

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63
Q

How often is methotrexate taken?

A

Weekly

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64
Q

When anticoagulating for AF - which pts should be offered 2nd line mx and what is this mx?

A

1st line = DOAC - these are CI if pt has liver / renal dysfunction

2nd line = warfarin

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65
Q

Hypoglossal nerve injury - which way does tongue deviate?

A

Deviates to side of injury

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66
Q

What blood test to monitor effect of levothyroxine treatment?

A

TSH

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67
Q

Which fractures are most commonly associated w compartment syndrome?

A

Supracondylar and tibial shaft fractures

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68
Q

Analgesia for NOFs?

A

Iliofascial nerve block

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69
Q

Which wave in ECG is cardioversion syncd to?

A

Electrical cardioversion is synchronised to the R wave - its the biggest

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70
Q

T2DM mx of blood glucose post ACS?

A

Stop diabetes meds + start IV insulin

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71
Q

Total hip replacement + pt cant dorsiflex foot - what nerve is damaged?

A

Sciatic

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72
Q

CT head multiple ring enchanced leisons - dx? mx?

A

Toxoplasmosis - treat w/ Pyrimethamine (+ sulphadiazine if immunocompromised)

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73
Q

1st line ix for hip fractures according to NICE?

A

MRI hip

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74
Q

Salicylate poisoning - ABG finding

A

Resp alkalosis + Metabolic acidosis -> usually met acidosis + raised anion gap

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75
Q

Pt w T2DM develops CVD what should be done to their mx?

A

Add SGLT-2 inhibitor

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76
Q

1st line for ix of stable angina?

A

CT Coronary Angio

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77
Q

Mx of salicylate poisoning?

A

IV sodium bicarb

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78
Q

Pt on clopidogrel w/ acid reflux - mx?

A

Lansoprazole > Omep / esomep - as those drugs decrease efficacy of clopidogrel due to preventing conversion into active form

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79
Q

Constipation in IBS - mx?

A

1st line = bulk forming laxative eg ispaghula husk

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80
Q

On examination he has weak hip flexion, weak knee extension, and impaired quadriceps tendon reflex, as well as sensory deficit in the anteromedial aspect of the thigh - which nerve is affected?

A

Femoral

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81
Q

A 42-year-old woman complains of a burning pain of her anterior thigh which worsens on walking. There is a positive tinel sign over the inguinal ligament

Which nerve is affected?

A

Lateral cutaneous nerve of thigh

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82
Q

Which drug used in mx of prostate cancer can cause bone pain + bladder obstruction etc

A

Tumour flare - can be triggered by use of GnRH agonists eg Goserelin

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83
Q

ECG change seen in digoxin therapy in a pt w AF?

A
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84
Q

HOCM - inheritance, how likely is a sibling to have it?

A

AD - 50% risk of passed on to siblings

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85
Q

What are the echo findings in HOCM?

A

Mnemonic - MR SAM ASH
- mitral regurgitation (MR)
- systolic anterior motion (SAM) of the anterior mitral valve leaflet
- asymmetric hypertrophy (ASH)

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86
Q

Which drugs need to be avoided in HOCM?

A

Nitrates

ACEi

Inotropes

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87
Q

What are CIs for statin therapy?

A

Macrolide - ‘thromycins

Pregnancy

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88
Q

What are the antibodies in adult onset stills disease?

A

RF and ANA negative

(high ferritin and leucocytosis)

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89
Q

Indications for steroid use in Sarcoidosis?

A

patients with chest x-ray stage 2 or 3 disease who are symptomatic. Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment

hypercalcaemia

eye, heart or neuro involvement

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90
Q

Weakness of foot dorsiflexion and foot eversion - which nerve is affected?

A

Common peroneal nerve palsy

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91
Q

How to treat cerebral oedema in brain tumour pts?

A

Dexamethasone

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92
Q

Possible complication of total hip replacement?

A

Posterior dislocation - internal rotation and shortening of affected leg

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93
Q

Secondary prevention of strokes if clopidogrel intolerant?

A

Aspirin + modified release dipyridamole

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94
Q

Pt on long-term steroids - what bone protection should be offered?

A

Bisphosphonate + vit d + ca - no scan needed if 65+, if under 65 bone scan 1st

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95
Q

Blockage of which part of the biliary tree does not cause jaundice?

A

Cystic duct or gall bladder

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96
Q

Imaging of choice for PSC?

A

ERCP / MRCP

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97
Q

Hypercalcaemia - ECG abnormality

A

Short QT

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98
Q

ECG change caused by thiazides and why?

A

Flattening of t waves due to hypokalaemia

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99
Q

Signs of SVCO + Myasthenia gravis - dx?

A

Thymoma -> causes SVCO and can also cause production of antibodies against acetylcholine receptors

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100
Q

Thiazide diuretics - electrolyte abnormalities?

A

Hypercalcaemia (hypocalcuria), hyponatraemia, hypokalaemia

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101
Q

Acute heart failure not responding to treatment - consider what?

A

CPAP

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102
Q

mx of infective exacerbations of COPD? when should additional measures be used?

A

5 days of pred, add abx if purulent sputum / clinical signs of pneumonia

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103
Q

mx of infective exacerbations of COPD? when should additional measures be used?

A

5 days of pred, add abx if purulent sputum / clinical signs of pneumonia

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103
Q

mx of infective exacerbations of COPD? when should additional measures be used?

A

5 days of pred, add abx if purulent sputum / clinical signs of pneumonia

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104
Q

What needs to be corrected prior to bisphosphonate therapy + why?

A

Ca and vit d deficiencies as this can be worsened by bisphosphonates

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105
Q

What should be avoided in severe colitis (in UC) due to risk of perforation, do what instead?

A

Avoid colonoscopy - do flexible sigmoidoscoppy

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106
Q

UC / Crohns - which is associated w gallstones?

A

Crohns

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107
Q

Iron studies in anaemia of chronic disease

A

Low Fe, Low ferritin, low / normal TIBC

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108
Q

Test results in alcoholic ketoacidosis?

A

Normal / low glucose + met ketoacidosis

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109
Q

What is the most sensitive and specific lab finding for liver cirrhosis in CLD?

A

Reduced platelet count

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110
Q

An acute presentation of abdominal pain with peritonism in a patient with known peptic ulcer disease is highly suggestive of ….. - what is the ix required?

A

gastrointestinal perforation - erect CXR = ix of choice -> if +ve follow w CT

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111
Q

Haemochromatosis - inheritance?

A

AR

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112
Q

Mild elevation in ferritn + Abnormal LFTs + Obese = ?

A

NAFLD

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113
Q

Test of exocrine func in chronic pancreatitis?

A

Faecal elastase

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114
Q

Ix of choice pancreatic ca?

A

High res CT

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115
Q

Sudden onset abdo pain + AF + big meal - dx?

A

Mesenteric ischaemia

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116
Q

initial ix when suspecting mesenteric ischaemia?

A

ABG/ VBG - check for raised lactate

CT angio abdo + pelvis + contrast is needed definitively

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117
Q

Upper GI endoscopy, stop what medication and when?

A

Stop PPIs 2w before to identify any pathology

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118
Q

What part of GI tract normally has diverticula?

A

Sigmoid colon - outpouchings

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119
Q

Liver sign in RHF?

A

Firm smooth enlarged tender and pulsatile liver edge

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120
Q

AI liver disease - mx?

A

Steroids +- other immunosuppression (eg azathiprine)

Liver transplant?

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121
Q

Biopsy of which part of small intestine in coeliac is required?

A

Jejunem / duodenum

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122
Q

How should you mx diverticulitis flares?

A

Oral abx at home - if no improvement in 72h admit for IV ceftriaxone + metronidazole

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123
Q

Biliary colic - what are the LFTs and inflammatory markers like?

A

Normal

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124
Q

Oesophageal varicies - prophylaxis of bleeding?

A

Non-cardioselective BB eg propanolol

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125
Q

What the features of mild, moderate, severe and life-threatening C. diff?

A
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126
Q

Which anal fissures are concerning?

A

Lateral ones - should normally be in posterior midline

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127
Q

Mx of hepatic encephalopathy?

A

Lactulose - increased excretion of ammonia

Prophylaxis w rifamixin - adjust gut flora to decrease ammonia production

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128
Q

AXR w signs of small bowel obstruction + air in biliary tree - what is possible dx?

A

Gallstone ileus - gallstone enters ileocaecal valve

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129
Q

What should be given before endoscopy in pts w variceal haemorrhage?

A

Terlipressin + prophylactic abx

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130
Q

Why should folate be replaced after B12 in deficiency?

A

Folate replacement prior to B12 can precipitate subacute combined degeneration of the spinal cord.

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131
Q

What class of drug is terlipressin?

A

Vasopressin analogue

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132
Q

ix findings in PBC? mx?

A

Ix:
- Raised ALP + GGT
- Raised AMA titre >1:40

Mx:
1st - ursodeoxycholic acid - slows disease and improves sx
Pruritis - cholestyramine
Fat soluble vitamins
Liver transplant if >100 bilirubin

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133
Q

What is the most common cause of large bowel obstruction?

A

Colon cancer

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134
Q

When checking if there is any anastamotic leaks following bowel surgery what ix is used and why?

A

Gastrograffin enema > barium - less toxic than barium if it leaks into abdo cavity

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135
Q

Imaging of choice for PE if renal impairment?

A

V/Q scan

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136
Q

ECG - II, III and aVF ST elevation - what vessel is affected? what is a possible complication?

A

Supplies right coronary artery -> supplies AV node so can cause arrhythmias inc bradycardia and AV block

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137
Q

Which type of MI is more likely to cause RBBB?

A

LAD - as blocks below level of AV node

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138
Q

What should not be given alongside verapamil, why?

A

BB due to risk of complete heart block / bradycardia -> death

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139
Q

What causes U waves on ECG? an example of a medication that can cause this?

A

caused by hypokalaemia (also see prolonged PR interval 1st degree heart block) - can be caused by thiazide

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140
Q

What is the most specific ECG finding in acute pericarditis?

A

PR depression secondary to atrial injury

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141
Q

How long before elective surgery is warfarin stopped?

A

5d - aim to get INR below 1.5

Usually resumed on evening of surgery / next day if hemostasis is adequate

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142
Q

mid-late diastolic murmur - describes what?

A

mitral stenosis - most commonly cause by rheumatic fever

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143
Q

How should orthostatic hypotension be mx?

A

education and lifestyle measures such as adequate hydration and salt intake

discontinuation of vasoactive drugs e.g. nitrates, antihypertensives, neuroleptic agents or dopaminergic drugs

if symptoms persist, consider compression garments, fludrocortisone, midodrine, counter-pressure manoeuvres, and head-up tilt sleeping

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144
Q

What should be offered to pts on symptomatic stable angina that require addition of another drug already on CCB but CI against BB?

A

long-acting nitrate, ivabradine, nicorandil or ranolazine

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145
Q

What are some side effects of thiazide like diuretics?

A

Dehydration
Postural hypotension
Gout
Impaired glucose tolerance
Impotence

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146
Q

What is pulsus paradoxus?

A

Large drop in BP upon inspiration seen in cardiac tamponade

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147
Q

What are the reversible causes of cardiac arrest ?

A

4H + 4T
Hypoxia
Hypovolaemia
Hyper/po - kalaemia, hypoglyc, hypocalc
Hypothermia

Thrombosis (coronary or pulmonary)
Tension pneumothorax
Tamponade
Toxins

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148
Q

What electrical activity is likely to be seen in tension pneumothorax?

A

Pulseless electrical activity

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149
Q

What should be done in CPR if suspecting PE?

A

Prove thrombolytic drugs eg alteplase and continue CPR for 60-90 mins

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150
Q

Early diastolic murmur - high pitched and blowing in character describes what murmur?

A

Aortic regurg

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151
Q

Which drugs need to be used with caution in pts w statins and why?

A

Erythro / clarithromycin - inhibits p450 leading to raised levels of statin in the body -> increased risk of rhabdomyolysis

EVEN GREATER RISK IN CKD PTS

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152
Q

What should you do in AF pt if ChadVasc is below threshold to treat?

A

Do a transthoracic echo to rule out to exclude valvular heart disease

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153
Q

Which anti-HTN can cause hypocalcaemia?

A

Loop diuretics eg furesomide

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154
Q

Widespread joint hypermobility + MR - dx?

A

Collagen disorder eg marfans , ehlers-danlos

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155
Q

What are some causes of postural hypotension - how is this defined?

A

Causes
- Hypovolaemia
- Autonomic dysfunction: diabetes, Parkinson’s
- Drugs: diuretics, antihypertensives, L-dopa, phenothiazines, antidepressants, sedatives
- Alcohol

Postural hypotension = >20mmhg drop

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156
Q

What drugs should be avoided in AS due to the theoretical risk of hypotension?

A

Nitrates

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157
Q

Broad complex tachycardia - what medication is CI?

A

This is VT - Verapamil is CI due to risk of haemodynamic deterioration, VF and cardiac arrest

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158
Q

VF / pulseless VT - mx?

A

1 shock as soon as identified followed by 2 mins of CPR

If arrest is witnessed in monitored pt - up to 3 stacked shocks v 1 before CPR

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159
Q

1st line mx of trigeminal neuralgia?

A

Carbamzepine

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160
Q

Mx of medication overuse headaches?

A

Simple analgesia + triptans can be stopped abruptly

Opioids should be weaned gradually

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161
Q

What should you do if a pt w pneumothorax has persistent air leak or recurrent episodes?

A

Consider referral for VATS (video-assisted thoracopscopic surgery) to allow for mechanical/chemical pleurodesis +/- bullectomy

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162
Q

1st line ix for osteoporotic vertebral fractures?

A

X-ray Spine -> if theres a compression fracture may need a CT spine

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163
Q

Ca + breathlessness of exertion + upper lobe findings on CXR?

A

Radiation pneumonitis - causing upper zone fibrosis

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164
Q

how can you have a definitive diagnosis of medication overuse headaches?

A

Symptoms must resolve (or revert back to their original pattern) within 2 months of stopping the causative medication.

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165
Q

Effect of clarithromycin + warfarin together?

A

Increased effect of warfarin due to inhibition of P450 system leading to decreased break down

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166
Q

Gene mutation associated w hereditary non-polyposis colorectal carcinoma?

