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Mixed Flashcards

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1
Q

Bloody diarrhoea causing organisms

A

Bac: E coli, Campylobacter, Salmonella, Shigella, Clostridium
Viruses: rotavirus
Parasites: Giardia, Entamoeba

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2
Q

4 histological layers of colon

A

Mucosa: epithelium + lamina propria + muscularis mucosa
Sub-muscosa
Muscularis propria
Adventitia

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3
Q

Pancreatic enzymes

A

Amylase: starch
Lipase: lipids
Chymotrypsin, trypsin, elastase: proteins

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4
Q

Role of cholesterol

A

Component of cell membranes, precursor of steroid hormones, precursor of bile acids, component of plasma lipoproteins

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5
Q

Why would ferritin be high if iron is low?

A

Ferritin= acute phase reactant of liver, elevated in times of illness or inflammation

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6
Q

3 bands of colon that longitudinal muscle fibres of muscular external are arranged into

A

taeniae coli

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7
Q

Venous ulcer typical appearance

A

Gaiter region- lower 1/3 of leg
Common over medial malleolus
May form Majrjolin’s ulcer (squamous cell carcinoma) if left

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8
Q

Basal cell carcinoma

A

May present as ulcer/lesion on sun exposed places
Starts as slow growing nodule that may be itchy/bleeds
Necrosis of centre leaves rolled edge
No lymphadenopathy + no mets

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9
Q

Squamous cell carcinoma

A

Bleeding more common + lymphadenopathy

Characteristic everted edge

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10
Q

Ischaemic ulcers

A

Very painful
Deeper than venous ulcers -> can penetrate down to the bone
Surrounding area cold as result of ischaemia

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11
Q

Neuropathic ulcers

A

Impaired sensation
DM most common cause
Characteristically painless

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12
Q

Ankle brachial pressure index

A

> 0.9 normal
0.6-0.9 claudication but no rest pain
<0.6 rest pain, critical ischaemia

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13
Q

Big surgical risk factors for PE

A

Pelvic + orthopaedic surgery

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14
Q

Bladder cancer presentation

A

Painless haematuria
Males
50-70yrs old

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15
Q

UK incidence of bladder cancer

A

1/6000 a year

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16
Q

Dilated tapering oesophagus on Ba swallow

A

Achalasia

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17
Q

Ddx of abdo cases

A 
Abdo pain
Abdo distention 
Change in bowel habits 
GI bleed
Jaundice
Ascites
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18
Q

Constant gastro pain indicates

A

Inflammation

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19
Q

Colicky gastro pain indicates

A

Obstruction

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20
Q

Enzyme reduced in chronic pancreatitis

A

Faecal elastase

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21
Q

5 causes of abdo distension

A 
Fluid
Flatus 
Faeces 
Fat
Fetus
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22
Q

What may cause Flatus and what signs/Hx might you be looking for?

A 
Obstruction
- N&amp;V
- Bowels not opening 
- High pitched tinkling sounds
Look for previous surgery eg adhesions
Tender irreducible hernia in groin
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23
Q

According to old classification, what are the two types of ascites and what may cause them

A

Transudate
- Cirrhosis, Cardiac failure, Nephrotic syndrome ie the failures
Exudate
- Malignancy (abdo, pelvic, peritoneal mesothelioma)
- Infection (TB, myogenic)
- Budd-chiari syndrome (hepatic vein thrombosis)

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24
Q

Low albumin gradient (ascites)

A

Serum-ascites albumin gradient <11g/L

  • nephrotic syndrome
  • TB
  • pancreatitis (acute, chronic)
  • cancer
  • peritonitis
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25
Q

High albumin gradient (ascites)

A

Serum-ascites albumin gradient >11g/L

  • Portal HTN
  • Constrictive pericarditis
  • Cardiac failure (acute, chronic)
  • Cirrhosis
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26
Q

Pale stools is caused by lack of

A

stercobilinogen

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27
Q

Cause of decreased conjugation of bilirubin

A

Gilberts syndrome

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28
Q

Causes of post-hepatic jaundice

A

Gallstones in GBD
Stricture
Cancer of head of pancreas

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29
Q

What is Trousseau’s sign of malignancy?

A

Superficial thrombophlebitis

-> Pancreatic cancer

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30
Q

Marker for pancreatic cancer

A

CA19-9

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31
Q

Possible differentials for bloody diarrhoea

A

Infective colitis

  • C -> Campylobacter
  • H -> Haemorrhagic E Coli
  • E -> Entamoeba histolytica
  • S -> Salmonella
  • S -> Shigella

Inflammatory colitis

  • In young
  • Extra-GI manifestations: episcleritis, scleritis, uveitis, erythema nodosum, pyoderma gangrenosum

Ischaemic colitis
- In elderly

Diverticulitis

Malignancy

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32
Q

Management of acute GI bleed

A 
ABC
IV access
Fluids
G&amp;S, Cross-match (X-match)
OGD: find underlying cause
If variceal bleed treat with:
-> Antibiotics (Tazosin to treat any bac translocation)
-> Terlipressin (causes splanchnic vasoconstriction)
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33
Q

Terlipressin causes

A

splanchnic vasoconstriction

- use in variceal bleed

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34
Q

How to manage acute abdo?

