misc to work on Flashcards
1
Q
what is the gold standard investigation for PE?
A
pulmonary angiography
2
Q
what is the gold standard investigation for acromegaly?
A
glucose tolerance test
3
Q
what is the most common cause of endocarditis?
A
s. viridians = most common
s. aureus = most common in IVDU
s. epidermidis = prosthetic valves
4
Q
what is the definition of sensitivity?
A
how many with the disease test positive
5
Q
what is the definition of specificity?
A
how many without the disease test negative
6
Q
what is prevalence?
A
number of new cases
7
Q
what is incidence?
A
number of new cases today
8
Q
what is primary prevention?
A
prevent disease from occuring
9
Q
what is secondary prevention?
A
early detection of disease and stop progression
10
Q
what is tertiary prevention?
A
reduce/treat complications
11
Q
what blood results are present in acute hep B infection?
A
IgM
Hep antigens
12
Q
what blood results are present in chronic hep B infection?
A
no IgM
IgG
some antigens present over 6 months
13
Q
what blood results are present in resolved hep B infection?
A
no IgM
IgG
no antigens
14
Q
what are the causes of peritonitis?
A
AEIOU A = appendicitis E = ectopic pregnancy I = infection O = obstruction U = ulcer
15
Q
what are the symptoms of acute cholecystitis?
A
RUQ pain
fever
no jaundice
16
Q
what are the symptoms of wernicke’s encephalopathy?
A
ataxia
ophthalmoplegia
confusion
17
Q
what is the most likely outcome of MI?
A
organisation
18
Q
what is becks triad?
A
raised JVP
hypotension + tachycardia
muffled heart sounds
19
Q
what is charcot’s triad?
A
RUQ pain
fever
jaundice
20
Q
what are the common causes of cardiac ischaemia?
A
coronary artery steal
coronary artery compression
coronary artery vasculitis
hypertrophic stenosis
21
Q
which pathway does pain to temperature travel in?
A
lateral spinothalamic
22
Q
what is the pathophysiology of RA?
A
arginine is converted to citrulline
APCs present citrulline to CDT4 helper cells which signal B cell proliferation
B cell differentiate into plasma cell and produce self antibodies which causes systemic inflammation
23
Q
what is the treatment for an acute migraine?
A
paracetamol
NSAID
aspirin
triptan
24
Q
what is the prevention for migraines?
A
propranolol
topiramate
amitripyline
25
what is the treatment for tension headaches
paracetamol
NSAID
aspirin
26
what is the prevention for tension headaches
amitriptyline
27
what is the treatment for acute cluster headaches?
sumatriptan
28
what is the prevention for cluster headahces?
verapamil
29
what is the most common cause of meningitis in babies under 3 months?
group B strep
e.coli
listeria monocytogenes
30
what is the most common cause of meningitis in children 3 months to 12 years old?
s. pneumoniae
n. meningitidis
h. influenzae
31
what is the most common cause of meningitis in teenagers?
n. meningitidis
s. pneumoniae
h. influenzae
32
what is the most common cause of meningitis in over 50s or immunocompromised?
listeria monocytogene
33
what is the staging system for lymphoma?
ann arbour
34
what is the scoring system for COPD?
MRC dyspnoea scale
35
what are different stages of MRC dyspnoea scale?
```
1 = not troubled by breathlessness
2 = SOB when hurrying or walking uphill
3 = walk slower as SOB, stop for breath
4 = stops for breath after 100m, stops after few mins on level walk
5 = too breathless to leave house
```
36
what is the treatment for pylonephritis?
ciprofloxacin / co-amoxiclav
fluids
catheter
analgesia
37
why is nitrofurantoin not used in pyelonephritis?
it stays in the lower urinary tract and does not collect above the bladder
38
how does oxybutynin work in treating urge incontinence?
anticholinergic
inhibits parasympathetic nervous system
decreases detrusor excitability, preventing symptoms of urgency
39
what are the side effects of oxybutynin?
```
dry eyes
dry mouth
dilated pupils/blurred vision
tachycardia
constipation
dizziness
confusion
```
40
what is the clinical presentation of wegener's granulomatosis?
hearing loss
sinusitis
nose bleeds
saddle shaped nose - perforated septum
41
what are the blood test results for sjogren's syndrome?