A

MSH2/MLH1 gene mutations

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167
Q

Rib fracture what to do if not controlled with normal analgesia? when might you consider further mx?

A

Nerve blocks

If conservative measures dont work after 12w consider surgical fixation or in the case of flail chest

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168
Q

What are the different rotator cuff muscles and what are their functions?

A
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169
Q

Effect of barbiturates and antiepileptics on warfarin?

A

P450 inducers - reduces concentration

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170
Q

Which is a mroe common cause of colorectal ca - HNPCC or FAP?what other ca does this increase risk of?

A

HNPCC -> endometrial

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171
Q

Diverticular sx + vaginal passage of faeces or flatus - dx?

A

Colovaginal fistula

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172
Q

Difference between diverticulosis and diverticulitis in presentation?

A

If symptomatic probs -itis

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173
Q

1st line osteoarthritis?

A

Paracetamol and NSAIDs - topical NSAIDs only if hand or knee

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174
Q

Tension pneumo mx - what size cannula and where?

A

14G cannula in 5th ICS MCL

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175
Q

Use of vibrating tools can cause what condition in the hands?

A

Raynauds

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176
Q

What foods should pts taking warfarin avoid?

A

Foods high in vit K - broccoli, spinach, kale and sprouts

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177
Q

What increases risk of chest infections in rib fractures?

A

Inadequate ventilation

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178
Q

Mx of acute confusional state?

A

Treating the underlying cause and environmental modification not working then haloperidol sometimes used - if parkinsonianism use atypical eg ozapines

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179
Q

What should you do for AF + TIA?

A

Start anti coagulation asap once haemmorhage is excluded - probs a DOAC

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180
Q

Cavitating upper lobe pneumonia in diabetic + alcoholic?

A

Kleb pneumoniae

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181
Q

Chronic steroid use + insidious development of anterior hip pain + stiffness - what should you be most worried about? what is the ix?

A

Avascular necrosis - MRI hip

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182
Q

On auscultation of the chest, what can you hear in the following conditions:

Asbestosis and Bronchiectasis

A

Asbestosis - inspiratory crackles
Bronchiectasis - coarse crackles and high-pitched inspiratory squeaks

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183
Q

How do you manage different types of seizures in men and women?

A
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184
Q

What are the clinical findings in ank spond?

A

Reduced:
- Chest expansion
- Lateral flexion
- Foward flexion

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185
Q

What should anticoagulant of choice be in a pt w/ AF who has a stroke / TIA?

A

Warfarin / direct thrombin / factor Xa inhibitor

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186
Q

What conditions do the following x-ray findings suggest:
- periarticular erosions and bone resorption
- Erosions with overhanging edges (‘rat-bite’ erosions)
- joint effusion
- loss of joint space, osteophytes, and subchondral sclerosis
- Widened, bulky physeal plates and irregularity

A
  • periarticular erosions and bone resorption = Psoriatic arthritis (pencil in cup)
  • Erosions with overhanging edges (‘rat-bite’ erosions) = Gout
  • joint effusion = septic arthritis
  • loss of joint space, osteophytes, and subchondral sclerosis = Osteoarthritis
  • Widened, bulky physeal plates and irregularity = Osteopaenia
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187
Q

Ix for aki of unknown origin?

A

Renal tract US

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188
Q

What to do if considering SAH, CT is negative?

A

If CT was done w/in 6h -> consider another dx no need fro LP

If CT was done after 6h -> Do an LP 12h after onset of sx (done to check for xanthochromia - product of RBC breakdown)

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189
Q

How is ADPKD screened for?

A

US abdomen

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190
Q

What drug can reduce progression of ADPKD?

A

Tolvaptan

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191
Q

What vit d replacement should be offered to those with CKD - why?

A

Alfacalcidiol - doesnt require activation in kidneys

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192
Q

Which Ig is found quicker in infection IgM or IgG?

A

IgM then IgG

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193
Q

How can you distinguish between amoebic and pyogenic liver abscesses?

A

Both have similar US appearances - homogenous hypoechoic round leisons

Amoebic - associated w travellers diarrhoea
Pyogenic - Associated w hepatobiliary / pancreatic disease

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194
Q

What needs to be monitored in pts w HSP?

A

BP and Urinalysis - check for progressive renal involvement

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195
Q

Reddening and thickening of nipple and areola - possible dx? mx?

A

Pagets disease of breast - suggestive of breast ca hence requires urgent referral to breast clinic for punch biopsy, mammography and US breast

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196
Q

How to distinguish between pagets disease of breast and nipple eczema? mx?

A

Nipple - starts areola and goes to nipple
Pagets - starts nipple and goes to areola

mx = Emollients (mild), Corticosteroids (mod), Tacrolimus (refractory)

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197
Q

How much monitoring is recommened in T1DM? when is more frequent monitoring of blood glucose suggested?

A

recommend testing at least 4 times a day, including before each meal and before bed (5-7 in morning and 4-7 at other times = target levels)

more frequent monitoring is recommended if frequency of hypoglycaemic episodes increases; during periods of illness; before, during and after sport; when planning pregnancy, during pregnancy and while breastfeeding

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198
Q

Epilepsy + learning disability + bilateral flank masses w/ haematuria - overall dx? cause of flank masses?

A

Tuberous sclerosis - masses are angiomyolipomas

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199
Q

Mx of hypothyroidism in pregnancy?

A

Maternal free t4 needs to be in upper 1/3rd to avoid foetal hypothyroidism

1st trimester - propylthiouracil > carbimazole - due to reduced risk of congenital abnormalites

2nd trimester+ = carbimazole - less risk of severe hepatic injury

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200
Q

When may renal replacement therapies such as haemodialysis be offered in mx of AKI?

A

When pt is not responding to medical mx of complications eg hyperkalemia, pulmonary oedema, acidosis or uraemia

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201
Q

how is a thyrotoxic storm treated?

A

BB, anti-thyroid drugs + steroids

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202
Q

When can stage 1 and 2 CKD be diagnosed?

A

If GFR is within the correct ranges + markers of kidney disease including proteinuria, haematuria, electrolyte abnormalities or structural abnormalities detected

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203
Q

All patients with a CD4 count lower than 200/mm3 should receive what mx of HIV?

A

very active ART + PCP prophylaxis (co-trimoxazole)

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204
Q

Abx for MRSA???

A

Vancomycin

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205
Q

Assymptomatic bacteria in catheterised pts - to treat or not to treat?

A

dont traet

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206
Q

How can you confirm dx of post-streptococcal glomerulonephritis?

A

Anti-streptolysin O titre

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207
Q

What thyroid disease can smoking cause?

A

graves - (hyperthyroid)

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208
Q

Mx of paediatric inguinal hernias?

A
  • Urgent referral if <1y due to increased risk of strangulation
  • Older can be considered for elective repair
  • Neonates and premature may be kept overnight due to increased risk of post op apnoea
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209
Q

3rd trimester UTI - what to use?

A

Amox / cefalexin for 7d

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210
Q

What defines the resolution of DKA? what if no resolution of ketonaemia + acidosis in 24h?

A

DKA resolution is defined as:
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L

review by senior endocrinologist

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211
Q

When to send MSU in women w UTI?

A

Have symptoms that are persistent or do not resolve with antibiotic treatment.

Have recurrent UTI (2 episodes in 6 months or 3 in 12 months).

Have a urinary catheter in situ or have recently been catheterised.

Have risk factors for resistance or complicated UTI such as abnormalities of the genitourinary tract, renal impairment, residence in a long-term care facility, hospitalisation for more than 7 days in the last 6 months, recent travel to a country with increased resistance or previous resistant UTI.

Have atypical symptoms.

Have visible or non-visible (on urine dipstick) haematuria.

Pregnant

Age more than 65 years old.

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212
Q

Mx of testicular torsion surgery?

A

Definitive is emergency exploratory surgery + bilateral orchidopexy

If surgery is delayed 6h+ / prep is being made for it - can do emergency manual de-torsin (anti clockwise rotation) - buy more time for surgery

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213
Q

What should be done to steroid dose during illness + why?

A

Double the dose - due to risk of adrenal crisis

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214
Q

When is surgical mx of hiatus hernia required?

A

If it is a paraoesophageal hernia or signs of complication eg UGI haemorrhage / necrosis

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215
Q

How long to wait after prostatitis to measure PSA levels?

A

1 month

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216
Q

Obstructive urinary calculi + signs of infection -> mx?

A

Urgent surgical renal decompression + IV Abx due to risk of sepsis

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217
Q

Anal fistula dx - what to do now?

A

MRI pelvis - to characterise its course -> surgery may be needed in emergencies if pt is v unwell

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218
Q

Missing dialysis - effect on K+, what is a sign of this happening severly on ECG?

A

Can increase K+

Severe hyperkalaemia -> Sinusoidal wave pattern

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219
Q

T2DM dx in assymptomatic pts?

A

Need 2 positive results

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220
Q

What conditions can lead to higher-than-expected and lower-than-expected levels of HbA1c?

A

Higher - increase RBC lifespan:
- Vit b12 / folate deficiency
- IDA
- Splenectomy

Lower - reduced RBC lifespan:
- Sickle cell
- G6PD deficiency
- Hereditary spherocytosis
- Haemodialysis

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221
Q

What are the possible extra renal manifestations of ADPKD?

A

Hepatic cysts which manifest as hepatomegaly
Diverticulosis
Intracranial aneurysms
Ovarian cysts

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222
Q

What are the possible extra renal manifestations of ADPKD?

A

Hepatic cysts which manifest as hepatomegaly
Diverticulosis
Intracranial aneurysms
Ovarian cysts

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223
Q

Menstrual issues in hyper / hypothyroid?

A

Hyperthyroid = oligomennorhoea / amennorhoea

Hypothyroid = menorrhagia

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224
Q

Brainstem stroke vessels and their presenting sx:
- Anterior cerebral artery
- Anterior inferior cerebellar artery
- Basilar artery
- Posterior cerebral artery
- Posterior inferior cerebellar artery

A
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225
Q

What is a good induction anasthesia in someone who is hemodynamically unstable?

A

Ketamine

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226
Q

Which people should be referred via suspected ca pathway for breast ca?

A

aged 30 and over and have an unexplained breast lump with or without pain or - routine referral if below this age

aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer in people:
with skin changes that suggest breast cancer or
aged 30 and over with an unexplained lump in the axilla

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227
Q

Possible electrolyte abnormality w infusing large amounts of NaCl?

A

Hyperchloraemic acidosis - use hartmanns instead

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228
Q

Traumatic injury + LOC + Lucid interval -> what dx? what feature may you see?

A

Extradural haematoma

Cushings reflex - HTN and bradycardia

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229
Q

Shoulder dislocation - when is anteroir more common and when is posterior more associated? how does it present on examination?

A

anterior = FOOSH - locked in external rotation

posterior = seizures / electric shock - locked in internal rotation

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230
Q

Which manoeuvre to open airway is preferred if concerned about C-spine injury?

A

Jaw thrust > Head tilt / chin lift

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231
Q

What type of myopathy can corticosteroids cause?

A

Proximal myopathy

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232
Q

Mx of raised ICP?

A

Ix and tx underlying cause

  1. Raise head of bed to 30deg
  2. IV mannitol
  3. controlled hyperventilation-> reduced co2 -> vasoconstriction of cerebral arteries -> reduced ICP (caution in ischaemia)
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233
Q

Suspected visual loss in temporal arteritis - mx?

A

IV methylpred

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234
Q

What are some possible complications following SAH?

A

Re-bleeding normally 1st 12hrs
Hydrocephalus
Vasospasm - causes stroke like sx
Hyponatraemia - secondary to SiADH
Seizures

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235
Q

Causes of unilateral and bilateral hydronephrosis?

A

Unilateral = PACT
- Pelvic-ureteric obstruction (congenital or acquired)
- Aberrant renal vessels
- Calculi
- Tumours of renal pelvis

Bilateral = SUPER
- Stenosis of the urethra
- Urethral valve
- Prostatic enlargement
- Extensive bladder tumour
- Retro-peritoneal fibrosis

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236
Q

Mx of hydronephrosis?

A

Remove obstruction and drainage of urine

Acute upper urinary tract obstruction = nephrostomy tube

Chronic upper urinary tract obstruction = ureteric stent or pyeloplasty

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237
Q

All men w/ ED should have what levels checked?

A

Morning free testosteroen

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238
Q

What is normal anion gap?

A

8-14

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239
Q

Mx of small bowel obstruction?

A

Drip + Suck - NG tub insertion + IV fluids w/ extra K+

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240
Q

Swelling at DIP joints - what sign is this, what condition?

A

Herberdens nodes - features of osteoarthritis

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241
Q

Radiotherapy after wide-local excision / masectomy in breast ca mx?

A
  • Whole breast radiation is recommended in wide local excision
  • Radiotherapy in only T3 and T4 tumours or 4+ positive axillary nodes in those w/ masectomy
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242
Q

initial mx of limb threatening ischaemia?

A

IV analgesia + heparin + vascular review

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243
Q

What should happen to pts own insulin when mx of DKA?

A

Stop short acting insulin

Continue long acting insulin

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244
Q

Mx of primary hyperaldosteronism?

A

Mx w spironolactone

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245
Q

Osteomyelitis ix of choice?

A

MRI

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246
Q

What is a common cause of bilateral carpal tunnel syndrome?

A

RA

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247
Q

When to add insulin in mx of HHS?

A

Only if glucose level stops falling just giving iv fluids otherwise there is a risk of central pontine myelinolysis

consider vte

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248
Q

Complete heart block following a MI - what vessel?

A

Right coronary artery

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249
Q

What is the definition of AKI?

A

Detect acute kidney injury, in line with the (p)RIFLE, AKIN or KDIGO definitions, by using any of the following criteria:
* a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
* a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
* a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than

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250
Q

Mx of ileus?

A

NBM -> can progress to small sips of clear fluids

NG tube if vomiting

IV fluids to maintain normovolaemia

TPN - needed for prolonged / severe cases

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251
Q

What are the indications for a CT head within 1 hour and what are the indications for CT head within 8 hours

A
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252
Q

Insulin dependent diabetic - when should they check blood glucose re driving?

A

Check before driving and every 2 hrs whilst driving

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253
Q

Raised which hormone is increased risk of pseudogout?

A

PTH - hyperparathyroidism

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254
Q

Renal colic - contrast or non-contrast KUB?