A

Fluids
NBM + NG tube

TRIPLE A:
Analgesia
Anti-emetics
Anti-biotics:
--> cover anaerobes (metronidazole)
--> Cef + Met

Monitor vitals + Urine output

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35
Q

How to manage ascites

A
  • Diuretics (furosemide/spiro)
  • Fluid restriction if Na <120
  • Weight management (daily)
  • Dietary Na restriction
  • Therapeutic paracentesis
  • If neutrophils >250 then SBP so ANTIBIOTICS
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36
Q

Investigations for Jaundice

A 
Bloods
- FBC/LFTs/CRP
Abdo USS
- Gallstones better seen after pt has fasted due to distended, bile filled gallbladder
- Look for duct dilatation
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37
Q

Dysphagia + weight loss investigations

A

Bloods

OGD

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38
Q

PR bleed + weight loss

A

Colonoscopy

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39
Q

How to manage encephalopathy

A

Lactulose
Phosphate enemas

Avoid sedation
Treat infections
Exclude a GI bleed

Treat cause

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40
Q

Anastamotic leak (cause + presentation)

A

Post-op complication

  • Diffuse abdo tenderness (due to peritonitis)
  • Guarding/tenderness
  • Hypotensive/tachycardic
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41
Q

Pelvic abscess presentation

A

eg due to post-appendectomy

  • Pain
  • Fever
  • Sweats
  • Mucus in diarrhoea
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42
Q

Recurrent abdo pain, bloating
Improves with defecation
Change in the frequency/form of stool

Suggests?

A

IBS

there will be no anaemia, weight loss, PR bleeding or nocturnal symptoms

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43
Q

Treatment of IBS

A

Anti-spasmodics: for abdo pain
If constipation: laxatives
If diarrhoea: anti-diarrhoeals eg loperamide

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44
Q

A 26yo woman has intermittent loose stool for the last 3 months on a background of IBS. She is otherwise well, no abdo pain, no vomiting, no weight loss. Her abdomen is soft and non-tender, bowel sounds normal. Her temperature is 37.1°C, pulse rate 64bpm, BP 114/76mmHg, RR of 14 breaths/min and Oxygen sat 100% breathing air.

Investigations:
Hb 140, WCC: 5.4, Urea: 3.6, Creatinine: 66, LFT: Normal, CRP <5, Uripe dip: no abnormality

Prescribe a med

A

Loperamide, 2mg, Oral, PRN

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45
Q

A 54 year old man has epigastric pain for 2 months. The pain started after he sustained a sporting injury, for which he took ibuprofen. His physical examination is normal. His temperature is 37.3°C, pulse rate 78 bpm, BP 136/76 mmHg, respiratory rate 14 breaths per minute and oxygen saturation 100 % breathing air.

Investigations:
Full blood count unremarkable
Upper GI Endoscopy: Small gastric ulcer with a smooth rounded edge, appears benign
Helicobacter pylori test negative

Please prescribe the most appropriate medication.

A

omeprazole

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46
Q

The target blood pressure for patients with chronic renal disease or diabetes plus microalbuminuria is a blood pressure less than

A

125/75

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47
Q

What is the KDIGO classification used for?

A

AKI
Serum creatinine >26micromol/L within last 48hrs
Serum creatinine 1.5x baseline within preceding 7 days
Urine volume <0.5ml/kg/hr for 6hours

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48
Q

Causes of hypokalaemia

A

Haemorrhage

Severe vomiting

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49
Q

Anuria

A

Failure of kidneys to produce urine

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50
Q

What can be checked in blood for lupus?

A
  1. Complement levels: low in active lupus
  2. Anti dsDNA antibodies: high in active lupus
  3. ANA - associated with SLE
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51
Q

4 indications of RRT

A
  1. Hyperkalaemia refractory to medical management
  2. Pulmonary oedema refractory to medical management
  3. Severe metabolic academia
  4. Uraemic complications
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52
Q

Normal eGFR

A

> 90ml/min per 1.73m2

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53
Q

Chronic use of which drugs are a risk of CKD

A

NSAIDs

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54
Q

Painless haematuria in a 50-70yr old think

A

Bladder cancer

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55
Q

Cytoscopy is

A

Endoscopy of urinary bladder via the urethra

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56
Q

FUND HIPS

A 
LUTS
Frequency
Urgency
Nocturia
Dysuria
Hesitancy
Incomplete voiding
Poor stream
Straining
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57
Q

First line treatment for UTI

A

Trimethoprim or Nitrofurantoin

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58
Q

Normal urine output

A

1mL per kg per hour

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59
Q

Oliguria

A

<0.5mL per kg per hour or <400mL per day

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60
Q

First thing to check with pt on ward who has reduced urinary output

A

Catheter not blocked

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61
Q

How much fluid do febrile pts need

A

500mL for every 1 degree above 37

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62
Q

What types of drugs can be nephrotoxic

A

NSAIDs
ACE inhibitors
Diuretics
Antibiotics eg gentamicin or vancomycin

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63
Q

What marker is unhelpful when checking for an obstructive cause in acute urinary retention?

A

PSA as raised anyway so can’t tell if prostate problem or not

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64
Q

Typical presentation of acromegaly

A

Prominent jaw and brow
Large hands and feet
Sweating

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65
Q

Typical presentation of acromegaly

A 
Prominent jaw and brow
Large hands and feet 
Sweating 
glycosuria 
enlarged nose
soft tissue changes
organomegaly 
visual impairment (if impact on optic chiasm)
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66
Q

Cadmium is related to which type of cancer

A

Prostate

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67
Q

How can you distinguish between BPH and prostate cancer on DRE?

A

BPH: smooth enlargement, bilateral, midline sulcus
Ca: Hard, asymmetrical, nodular, loss of midline sulcus

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68
Q

Polycystic kidney disease mode of inheritance

A

Autosomal dominant

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69
Q

Mutation on PKD1 on chromosome 16

A

Polycystic kidney disease

85% of cases

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70
Q

PKD2 mutation chromosome 4

A

15% of cases

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71
Q

Condition associated with berry aneurysms

A

Polycystic kidney disease

May present as SAH

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72
Q

ACEi are contra-indicated in which renal condition

A

Renal artery stenosis

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73
Q

What lung finding may you see in renal artery stenosis pts?