ANA
anti-Ro
anti-La
RF
42
describe the type of arthritis found in sjogren's syndrome
```
chronic
systemic
inflammatory
symmetric
autoimmune
non-erosive
```
43
what are the complications of SLE?
```
CVD
infection
anaemia of chronic disease
pericarditis
pleuritis
interstitial lung disease
lupus nephritis
neuropsychiatric SLE
recurrent miscarriage
venous thromboembolism
```
44
what are the x-ray finding for ankylosing spondylitis?
- bamboo spine
- squaring of vertebral bodies
- subchondral sclerosis and erosions
- syndesmophytes
- ossification of ligaments, discs and joints
- fusion of facet, sacroiliac and costovertebral joints
45
what is the causes of joint changes in OA?
imbalance between cartilage being worn down and chondrocytes repairing it
causes structural issues in the joint
46
what is the appearance of the skull in Paget's disease?
→ Cotton wool appearance - due to patches of increased and decreased density. This is due to the increase in activity of both osteoblasts and osteoclasts.
47
which LFT would you expect to be raised in Paget's disease?
alkaline phosphatase (ALP)
48
what type of drug would you use to treat Paget's disease?
bisphosphonates
49
what is the management for RA?
1st line: DMARDs - methotrexate
2nd line: 2 DMARDs (methotrexate, sulfasalazine)
3rd line: methotrexate + biologic (Anti-TNF = infliximab)
4th line: methotrexate + rituximab
50
what are the complications of RA?
Felty's syndrome
anaemia of chronic disease
pulmonary fibrosis
amyloidosis
51
what is Felty's syndrome?
RA
neutropenia
splenomegaly
52
what is dermatomyositis?
chronic inflammation of the skin and muscles
53
what is polymyositis?
chronic inflammation of muscles
54
other than polymyositis/dermatomyositis what can cause raised creatinine kinase?
```
rhabdomyolysis
AKI
MI
statins
strenuous exercise
```
55
what are the symptoms of polymyositis?
- muscle pain, fatigue, weakness
- occurs bilaterally
- typically affects proximal muscles
- shoulder and pelvic girdle
- develops over weeks
56
what are the skin symptoms for dermatomyositis?
- Gotton lesions (erythematous plaques)
- photosensitive erythematous rash on back, shoulders and neck
- purple rash on face and eyelids
- periorbital oedema
- SC calcinosis
57
which antibodies are present in polymyositis and dermatomyositis?
- anti-Jo-1 = poly and derm
- Anti-Mi-2 = derm
- ANA = derm
58
which disease presents with brittle bones?
osteomalacia
59
what is osteomalacia?
Osteomalacia is a disease of defective bone mineralisation, due to Vitamin D deficiency.
60
what is the presentation of osteomalacia?
fatigue, bone pain, bone and muscle weakness, and pathological / abnormal fractures.
61
what are the investigations for osteomalacia?
```
serum 25-hydroxyvitamin D low,
serum calcium & phosphate low,
serum ALP high,
PTH high,
z-ray may show osteopenia,
DEXA may show low bone mineral density
```
62
what is the management for osteomalacia?
vitamin D supplementation (colecalciferol)
63
what is the treatment for gout?
1st line = NSAIDs
2nd line = colchicine
3rd line = steroids
64
what is seen in x-rays in pseudogout?
chondrocalcinosis - calcium deposition in joint space
65
what is the most likely causative organism for septic arthritis?
s.aureus
66
ehat is the treatment for septic arthritis?
flucloxacillin (+ rifampicin for first 2 weeks)
67
what are the differential diagnoses for Parkinsons?
```
benign essential tremor
lewy body dementia
drug induced parkinsonism
stroke
PSP
MSA
wilsons disease
```
68
what are the complications of Parkinson's disease?
```
reduced quality of life
depression
treatment side effects
dementia
constipation
```
69
A 71 year old man complained of progressive weakness and double vision that was more pronounced in the evenings. On examination he had fatiguable weakness of upgaze and shoulder abduction. Initial tests showed that his acetylcholine receptor antibodies were positive. Which further test would you also consider?
CT chest
70
what are the components of CURB65?