A

non-contrast KUB

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255
Q

mechanism of action of tamsulosin?

A

a-1 antagonist

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256
Q

What are the red flag sx and signs that suggest a serious underlying cause for trigeminal neuralgia?

A

Sensory changes

Deafness or other ear problems

History of skin or oral lesions that could spread perineurally

Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally

Optic neuritis

A family history of multiple sclerosis

Age of onset before 40 years

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257
Q

What cause of n+v should the following medications be used for?
Ondansetron
Haloperidol
Prochlorperazine
Metoclopramide

A

Ondansetron for chemotherapy-induced nausea

Haloperidol for intracranial causes (raised ICP, direct effect of tumour)

Prochlorperazine for vestibular causes

Metoclopramide for gastrointestinal causes

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258
Q

Pt on steroids - has surgery what do you need to do and why?

A

The patient needs steroid cover with hydrocortisone or dexamethasone before and after major surgery to prevent adrenal crisis

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259
Q

Describe the different epilepsy localising features in terms of lobe affected?

A
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260
Q

What is the mx of neuropathic pain?

A

first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin- if the first-line drug treatment does not work try one of the other 3 drugs

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261
Q

What are the causes of postural hypotension w/ compensatory tachycardia -what doesn’t have compensatory tachy?

A

The ‘4Ds’ can be useful in remembering causes of postural hypotension with compensatory tachycardia.
- Deconditioning.
- Dysfunctional heart: aortic stenosis.
- Dehydration: disease (acute illness, adrenal insufficiency), dialysis, drugs (diuretics, narcotics).
- Drugs: anti-anginals, anti-parkinsonian medications (levodopa), antidepressants, antipsychotics, anti–benign prostatic hyperplasia drugs (tamsulosin)

Autonomic failure eg in parkinsons

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262
Q

Why do you get long QT syndrome?

A

Usually due to loss of function / blockage of K+ channel

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263
Q

What is the new definition of a TIA?

A

New ‘tissue-based’ definition is now used: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction

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264
Q

Which pts should be offered urate lowering therapies (allopurinol / febuxostat) in mx of gout?

A

Those w 2 or more attacks per year, tophi, renal disease, uric acid renal stones and if on cytotoxic / diuretics

When prescribing this colchicine should be co-prescribed for 1st 6m (otherwise NSAIDs)

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265
Q

Which pts should be offered urate lowering therapies (allopurinol / febuxostat) in mx of gout?

A

Those w 2 or more attacks per year, tophi, renal disease, uric acid renal stones and if on cytotoxic / diuretics

When prescribing this colchicine should be co-prescribed for 1st 6m (otherwise NSAIDs)

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266
Q

What is the most common type of thyroid cancer, most likely complication of this type and prognosis?

A

Papillary

Spreads to cervical lymph nodes

Excellent prognosis

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267
Q

Mx of HAP?

A

Within 5 days of admission: co-amoxiclav or cefuroxime

More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

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268
Q

What is CK like normally in Rhabdomyolysis?

A

10,000+

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269
Q

Stroke + AF = mx?

A

Start anticoag w DOAC or Warfarin

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270
Q

Best ix to identify C spine fractures?

A

CT Spine

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271
Q

Needle biopsy: nuclei that are enlarged, hyperchromatic and pleomorphic - suggests what ca?

A

Carcinoma

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272
Q

OAB mx?

A

Oxybutinin - antimuscarinic

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273
Q

Incidental AF found what to do?

A

CHADVASC then decide if you need anticoagulation

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274
Q

Nose bleed - mx?

A

cautery -> minor bleeding + accessible site = cautery, anterior pack used for profuse bleeding w/ sites difficult to localise

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275
Q

MSM + Procitis + Lymphadenopathy - possible dx?

A

Lymphogranuloma venereum

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276
Q

Cord compression due to spinal mets + too frail for surgery possible mx?

A

External beam radiotherapy

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277
Q

what type of peptic ulcer is relieved by eating and worse on rest?

A

duodenal

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278
Q

Acute gout but NSAIDs are ruled out in CKD stage 4 what should you use?

A

Oral pred

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279
Q

Down and out eye - which nerve palsy, what if there’s pupil dilation?

A

3rd nerve - if dilation it is surgical 3rd nerve

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280
Q

What to do if severe hyperkalaemia in context of AKI?

A

Immediate discussion w/ crit care / nephrology to consider renal replacement therapies

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281
Q

Myasthenia gravis antibodies?

A

Anti-ACHr

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282
Q

How can you diagnose IgA nephropathy definitively?

A

Renal biopsy - shows diffuse mesangial IgA deposition

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283
Q

What are the main causes of non-gonococcal urethritis?

A

1 = Chlamydia trachomatis

If negative for chlamydia -> mycoplasma genitalium

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284
Q

Mx of subclinical hypothyroidism - raised TSH but normal T3/4?

A

If TSH >10 consider offering levothyroxine if levels remain like this at 2 occasions 3m apart

if TSH 5.5-10 depends on age
- 65> - measurements are true 2x 3m apart + sx -> consider supplementation
- older people (particularly 80+) - watch and wait
- Assymptomatic - observe and repeat in 6m

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285
Q

What common drugs can cause SJS?

A

Antibiotics such as penicillin, amoxicillin, erythromycin, ciprofloxin and sulfonamides

Anticonvulsants such as Lamotrigine, phenobarbital, valproic acid, phenytoin and carbamazepine

NSAIDs- Pain relievers such as acetaminophen, ibuprofen, naproxen sodium and allopurinol

Antifungals such as ketoconazole, itraconazole and fluconazole

Antivirals such as abacavir

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286
Q

What is Lights criteria for exudative v transudative pleural effusion and when should it be applied?

A

Applied when pleural fluid protein is 25-35

Criteria that suggest exudative is:
- pleural fluid protein divided by serum protein >0.5 (more than 1/2)
- pleural fluid LDH divided by serum LDH >0.6 (more than 60%)
- pleural fluid LDH more than two-thirds the upper limits of normal serum LDH - more than 150

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287
Q

What is the max metformin can be titrated up to - when does this need to be done?

A

Increase to 500mg TDS (3x daily) - before initiating SGLT-2 inhibitors

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288
Q

What bacteria does this describe:
- Gram -ve rod
- Non-lactose fermenting
- Oxidase +ve

A

Pseudomonas eurginosa

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288
Q

What bacteria does this describe:
- Gram -ve rod
- Non-lactose fermenting
- Oxidase +ve

A

Pseudomonas eurginosa

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289
Q

What blood pressure reading in clinic is the criteria for immediate tx?

A

180/120<

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290
Q

Medial epicondylitis - what aggrevates pain and what might this accompany?

A

pain is aggravated by wrist flexion and pronation

symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement

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291
Q

What form of encephalitis typically shows bilateral temporal lobe changes on CT? how do different causes of encephalitis varus?

A

this is textbook HSV encephalitis

Cryptococcus - weeks not days and CMV (CD <50) encephalitis occur in immunocompromised (HIV) pts

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292
Q

Painful 3rd nerve palsy + dilated eye suggests what?

A

Posterior communicating artery aneurysm - dilation suggests compressive leison

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293
Q

Diabetic foot ulcer + raised temp + raised HR -> suggests what? how to dx?

A

These are signs of systemic illness - suggestive of osteomyelitis

Dx is done using MRI - requires 6w of fluxcox

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294
Q

Which viruses are most likely to cause meningitis in adults?

A

Enterovirsuses eg coxsackie, echovirus

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295
Q

Breast Ca - post surgery adjuvant therapy choices if hormone +ve?

A

If post-menopausal - aromatase inhibitors eg anastrozole

If pre/peri-menopausal - tamoxifen (can increase risk of endometrial, VTE and menopausal sx)

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296
Q

Signs of hydrocephalus?

A

Wet weird wobbly

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297
Q

Signs of venous sinus thrombosis?

A

Risk factors for thrombosis, headache, reduced consciousness, vomiting

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298
Q

contralateral homonymous hemianopia with macular sparing and visual agnosia - what vessel

A

Posterior cerebral artery

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299
Q

What are the signs seen in lateral medullar syndrome?

A

cerebellar signs, contralateral sensory loss & ipsilateral Horner’s

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300
Q

Mx of VT - what drug is CI?

A

Verapamil

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301
Q

Pt w/ gonorrhoea - what can be offered if they refuse IM ceftriaxone?

A

Oral cefixime + oral azithromycin

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302
Q

Ejection systolic murmur - worse on inspiration (downs) -dx?

A

ASD

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303
Q

Spinal cord trauma + low BP + normal HR - suggests what? mx?

A

Neurogenic shock - low BP due to reduced sympathetic tone / increase parasympathetic tone + cannot produce tachycardia response

Will need vasopressers

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304
Q

Which lung ca can cause SiADH, ACTH rise and lambert eaton?

A

Small cell

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305
Q

Which lung ca can cause increased release of PTH-rp?

A

Squamous cell

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306
Q

Which lung ca can cause gynaecomastia?

A

Adenocarcinoma

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307
Q

What is a common complication of intraventricular haemorrhage? how can this be distinguished from expansion of hematomas?

A

Hydrocephalus - this is way more common and doesn’t cause midline shift

Treat w external ventricular drain

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308
Q

What electrolyte abnormality can Trimethoprim cause?

A

Trimethoprim -> tubular dysfunction -> HYPERKALAEMIA

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309
Q

Effect of Ca on QT interval?

A

Rising calcium shortens QT interval

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310
Q

In trauma - when fluid is draining from ear / nose - how can you check if its CSF?

A

Check glucose - present in CSF not in mucus

Beta-2-transferrin is gold standard

xanthachromia takes 12h to present

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311
Q

UTIs and breastfeeding - which abx is safe and which isn’t?

A

Both nitrofurantoin and trimethoprim are present in breast milk

Trimethoprim - isnt harmful for short term use

Nitrofurantoin - can cause haemolysis in G6PD infants

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312
Q

In diagnosing PSC - when may you prefer to use ERCP over MRCP?

A

ERCP is more invasive so generally avoided unless - MRCP is unsuitable eg metal implants

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313
Q

Differences and similarites between churg strauss and Granulomatosis w/ polyangiitis?

A

Similarities:
- Vasculitis
- Sinusitis
- Dyspnoea

Churg:
- Asthma
- pANCA
- Eosinophilia

Granulomatosis w/ polyangiitis (wegners):
- Renal failure
- cANCA
- Epitaxis / haemoptysis

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314
Q

What causes TLCO to be lower?

A

pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output

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315
Q

What causes TLCO to be raised

A

asthma
pulmonary haemorrhage (Wegener’s, Goodpasture’s)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise

316
Q

What are the most common causes of endocarditis?

A

Staph aureus - acute and IVDU - most common overall

Staph epidermis - most common 2m following valve replacement

Staph bovis - colorectal ca
Staph viridans - developing countries

HACEK - culture negative causes

317
Q

Strongest RF for anal cancer?

A

HPV

Increasing age, smoking, HIV and multiple anal sex partners = other RFs

318
Q

What worsens lateral epicondylitis pain?

A

Opposite of medial epicondylitis - resisted wrist extension and elbow extension/supination

This is tennis elbow

319
Q

Thoracic kyphosis causes what type of lung disease?

A

Restrictive - raised FEV1/FVC ratio

Can cause reduced TLCO (measure of gas transfer from lung to alveoli) - chest wall deformeties affect how much alveoli can expand

KCO (measure of gas exchange efficiency) = TLCO / alveolar SA -> in this case alveolar SA would be reduced thus increasing KCO

320
Q

What is the intervention of choice in pts w malignant distal obstructive jaundice due to unresectable pancreatic carcinoma?

A

Biiliary stenting

321
Q

Signs of infants w/ hydrocephalus?

A

Increased head circumfrence + bulging fontanelle + sunsetting of eyes (impaired upward gaze)

322
Q

MoA of fondaparinux?

A

Activates antithrombin III - similar to LMWH

323
Q

bupropion - moa?

A

a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

CI in pregnancy, epilepsy (reduces seizure threshold) and breast feeding - Eating disorder = relative CI

324
Q

What is pellagra - how does it present?

A

B3 (niacin) deficiency - presents w/ DDDD:

Dermatitis
Diarrhoea
Dementia / delusion
Leads to DEATH

325
Q

What is BeriBeri - how does it present / get categorised?

A

B1 (thiamine) deficiency, split into wet and dry beriberi

Wet beriberi (presenting with tachypnoea, dyspnoea and pedal oedema)

Dry beriberi (presenting with pain, paresthesia and confusion).
-> Wernicke–Korsakoff syndrome is a subtype of dry beriberi

326
Q

CMT disease inheritance pattern?

A

CMT1 + 2 = AD

CMT3 = AD / AR

CMT4 = AR

327
Q

What are the ottowa rules for ankle injuries?

A

An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
* Bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
* Bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
* Inability to walk four weight bearing steps immediately after the injury and in the emergency department

328
Q

What are the definitions of malnutrition?

A

BMI <18.5

BMI <20 + 5% unintentional weight loss in 3-6m

10% unintentional weight loss in 3-6m

329
Q

Why might crohns cause intermittent jaundice?

A

Bile salts absorbed in terminal ileum -> if absorption is impaired due to crohns -> development of gallstones which can go into CBD and cause jaundice

330
Q

What is mirizzi syndrome?

A

When gallstones compress bile duct directly -> one rare time cholecystitis presents w jaundice

331
Q

What organ is most likely to be enlarged in ADPKD and why?

A

Hepatomegaly due to hepatic cysts

332
Q

Do pts who have had catheter ablation for AF need long term anticoagulation?

A

Yes if their CHAD VASC score says so (>1 indicates this)

If score is 0, then 2 months of anticoagulation needed only

333
Q

CKD + Urinary A:CR >30mg/mol - what mx is required?

A

Need to be started on ACEi / ARB

334
Q

What is an alternative to long-term anticoagulation medication in pts w AF?

A

Left atrial appendage closure surgery

335
Q

Pt w intracranial bleed -> becomes unresponsive - what ix is needed and why?

A

CT head needed to rule out hydrocephalus

336
Q

How can you distinguish between CT heads of extra and subdural hematoma? which is this?

A

Extradural = Lemon - within suture lines cause life gives you (extra) lemons

Subdural = Banana - The banana is (sub) under the skin to eat

337
Q

What do different ABPI results mean?