A

Hx of flash pulmonary oedema

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74
Q

Gold standard investigation for renal artery stenosis

A

Digital subtraction angiography

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75
Q

Markers for testicular cancer

A
  1. alpha feto-protein
  2. beta-HCG
  3. lactate dehydrogenase
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76
Q

What is the problem with myoglobin?

A

Renotoxic

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77
Q

Excess insulin injection results in

A

Hypoglycaemia
Reduction in K+ due to shift into intracellular compartment
Pts become sweaty, irritable, can eventually fall into coma

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78
Q

MOA biguanides

A

decrease HGO

increase peripheral glucose uptake

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79
Q

MOA thiazolidinediones

A

activate PPAR-gamma, which increases LPL and FATP1 transcription -> increases peripheral insulin sensitivity

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80
Q

MOA sulphonylureas

A

block K(ATP) channel in pancreatic b cells, causing depolarisation and Ca entry -> stimulates insulin secretion

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81
Q

What is needed to manage a HONKC

A 
IV insulin (50U soluble in 50ml of normal saline)
\+ thromboprophylaxis
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82
Q

Groin lump in male that reduces completely when they lie down

A

Saphena varix

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83
Q

Where is the saphenofemoral junction?

A

2-3cm inferolateral to pubic tubercle

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84
Q

Pantaloon hernia

A

coexisting direct and indirect inguinal hernias

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85
Q

Differentials for non-tender, fluctuant groin lump with cough impulse

A

hernia or

saphena varix

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86
Q

Boundaries of Hesselbach’s triangle

A

Medially: rectus sheath
Inferiorly: inguinal ligament
Superiorly: deep inferior epigastric artery

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87
Q

Boundaries of inguinal canal

A

Anterior: Skin, superficial fascia, external oblique aponeurosis, internal oblique (lateral 1/3)
Posterior: Transversalis abdominis + conjoint tendon
Roof: internal oblique + transverses abdominis
Floor: inguinal ligament

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88
Q

Boundaries of femoral canal

A

Anterior: Inguinal ligament
Posterior: pectineal ligament and pectineus
Medial: lacunar ligament
Lateral: femoral vein

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89
Q

Risks of surgery in general

A 
Haemorrhage
Infection
Thromboembolism
Anaesthetic complications 
Death
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90
Q

Maydl’s hernia

A

W loop ie two loops of bowel herniate, with intraabdo portion in the middle

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91
Q

Urine dip result in diabetes

A

Glucose

Ketones

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92
Q

Management of hyperkalaemia

A 
IV calcium
Insulin and dextrose (moves K from extra-cellular compartment to intra-cellular)
Nebulised salbutamol
Ca resonium 
Dialysis
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93
Q

Management of hyperkalaemia

A

IV calcium
Insulin and dextrose (moves K from extra-cellular compartment to intra-cellular)
Nebulised salbutamol
Ca resonium
Dialysis
(would see massive inverted t waves on ecg)

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94
Q

Nephrotic syndrome

A

> 3g protein

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95
Q

Normal protein in urine

A

<150mg/day

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96
Q

Normal protein to creatinine ratio

A

<20

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97
Q

Robson staging

A

Renal cell carcinoma

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98
Q

Diabetics are at risk of which condition between buttocks

A

Pilonidal sinus

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99
Q

Oesophageal varices treatment

A

Propanolol + endoscopic variceal banding

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100
Q

Koilonychia

A

Iron deficiency
Haematochromatosis
Endocrine disorders eg acromegaly or hypothyroidism
Malnutrition

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101
Q

What happens to cells in alcoholism?

A

Increased MCV

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102
Q

Mutation in a gene on chromosome 13 for ATP7B

A

copper transporting ATPase

wilsons disease

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103
Q

Caeruloplasmin is a

A

acute phase protein

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104
Q

Inflammatory infiltrate, crypt abscesses + goblet cell depletion on histology report

A

UC

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105
Q

Barium enema in Crohn’s reveals

A

cobblestoning, rose thorn ulcers, +/- colonic strictures

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106
Q

Smoking increases risk of which bowel disease

A

Crohn’s (3-4x)

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107
Q

Triple therapy

A

Seven-day course of twice daily omeprazole 20mg, 1g amoxicillin and 500 mg clarithromycin

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108
Q

Most common cause of upper GI bleeding

A

Peptic ulcer

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109
Q

Treatment for chronic hep B

A 
Interferon alpha (but SEs of flu symptoms eg headaches, myalgia, pyrexia, chills, bone marrow suppression + depression)
Nucleoside/nucleotide analogues eg tenofovir, adefovir, entecavir
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110
Q

Histological report of HAV/HEV

A

Zone 3 necrosis
Inflammatory cell infiltration of portal tracts
Bile duct proliferation

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111
Q

Histological report of HCV

A

Chronic hepatitis
Lymphoid follicles in portal tracts
Fatty change
Cirrhosis may be present

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112
Q

Cholestyramine

A

Bile acid sequestrant
- either lowers cholesterol
OR
- used in hepatitis infections to reduce diarrhoea

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113
Q

Signs of portal HTN

A

Caput medusae
Ascites
Splenomegaly

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114
Q

Hepatic hydrothorax

A

A tranudative pleural effusion in pts with portal HTN with no underlying primary cardiopulmonary cause

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115
Q

Opthalmoplegia, ataxia, confusion

A

Wernicke’s

Thiamine/B1 deficiency

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116
Q

3Ds of pellagra

A

Diarrhoea
Dementia
Dermatitis

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117
Q

Halitosis

A

Foul breath

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118
Q

Potential causes of peritonitis

A 
Perforation of 
peptic/duodenal ulcer
diverticulum 
appendix
bowel
gallbladder
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119
Q

Who is primary peritonitis seen in

A

Adolescent females

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120
Q

SBP management

A

IV
Cefuroxime + Metronidazole
OR
Quinolones

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121
Q

Nausea + sweating usually associated with

A

cardiac pain

indicates ischaemia

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122
Q

Who do silent infarcts occur in?