```
C = confusion
U = urea >7mmol/L
R = resp rate >30
B = BP systolic <90 and/or diastolic <60
age >65
```
71
what is the FEV1 and FVC values for obstructive lung diseases?
FEV1/FVC < 0.7
| FEV1
72
what is the FEV1 and FVC for restrictive lung diseases?
FEV1/FVC > 0.7
| FVC and FEV1 < 80%
73
give 3 obstructive lung diseases
COPD
asthma
bronchiectasis
74
give 3 restrictive lung diseases
```
interstitial lung disease
scoliosis
sarcoidosis
idiopathic pulmonary fibrosis
neuromuscular disease
marked obesity
```
75
what is the first line treatment for goodpastures syndrome?
corticosteroids - IV methylprednisolone
76
what is the incubation period for influenza?
1-4 days
77
what are the signs of COPD on x-rays?
hyperinflation
bullae
flat hemidiaphragm
78
```
which of these is least likely to metastasise to a distant location?
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Large cell carcinoma
D) Mesothelioma
E) Small cell carcinoma
```
D) mesothelioma
rarely metastasise to distant sites
79
what are you likely to see on the sputum culture and biopsy for TB?
sputum = mycobacterium TB
biopsy = caseating granuloma
80
give 3 extrapulmonary signs of TB
```
persistent swollen glands
abdominal pain
dysuria
haematuria
pain
loss of movement in affected joint
confusion
persistent headache
seizures
```
81
which organism is the most common for HAP?
pseudomonas aeruginosa
82
what are the risk factors for developing a PE?
```
DVT
previous PE
malignancy
pregnancy
recent surgery or fracture
combined OC
HRT
```
83
give 5 differential diagnoses for influenza
```
common cold
URTI
pharyngitis
meningitis
bacterial/lower RTI
malaria
CMV pneumonia
infectious mononucleosis
```
84
what is the difference between transudate and exudate?
transudate has <30g/L protein
| exudate has >30g/L protein
85
what is the difference between a primary spontaneous and tension pneumothorax?
In a primary spontaneous pneumothorax, there is a pocket of air in the pleural cavity -> Partial/complete collapse of the lung on affected side, whereas a tension pneumothorax is where the Pleural tear acts as a one-way valve. It allows air into the cavity but not out. Increasing unilateral pressure -> Severe respiratory distress, shock and cardiorespiratory arrest.
86
what are the blood results for primary hyperparathyroidism?
```
Ca2+ = high
phosphate = low
PTH = normal
```
87
what is the gold standard investigation for pheochromocytoma?
elevated plasma free metanephrine
88
what is the treatment for acute STEMI?
```
MONA
Morphine
Oxygen (if O2 sats < 94%)
N = nitrates
A = aspirin
```
89
which of the following may show ST elevation on ECG?
a) unstable angina
b) pritzmetal angina
c) cardiomegaly
d) stable angina
e) NSTEMI
b) prinzmetal angina
90
what is the first line investigation for heart failure?
BNP
91
which biliary condition is associated with ulcerative colitis?
primary sclerosing cholangitis
92
what is the gold standard investigation for acute diverticulitis?
contrast CT colonography
93
does dysphagia of solids and liquids from the start indicate a malignant or benign disease?
benign
gradual onset would indicate malignant
94
which conditions are associated with primary sclerosing cholangitis?
cholangiosarcoma
95
which conditions are associated with primary biliary cirrhosis?
RA
HCC
sjogren's syndrome
coeliac
96
what is the clinical presentation of primary biliary cirrhosis
jaundice
pruritus
fatigue
+/- IBS symptoms
97
what is the pathway for hypertension treatment?
T2DM or <55 or caucasian
- ACEi (or ARB if intolerant)
- ACEi/ARB + CCB
- ACEi/ARB + CCB + thiazide
>55 or african/caribbean
- CCB
- CCB + ACEi/ARB
- CCB + thiazide + ACEi/ARB
- if still uncontrolled add spironolactone
98
which scoring system is used to calculate the risk of having a heart attack in the next 10 years?
