Mixed specialites Flashcards
1
Q
How many days after conception would an over the counter urinary pregnancy test become positive?
A
9
2
Q
What is the condition that causes cataracts, muscle weakness and frontal balding?
A
Myotonic dystrophy
3
Q
What does an FEV1/FVC ratio of less <70% represent?
A
Obstructive disease
4
Q
What is hemiballismus
A
Involuntary flinging motions of the extremities
5
Q
What is chorea?
A
Involuntary, irregular random and flowing movements which flit from one part of the body to another.
6
Q
How long does a man have to wait before he can drive again after an STEMI
A
1 month
7
Q
How long does a man have to wait before resuming sexual intercourse?
and what about working?
A
1 month
and
2 months
8
Q
What is sick euthyroid syndrome (SES)?
A
Low T3/T4 and normal TSH with acute illness.
9
Q
What electrolyte abnormality can you find in addisons disease
A
Hyponatraemia and hyperkalaemia
10
Q
Secondary prevention following an ischaemic stroke
A
Clopidogrel + statin
11
Q
How is impaired fasting glucose diagnosed
A
Greater than or equal to 6.1 but less than 7.0 mmol/L.
12
Q
Difference between MODY and DM
A
C peptide is low in DM.
13
Q
During acute illness, how would you change the dose of steroids in addisons pt
A
Double the glucocorticoids (hydrocortisone) and keep fludrocortisone dose the same.
14
Q
What kind of drug is memantine
A
NMDA receptor antagonist
15
Q
nerve root vibes
A
S1-S2 (1-2 buckle my shoe) - Ankle
L3-L4 (3 -4 kick the door) - Knee
C5-C6 (5-6 pick up the stick) - biceps
C7-C8 (7-8 close the gate) - tricep
16
Q
What vessel gets damaged in a subdural haemorrhage?
A
Subdural haemorrhage results from bleeding of damaged bridging veins between the cortex and venous sinuses
17
Q
What vessel gets damaged in epidural haemorrhage?
A
Middle meningeal
18
Q
What medications cause gingival hyperplasia?
A
Phenytoin, ciclosporin, CCB and AML
19
Q
What organism causes BV?
A
Gardnerella vaginalis
20
Q
How do you treat Bell’s palsy?
A
Oral prednisolone
21
Q
What is the first line management of type 2 DM in patients with a high risk of CVD or chronic HF
A
Metformin and then once established add: SGLT-2 inhibitor (dapagliflozcin)
22
Q
Switching from oral morphine to parenteral morphine dose conversion
A
The equivalent parenteral dose of morphine (subcutaneous, intramuscular, or intravenous) is about half of the oral dose. If the patient becomes unable to swallow, generally morphine is administered as a continuous subcutaneous infusion
23
Q
How are genital warts treated?
A
Topical podophyllum or cryotherapy.
24
Q
How do sulfonylureas work?
A
Gliclazide:
Bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells
25
How do you treat mastitis during breast feeding?
Fluclox
26
Name the 3 cardinal signs of Parkinson's disease?
Resting tremor, bradykinesia and rigidity
27
Features of minimal change disease:
- Nephrotic syndrome: hypoalbuminaemia and proteinuria
- Normotension
- Highly selective proteinuria
28
What are the features of an acute haemolytic reaction?
Fever, abdominal pain and hypotension.
29
What are the features of transfusion-associated circulatory overload?
TACO
Pulmonary odema, hypertension
30
Transfusion-related acute lung injury (TRALI)
A rare but potentially fatal complication of blood transfusion. Characterised by the development of hypoxaemia / acute respiratory distress syndrome within 6 hours of transfusion.
Features include:
hypoxia
pulmonary infiltrates on chest x-ray
fever
hypotension
31
How many doses of tetanus vaccine generally confers life-long protection?
5 doses of tetanus vaccine
32
What is the first line management for polycythaemia vera?
Venesection/phlebotomy is the first-line treatment in polycythaemia vera to keep the haemoglobin in normal range.
33
What condition do you find a narrow pulse pressure and slow rising pulse in?
Aortic stenosis
34
What condition do you find a collapsing pulse in?
Aortic regurgitation
35
Which valve is most commonly affected in IVDU users?
Tricuspid valve - infective endocarditis in IVDU most commonly affects Tricuspid valve
36
Do platonic soulmates exist?
Yes, for confirmation please meet Sreya and Subo
37
What is the most common cause of infective endocartitis?
Staph aureus
38
What medication is used as prophylaxis for contacts of patients with meningococcal meningitis?
Oral ciprofloxacin
39
Other than antibiotics what other meds are associated with c diff?
PPIs
40
What organism causes a chancroid?
Haemophilus ducreyi -Chancroid is a tropical disease caused by Haemophilus ducreyi. It causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
41
What is the second line therapy for controlling BP if ACE inhibitor is not enough - in under 55 yo
CCB or Thiazide-like diuretic (indapamide)
42
Air crescent sign
Aspergilloma
43
What is aspergilloma
An aspergilloma is a mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to tuberculosis, lung cancer or cystic fibrosis).