A

Elderly & diabetics

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123
Q

Which two enzymes can be raised post MI?

A

AST (24hrs)

LDH (48hrs)

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124
Q

Unstable angina or NSTEMI on ECG may show

A

ST depression

T wave inversion

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125
Q

STEMI on ECG

A 
ST elevation (>1mm in limb leads, >2mm in chest leads)
Hyperacute T waves
New onset LBBB
Later changes:
- T wave inversion 
- Pathological Q waves
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126
Q

Posterior MI on ECG

A

Tall R wave

ST DEPRESSION V1-3

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127
Q

5 (weird) tests to do for ischaemic heart disease

A 
rMPI (technetium 99 or tetrofosmin)
Echo (either at rest or exercise/dobutamine stress)
Pharm stress testing 
Cardiac catheterisation/angiography
Coronary Ca scoring
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128
Q

What pharm agents can induce a tachycardia

A

Dipyridamole
Adenosine
Dobutamine

(don’t give 1/2 in reactive airway disease or AV block)

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129
Q

What should all stable angina patients receive?

A

75mg aspirin per day

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130
Q

Echo in MI may reveal

A

RWMA: regional wall motion abnormality

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131
Q

Right heart murmurs are louder on…

A

Inspiration

ie tricuspid or pulmonary

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132
Q

Pan systolic murmur indicates

A

Mitral regurg
Tricuspid regurg
Ventricular septal defect

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133
Q

Slow rising pulse associated with

A

aortic stenosis

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134
Q

Mitral regurgitation is associated with

A

Displaced apex beat

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135
Q

Tricuspid regurgitation is associated with

A

raised JVP

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136
Q

Ventricular septal defect

A

Loudest left sternal border, accompanied with parasternal thrill

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137
Q

Coarse crackles

A

Consolidation or bronchiectasis

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138
Q

Fine crackles

A

Pulmonary oedema or fibrosis

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139
Q

On ECG how do you differentiate between AF and SVT?

A

Both have no P waves before the QRS complexes
BUT
in AF its irregular rhythm

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140
Q

In AVRT what do you see on ECG leading into QRS complex

A

Delta wave

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141
Q

When will a varicocele be palpable

A

Only when pt is standing

142
Q

In hydrocele is it possible to palpate the testes

A

No

143
Q

Sudden left varicocele consider

A

Renal tumour

144
Q

young pt complaining of regular palpitations think

A

SVT

145
Q

CHAD VASC score

A 
for stroke prevention in AF
Age >75yrs
Diabetes
HTN
Hx of stroke/TIA
Hx of CCF

if low score -> aspirin
high score -> warfarin

146
Q

Valsalva manoeuvre

A

blow out cheeks while holding breath

147
Q

Diagnosing HTN via ECG

A

V1/2 DEEP S

V5/6 TALL R

148
Q

Two causes left ventricular hypertrophy

A

HTN

Aortic stenosis

149
Q

Lupus antibodies

A

Anti-dsDNA
ANA
Anti-cardiolipin

150
Q

Difference between LVH by voltage criteria and LVH

A

LVH by voltage criteria is using ECG to diagnose

LVH is definitively diagnosed by ECHO

151
Q

Difference between sinus tachycardia + SVT or VT on ECG

A

P waves present in sinus tachycardia

152
Q

Difference between cardioversion and defibrillation?

A

Defibrillation: shock pt, ie not syncronised
Cardioversion: synchronised

153
Q

How to treat acute heart failure?

A

Sit up
60-100% oxygen
IV furosemide (to prevent lack of absorption due to gut oedema)

Treat underlying cause
(can give GTN infusion if they have angina too)

154
Q

ST elevation in all leads suggests

A

Pericarditis (saddle shaped ST elevation)

can’t be MI as otherwise would be dead

155
Q

Pleuritic chest pain causes

A 
Pericarditis
Pneumonia
Pneumothorax
PE
Pleural pathology
(Sub-diaphragmatic pathology eg hepatic abscess)
156
Q

Where is a pericardial friction rub best heard?

A

Left lower sternal edge, on expiration, pt sitting forward

157
Q

Tamponade

A

Pressure that restricts blood flow

158
Q

Pulsus paradoxus

A

Drop in SBP >10mmHG during inspiration

159
Q

Beck’s triad

A

Raised JVP
Low BP
Muffled heart sounds

160
Q

Pericardial effusion on x-ray

A

bottle water shaped enlarged cardiac silhouette

161
Q

ASO titre

A

anti streptolysin O

162
Q

Drugs that can induce liver cirrhosis

A

Amiodarone
Methyldopa
Methotrexate

163
Q

Hepatic failure leads to

A 
coagulopathy 
hepatic encephalopathy 
hypoalbuminaemia 
sepsis 
hypoglycaemia
164
Q

Things to test in ascitic tap

A 
neutrophils to check for SBP
glucose
protein 
LDH
cell count
biochem
165
Q

Koilonychia

A

signs of IRON deficiency anaemia

166
Q

How do cells haemotologically change in chronic alcohol disease

A

raised MCV

167
Q

Mutation in HFE gene

A

Hereditary haemochromatosis

168
Q

Slate grey skin pigmentation

A

Hereditary haemochromatosis

169
Q

Recent dental work or poor dental hygiene predisposes you to

A

Streptococcus viridans

infective endocarditis!!