A

0.3 - critical limb ischaemia

<0.5 = severe arterial disease - PAD

0.5-0.8 = suggests presence of arterial disease or mixed arterial/venous disease - PAD or mixed PAD and PVD

0.8-1.3 = no evidence of significant arterial disease

> 1.3 = suggests presence of arterial calcification, such as in some people with diabetes, RA, systemic vasculitis, atherosclerotic disease and advanced chronic renal failure.

338
Q

What needs to be co-administered w/ Izonisaid to prevent peripheral neuropathy?

A

Pyoxidine - Vit B6

339
Q

When can you drive again following TIA?

A

When sx free for 1m no need to tell DVLA

340
Q

Difference between low pressure and high pressure chronic urinary retention?

A

High pressure retention:
- impaired renal function and bilateral hydronephrosis
- typically due to bladder outflow obstruction

Low pressure retention:
- normal renal function and no hydronephrosis

341
Q

When should darboetin be given to pts w CKD?

A

If they develop anaemia secondary to CKD

342
Q

Should pts w/ CKD be on statins?

A

Yes - lipid-lowering therapy with a statin is also recommended for all patients with CKD <60 for the primary or secondary prevention of cardiovascular disease

343
Q

What GFR means metformin is CI?

A

GFR <45 use w/ caution

GFR <30 stop using

343
Q

Black and HTN w/ T2DM - 1st line?

A

ARBs - ‘-artans’

344
Q

How can you distinguish between drug induced and idiopathic parkinsons?

A

Drug induced = bilateral sx

Idiopathic = unilateral

345
Q

Goserelin - MoA?

A

GnRH AGONIST -> -ve feedback to anterior pituitary

346
Q

Side effects of B-blockers?

A

Bronchospasm
Cold peripheries
Fatigue
Sleep disturbances + nightmares
ED

347
Q

What drugs are the most common cause of drug-induced angioedema?

A

ACEi

348
Q

Bromocriptine - galactorrhoea - does it cause it?

A

Galactorrhoea - no bro, no homo - its used to treat it

349
Q

What monitoring is needed on statins?

A

LFTs at baseline, 3m and 12m

Fasting lipid profline can also be checked during monitoring to assess response to mx

350
Q

What is the criteria for diagnosing RF?

A

Joints (migrating polyarthritis).
Obvious, the heart would be involved (carditis, pancarditis, pericarditis).
N (Subcutaneous Nodules).
E (Erythema marginatum).
S (Sydenham’s chorea).

351
Q

Surgery + diabetes - what to do if a pt has poorly controlled diabetes ? who else should do this?

A

Usually require variable rate insulin infusion

  • if more than one meal is to be missed
    patients with poor glycaemic control
  • risk of renal injury (e.g. low eGFR, contrast being used)
352
Q

Green-blue colour + chronic wound infection +offensive smell (esp in immunocompromised) - what organism?

A

Pseudomonas

353
Q

What type of visual loss is associated w macular degeneration?

A

Central field loss

354
Q

RFs for macular degeneration?

A

Older age - 75+

Smoking

FHx

Same as increased risk of ischaemic CVD

355
Q

RFs for macular degeneration?

A

Older age - 75+

Smoking

FHx

Same as increased risk of ischaemic CVD

356
Q

What type of hearing loss in Menieres?

A

Unilateral sensorineural

357
Q

Oral pred + dendritic corneal ulcer -> likely dx and mx?

A

herpes simplex keratitits treated w topical aciclovir

358
Q

What cause of conductive hearing loss is associated w chronic smelly ear discharge and recurrent glue ear?

A

Cholesteatoma

359
Q

What causes chalky patch on tympanic membrane upon otoscopy? what type of hearing loss is this?

A

Tympanosclerosis - conductive hearing loss

360
Q

What does abnormal fluorescin staining showing linear branching corneal ulcer suggest?

A

Herpes simplex keratitits - presents w painful red eye w/ photophobia and epiphora (excessive tearing)

361
Q

How does spider naevi differ from teleangtasia?

A

Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill.

Spider naevi fill from the centre, telangiectasia from the edge

362
Q

What side is the language centre in right-handed and left-handed people?

A

Left side for 95-99% of right handed people

Left side for 70% of left-handed people

363
Q

When should BB be stopped in acute heart failure?

A

Only stopped if:
- HR <50bpm
- 2nd / 3rd degree AV block
- Shock

363
Q

When should BB be stopped in acute heart failure?

A

Only stopped if:
- HR <50bpm
- 2nd / 3rd degree AV block
- Shock

364
Q

Suspected GCA, pt is started on prednisolone but biopsy is clear - what is the mx?

A

Continue pred - regardless of biopsy result as complication is blindness and GCA has skip leisons which can show normal biopsy (ideally biopsy in 1st 7d of steroid mx)

365
Q

How can cholera present?

A

Dehydration + Hypoglycaemia

366
Q

What to do for pts on warfarin going to have emergency surgery?

A

If surgery can wait for 6-8 hours - give 5 mg vitamin K IV

If surgery can’t wait - 25-50 units/kg four-factor prothrombin complex

367
Q

How much insulin is there in 1ml?

A

100 units

368
Q

How can you differentiate between seizures and vasovagal syncope?

A

Syncopal episodes are associated with a rapid recovery and short post-ictal period.

Seizures are associated with a far greater post-ictal period

369
Q

What is subacute combined degeneration of spinal cord cause by and what are its features?

A

Caused by B12 deficiency

Causes these features + peripheral parasthesia

370
Q

What are the key indications for NIV?

A
371
Q

What are the initial ix in acute limb threatening ischaemia?

A

Initial investigations should include a handheld arterial Doppler examination.

If Doppler signals are present, an ankle-brachial pressure index (ABI) should also be obtained.

372
Q

Wilsons or Haemochromatosis? What causes cranial DI

A

Haeochromatosis

373
Q

HOCM heart sounds?

A

S4 + mid-diastolic murmur (no radiation to carotids)

374
Q

If a pt w/ parkinsons cant take levodopa - what can they take instead?

A

They can be given a dopamine agonist patch as rescue medication to prevent acute dystonia

co-careldopa -> can be given orally

375
Q

What are the RFs for asystole in bradycardia - how should these be mx?

A

complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
ventricular pause > 3 seconds

They need transvenous pacing

376
Q

What is the key parameter to monitor in HHS? how is this measured?

A

Serum osmolality - 2xna+glucose+urea

Will be more than 320

377
Q

Secondary prevention in TIA?

A

1st line clopidogrel

2nd line aspirin + dipyridamole

378
Q

What are some RFs for gallstones that arent the 4Fs?

A

DM

Crohns

Rapid weight loss

Drugs - fibrates, COCP

379
Q

How much stenosis of internal carotid is required to be reffer for carotid endarterctomy?

A

> 70% + suffered stroke / TIA in carotid territory and not severely disabled

380
Q

Why should B12 levels be checked and corrected before adjusting folate levels?

A

Can cause subacute degeneration of the spinal cord -> Loss of proprioception + vibration + muscle weakness + hyperreflexia (Spinocerebellar, lateral corticospinal and dorsal columns)

381
Q

What are some x ray changes seen in avascular necrosis ?

A

Flattening, subchondral fractures and smaller size of bone

Remember MRI is ix of choice

382
Q

How can SAH cause hyponatraemia?

A

due to SiADH

383
Q

Mx of HSV in pregnancy - w/in 6w of delivery?

A

mother to take 400mg aciclovir til delivery + elective c-section recommended

384
Q

How can vasopasm be prevented after SAH?

A

21d course of Nimodipine

385
Q

How can aneurysms causing SAH be treated?

A

Coiling by interventional neuroradiologist

386
Q

If symptomatic AV type 2 block - what is mx?

A

Surveilance

If symptomatic - can stop CCBs and BB -> then if still problematic pacemakers

387
Q

what is the 1st line mx of parkinsons?

A

If the motor symptoms are affecting the patient’s quality of life: levodopa

If the motor symptoms are not affecting the patient’s quality of life: dopamine agonist (non-ergot derived), levodopa or monoamine oxidase B (MAO‑B) inhibitor

388
Q

What should be given alonside insulin kit to diabetics?

A

Glucagon kit +- glucose

389
Q

What is Felty syndrome? how can you distinguish between this and methotrexate use?

A

Both cause neutropaenia however no splenomegaly in methotrexate use

Felty syndrome occurs in RA and causes splenomegaly hence the hypersplenism -> increased RBC breakdown

390
Q

What imaging is required in RA pts pre surgery and why?

A

AP + lateral C-spine radiographs - atlantoaxial subluxation is a complication of RA -> cervical cord compression

hence this needs to be checked for and if present -> wear C-spine collar + ensure neck isnt hyperextended on intubation

391
Q

Ischaemic stroke - 6h+ after sx + limited infarct core on CT -> mx?

A

Thrombectomy

392
Q

What is the most common organism found in bronchiectasis?

A

H influenzae

393
Q

In status epilepticus what needs to be checked before thinking about other causes?

A

Hypoxia and hypoglycaemia

394
Q

What is whipples triad of Insulinoma? Which type of MEN1 does this occur w?

A
  1. Hypoglycaemia w/ fasting / exercise
  2. Reversal of sx w/ glucose
  3. Recorded low BM at time of sx

MEN1 -PPP - parathyroid adenoma, pituitary tumour + pancreatic tumour

395
Q

Ix? Mx of insulinoma?

A

Ix = Supervised prolonged fasting (upto 72h) + CT pancreas

Surgery - if not suitable diazoxide + somatostatin

396
Q

Which pts in tachycardia require immediate DC (synchronised) cardioversion?

A

Unstable pts defined as the following signs:
- shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness
- syncope
- myocardial ischaemia
- heart failure

397
Q

What causes the following changes to S2:
- Loud S2
- Soft S2
- Widely split S2
- Fixed split S2
- Reverse split S2

A
398
Q

What blood test abnormalities can be caused by TPN?

A

LFT derangement

399
Q

What is the bone profile like in osteogenesis imperfecta?

A

All normal!

Ca, PTH, ALP and PO4- all normal

400
Q

What is the mx of angina?

A

Aspirin and statin for all patients unless contraindicated

Sublingual glyceryl trinitrate for angina attacks

First-line: beta-blocker or calcium channel blocker (rate-limiting if on its own eg diltiazem / verapamil)

Second-line: increase dose of first-line drug or add another drug from the same class

Third-line: add one of these drugs: long-acting nitrate, ivabradine, nicorandil, ranolazine

Refer for PCI or CABG if still symptomatic after three drugs

401
Q

What are the typical signs of acute interstitial nephritis? what can cause this?

A

The patient presents with typical symptoms of acute interstitial nephritis: fever and rash. Eosinophilia would likely be found on blood tests. HTN and mild impairment can also be seen

Medications including penicillin, rifampicin, NSAIDs, allopurinol and furosemide have been linked with acute interstitial nephritis

402
Q

Increased SOB + Fever following stroke - likely dx? which part is likely affected?

A

Aspiration pneumonia - more likely in right lung

403
Q

Blood stained discharge + no palpable lump + younger pt - likely dx?

A

Intraductal papilloma

404
Q

What initial ix can be useful in identifying contributing factors to post op ileus?

A

U+Es - can often be triggered by underlying electrolyte abnormalities (K, Mg, PO4-)

405
Q

Statins should be stopped when patients are on what type of abx?

A

Macrolides - Clarithromycin, erythromycin etc

406
Q

Partial anterior circulation infarcts - 2 of the following:

A

unilateral hemiparesis and/or hemisensory loss of the face, arm & leg

homonymous hemianopia

higher cognitive dysfunction e.g. dysphasia

407
Q

Differences between Brocas and Wernickes Aphasia -> What part of the brain is affected

A

Broca = FRONTAL LOBE - front of brain, near mouth hence used for language production

Wernickes = TEMPORAL LOBE - back of brain, near back of brain more thinking hence language comprehension

408
Q

What to do if effective removal of milk hasnt improved sx of lactational mastitis after 12-24h ?

A

Oral fluclox 10-14d

If untreated becomes breast abscess -> needs I+D

409
Q

Post-exposure prophylaxis for HIV - what and how long for?

A

4w of oral ART

410
Q

Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis likely dx in an MSM?

A

Lymphogranuloma venerum

411
Q

What is the general course of LGV?

A

LGV is a sexually transmitted infection caused by a type of bacteria called chlamydia

The first sign of LGV is a small blister or sore on the genitals or anus that may not hurt or itch and may go away quickly

The second sign of LGV is swollen and painful glands in the groin area, usually on one side but sometimes on both

The third sign of LGV is inflammation and bleeding from the rectum (the end of the bowel), especially if you have sex with men or have HIV

412
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous nephropathy

413
Q

Renal biopsy shows: thickened basement membrane

Silver staining shows: subendothelial spikes

What is likely dx?

A

Membranous nephropathy

414
Q

What abx is used for prophylaxis against infective exacerbations of COPD + what things need to be done before this can be done?

A

Azithromycin

Pt must:
- Not smoke + Optimised treatments and still have exacerbations
- CT thorax (exclude bronchiectasis) + sputum culture (exclude TB)
- LFT + ECG - exclude QT prolongation as macrolides can prolong it

415
Q

What does raised T3 + T4 but normal fT3 + fT4 suggest?

A

Increased amounts of thyroid binding globulin - seen normally in pregnancy (dont be tricked by minor weight gain and fatigue)

416
Q

Can you give fluclox in pregnancy if not whats the alternative?

A

Yes - Erythromycin if allergic (for cellulitis)

Outside of pregnancy its doxycycline 2nd line

417
Q

Indwelling catheter -> Osteomyelitis - likely organism?

A

Staph aureus

418
Q

NSAIDs + AKI - are they okay to continue?

A

No - except aspirin at cardio dose

418
Q

NSAIDs + AKI - are they okay to continue?

A

No - except aspirin at cardio dose

419
Q

What is Hedingers syndrome?

A

Carcinoid heart disease - Pulmonary stenosis in a pt w/ carcinoid tumour

420
Q

Which drugs are safe to continue in AKI?

A

Paracetamol
Warfarin
Statins
Clopidogrel
BB
Aspirin @ 75mg

421
Q

Broad complex tachycardia - likely dx? what drug should be avoided as it can percipitate severe hypotension, VF or cardiac arrest?

A

VT

Avoid verapamil!!