QRISK3
99
what is the ABCD2 score used for?
to determine the stroke risk after a TIA
100
what is the classic triad of symptoms caused by carcinoid syndrome?
cardiac involvement
diarrhoea
flushing
101
which type of cancer is painless haematuria an indicator of?
bladder cancer
102
what are the side effects of tamusolin?
postural hypotension
dizziness
syncope
103
what are the common causes of UTIs?
```
KEEPS
K - Klebsiella
E - e.coli
E - enterococcus
P - proteus / pseudomonas
S - staph. saprophyticus
```
104
what are the side effects of loop diuretics?
```
dehydration
hypotension
hypokalaemia
metabolic alkalosis
ototoxicity
```
105
what are the side effects of spironolactone?
GI upset
hyperkalaemia
metabolic acidosis
gynecomastia
106
what are the side effects of thiazide diuretics?
```
hypokalaemia
metabolic alkalosis
hypovolaemia
hyponatraemia
hyperglycaemia in diabetics
```
107
which of the following is a complication of c.diff?
a) ascending cholangitis
b) diverticulitis
c) ischaemic colitis
d) peptic ulcer
e) pseudomembranous colitis
e) pseudomembranous colitis
108
what is ground coffee vomitus a sign of?
upper GI bleeding
109
which heart valve is most commonly affected in IE?
tricuspid valve - it is the first heart valve to be encountered after blood has returned from systemic circulation
110
which is the most common cause of pneumonia?
s.pneumoniae
111
which medication is used to control chorea in huntingtons?
risperidone - dopamine receptor antagonist
112
how do you read ABGs?
1. look at pH
| 2. look at CO2 - if it goes in same direction as pH = metabolic, if it goes in opposite direction = resp
113
which electrolyte imbalance is most indicative of sarcoidosis?
hypercalcaemia
114
What is the most common congenital heart defect and describe how it affects cardiac blood flow.
Ventricular septal defect (VSD).
It is an opening in the wall or septum which separates the right and left ventricle. This hole results in what is called a left to right shunt which means that oxygenated blood from the left ventricle is passed to the right ventricle.
115
In what other conditions besides myocardial infarction does a patient have increased risk of when diagnosed with artherosclerosis?
Ischaemic stroke or cerebrovascular accident (CVA)
critical limb ischaemia
Sudden cardiovascular death
116
What are the two most common causes of acute pericarditis?
viral and autoimmune
117
What medications do we use to help relieve the symptoms of heart failure?
Furosemide and bumetanide are used initially and spironolactone can be added in if required.
118
What medications do we give when treating acute coronary syndrome (ACS)?
Aspirin (Anti-platelet)
Ticagrelor (Anti-platelet)
Fondaparinux (Low Molecular Weight Heparin)
A statin (lowers cholesterol)
Beta blocker (Decreased oxygen demand due to the reductions in heart rate, blood pressure, and contractility)
Morphine (Pain management)
GTN (Opens coronary arteries improving blood flow)
119
what is the most common cause of addisonian crisis?
abruptly stopping steroid treatment
120
what is the treatment for addisonian crisis?
The most important initial treatment is Hydrocortisone.
121
how can you distinguish between diabetes mellitus and diabetes insipidus?
dip testing the urine for glucose can assist the diagnosis differentiation as diabetes mellitus will show glycosuria.
122
name 5 conditions associated with erectile dysfunction
```
Diabetes mellitus
Cardiovascular disease - MI, hypertension
Liver disease and alcohol
Renal failure
Trauma - Pelvic fracture
Iatrogenic - Prostatectomy 75%
```
123
what is the first line treatment for erectile dysfunction?
Phosphodiesterase (PDE5) inhibitors e.g. sildenafil or tadalafil
124
what is the treatment for chlamydia?
Doxycycline 100mg bd for 7 days
| Erythromycin 500mg bd for 14 days or Azithromycin in pregnancy
125
How does its antibiotic treatment for pyelonephritis differ from a lower urinary tract infection?
In lower tract infection broad spectrum antibiotics should be avoided whereas in upper urinary tract infections they are used first line.
126
What is the commonest presentation of testicular cancer? What differentiates it as a true scrotal mass?
A painless lump in the testicle is the commonest presentation, may be hard and craggy and does not transilluminate
A true scrotal lump you can palpate above it (rather than one arising from the inguinal canal where you cannot
127
What issues are there which prevent the Prostate Specific Antigen (PSA) test being used routinely for screening?