170
Q

Roth spots on retina

A

Infective endocarditis

171
Q

Many infective endocarditis pts tend to be positive for what

A

rheumatoid factor positive

172
Q

20-30% pts with PSC are more likely to develop

A

Cholangiocarcinoma

173
Q

Thrombophlebitis migrans

A

vessel inflammation due to blot clot occurring in multiple places over time
(pancreatic cancer)

174
Q

Aortic dissection

A

Male, 40-60yrs

175
Q

Collapsing pulse

A

aortic regurg

176
Q

For what condition do you x match 10 blood units

A

Aortic dissection

177
Q

Seen in aortic regurgitation (wrt pressure)

A

increase in low end diastolic AORTIC pressure

178
Q

Collapsing pulse/early diastolic murmur

A

Aortic regurgitation

179
Q

Austin flint mid-diastolic murmur

A

heard at apex

reflux of blood in aortic regurgitation hitting ant cusp of mitral valve causing physiological mitral stenosis

180
Q

Slow rising pulse

A

Aortic stenosis

181
Q

Signs of right heart failure

A

Pleural effusion
Ascites
Hepatomegaly
Pitting oedema

182
Q

Common sign seen in mitral regurgitation

A

AF -> IRREGULARLY IRREGULAR PULSE

183
Q

Malar flush is seen in

A

Mitral stenosis

184
Q

Which ulcers have a punched out appearance

A

arterial

185
Q

Lipodermatosclerosis

A

champagne bottle leg

seen in severe venous ulcer disease

186
Q

Marjolin’s ulcer

A

aggressive, ulcerating squamous carcinoma in area of skin where previous inflammation/trauma

187
Q

When do you give a precordial thump to a pt?

A

Ulnar aspect of wrist to thump sternum in cardiac arrest if you witness

188
Q

What do you do in acute cardiac tamponade

A

Pericardiocentesis

189
Q

Prinzmetal angina

A

variant angina due to coronary vasospasm rather than atherosclerotic disease (see ST elevation on ECG rather than depression)

190
Q

DEXA criteria

A

0 or greater: good bone
0 to -1 BMD in top 84%, no evidence of osteoporosis
-1 to -2.5 osteopenia
-2.5 or worse osteoporosis

191
Q

Pruritis after a hot bath suggests

A

polycythaemia

192
Q

Faecolith

A

calcified stone of faeces

193
Q

Which type of melanoma is more common in non-whites?

A

Acral lentiginous (5% of melanomas)

194
Q

What is a common site of metastasis in melanoma

A

Liver

195
Q

Surveillance of AAA every 1 years is done for

every 3 months is done for

A
  • > 3-4.5cm

- > 4.5-5.5cm

196
Q

How does the clotting screen change in haemolytic uraemic syndrome?

A

Stays the same ie its normal

197
Q

How does the clotting profile change in DIC?

A

Decreased platelets
Decreased Hb
Decreased fibrinogen
Increased APTT/PT

198
Q

What condition is suggested by an ejection systolic murmur that decreases on squatting and increases on valsalva manoeuvre

A

HOCM

199
Q

Heinz bodies seen on smear of

A

G6PD deficiency

- cause of hereditary haemolytic anaemia

200
Q

In MAHA/HUS what is seen on blood film

A

schistocytosis

reticulocytosis

201
Q

tear drop poikilocyte red cells

A

myelofibrosis

202
Q

3 tests to do in acute left ventricular failure

A

ABG
Troponin
BNP

203
Q

Colchicine is given for

A 
recurrent pericarditis
along with
- NSAIDs + PPIS
- immunosuppressants
- steroids
204
Q

Clostridia perfringens

A

Causes gas gangrene

205
Q

Crepitus

A

Crackling sound due to air trapped in tissue, can get in gas gangrene

206
Q

Stoke adams attack

A

Syncope caused by ventricular assystole

207
Q

Canon a waves

A

seen in jugular vein
happen when atria and ventricles contract simultaneously
can be seen in complete heart block along with slow, large vol pulse

208
Q

Radiofemoral delay

A

Aortic coarctation distal to left subclavian artery

209
Q

Leriche syndrome

A

Absent/weak distal pulses
Buttock claudication
Impotence

210
Q

Grading system for PVD

A 
Fontaine classification
1 Asymptomatic
2 Intermittent claudication
3 Rest pain
4 Ulcers/gangrene
211
Q

Ebstein’s abnormality

A

Congenital abnormality of heart, displacement of septal and posterior tricuspid valve leaflets

212
Q

Shortened PR interval
Broad QRS complex
Slurred upstroke producing delta wave
suggests…

A

Wolff-Parkinson-White syndrome

213
Q

Which type of tachycardia is more common in females?

A

SVT

214
Q

Why do we only do carotid sinus massage in younger pts?

A

Can dislodge atherosclerotic plaques so cause older ppl stroke

215
Q

When would adenosine be contra-indicated?

A

Severe asthma

216
Q

Murmur on back, below left scapula, descending into abdomen

A

Aortic dissection

217
Q

Wide pulse pressure

A

Aortic dissection

Aortic regurgitation

218
Q

Pulsus alternans

A

Acute left ventricular failure

219
Q

Globally dilated, hypokinetic heart is seen on echo with which condition

A

dilated cardiomyopathy

220
Q

Cardiac tamponade signs

A

PULSUS PARADOXUS
Tachycardia
Becks triad (muffled heart sounds, hypotension, distended jugular vein)

221
Q

Kartagener’s syndrome

A

cause of bronchiectasis, immobile cilia, chronic sinusitis, infertility, situs invertus

222
Q

How big should a fibroadenoma be before its excised?