422
Q

How can you distinguish between carotid and aortic dissection?

A

Both can cause neurological deficits (often Horners) however carotid doesnt cause marked chest pain

423
Q

What anti-HTNsive is CI in renovascular disease?

A

ACEi - OPPOSITE OF CKD!!

424
Q

Can amylase levels be raise in small bowel obstruction?

A

Yes - so be aware of this as a differential in pts w/ RFs for this

424
Q

Mx of fibroadenomas?

A

Only needed if >3cm - surgical excision is the response

425
Q

What drugs can cause PROXIMAL MYOPATHY?

A

PREDNISOLONE - corticosteroids

426
Q

Bone pain + Low Ca, Low PO4-, High ALP and PTH - likely dx?

A

Osteomalacia -> low vit d -> needed for GI absorption of ca and po4- -> raised PTH -> increased bone resorption hence raised ALP

427
Q

What is ostetis fibrosa cystica found in and what are the bone profile results?

A

Late primary hyperparathyroidism hence

Raised PTH -> Raised Ca, ALP + Low PO4-

428
Q

Mx of severe cellulitis?

A

Only say the C word if its a SEVERE situation
Cellulitis Mx = Co-amox / Cefuroxime / Clindamycin / Ceftriaxone
(4 Letters in the C word 4 C drugs)

429
Q

Effects of thiazides upon glucose control?

A

Worsens it

430
Q

Seizures features and lobes involved?

A

Frontal = motor eg jacksonian march, hand/leg + post ictal weakness

Parietal = Parasthesia (sensory)

Occipital = Floaters / flashes (visual)

Temporal = everything else - aura, w or w/out impaired conciousness + automatisms

431
Q

What is Todds paresis?

A

Post ictal weakness in a pt w/ focal seizure

432
Q

how does orlistat work?

A

Orlistat works by inhibiting gastric and pancreatic lipase to reduce the digestion of fat

433
Q

What drug acting on the kidneys can cause ototoxicity?

A

Loop diuretics eg Furosemide

434
Q

Thyroid scintigraphy scan in subacute dequervains thyroiditis - shows what?

A

Decreased Iodine uptake

435
Q

What is torsades de points? mx?

A

VT w/ long QT -> can become VF and hence lead to death

IV mag sulf

436
Q

How to measure QT interval?

A

QT interval: Time between the start of the Q wave and the end of the T wave

437
Q

What dose of statins should patients be on?

A

Primary prevention (T1DM, CKD <60, Qrisk >10) of CVD = 20mg of atorvastatin -> can increase dose if non-HDL doesnt reduce by 40%or more

Secondary prevention of CVD = 80mg of atorvastatin

438
Q

Most common type of breast ca?

A

Invasive ductal carcinoma (no special type) is the most common type of breast cancer

439
Q

What is the likely dx and tx?

A 54-year-old man presents with a persistent tremor. On examination there is 6-8 Hz tremor of the arms which is worse when his arms are outstretched. His father suffered from a similar complaint.

A

Essential tremor - made better by alcohol and propanolol (sometimes primidone)

440
Q

RFs for avascular necrosis?

A

Long term steroids
Alcohol excess
Chemo
Trauma

441
Q

Which nerve is commonly injured in posterior hip dislocations?

A

Sciatic - loss of sensation in sciatic nerve distrubution + foot drop (as sciatic nerve supplies common peroneal)

Femoral - can also be injured loss of sensation in the anterior and medial aspects of the thigh and leg, as well as weakness in hip flexion and knee extension

442
Q

Which nerve is commonly injured in posterior hip dislocations?

A

Sciatic - loss of sensation in sciatic nerve distrubution + foot drop (as sciatic nerve supplies common peroneal)

Femoral - can also be injured loss of sensation in the anterior and medial aspects of the thigh and leg, as well as weakness in hip flexion and knee extension

443
Q

Which nerve is commonly injured in posterior hip dislocations?

A

Sciatic - loss of sensation in sciatic nerve distrubution + foot drop (as sciatic nerve supplies common peroneal)

Femoral - can also be injured loss of sensation in the anterior and medial aspects of the thigh and leg, as well as weakness in hip flexion and knee extension

443
Q

Which nerve is commonly injured in posterior hip dislocations?

A

Sciatic - loss of sensation in sciatic nerve distrubution + foot drop (as sciatic nerve supplies common peroneal)

Femoral - can also be injured loss of sensation in the anterior and medial aspects of the thigh and leg, as well as weakness in hip flexion and knee extension

444
Q

What changes are seen in septic shock (interms of BP and Hr etc)

A

reduced SVR
increased HR
normal/increased cardiac output
decreased blood pressure

445
Q

What changes are seen in cardiogenic shock (interms of BP and Hr etc)

A

increased SVR (vasoconstriction in response to low BP)
increased HR (sympathetic response)
decreased cardiac output
decreased blood pressure

446
Q

Malignancy + raised CK - might suggest what condition? how might this present?

A

Polymyiositis - might present w/ proximal muscle weakness + tenderness

447
Q

Headache that is worse when standing up and better lying down suggests what? name a cause? associated w?

A

Low ICP headache - can be caused by spontaneous intracranial hypotension

Connective tissue disorders eg marfans

448
Q

A 38-year-old woman presents with fever, malaise and jaundice. On examination she has moderate hepatomegaly. Laboratory analysis confirms a positive anti-smooth muscle antibody and anti-nuclear antibody. likely dx?

A

AI hep

449
Q

How is cellulitis diagnosed?

A

Clinically

450
Q

Which ca is increased risk in a pt w/ hashimotos thyroiditis?

A

MALToma

451
Q

Metastatic ca - effect upon adrenal gland?

A

Adrenal disorder - it can cause addisons (hyponatraemia, hyperkalaemia, hypotension etc)

452
Q

Roughened red papules over the knuckles described what seen in what condition?

A

Grottons papules seen in Dermatomyositis - refer urgently to rheum

453
Q

Vomiting + Addisons - how should mediactions be changed?

A

Take IM hydrocortisone until vomiting stops

454
Q

Which valvular abnormality is associated w ADPKD?

A

Mitral valve prolapse

455
Q

Which anti-epileptic causes peripheral neuropathy?

A

Phenytoin

456
Q

What type of shock will cause warm peripheries?

A

Neurogenic, septic, and anaphylactic shock (together are all distributive shock) will cause warm peripheries, with the others causing cool peripheries

457
Q

What are some local complications of gonnorhea infection?

A

male- urethral strictures, epididymitis and salpingitis (hence may lead to infertility)

female - PID and Bartholin’s abscesses

458
Q

What are the 3 main presentations of basilar artery strokes?

A

Locked-in syndrome:

  • An acute decreased GCS and advanced motor symptoms.
  • Insidious, gradual deterioration in GCS and motor symptoms with a subsequent sudden advanced decrease in GCS and motor symptoms.
  • A ‘herald hemiparesis’ with associated headache and vision changes prior to the onset of permanent symptoms of motor loss.
459
Q

Ix of suspected spinal abscess?

A

MRI whole spine as there may be skip leisons

460
Q

What anasthetic agent:
Reverses action of midazolam

A

Flumazenil

461
Q

What anasthetic agent:
Is hepatotoxic

A

Halothane

462
Q

What anasthetic agent:
Has antiemetic properties

A

Propofol

463
Q

Prolonged incubation period + foreign travel + non-bloody diarrhoea - organism?

A

Giardasis -> can get lactose intolerance and malabsorption w it

464
Q

A 48-year-old male presents with a 8 week history of epistaxis and nasal stuffiness. On examination there is evidence of nasal crusting. A chest x-ray demonstrates multiple cavitary lesions

Likely dx? antibody?

A

Wegners granulomatosis (granulomatosis w/ polyangiitis)

cANCA

465
Q

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller →

A

Dengue

466
Q

Which drug can reduce awareness of hypoglycaemic sx and thus increase risk of hypoglycaemia?

A

BB

467
Q

How long after abx use does drug induced interstitial nephritis occur and is it common?

A

4-7d after abx exposure and it is still relatively rare

468
Q

Hypermigmented + thickened waxy skin + brown discolouration (lipodermatosclerosis) + little pain ulcer = what type of ulcer?

A

Venous

469
Q

Oxybutinin - can cause constipation or nah?

A

Yes

470
Q

Increasing number of floaters in one eye, what is likely dx?

A

Retinal detachment

471
Q

What is the most likely cause of developing fever in early post-op period + reduced O2 sats esp in a pt w/ abdo surgery + has pain?

A

Bibasal atelectasis

472
Q

Most important prognostic factor in melanomas?

A

Breslow depth / thickness

473
Q

hat is the purpose of cricoid pressure during anasthesia?

A

Prevent passage of gastric content into the airway

474
Q

When is vestibular neuroniits more ikely thna BPPV and Vestibular migraine?

A

When its an isolated incident

475
Q

Wasting of muscles instrins hand muscle? where is leison

A

T1

476
Q

Painful eye w/ loss of acuity in primary care mx?

A

Needs urgent opthal assessment

477
Q

Graves antibody?

A

Anti-TSH

478
Q

What should be prescribed to all people w/ PBC?

A

Ursodeoxycholic acid

479
Q

Multiple fractures followed by early onset (within 24 hours) of hypoxia, dyspnea, and
tachypnea are the most frequent findings. Neurologic manifestations range from the development of an acute confusional state and altered level of consciousness to seizures and focal deficits and usually follow respiratory symptoms. A petechial rash is the last component to appear and only appears in about a third of cases - What does this describe a case of?

A

Fat embolism syndrome

480
Q

A 51 year old woman presents to her GP with 6 months of dry mouth and gritty eyes. She has had vitiligo for the last 10 years. Both parotid glands are mildly enlarged. What is the likely dx?

A

Sjogrens syndrome

481
Q

Above what level do spinal cord lesions have to be in order to cause autonomic dysreflexia?

A

Above T6

482
Q

Describe the COPD mx

A
483
Q

What is the CXR finding in PE?

A

Usually normal

however if theres going to be anything it would be a wedge-shaped opacification of the lung -> might also see pleural effusion

484
Q

What should pts w/ frequent infective exacerbations of COPD be offered to have at home?

A

Home supply of predniolone and abx

485
Q

What blood results suggests atopic features in COPD?

A

High esinophil count

486
Q

What are the features of anterior cord syndrome?

A

This is a specific cord lesion affecting the anterior 2/3 of the cord.

  • complete motor paralysis below the level of the lesion
  • loss of pain/temperature sensation
  • intact proprioception/vibration sensation.
487
Q

Which pts should be offered annual influenza vaccinations and 5 yearly pneumococcal?

A

CKD or Hyposplenism

488
Q

What are the features of acetabular labral tear?

A

Hip/groin pain

Snapping sensation around hip

Occasionally may involve sensation of locking

Usually involved w/ trauma or degenerative change in older adults

489
Q

Primary hypogonadism + High LH, FSH and Low Testosterone - likely dx?

A

Klinefelters syndrome - XXY

Usually taller than average, infertile and small firm tested

+ gynaecomastia + increased risk of breast ca

490
Q

Mx of Bells palsy?

A

Oral pred w/in 72 hr + eye care

F/U
- Refer to ENT if no improvement in 3w
- If long standing weakness (months) may need referral to plastics

491
Q

Mx of human and animal bites?

A

Abx - Co-amoxiclav or if allergic doxycyc + metronid

If skin is broken and blood is drawn OR if in high risk area (hands, feet, face, genitals, skin overlying cartilaginous structures or an area of poor circulation)

492
Q

An x-ray spine shows vertebral wedge compression fractures and focal sclerotic bony lesions

Suggests what

A

Metastatic prostate ca

493
Q

What are the most common tumours causing bone mets in order?

What are the most common sites of bony mets?

A

Prostate
Breast
Lung

Spine
Pelvis
Ribs
Skull
Long bones

494
Q

Describe ALS pathways

A
495
Q

What drug can induce neutrophilia?

A

Corticosteroids eg prednisolone

496
Q

What organism is most likely to cause chest infections in CF?

A

Pseudomonas

497
Q

What are the features of Wernickes encephalopathy + Korsakoffs syndrome?

A

Noa(H) was feeling too hot after drinking so he needed the AC on

498
Q

Baby bilous vomiting + double bubble on xr -> ??

A

Intestinal / duodenal atresia

499
Q

Absent corneal reflex - what nerve?

A

CN V1

500
Q

A 68-year-old man, while talking to his wife, starts staring into space. He seems unresponsive to what his wife is saying to him, and he is also smacking his lips multiple times. After 1 minute, he stops and acts normally again, but denies any of this happened when his wife questions him.

What type of seizure?

A

Focal impaired awareness

501
Q

What is the most common cause of brown-green nipple discharge?

A

Duct ectasia - may also be associated w small lump right under nipple

502
Q

Acute HF mx?

A

All pts - IV loop diuretics

O2 - maintain sats 94-94
Vasodilators (nitrates) - if severe HTN, MI or regurg (A or M) - CI if hypotensive

If resp failure - CPAP

If hypotensive:
- Ionotropes (dobutamine) - LV dysfunction + versible cardiogenic shock
- Vasopressor (NE) - if insufficient response to above or evidence of end organ hypoperfusion
- Mechanical circulatory asistence also can be considered

503
Q

Asthma - reversibility testing results?

A

in adults, a positive test is indicated by an improvement in FEV1 of 12% or more and increase in volume of 200 ml or more

in children, a positive test is indicated by an improvement in FEV1 of 12% or more

504
Q

A CT chest, abdomen, and pelvis shows mural thickening of the colon and the presence of pericolic fat stranding in the sigmoid colon - suggests what dx?

A

Diverticulitis - esp since ct findings are limited to the sigmoid colon

505
Q

EEG in absence seizures?

A

3 Hz spike and wave

506
Q

When should ACEi be stopped in CKD pts?

A

A potassium above 6mmol/L should prompt cessation of ACE inhibitors in a patient with CKD (once other agents that promote hyperkalemia have been stopped)

507
Q

Mx of rhabdomyolysis?

A

IV fluids

508
Q

Maturity-onset diabetes of the young (MODY) - inheritance?

A

AD

509
Q

Which abx used to treat UTIs CANNOT be given alongside methotrexate?

A

Trimethoprim

510
Q

When should triptans be avoided in the Mx of cluster headaches ?