It is not cancer specific – it can be raised in benign prostatic hypertrophy, UTI, prostatitis
6% of men with a normal PSA will have prostate cancer whilst 70% of men with a raised PSA will not have prostate cancer
128
What are the criteria for a 2 week wait referral for suspected bladder cancer?
Aged 45 and over and have:
- Unexplained visible haematuria without urinary tract infection or
- Visible haematuria that persists or recurs after successful treatment of urinary tract infection
Aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test
129
What are the 4 commonest types of urinary tract stones?
Calcium stones (oxalate, phosphate) 80%
Uric acid 10%
Struvite 5-10%
Cystine 1%
130
define glomerulonephritis
Glomerulonephritis is any of a group of diseases that injure the part of the kidney that filters blood (the glomeruli).
131
define nephrotic syndrome
Nephrotic syndrome is characterised by finding of oedema in a person with increased protein in the urine and decreased protein and increased fat in the blood.
132
define nephritic syndrome
Nephritic syndrome is characterised by blood in the urine (especially Red blood cell casts with dysmorphic red blood cells) and a decrease in the amount of urine in the presence of hypertension
133
give 4 causes of acute liver failure
```
Viral
Drugs - illicit or medical
Obstruction (gallstones, strictures, masses/cancer)
Vascular (thrombosis)
Alcohol
Congestion (heart failure)
```
134
what is the first line of treatment for angina?
GTN spray
| BB - bisoprolol
135
what bedside test can be used to assess mobility in the spine?
- Schoebers test
136
what is the NICE exacerbation grading for asthma?
moderate
- PEFR = 50-75%,
- normal speech
acute severe
- PEFR = 33-55%,
- RR >25,
- HR >110,
- inability to complete sentences
life-threatening
- PEFR <33%
- O2 sat <92%
- altered consciousness
- poor respiratory effort
- silent chest
- confusion
137
what is the acute asthma attack treatment pathway?
- salbutamol
- ipratropium bromide nebuliser
- oral prednisolone or IV hydrocortisone
138
what are the extra-articular manifestations of ankylosing spondylitis?
5A's
- anterior uveitis
- autoimmune bowel disease
- apical lung fibrosis
- aortic regurgitation
- amyloidosis
139
what is Schoebers test?
1. have patient stand and locate L5 vertebrae
2. mark 10cm above and 5cm below
3. ask pt to bend over as far as they can and measure between the 2 points
4. <20cm = reduced lumbar movement
140
what are the indicators of good asthma control?
- no night-time symptoms
- inhaler used < 3 times per week
- no breathing difficulties, cough or wheeze on most days
- able to exercise without symptoms
- normal lung function tests
141
what would you prescribe as prophylaxis for migraine?
- propranolol
- topiramate
- amitriptyline
142
what is the mechanism of action for adrenaline in treatment of anaphylaxis?
agonist of beta adrenergic receptors
143
give 2 non malignant causes of lymphadenopathy?
```
infection
sarcoidosis
phenytoin
EBV
SLE
```
144
which type of cells are involved in CLL?
B cells
145
which test should be undertaken to confirm CLL diagnosis once blood film has been done?
immunophenotyping
146
give 3 non-pharmacological management options for OA
```
pt education
activity/exercise
physiotherapy
weight loss
improved diet
occupational therapy
```
147
give one topical and 2 oral management options in the management of OA
topical = NSAID, capsaicin
Oral = paracetamol, NSAID, opioid, bisphosphonates
148
what is the definition of a stroke?
sudden-onset neurological deficit due to ischaemic or haemorrhagic compromise in blood supply
lasts over 24 hours
149
what is the criteria for total anterior circulation stroke?
- unilateral weakness of face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (e.g. dysphasia)
150
1. Which of the following conditions is not a cause of finger clubbing?
a. Bronchiectasis
b. Mesothelioma
c. Idiopathic pulmonary fibrosis
d. Asthma
e. Lung abscess
d. asthma
151
what is the management for giant cell arteritis?
IV methylprednisolone
152
what are the symptoms of mitral stenosis?