A

> 4cm

223
Q

Pattern of headache for CNS tumour

A

Worse in morning and lying down

224
Q

What is seen on double contrast barium enema in colorectal carcinoma?

A

Apple core strictures

225
Q

What can often be the first sign of gastric cancer?

A

Virchow’s node

226
Q

Sister Mary Joseph’s nodule

A

Indicates metastatic umbilical nodule eg due to gastric carcinoma

227
Q

Krukenberg’s tumour

A

Mets in ovaries, most commonly from gastric adenocarcinoma

228
Q

Keratoconjunctivitis sicca

A

Dry eyes

229
Q

SE of beta 2 adrenoceptor agonists eg salbutamol

A

hypokalaemia in high doses

230
Q

What causes gigantism?

A

excess GH secretion pre-puberty

231
Q

Octreotide + Cabergoline are used to treat which condition

A

Octreotide: SS analogue
Cabergoline: oral dopamine agonist
Acromegaly

232
Q

What happens in an addisonian crisis?

A

acute adrenal insufficiency
major haemodynamic collapse
precipitated by stress eg trauma or infection

233
Q

Electrolytes in addisonian crisis

A

raised urea
low Na
raised K
may be raised Ca

234
Q

Treating hypothyroid + adrenal insufficiency

A

give hydrocortisone before thyroxine

235
Q

Management of addisonian crisis

A

IV fluid resus
50mL bolus of 50% dextrose to treat hypoglycaemia
IV 200mg hydrocortisone bolus
followed by 6 hourly 100mg hydrocortisone until BP stable
Treat cause + monitor

236
Q

Definition of obesity wrt BMI

A

> 30kg/m2

237
Q

What drug can cause nephrogenic diabetes insipidous?

A

Lithium

238
Q

Enuresis is

A

bed wetting

239
Q

Dehydration signs

A

Dry mouth/mucous membranes
Tachycardia
Reduced skin turgor
Postural hypotension

240
Q

How do you treat mild diabetes insipidus?

A

Potentiate ADH so chlorpropamide or carbamazepine

241
Q

Nelsons syndrome

A

Locally aggressive pituitary tumour causing skin pigmentation due to ACTH secretion

242
Q

What is hyperchloraemic acidosis?

A

Happens in primary hyperparathyroidism
Normal anion gap
High PTH inhibits bicarbonate reabsorption in kidneys

243
Q

How can you distinguish familial hypocalciuric hypercalcaemia from primary hyperPTH?

A

Check urine Ca:creatinine ratio

244
Q

Dyspareunia

A

painful sex

245
Q

Eunuchoid

A

Long legs, arm span > height

246
Q

Kallman’s syndrome

A

Deficiency of GnRH

Key symptom: anosmia

247
Q

Lawrence moon biedel causes what…and features are

A 
hypogonadism in males
obesity
polydactyly
learning difficulties
retinitis pigmentosa
248
Q

Klinefelter’s syndrome

A 
Tall stature 
Lack of secondary characteristics 
Gynaecomastia 
Lower IQ than siblings
Small testes/infertility
249
Q

Signs of pituitary apoplexy

A

Signs of hypopituitarism

  • headache
  • visual loss
  • cranial nerve palsies
250
Q

Causative organism for syphilis

A

Treponema pallidum

251
Q

Signs of myxoedema coma

A 
Hypoventilation
Hypothermia
Hyponatraemia
Confusion
Cardiac failure
Coma
252
Q

Sail sign on cxr indicates

A

left lower lobe collapse

253
Q

Golden s sign on cxr

A

Right upper lobe collapse

254
Q

Dilated loops of bowel on x-ray indicate

A

bowel obstruction

255
Q

pt with painful sensation on outer thigh, tingling or burning sensation at times. no PMHx/DHx/SHx

A

Meralgia paraesthetica

256
Q

Which clinical test is used to diagnose ankylosing spondylitis?

A

Schober’s test
Mark L5 at level of PSIS, mark 10cm above. Get pt to bend over, normally should make 15cm gap, if not -> reduced spinal flexion -> ankylosing spondylitis

257
Q

Schirmir’s test

A

Tear production in Sjogrens

258
Q

Buerger’s test

A

PVD

259
Q

Tensilon test

A

Myasthenia gravis

Administer short acting acetylcholinesterase inhibitor -> rapid improvement in muscle weakness

260
Q

5 Ps of pleuritic chest pain

A 
Pneumonia
Pneumothorax
Pericarditis
PE
Pleurisy

Otherwise
Fractured rib
Costochondritis
Sub-phrenic pathology

261
Q

Jelly like stools or mucoid?

A

Salmonella infection or villous polyps in colon

262
Q

Foul smelling and floating stools

A

Malabsorption eg coeliac
Biliary insufficiency eg cholecystectomy
Pancreatic problem eg cancer, duct obstruction, CF

263
Q

Hirschsprung’s disease

A

Chronic constipation due to lack of ganglion cells in myenteric plexus. Affects children.

264
Q

Left axillary nodule

A

Irish node

Can be felt in gastric cancer

265
Q

Fox’s sign

A

Brusing in abdomen over inguinal ligament, acute haemorrhagic pancreatitis

266
Q

Haemorrhoids

A

Painless PR bleeding/perianal pain + mass in area. Mucus discharge. Blood in pan.