A

In pts w/ CAD as it has the potential to cause coronary vasospasm

511
Q

What is a parapneumic effusion

A

Any effusion caused by pneumonia or lung abscess

512
Q

What are the signs and sx of myxedema coma? How can this be mx?

A

confusion, bradycardia, hypothermia and profoundly hypothyroid

Mx = IV thyroid replacement + IV hydrocortisone (as giving thyroid replacement in a adrenal deficient person can perciptiate adrenal crisis so this needs to be given until this can be excluded)

513
Q

In a patient with hypercalciuria and renal stones, calcium excretion and stone formation - how can this be decreased?

A

Thiazide diuretics

514
Q

Raised CK in a person w/ recent initiation of Statins?

A

Rhabdomyolysis

515
Q

What are some drugs that impair wound healing?

A

Non steroidal anti inflammatory drugs
Steroids
Immunosupressive agents
Anti neoplastic drugs

516
Q

What are some complication of acromegaly?

A

HTN

Diabetes >10%

Cardiomyopathy

Colorectal Ca

517
Q

Sx of claudication in femoral and iliac vessels?

A

Femoral = more calf pain

Iliac = more buttock pain

518
Q

A wide-based gait with loss of heel to toe walking is called an ….. gait

A

Ataxic

519
Q

What are some causes of cerebellar injury?

A

P - Posterior fossa tumour
A - Alcohol
S - Multiple sclerosis
T - Trauma
R - Rare causes
I - Inherited (e.g. Friedreich’s ataxia)
E - Epilepsy treatments
S - Stroke

Pastries

520
Q

When is S3 normal? what are some pathalogical causes?

A

Caused by diastolic filling of ventricles - normal if <30y can be upto 50y in women

LVF (eg dilated cardiomyopathy), Constrictive pericarditis and mitral regurg

521
Q

How remember difference between Galeazzi and Monteggia fractures?

A

MUgGeR

Montegia = Ulnar
Galaeazii = Radius

MonteggiA = M is A (proximal fracture w/ dislocation)
GalaeazZi = G is Z (distal fracture w/ dislocation)

522
Q

Which patients need v urgent (48h) access Xray to assess for bone sarcoma?

A

Children and young people with unexplained bone swelling or pain

523
Q

What is given to replace thiamine?

A

Pabrinex

524
Q

Which anti-HTN meds are CI in pregnancy and why?

A

ACEi due to causing foetal abnormalities and renal failure

525
Q

What is power like in limb girdles in polymyalgia rheumatica? CK?

A

There is no true weakness of limb girdles in polymyalgia rheumatica on examination. Any weakness of muscles is due to myalgia (pain inhibition)

Normal CK

525
Q

What is power like in limb girdles in polymyalgia rheumatica? CK?

A

There is no true weakness of limb girdles in polymyalgia rheumatica on examination. Any weakness of muscles is due to myalgia (pain inhibition)

Normal CK

526
Q

How much water, k, na, cl and glucose is needed for maintence fluids of adults?

A

25-30 ml/kg/day of water #

approximately 1 mmol/kg/day of potassium, sodium and chloride

approximately 50-100 g/day of glucose to limit starvation ketosis

527
Q

Describe the mx of different amounts of splenic trauma:

A

Conservative:
- Small subcapsular haematoma
- Minimal intra abdominal blood
- No hilar disruption

Laparotomy w/ conservation:
- Increased amounts of intraabdominal blood
- Moderate haemodynamic compromise
- Tears or lacerations affecting <50%

Resection:
- Hilar injuries
- Major haemorrhage
- Major associated injuries

528
Q

COPD o2 sats target?

A

88-92% + Do an ABG

If ABG doesnt show signs of hypercapnia -> then aim for 94-98%

529
Q

Which type of hip dislocation is more common? how does this appear?

A

Posteerior hip dislocation - leg is internally rotated and appears shorter than the other one

530
Q

Direct v indirect inguinal hernia - how to tell the diffrence?

A

Indirect = No reappearance during coughing when covering the deep inguinal ring

Direct = Reappearance during coughing when covering the deep inguinal ring

531
Q

What are some possible complications of radical prostatectomy?

A

Late/ longterm complications = ED, incontinence and urethral stenosis

532
Q

Warfarin - bleeding test results?

A

PT - Long
APTT - normal

533
Q

Which abx for Leigionella?

A

Macrolides - clarithromycin

534
Q

Pt presenting to GP w/in 7d of TIA -> mx?

A

300mg aspirin immediately (and be referred for specialist review within 24h)

535
Q

Breathing problems in a pt w clear chest should warrant consideration of what dx?

A

PE

536
Q

What are the features of INO (Internuclear ophthalmoplegia)?
Causes?

A

impaired adduction of the eye on the same side as the lesion

horizontal nystagmus of the abducting eye on the contralateral side

Causes = MS and Vascular diseas

537
Q

What is plasma and urine osmolality like in DI?

A

HIGH plasma osmolality in DI

LOW urine osmolality in DI

538
Q

U+E before and after ACEi - what is accepted and when should it be stopped?

A

Rise in creatinine and potassium may be expected after starting ACE inhibitors

Acceptable changes are:
- Increase in serum creatinine, up to 30% from baseline
- Increase in potassium up to 5.5 mmol/l.

539
Q

What is the initial mx of open fractures?

A

Immediate wound debridement and application of spanning external fixation device

540
Q

UTI in pregnancy - what should you do after treatment?

A

Test of cure MSU

541
Q

Gold standard ix for intracrainal venous thrombosis? mx?

A

Non-contrast CT head

LMWH acutely then warfarin generally long term

542
Q

‘empty delta sign’ seen on venography

A

Saggital sinus thrombosis - headache, diplopia, bilateral papilloedema

543
Q

Management of atelectasis?

A

Chest physiotherapy with mobilisation and breathing exercise

544
Q

Difference between HF-pEF and HF-rEF?

A

HFpEF = diastolic (heart filling issue) eg HOCM, restrictive cardiomyopathy, cardiac tamponade and constrictive pericarditis

HFrEF = IHD, Dilated cardiomyopathy, Myocarditis and Arrhythmias

545
Q

affected eye is unable to look down as easily, therefore causing vertical diplopia, worst on looking down (whilst reading) - which nerve palsy?

A

Trochlear

546
Q

What features are usually spared in MND?

A

doesn’t affect external ocular muscles

no cerebellar signs

abdominal reflexes are usually preserved and sphincter dysfunction if present is a late feature

547
Q

How can local anasthetic toxicity be treated?

A

w/ 20% lipid emulsion

548
Q

Which abx can cause trosardes du pointes?

A

Macrolides eg erythromycin

549
Q

Proximal muscle weakness + raised CK + no rash - whatis dx?

A

Polymyositis - treated w/ corticosteroids and / or immunosuppressants such as methotrexate

550
Q

PCP treatment abx?

A

Co trimoxazole

551
Q

patient is noted to have persistent ST elevation 4 weeks after sustaining a myocardial infarction. Examination reveals bibasal crackles and the presence of a third and fourth heart sound = what dx? mx?

A

Left ventricular aneurysm - anticoagulation due to risk od stroke

552
Q

Occurs around 1-2 weeks afterwards. Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds).

what dx? mx?

A

Left ventricular free wall rupture - Urgent pericardiocentesis and thoracotomy are required

553
Q

What does ECG show for posterior MI?

A

Tall R waves in lead V1-3

554
Q

Why might a person w/ mycoplasma pneumoniae present w/ tiredness?

A

AIHA - causing anaemia raised LDH and raised unconjugaed bilirubin

555
Q

What can cause a isolated fever in a pt 24h after surgery?

A

Physiological reaction to operation

556
Q

A 40-year-old woman complains of a permanent ‘funny-bone’ sensation in her right elbow. This is accompanied by tingling in the little and ring finger. Her symptoms are worse when the elbow is bent for prolonged periods. What is the most likely diagnosis?

A

Cubital tunnel syndrome

557
Q

Seminomas or tetromas which have a better prognosis?

A

Seminomas

558
Q

What are the features of adhesive capsulitis?

A

Active and passive movement is painful / affected

External rotation is more affected than internal rotation and abduction

558
Q

What are the features of adhesive capsulitis?

A

Active and passive movement is painful / affected

External rotation is more affected than internal rotation and abduction

559
Q

Brain bleed w/ fluctuating levels of conciousness / confusion?

A

Subdural haematoma

560
Q

in AS when is Aortic valve replacement required?

A

If assymptomatic the valvular gradient >40mmHg and features such as LV systolic dysfunction

If symptomatic replace

561
Q

What can make the ejetion systolic murmur in aortic stenosis quieter?

A

Left ventricular systolic dysfunction - due to decreased flow rate

562
Q

DCM and HOCM what causes S3 and what causes S4?

A

S3 - 3 so DCM

S4 - 4 so HOCM

563
Q

Marfans inheritance?

A

AD

564
Q

Rotator cuff injury

Painful arc of abduction between 60 and 120 degrees

Tenderness over anterior acromion

What do these sx suggest ?

A

Supraspinatus tendonitis (subacromial impingement, painful arc)

565
Q

Give me a poem for the nerves involved for different reflexes

A

S1-2 buckle my shoes (ankle)
L3-4 kick open the door (knee)
C5-6 pick up the sticks (biceps)
C7-8 lay them straight (triceps)

566
Q

Which diabetes drugs are CI in HF?

A

Thiazalidizones - “zones”

They can cause fluid retention

567
Q

What test should be performed in NAFLD to check for liver fibrosis?

A

Enhanced liver fibrosis (ELF) blood test

568
Q

How is barrets oesophagus mx?

A

High dose PPIs

Endoscopic surveilance w/ biopsies every 3-5 years

If dysplasia identified:
- Radiofrequency ablation (particularly for low-grade = 1st line)
- Endoscopic mucosal resection

569
Q

What conditions are the following fundoscopy findings present in?

A
570
Q

What does a headache related to valsalva manourve suggest (eg straining on toilet)? Ix?

A

Raised ICP - non contrast CT head

571
Q

Which cerebral vessel is normally affected in strokes that show aphasia?

A

MCA

572
Q

What is the mx of acute clot retention aki?

A

continuous bladder irrigation + catheter insertion

573
Q

What liver problem are pts w/ haemochromatosis at risk of ?

A

HCC + liver cirrhosis

574
Q

Reduced GCS, paralysis and bilateral pin point pupils - suggest what condition?

A

Pontine haemorrhage

575
Q

If there is a high enough Wells score what ix should be ordered prior to CTPA?

A

CXR - to rule out other causes of chest pain eg pneumothroax

576
Q

All house bound patients should be prescribed what?

A

Vit D

577
Q

Salter harris fracture types

A
578
Q

Definitive dx ix for small bowel obstruction?

A

CT abdo

579
Q

How do you measure the severity of COPD?

A

Using FEV1

> 80% of predicted - mild
50-79 - moderate
30-49 - severe
<30 - v severe

580
Q

Primary care w/ pt who has suspected UGI -mx?

A

Endoscopy in hospital w/in 24h

Do not give PPIs before endoscopy - after this you can give for variceal bleeds

If variceal give terlipressin and prophylactic abx

581
Q

How can you know if acute limb ischaemia is due thrombis or embolus?

A
582
Q

How can you distinguish between AKI and dehydration?

A

Both have raised creatinine and urea however rise in urea is greater than rise in creatinine

May also see a mild hypernatraemia

(In dehydration)

583
Q

What to do if triple therapy doesnt work / isn’t tolerated in T2dm?

A

Switch a drug for a GLP-1 mimetic if BMI >=35 or insulin would have occupational implications

Can only add GLP-1mimetic to insulin under specialist care

584
Q

What is a possible complication of radiotherapy for prostate ca?

A

Increased risk of bladder, colon and rectal cancer

585
Q

Liver USS - There is a single 12cm x 9cm, hyperechoic lesion in the left lobe of the liver. No other abnormalities detected. No abnormalities noted in the biliary tree.

In another otherwise normal person suggests what?

A

Hepatic hemangioma

586
Q

Pt recently diagnosed w/ parkinsons falls - what do you need to consider and how can you assess this?

A

Consider alternative dx of of parkinsons-plus syndromes such as PSP

can assess CN III, IV and VI - vertical supranuclear gaze palsy

587
Q

Urine sodium and osmolality in pre-renal disease and ATN causing AKI?

A

pre-renal - Na <20, osmolality >500, good response to fluid challenge

ATN - Na >40, osmolality <350, poor response to fluid challenge

588
Q

When calculating drug doses, what does 2% mean?

A

2g is dissolved in 100ml

589
Q

What oesophageal ca is at increased risk in pts w/ achalasia?

A

SCC

590
Q

If a pt w/ hypocalcaemia has had calcium adequately replaced but still remain hypocalcaemic what other electrolyte may be deficient?

A

Magnesium - important for Ca absorption

591
Q

Mx of urinary retention in urethral injury?

A

Suprapubic catheter

592
Q

Most common renal ca?

A

Renal adenocarcinoma

593
Q

What are some reasons pts may fail to respond to erythropoietin therapy?

A

iron deficiency - pencil cells
inadequate dose
concurrent infection/inflammation
hyperparathyroid bone disease
aluminium toxicity

594
Q

What to do in mx of bradycardia if atropine and transcutaneous pacing isn’t tolerated?

A

isoprenaline/adrenaline IV titrated to response

595
Q

HNF-1 MODY diabetes mx ?

A

Sulfonureas (glicalazide)

596
Q

For Ottowa fracture rules (ankle0 where is lateral and medial malleolar zones?

A

lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)

medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)

596
Q

Postural headache but normal MRI suggests what?

A

Idiopathic intracranial HTN

597
Q

Diverticulitis symptoms + pneumaturia or faecaluria → ???

A

Colovesical fistula

598
Q

What are the 2 classifications of the aortic dissection?

A

Stanford classification
- type A - ascending aorta, 2/3 of cases
- type B - descending aorta, distal to left subclavian origin, 1/3 of cases

DeBakey classification
- type I - originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
- type II - originates in and is confined to the ascending aorta
- type III - originates in descending aorta, rarely extends proximally but will extend distally

599
Q

Mx of Aortic dissection?

A

Type A - Ascending aorta - ASS
Aortic root replacement
Systolic BP target 100-120
Surgery

Type B - BooBs
Bed rest and Beta blockers

600
Q

Sudden weight loss / starvation + ljaundice suggests what?