```
SOB
fatigue
palpitations
haemoptysis
flushed cheeks
```
153
what investigation is used to confirm the diagnosis of coeliac disease?
Endoscopy + Duodenal Biopsy is the investigation used to confirm Coeliac Disease, the duodenal biopsy would show crypt hyperplasia, villous atrophy and raised intracellular WBCs.
154
what is the inheritance pattern of duchenne muscular dystrophy?
X-linked recessive
155
what is the first line treatment for bowel obstruction?
Nil by mouth
IV fluids
NG tube aspiration
156
what can be added to beta lactam antibiotics to inhibit beta lactamase?
clavulanic acid
157
what is the gold standard treatment for parkinson's?
levo-dopa
158
what are the different stages of COPD?
stage 1 (early)
FEV1/FVC <0.7,
FEV1 >80%
stage 2 (moderate)
FEV1/FVC <0.7
FEV1 <80%
stage 3 (severe)
FEV1/FVC <0.7
FEV1 <50%
stage 4 (very severe)
FEV1/FVC < 0.7
FEV1 < 30%
159
what is the gold standard investigation for portal hypertension?
hepatic venous pressure gradient
160
what karyotypes are found in turner syndrome?
45X
161
which clinical measurement gives the best estimate of activity of the intrinsic pathway of the coagulation cascade?
Activated partial thromboplastin time (aPTT)
162
what is the difference between the presentation of a craniopharyngioma and a pituitary adenoma?
craniopharyngioma = worse in lower visual field
pituitary adenoma = worse in upper visual field
163
what is the normal range for ejection fraction?
50-75%
164
where is adenocarcinoma of the pancreas most likely to originate from?
head of the pancreas
165
what are the 1st and 2nd line treatment for OA?
1st line
oral paracetamol + topical NSAID
2nd line
paracetamol + oral NSAID/oral weak opioid/ topical capsaicin
166
what are the domains of CURB65?
```
C = confusion
U = urea > 7mmol/L
resp rate >30
BP systolic <90 or diastolic <69
age >65
```
167
what is the biggest risk factor for primary biliary cholangitis?
female sex
168
what is the 1st line investigation for renal cell carcinoma?
CT urogram
169
what is cut in surgery to relieve carpal tunnel syndrome?
transverse carpal ligament
170
what is DIC?
abnormal activation of coagulation, where there is unregulated fibrinogen deposition or fibrinolysis
171
what are the blood results for DIC?
prolonged coagulation times,
thrombocytopenia,
low fibrinogen
raised fibrin degradation products
172
what is a diagnostic test for multiple myeloma?
serum and urine electrophoresis
173
Which of the following is diagnostic of acute pancreatitis?
a. Raised AST
b. CT abdomen
c. Raised urinary amylase
d. MRI abdomen
e. Low blood amylase
c - raised urinary amylase
174
what is the antibiotic of choice for tonsilitis?
phenoxymethylpenicillin for 10 days
175
what is the treatment for sinusitis?
- Nasal decongestants such as xylometazoline
| - Broad spectrum antibiotics such as co-amoxiclav
176
what is the treatment for acute epiglossitis?
- Can be a life-threatening emergency and requires urgent endotracheal
intubation
- IV antibiotics e.g. ceftazidime
177
what is the treatment for croup?
- Nebulised adrenaline gives short-term relief
- Oral or intramuscular corticosteroids e.g. dexamethasone should be given
with oxygen and adequate fluids
178
what drug is used to maintain remission of crohns?
azathioprine
| methotrexate if intolerant
179
what is the treatment for chlamydia?
doxycycline or azithromycin
180
what is the treatment for gonorrhoea?
ceftriaxone single dose
| azithromycin single dose
181
what is the antibiotic for pneumonia caused by s.pneumoniae?
amoxicillin or benzylpenicillin
182
what is the antibiotic for pneumonia caused by m.pneumoniae?
erythromycin or clarithromycin
183
what is the antibiotic for pneumonia caused by c.pneumoniae?
erythromycin or clarithromycin
184
what is the antibiotic for pneumonia caused by s.psittaci?
doxycycline
185
what is the antibiotic for pneumonia caused by c.burnetii?
doxycycline
186
what is the antibiotic for pneumonia caused by legionella?
clarithromycin +/- rifampicin