267
Q

Risk factors for anal abscess

A

Anal fistulae
Crohn’s

Need to surgically drain abscess + antibiotics if elderly/diabetic

268
Q

Treatment options for haemorrhoids

A 
Fibre
Ligation
Photocoagulation 
Sclerotherapy 
Surgical haemorrhoidectomy
269
Q

Most common cause of hypothyroidism worldwide

A

Iodine deficiency

270
Q

Anti-spasmodics

A

Peppermint oil

Dicycloverine

271
Q

Opiate overdose treatment

A

Naloxone

272
Q

A 70 year old woman has seen her GP for depression on several occasions. She now complains of abdominal pain, constipation & thirst

A

“Stones, bones, abdominal groans + psychiatric moans”

273
Q

A 30 year old male intravenous drug user with a history of tuberculosis develops profuse watery diarrhoea with no abdominal pain.

A

Cryptosporidium
think ‘HIV/immunocompromised/T cell deficient ppl’ + watery diarrhoea
can be painless
otherwise: crampy abdo pain for 7+days

274
Q

If pt with infection due to food poisoning type problem, and vomiting main symptom, suspect which organisms

A

Staph aureus
Bacillus cereus
Norovirus

275
Q

What should you check in chronic pancreatitis?

A

Has pt become diabetic?

276
Q

When to suspect villous adenoma

A

Villous adenomas secrete large amounts of mucus and result in hypokalaemia.
+ watery diarrhoea

277
Q

Colles vs smith’s fracture

A

osteoporosis
both falling on hands but colles is outstretched so fracture radius out
smith’s is inward fracture

278
Q

Severe pain when hip is flexed and externally rotated suggests

A

NOF fracture

Osteoporosis

279
Q

Osteoporosis circumscripta

A

Areas of osteolysis in frontal and occipital lobe seen on radiographs in pagets

280
Q

acthanthosis nigricans in women can be a sign of

A

PCOS

-> velvet thickening + increased pigmentation in skin folds

281
Q

Signs of hypokalaemia

A

Muscle weakness
Tetany
Paraesthesia
Polyuria/polydypsia -> Nephrogenic DI

282
Q

Two confirmatory tests for primary hyperaldosteronism

A

Salt loading

Postural test

283
Q

TRH can stimulate release of which other pituitary hormone

A

Prolactin

so check TFTs in hyperprolactinaemia, ie hypothyroid -> raised TRH -> raised prolactin

284
Q

Test for suspected SAH

A

CT head looking for blood in CSF if <6hrs

If 12hrs-12days post do LP looking for xanthochromia

285
Q

Difference between TIAs/strokes and epilepsy

A

TIAs/Strokes are LACK of blood so LACK of function -> negative symptoms ie things STOP working -> lose sight, muscle power, sensation
Epilepsy -> GAIN of function symptoms -> flashing lights, muscle convulsions, odd sensations in the skin

286
Q

Pt with recurring episodes of shimmering lights, noises, zigzag lines, last half an hour at time, no PMHx etc

A

Migraine aura WITHOUT headache

287
Q

Main causes of SAH

A

Aneurysm rupture (berry)
Trauma
Arteriovenous malformations, rupture of hemangiomas, rupture of cerebral vein around brainstem

288
Q

Neurofibromatosis type II predisposed to

A

meningiomas

schwannomas

289
Q

Where to find place to do LP and what landmarks?

A

Spinal cord ends around L1/2
So do below L4
Tuffier’s line: line between PSIS(s) at L4/5 space

290
Q

Structures transversed during LP

A 
Skin
Subcutaneous tissue
Supraspinous ligament 
Interspinous ligament 
Ligamentum flavum 
Dura mater 
Arachnoid space
291
Q

Subtotal villous atrophy with crypt hyperplasia

A

Coeliac disease

292
Q

Ziehl-Neelsen stain

A

Used in TB sputum sample for acid fast bacilli

293
Q

Magnesium ammonium phosphate

A

Struvite (type of renal stone)

294
Q

Reflex in response to raised ICP

A

Cushing’s reflex -> triad
High BP
Bradycardia
Irregular breathing

295
Q

Kussmaul sign

A

Paradoxical rise in JVP on inspiration, indicates right ventricular filling defect eg constrictive pericarditis, restrictive cardiomyopathy

296
Q

Triad seen in cardiac tamponade

A

Beck’s triad

  • raised JVP
  • muffled heart sounds
  • hypotension
297
Q

Charcot’s triad

A

Ascending cholangitis

  • right upper quadrant pain
  • jaundice
  • fever
298
Q

Embryo sign on AXR

A

caecal bowel obstruction

299
Q

DR PITHS

A 
causes of oncholysis 
Drugs eg tetracyclines, oral contraceptive pill, diabetic drugs
Reactive arthritis, Rieter's syndrome
Psoriasis 
Infection
Trauma 
Hyper+Hypothyroidism
Sarcoidosis, scleroderma
300
Q

Damage to Wernicke’s area

A

Area for speech understanding, pt cannot understand language, but can produce fluent but nonsensical speech

301
Q

Damage to Broca’s area

A

Intact understanding but can’t produce speech

302
Q

Arcuate fasciculus lesion

A

Connects wercicke’s + broca’s area -> intact language comprehension + speech production but poor repetition

303
Q

Severe hyperkalaemia is treated…

A

10mL 10% calcium gluconate

304
Q

Aortic and Pulmonary Regurgitation

A

EARLY DIASTOLIC MURMURS

305
Q

Mitral and Tricuspid Stenosis

A

Mid-diastolic murmurs

306
Q

H pylori tests

A
  1. Urea breath test, look for CO2 in breath 10-30mins later, urea cleaved by urease produced by H pylori
  2. Blood antibody test
  3. Stool antibody test
  4. Rapid urease/campylobacter like organism test
307
Q

HLA-B27 allele

A

Ankylosing spondylitis

308
Q

What can cause central pontine myelinolysis?