A

NAFLD

601
Q

OSA findings:

A

Daytime somnolence
Compensated resp acidosis
HTN

602
Q

When are nasopharyngeal airwaysCI?

A

Suspected base of skull fractures

603
Q

PPI electrolyte abnormalities?

A

Hyponatraemia + hypomagnesiumaeia

604
Q

Elderly, alcoholic, head injury, insidiuous onset symptoms

What dx is likely?

A

Subdural haematoma

605
Q

Newly diagnosed dermatomyositis what ix is needed?

A

Malignancy screen

606
Q

What drug can cause cold peripheries?

A

BB - baby your feet are cold!!!

607
Q

Mx of hyperkalaemia - what is the role of clacium resonium?

A

RemovesK fromt the body

608
Q

Renal biopsy shows: Podocyte fusion and effacement of foot processes on electron microscopy

Dx?

A

Minimal change disease

609
Q

Which airway is bad if the pt hasnt fasted?

A

Laryngeal mask

610
Q

SAH can cause what type of ECG changes?

A

Torsades du pointes - Polymorphic VT

611
Q

Poor prognostic factors for ACS?

A

age
development (or history) of heart failure
peripheral vascular disease
reduced systolic blood pressure
Killip class*
initial serum creatinine concentration
elevated initial cardiac markers
cardiac arrest on admission
ST segment deviation

612
Q

Which diabetes drug is CI in HF?

A

Thiazalidinones (-zone)

613
Q

What durg scan be used in combination of triple therapy in T2DM?

A

If this fails, NICE recommends triple therapy with either

Metformin + gliclazide + gliptin/glifozin/pioglitazone or

Metformin + pioglitazone + glifozin or

Insulin +/- other drug

614
Q

What should you do in T2DM if pt is on metformin and develops GI side effects

A

Switch to modified release metformin before trying anything else

615
Q

Adrenaline dose in ALS?

A

1mg

616
Q

What electrolyte abnormlaity can be caused by excessive fluid resus w/ NACL

A

Hyperchloraemic met acidosis

617
Q

Who should not be givenHartmanns solution?

A

Hyperkalaemic pts - contains K

618
Q

Visual field defect likely seen in pituitary tumours?

A

Bitemporal hemianopia -> if not big enough for full compressiojn - bitemporal superior quadrantanopia (only squashes the top)

619
Q

Sex hormones in Kallmans syndrome?

A

LF, FSH - low / normal
Testosterone - low -> will need supplementation

620
Q

What is the triad of budd chiari syndrome?

A

abdominal pain: sudden onset, severe
ascites → abdominal distension
tender hepatomegaly

Raised SAAG

Ix w/ doppler flow studies

621
Q

Can you use multiple drugs for neuropathic pain?

A

No tends to be monotherapy if one doesn’t work you normally switch drugs

Amitripyline, pregabalin, gabapentin, duloxetine

622
Q

What are the features of syringomelia?

A

a ‘cape-like’ (neck, shoulders and arms)
loss of sensation to temperature but the preservation of light touch, proprioception and vibration

classic examples are of patients who accidentally burn their hands without realising

this is due to the crossing SPINOTHALAMIC TRACTS in the ANTERIOR COMMISURE of the spinal cord being the first tracts to be affected
spastic weakness (predominantly of the lower limbs)

623
Q

Distal transverse or descending colon cancer mx?

A

Left hemicolectomy

624
Q

upper rectal tumours

low rectal tumours

mx?

A

High anterior resection

Low anterior resection

625
Q

cecum, ascending or a proximal third of the transverse colon cancer mx?

A

Right hemicolectomy

626
Q

Gold standard for dx and screening of HIV?

A

Combination tests (HIV p24 antigen and HIV antibody) @ 4w and 3m

627
Q

What causes milky fluid drained from chest after surgery?

A

Chylothorax

628
Q
  1. Cholesterol >9.0, triglycerides normal, HDL normal. Dx?
A

heterozygous Familial hypercholesteraemia

629
Q

Amaaurosis fugas - what vessel is affected ?

A

Retinal / ophthalmic artery - usually caused by atherosclerosis of ipsilateral internal carotid

630
Q

dizziness and palpitations. The ECG shows an irregular trace with a QRS complex of 130 ms, accompanied by a heart rate of 150/min. These are defining features of an irregular broad complex tachycardia.

What is the dx?

A

AF w/ bundle branch block - differernt from just AF due to presence of slightly longer QRS

631
Q

Why can adenosine cause chest pain?

A

Due to its vasodilatory effects, it can cause flushing, nausea, sweating, bronchospasm and also chest pain

632
Q

Mx of variceal haemorrhage?

A

Once terlipressin, abx(+- transfusions, FFP, vit k etc) have been administered

Endoscopic - variceal band ligation > sclerotherapy

If uncontrolled bleeding - sengstaken blakemore tube

TIPSS if these fail - however this can make hepatic encephalopathy worse

633
Q

A 28-year-old female sex worker presents to her general practitioner with a sore throat, fever and fatigue which has been going on for two weeks. When examining the throat, the GP notices several white patches on the lateral borders of the tongue as well as the buccal mucosa. These lesions are not painful and had not been noticed by the patient until now. The patches can’t be removed by the application of light pressure.

Given the patient’s history, what is the most likely cause of the lesions on the tongue?

A

Oral hairy leukoplakia

634
Q

What is the mx of latent tb?

A

3 months of isoniazid (with pyridoxine) and rifampicin, or

6 months of isoniazid (with pyridoxine)

635
Q

What is a sign of L5 radiculopathy?

A

Pain upon straight leg raise + weak hip abductors

636
Q

What are the main features of CJD?

A

Rapid onset dementia + myoclonus

DM - linked w/ united called CJD

637
Q

Why should nitrates be used iw/ caution in patients w/ pneumothorax?

A

Can cause a tension pneumo

637
Q

Why should nitrates be used iw/ caution in patients w/ pneumothorax?

A

Can cause a tension pneumo

638
Q

When starting goserelin (gonadorelin analogue) for mx of prostate ca - what should be co prescribed and why?

A

Anti-androgen treatment such as cyproterone acetate -> due to the risk of tumour flare

639
Q

What is the most common cause of HCC?

A

Hep B - worldwide
Hep C - Europe

640
Q

most common symptom of Crohn’s disease in children?

A

Abdo pain

641
Q

What else is H pylori infection associated w?

A

peptic ulcer disease - strongest associations
- 95% of duodenal ulcers
- 75% of gastric ulcers

gastric cancer

B cell lymphoma of MALT tissue (eradication of H pylori results causes regression in 80% of patients)

atrophic gastritis

642
Q

What should invasive diarrhoea (causing bloody diarrhoea and fever) be treated w?

A

Ciprofloxacin

643
Q

Whats live attenuated vaccines?

A

Mi BOOTY

M - MMR
I - Influenza (intranasal)
B - BCG
O - Oral rotavirus
O - Oral polio
T - Typhoid
Y - Yellow fever

644
Q

What stoma can be used to defunction the colon to protect an anastomosis?

A

Loop ileostomy

645
Q

What stoma is performed when when the colon is diverted or resected and anastomosis is not primarily achievable or desirable

A

End colostomy

646
Q

What stoma is done following complete excision of colon or where ileocolic anastomosis is not planned. It may be used to defunction the colon, but a reversal is more difficult.

A

End ileostomy

647
Q

What stoma is used for gastric decompression or feeding.

A

Gastrostomy

648
Q

Loop ileostomy is a method to divert bowel contents away from a distal anastomosis. It is often indicated in rectal cancers. And can be reversed to restore bowel continuity?

A

Loop ileostomy

649
Q

AR murmur + Inferior MI ECG changes suggests what?

A

II, III and aVF ST elevation + AR murmur suggests ascending aortic dissection (proximal aortic dissection)

650
Q

Bilateral hydronephrosis - mx?

A

If stone based = bilateral nephrostomy

If UTi baed = Urethral catheter

651
Q

Urea breath test - what should be done prior to test to improve accuracy?

A

No ABX in 4w before

No anti-secretory drugs 2w before (eg PPI)

652
Q

What isthe ECG finding that is sometimes found in PE and why?

A

S1Q3T3 pattern (deep S in lead I, pathological Q waves in lead III, and T wave inversion in lead III) - acute right heart strain

653
Q

Mx of primary hyperparathyroidism?

A

Parathyroidectomy

654
Q

TFTs in sick euthyroid?

A

Normal TSH

Low T3/T4

655
Q

What antibody is most specific for pdermatomyositis?

A

anti-jo-1 antibody

80% = ANA positive as well

656
Q

What ca is likely to cause myasthenia gravis?

A

Thymomas

657
Q

What is the most sensitive scan to diagnose diffuse axonal injury

A

MRI brain

658
Q

What is the nipple discharge associated w prolactinoma likely to look like?

A

bilateral + often cream coloured

659
Q

What do the following tests test for?
Lachmanns
Empty can
McMurrays
Posterior Draw
Sweep test

A

Lachmanns - ACL
Empty can - Supraspinatus integrity
McMurrays - Meniscus
Posterior Draw - PCL
Sweep test - Knee effusion

660
Q

Fundoscopy finding in temporal arteritis?

A

Ischaemia to anterior optic nerve

  • Anterior ischemic optic neuropathy accounts for the majority of ocular complications in temporal arteritis
661
Q

In ALS if there is no amiodarone, what drug can be used instead?

A

Lidocaine

662
Q

What are some recognised complications of enteral feeding?

A

Diarrhoea

Aspiration

Metabolic - Hyperglycaemia and refeeding syndrome

663
Q

On examination, her observations are heart rate 85/minute, respiratory rate 18/min, blood pressure 124/82mmHg, temperature 38.5ºC. There is a 1cm wound on her lower right calf. It is surrounded by an area of prominent erythema and swelling that is approximately 15cm at its widest diameter. There is also a very dark purple area around the wound. There is one blister with foul-smelling discharge. The wound is very tender.

An emergency x-ray demonstrates air bubbles in the tissues.

Swabs are taken and broad-spectrum antibiotics are started. What is the most likely organism to be isolated? What is the condition called? what increases the risk?

A

Gas gangrene caused by Clostridium perfringens

Having peripheral vascular disease increases your risk

664
Q

Why is nephrotic syndrome associated w ith a hypercoagulable state?

A

due to loss of antithrombin III via the kidneys

665
Q

When should you surgical mx of dupuytrens contracture?

A

MCP cant be straightened and cant be lied flat on table

666
Q

What is kussmauls sign and what is it sseen in ?

A

Raised JVP upon inspiration and seen in constrictive pericardiits

667
Q

What is the main benefit of epidural form of analgesia compared to alternative forms?

A

Fasster return to normal bowel func following abdo surgery

668
Q

What test should be offered to all people w TB?

A

HIV test

669
Q

What are some possible complications of axillary node clearance?

A

arm lymphedema and functional arm impairment

Intercostobrachial nerve damage

670
Q

What is a possible comlication that can occur if a pleural effusion is drained too quickly?

A

re-expansion pulmonary oedema

671
Q

An x-ray confirms a fracture of the surgical neck of the humerus. Which nerve is at risk?

A

Axillary nerve

672
Q

What is klumpkes paralysis?

A

Classically there is weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner’s syndrome. It occurs as a result of traction injuries or during delivery.

Involves brachial trunks c8-t1

673
Q

What is Erbs palsy?

A

Clinically his arm is hanging loose on the side. It is pronated and medially rotat

C5-6

674
Q

Smiths fracture possble nerve injury - weakness of thumb opposition?

A

Median

675
Q

hot solitary nodule indicates what thyroid pathology

A

Toxic adenoma

676
Q

pain and swelling of the left shoulder. There is a large radiolucent lesion in the head of the humerus extending to the subchondral plate.

x-ray have a ‘soap bubble’ appearance. They present as pain or pathological fractures. They commonly metastasize to the lungs.

A

Giant cell umour

677
Q

reduces Glasgow coma score, quadriplegia, miosis, and absent horizontal eye movements - waht type of stroke

A

Pontine stroke?

678
Q

ppearance (progressive, erythema and oedema of the breast in the absence signs of infection such as fever, discharge or elevated WCC and CRP) and an elevated CA 15-3

dx?

A

Inflammatory breast ca

679
Q

What is the triad of fat embolism syndrome?

A

Respiratory
Neurological
Petechial rash (tends to occur after the first 2 symptoms)

680
Q

How can you distinguish between unilateral adenoma and bilateral hyperplasia in primary hyperaldosteronism?

A

Adrenal venous sampling

681
Q

HOCM is associated w/ what other heart sondition?

A

WPW

682
Q

After starting an ACE inhibitor, significant renal impairment may occur if ….

A

the pt has undiagnosed bilateral renal stenosis

683
Q

Reactive arthritis - synovial fluid resulsts?

A

Develops after an infection where the organism cannot be recovered from the joint - Will normally be sterile synovial fluid where organism cannot be recovered from the joint

Even thought its normally caused by chlamydia trachomatis

684
Q

Mechanism behind carpal tunnel

A

Carpal tunnel syndrome causes action potential prolongation in both sensory and motor axons

685
Q

What are the RFs for testicular cancers?

A

Infertility (increases risk by a factor of 3)
cryptorchidism
family history
Klinefelter’s syndrome
mumps orchitis

686
Q

……………………….. is characterised by fever, hypotension and a rash → desquamation

A

Staphylococcal toxic shock syndrome

687
Q

Tetanus vaccine history last dose <10y what to do?

A

no vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

688
Q

Patient has had a full course of tetanus vaccines, with the last dose > 10 years ago

A

if tetanus prone wound: reinforcing dose of vaccine

high-risk wounds (e.g. compound fractures, delayed surgical intervention, significant degree of devitalised tissue): reinforcing dose of vaccine + tetanus immunoglobulin

689
Q

If vaccination history is incomplete or unknown

A

If vaccination history is incomplete or unknown

reinforcing dose of vaccine, regardless of the wound severity

for tetanus prone and high-risk wounds: reinforcing dose of vaccine + tetanus immunoglobulin

690
Q

What is conduction aphasia and what causes it?

A

A stroke affecting the arcuate fasiculus - the connection between wernickes and brocas area

Here the speech is fluent but repitition is poor

691
Q

What is global apahasia and what causes it?

A

A large stroke affecting - broca, wernickes and the arucate fasiculus

Causes severe expressive + receptive apahasia - may be able to communicate using gestures

692
Q

Questionnaire to assess frailty?

A

Frailty should be specifically assessed through the evaluation of gait speed, self-reported health status, or the PRISMA-7 questionnaire

693
Q

Which CNs can be affected vestibular schwannoma?

A

CN VIII, VII, V

Vestibular schwannoma - cant hear you right so they thought 578 ml in a pint

694
Q

Gold standard ix for small bowel obstruction?

A

CT abdo

695
Q

The following are all NICE criteria for referring a patient to secondary care for consideration of interventional treatment of varicose veins as laid out in the NICE CKS summary:

A

Symptoms associated with varicose veins such as ‘heavy’ or ‘aching’ legs.

Skin changes associated with chronic venous insufficiency such as venous eczema or haemosiderin deposition.

Superficial vein thrombosis.

A venous leg ulcer (a break in the skin below the knee that has not healed in 2 weeks), either active or healed.

696
Q

Mx of nephrogenic DI?

A

Thiazides + low salt / protein diets

697
Q

A 19-year-old woman presents to the emergency department with new-onset chest pain and shortness of breath.

The pain started today and is centrally located, sharp in nature and doesn’t change with breathing or position.

She has been unwell for the past week, with fever and joint pains.

She has no past medical history of note.

On examination, she has bibasilar crackles, with dull heart sounds with no added sounds. Her vital signs are normal apart from a respiratory rate of 24/min.

An ECG is performed and shows diffuse T-wave inversion.

What is the most likely diagnosis?

A

Myocarditis - The dull heart sounds are due to the myocardium being inflamed and thickened. The shortness of breath and bibasilar crackles are likely due to myocardial dysfunction causing pulmonary congestion

698
Q

Upper GI bleed: the xxxxxxxx score is used after endoscopy and provides a percentage risk of rebleeding and mortality

A

Rockall

699
Q

Surgery / sulfonylureas on day of surgery:

A
  • Omit on the day of surgery
  • Exception is morning surgery in patients who take BD - they can have the afternoon dose
700
Q

xxxxxx lesion features = Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

A

S1

701
Q

HF + Fluid overload + low BP what is mx?

A

This is cardiorenal syndrome

IV loop diuretics / increased dose - to ensure there’s enough conc in the tubules

702
Q

What are the features of small intestine bacterial overgrowth syndrome? ix? mx?

A

It should be noted that many of the features overlap with irritable bowel syndrome:
- chronic diarrhoea
- bloating, flatulence
- abdominal pain

ix = hydrogen breath test

mx = abx - rifaximin

703
Q

CK levelsin temporal arteritis?

A

Normal

704
Q

Hep B PEP?

A

accelerated course of hep b vaccine + hep b Ig

705
Q

EBV associated ca?

A

Burkitt’s lymphoma*
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas

706
Q

Hypothyroid taking levothyroxine- Right T3/4 + HIGH TSH - dx?

A

They have poor compliance w/ meds

707
Q

What to do before giving TB vaccines?

A

It is important that a tuberculin skin test is performed (to exclude past exposure to tuberculosis) prior to giving the vaccine.

708
Q

What to do before giving TB vaccines?

A

It is important that a tuberculin skin test is performed (to exclude past exposure to tuberculosis) prior to giving the vaccine.

709
Q

On the soles of both feet you notice a waxy yellow rash + swollen joints - dx? what is the rash?

A

Rash = Keratoderma blenorrhagic

Dx = Reactive arthritis

710
Q

Neuroleptic malignant syndrome more common in newly initiated treatment or prolonged treatment?

A

Prolonged

711
Q

What is the latest time that HIV post-exposure prophylaxis may be given?

A

72 h after

712
Q

What is Zollinger Ellison syndrome?

A

multiple gastroduodenal ulcers causing abdominal pain and diarrhoea - this is seen in pts w/ MEN1

713
Q

Contraindications to thrombolysis?

A

active internal bleeding

recent haemorrhage, trauma or surgery (including dental extraction)

coagulation and bleeding disorders

intracranial neoplasm

stroke < 3 months

aortic dissection

recent head injury

severe hypertension

714
Q

Mx of lung ca?

A

Low grade disease - T1-2a, N0, M0 = surgery

High grade = Chemo + radio

715
Q

Factors which may affect the result of egfr?

A

pregnancy
muscle mass (e.g. amputees, body-builders)
eating red meat 12 hours prior to the sample being taken

716
Q

Renal transplant + infection ?

A

CMV

717
Q

Features of aortic stenosis?

A

narrow pulse pressure
slow rising pulse
a thrill palpable over the cardiac apex
a fourth heart sound (S4) indicative of left ventricular hypertrophy
a soft/absent S2

718
Q

The flu-like symptoms, bilateral consolidation and erythema multiforme point to a diagnosis of …….

A

Mycoplasma pneumoiniae

719
Q

How does yellow fever present?

A

flu like illness → brief remission→ followed by jaundice and haematemesis

720
Q

DPP4 inhibitors and weight gain /loss?

A

Dont cause weight gain

721
Q

Sx of sinusitis a few weeks ago –> headache, fever and focal neurology - possible complication?

A

Brain abscess - use CT to confirm

will need a craniotomy , iv abx and intracranial pressure mx (dex)

722
Q

Which anasthetic can cause addisonian crisi? and how?

A

Etomidate may result in adrenal suppression - potentiating of GABAa receptors

723
Q

What is the presentation of entamoeba histolytica?

A

dysentery (bloody diarrhoea, fever, and abdominal cramps) following travelling.

There has been a long incubation period, along with profuse bloody diarrhoea, fevers, and right upper quadrant pain (suggesting liver involvement and the potential formation of a liver abscess)

724
Q

Productive cough + choking after feeds + aspiration pneumonia in a long term vintaltion pt suggests what?

A

Tracheo eosophageal fistula

725
Q

What is seen in a CN IV leison?

A

Trochlear leison = Defective downward gaze + vertical diplopia

726
Q

What is drug is used to treat schistosomiasis?

A

Praziquantel - anti helminth

727
Q

How do you check for malignancy in dermatomyositis@?

A

CT chest, abdo and pelvis

728
Q

What cardiac features can be caused by carcinoid tumours?

A

Affected right side of heart - The valvular effects are tricuspid insufficiency and pulmonary stenosis

729
Q

Mx of asymptomatic gallbladder stones??

A

Reassure people with asymptomatic gallbladder stones.

Stones that are found incidentally, as a result of imaging investigations unrelated to gallstone disease in people who have been completely symptom-free for at least 12 months before diagnosis do not require intervention.

They must be found in a normal gallbladder and normal biliary tree. Symptomatic patients or those with stones within the common bile duct (CBD) do require intervention to clear the CBD.

This can be done:
Surgically at the time of laparoscopic cholecystectomy or
With endoscopic retrograde cholangiopancreatography (ERCP) before or at the time of laparoscopic cholecystectomy.

730
Q

Mx of cardiac arrest due to hypothermia?

A

In cases of hypothermia causing cardiac arrest, defibrillation is less effective and only 3 shocks should be administered before the patient is rewarmed to 30 degrees centigrade

Drugs should be withheld until the patient is 30 degrees and then should be given at double time intervals until the patient is reaching normothermia or has the return of spontaneous circulation (ROSC)

731
Q

What are the indications for indications for adjuvant ipsilateral chest wall and regional lymph node radiotherapy following masectomy?

A

positive axillary lymph nodes and residual tumour at resection margins post-mastectomy a

732
Q

Mx of women with breast cancer and no palpable lymphadenopathy, w/ pre-operative axillary ultrasound is positive

A

sentinel node biopsy to assess the nodal burden

axillary node clearance if extensive nodal burden identified at SNB

733
Q

Returning traveller fever + bradycardia =?

A

Typhoid!!

734
Q

What side effects are seen to the different chemotherapy agents - remember toxicity bear!

A
735
Q

finger abduction weakness - what nerve leison?

A

T1

736
Q

What is the preferred way to support nutrition in MND?

A

Using a percutaneous gastrostomy tube (PEG)

737
Q

Use of BB in acute HF?

A

Beta-blockers should only be stopped in acute heart failure if the patient has heart rate < 50/min, second or third degree AV block, or shock

738
Q

Addisons causes what effect on blood glucose?

A

hypogycaemia

739
Q

Most common cause of addisons in the UK?

A

AI

740
Q

Sudden hypoxia and increased ventilation ipresure in a pt w/ flail chest being treated w/ intubation + ventilation may suggest what?

A

Tension pneumothorax

741
Q

What drug can increase survival rates in MND?

A

Riluzole

742
Q

Which endo hormones are increased in response to stress and which are decreased?

A

Increased:
GH
Cortisol
Renin
ACTH
Aldosterone
Prolactin
ADH
Glucagon

Decreased
Insulin
Testosterone + Oestrogen

743
Q

mx of chronic subdural?

A

Burr hole

744
Q

What does high SAAG suggest?

A

Portal HTN

745
Q

What tests are required before TB meds?

A

Urea and Electrolytes, LFTs, vision testing, FBC
57%

746
Q

What vessel is affected in subdural haemorrhage?

A

Bridging veins between cortex and venous sinuses

747
Q

How should diabetic nephropathy be screened for?

A

all patients should be screened annually using urinary albumin:creatinine ratio (ACR)should be an early morning specimenACR > 2.5 = microalbuminuria

748
Q

fundoscopy typically shows a swollen pale disc and blurred margins in what condition?

A

Anterior ischaemic optic neuropathy

749
Q

Peptic ulceration, galactorrhoea, hypercalcaemia suggest what condition

A

MEN1

750
Q

Right-sided tenderness on PR exam - dx?

A

think appendicitis

751
Q

How does Malignant hyperthermia pressent? What anasthetic can cause it? Mx?

A

autosomal dominant disorder presenting as a hypermetabolic crisis characterised by an increased end-tidal carbon dioxide [ETCO2] (hypercapnia), tachycardia, muscle rigidity, rhabdomyolysis, hyperthermia, and arrhythmia

Associated w/ volatile inhalational anasethetics + suxamethonium (succinylcholine)

treat w/ dantrolene

752
Q

How long is treatment of graves carried out for?

A

Carbimazole is given for 12-18 m to induce remission

753
Q

Rheumatoid + nail changes =?

A

Psoriatic arthritis

754
Q

Rheumatoid + nail changes =?

A

Psoriatic arthritis

755
Q

Effect of the following drugs on QT interval?
Salbutamol
Solatol

A

Salbutamol = shortened QT (all SABAs do this)
Solatolol = prolonged QT (only BB that does this)

756
Q

Wernickes and Brocas - locationin the brain?

A

Wernicke and Broca make me STIF

Wernicke ‘sends’ to Broca’s -> Superior Temporal gyrus then Inferior Frontal

757
Q

What location of the brain is affected by what ataxia?
Gait v finger-nose?

A

gait ataxia = cerebellar vermis

finger-nose = cerebellar hemisphere

758
Q

Hypersenitivity in SLE?

A

Type 3

759
Q

The rash consists of a raised purple plaque of indurated skin that affects the tip of her nose and the skin around the right nostril.

It is neither itchy or painful however the patient is distressed by its appearance.

What does this describe and what condition causes it?

A

Lupus pernio - sarcoidosis

760
Q

C-peptide production does NOT fall on exogenous insulin injection in patients with xxxxxx

A

insulinoma

761
Q

Which NM blocker is CI in pts w/ hyperkalaemia? (particularly inmportant in trauma and burns pts?

A

Suxamethonium

762
Q

NF1 v NF2 easiest way to notice different?

A

Both cause cafe-au-lait spots

however NF2 is the one that casues bilateral vestibular schwannomas -> sensorineural hearing loss

763
Q

How are murmurs graded?

A

Levine scale
Grade 1 - Very faint murmur, frequently overlooked
Grade 2 - Slight murmur
Grade 3 - Moderate murmur without palpable thrill
Grade 4 - Loud murmur with palpable thrill
Grade 5 - Very loud murmur with extremely palpable thrill. Can be heard with stethoscope edge
Grade 6 - Extremely loud murmur - can be heard without stethoscope touching the chest wall

764
Q

What must be assessed in pts w/ potential bilateral urinary tract obstruciton?

A

Renal function - U+E

765
Q

Mx of pituitary incidentaloma?

A

If a pituitary incidentaloma is found within the sellar, laboratory investigation must be done to determine if it is functional or non-functional

766
Q

Which diabetes drugs are ahypoglycaemics??

A

Sulphonylureas,

Metformin,

Glitazones

GLP receptor agonists

DPP-4 inhibitors

767
Q

What is the definition of a UGI?

A

Haemorrhage w/ orgigin proximal to ligament of treitz

768
Q

Which organism causes type1 and type2 nec fac?

A

type 1 = clostridium perfringens

type 2 = strep pyogenes

769
Q

Which type of motor neuron disease carries the worst prognosis?

A

Progressive bulbar palsy

770
Q

Painful shin rash + cough = ????

A

Sarcoidosis

771
Q

homonymous quadrantanopias: which part causes inferior and which part causes superior?

A

PITS (Parietal-Inferior, Temporal-Superior)

772
Q

Fever, facial spasms, dysphagia in an intravenous drug use? - what if the facial paralysis was flaccid?

A

Clostridium tetani

Clostridium botulinum

773
Q

allergic bronchopulmonary aspergillosis mx of choice?

A

Oral pred

itraconazole 2nd line sometimes

774
Q

What tumour can cause cranial DI? what is the visual field defect seen?

A

Lower bitemporal hemianopia

775
Q

What nerve is used for finger adduction?

A

Ulnar

776
Q

What nerver is used for finger extension?

A

Radial

777
Q

What type of hernia can go into the testicles?

A

Indirect inguinal

778
Q

Mx of renal stones?

A
778
Q

What test can you do to help distinguish between ATN and dehydration?

A

Fluid challenge - ATN = poor response

779
Q

How can you distinguish between emphysema in a1at deficiency and copd?

A

Emphysema is most prominent in the lower lobes in A1AT deficiency and the upper lobes in COPD

780
Q

What is the main mx of wilsons?

A

Pencillamine

781
Q

What might pPeriureteric fat strandin on CT KUB suggest?

A

Recently passed ureteric stone

782
Q

Young female who develops AKI after starting ACEi - consider what dx?

A

Fibromuscular dysplasia

Passmed Mistakes (9 decks)

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