A

Rapid correction of hyponatraemia
Quadriparesis
Respiratory arrest
Fits

309
Q

What can cause central pontine myelinolysis?

A

Rapid correction of hyponatraemia (50% mortality)
Quadriparesis
Respiratory arrest
Fits

310
Q

Coeliac causes malabsorption of which minerals

A

Fat soluble: A, D, E, K

311
Q

HYPERKALAEMIA can cause on ECG

A

tall tented T waves

312
Q

Hypokalaemia on ECG

A

flattened T waves, prominent U waves

313
Q

Charcot’s joints

A

Severe neuropathic arthropathy

314
Q

Diabetic amyotrophy

A

More common in elderly untreated pts
Painful proximal motor neuropathy
Lower limbs
weakness + wasting of thigh muscles

315
Q

Treatment for hep C

A

Peginterferon

Ribavirin

316
Q

Auer rods

A

Cytoplasmic inclusions in myeloid blast cells -> acute myeloid leukaemia

317
Q

Sternberg-Reed cells

A

Hogkin’s lymphoma

318
Q

In Hogkin’s lymphoma what can happen to the mass after drinking alcohol

A

Mass can become painful

319
Q

Bell’s phenomenon

A

Eye balls roll up but eye remains open when try to close the eye

320
Q

Classification for depression

A

DSM-IV

321
Q

Conjunctival injection

A

Dilation of the blood vessels in conjunctiva

322
Q

Drugs that make GORD worse

A

Damage the mucosa: NSAIDs, aspirin, steroids, bisphosphonate

Affect oesophageal motility: TCAs, nitrates, anti-cholingerics

323
Q

Slurred upstroke of QRS complex and short PR interval

A

AVRT, eg bundle of kent in wolff parkinson white syndrome

324
Q

Oxygen therapy for COPD pts

A 
PaO2 <7.3kPa despite max treatment 
OR
PaO2 7.3-8kPa + one of
pul HTN
peripheral oedema 
polycythaemia 
nocturnal hypoxia
palliative
325
Q

Hypopyon

A

Exudate + inflammatory cells in inferior angle of anterior chamber

326
Q

Sympathetic Ophthalmia

A

Inflammation in contralateral eye weeks or months after penetrating injury to original eye (due to T cell response to eye antigens)

327
Q

Herpetic whitlow

A

abscess at end of finger as result of HSV1 infection

328
Q

Herpes labialis

A

reactivation of HSV-1 (ie oral herpes, cold sores)

329
Q

Dendritic ulcer on iris with fluorescein stain

A

HSV keratoconjunctivation

330
Q

Maculopapular rash occurring in dermatomal distribution

A

shingles

331
Q

Zoster ophthalmicus

A

rash in the ophthalmic division of the trigeminal nerve

332
Q

Ramsay hunt syndrome

A 
reactivation of HSV (ie shingles) in geniculate ganglion
triad:
vesicles behind pinna or in ear canal
lmn facial nerve palsy
loss of taste ant 2/3 tongue
333
Q

Stoke-Adams attack

A

Transient loss of consciousness due to cardiac arrhythmia eg bradycardia due to complete heart block. pt out for couple of seconds, flushed upon recovery.

334
Q

What systemic diseases is pyoderma gangrenous associated with?

A

IBD, Sarcoidosis, Behcet’s

335
Q

Associations of pyoderma gangrenosum

A 
IBD
Autoimmune hepatitis 
Granulomatosis with polyangiitis 
Myeloma 
Neoplasm
336
Q

Signs of malabsorption

A

Dry skin
Leukonychia
Easy bruising
Hair loss

337
Q

Haematological SE of methotrexate

A

Megoblastic macrocytic anaemia

dihydrofolate reductase inhibitor

338
Q

4 signs of pernicious anaemia

A

mild jaundice
weight loss
angular stomatitis
glossitis

339
Q

Why would pregnant women take folic acid supplements?

A

Lack of folate can cause neural tube defects

340
Q

Sideroblastic anaemia

A

abnormal haem synthesis, microcytic anaemia (can be primary/secondary)

341
Q

What anaemia can cause glossitis and angular stomatitis?

A

Pernicious anaemia

Iron deficiency anaemia

342
Q

Scoring system for predicting stroke after TIA

A

ABCD2 (score of 4+ needs TIA clinic within 48hrs)
Age >60 (1)
BP >140/90 (1)
Clinical features (1) speech disturbance no weakness (2) unilateral weakness
Duration of symptoms (1) 10-59mins, (2) >60mins
Diabetes

343
Q

MRC scale for power

A

5: Normal power
4: Can move limb against gravity and a bit against resistance
3: Can move limb against gravity
2: Movement if gravity eliminated
1: Flicker in muscle
0: No movement

344
Q

Charcot bouchard microaneurysm

A

Aneurysms in brain in small vessels, can rupture and cause haemorrhagic stroke

345
Q

Mid-systolic click

A

Mitral valve prolapse

346
Q

Lichenification

A

Chronic itching

347
Q

Which type of eczema is a medical emergency?

A

Eczema herpeticum

348
Q

Two types of contact dermatitis

A

Allergic

Irritant

349
Q

Define eczema

A

Pruritic papulovesicular skin reaction to endogenous and exogenous agents

350
Q

What type of eczema mainly affects the hands and feet

A

Pompholyx

351
Q

Panniculitis

A

Inflammation of sub-cut fat tissue

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