44
Features of idiopathic pulmonary fibrosis
Features:
progressive exertional dyspnoea
bibasal fine end-inspiratory crepitations on auscultation
dry cough
clubbing
45
Explain the dexamethasone suppression test
Low dose dexamethasone test 1 mcg: Used to diagnose
46
How do you treat severe campylobacter
Clarithromycin
47
How do you treat gonorrhoea?
IM ceftriaxone 1g is the treatment of choice for gonorrhoea.
48
If Angina is not controlled with a beta blocker, what medication would you use?
dihydropyridine calcium channel blocker should be added
49
Hypocalcaemia is an indication that kidney disease is chronic and not acute.
Chronic renal failure can lead to impaired conversion of 25-hydroxyvitamin D to its active form, which is needed for intestinal calcium absorption. This makes hypocalcaemia a marker that suggests the kidney disease is chronic and not acute, as an acute kidney injury is not associated with hypocalcaemia.
50
BMI range and classification
BMI Old classification NICE classification
< 18.5 Underweight Underweight
18.5 - 24.9 Normal Normal
25 - 29.9 Overweight Overweight
30 - 34.9 Obese Obese I
35 - 39.9 Clinically obese Obese II
> 40 Morbidly obese Obese III
51
Features of Lyme disease
Early features (within 30 days)
erythema migrans
'bulls-eye' rash is typically at the site of the tick bite
typically develops 1-4 weeks after the initial bite but may present sooner
usually painless, more than 5 cm in diameter and slowlly increases in size
present in around 80% of patients.
systemic features
headache
lethargy
fever
arthralgia
52
Whats the first line pharmacological treatment for torsades de pointes
IV magnesium sulphate
53
What is donepazil contraindicated in?
Bradycardia
54
Mnemonic to remember live attenuated vaccines
MY BOO
MMR
YELLOW FEVER
BCG
Oral polio
Oral typhoid
55
What is the mechanism of action of buproprion?
Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist. Bupropion is an atypical antidepressant and smoking cessation aid. Its primary mechanism of action involves the inhibition of the reuptake of norepinephrine and dopamine, thereby increasing their synaptic concentrations. It also acts as a non-competitive antagonist of nicotinic acetylcholine receptors, which is thought to contribute to its efficacy in smoking cessation.
56
Provoked vs Unprovoked dvt management
GIVE BOTH DOAC for 3 months,
but continue for further 3 months (6 months) in unprovoked DVT (including cancer)
57
What condition would affect cause dysphagia affecting both solids and liquids from the start
Achalasia
58
What abx would you give for human bites
Co-amoxiclav
59
What causes a foot drop
Peroneal nerve lesion
60
Management of minimal change disease
Oral corticosteroids: majority of cases are steroid responsive
61
What are the features of a thyroid storm?
Fever > 38.5.
Abnormal LFTs - jaundice may be seen
Tachycardia
Confusion
nausea and vomitting
hypertension
Complication of thyrotoxicosis. Precipirating events are thyroid surgery, trauma, infection.
62
What is the first line management for thyroid storm?
Iv PROPRANOLOL.
63
Which medication is used to manage tremor in drug induced parkinsonism
Procyclidine
63
What is the first line treatment for COPD
SABA or SAMA
Ipratropium SAMA
SABA
64
Which parkinson's medication is associated with pulmonary fibrosis
Cabergoline
65
Which parkinson medication has reduced effectiveness with time?
Levodopa.
66
Side effects of Levodopa
Dry mouth, anorexia, palpitations, postural hypotension, psychosis.
67
What vaccination is contraindicated in hIV positive patients?
Live vaccines
MY BOO
MMR
YELLOW FEVER
BCG
oral polio
oral typhoid
68
What is peutz-Jeghers syndrome?
Peutz-Jeghers syndrome is an autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract. It is also associated with pigmented freckles on the lips, face, palms and soles.
69
What is the first line treatment for newly diagnosed asthma
SABA (short acting beta agonist)
70
Painless blurring of vision after cataract surgery?
Blurring of vision again years after cataract surgery can occur due to posterior capsule opacification
71
What tumour is calcitonin a marker of?
Medullary thyroid cancer
72
What is hyper acute transplant rejection due to?
Pre-existing antibodies against ABO or HLA antigens
73
ECG features of hypokalaemia
U waves
Small or absent T waves
Prolong PR interval
ST depression
Long QT
74
What STI presents as a painless ulcer known as chancre
Syphillus
75
Triad of shaken baby syndrome
Retinal haemorrhage, subdural haematoma and encephalopathy
76
What causes vit D deficiency in babies
Being exclusively breastfed
77
What is the most common congenital abnormality in Down’s syndrome
Atroventrivular septal defect
78
X linked recessive conditions transmission
No male to male transmission
79
What is Perthes disease
Avascular necrosis of the femoral head - progressive hip pain, limp and stiffness
80
How do you investigate reflux nephropathy?
Micturating cystography
81
What is a common endocrine complication of small cell lung cancer
SIADH
82
What are some features of Down's syndrome?
face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
flat occiput
single palmar crease, pronounced 'sandal gap' between big and first toe
hypotonia
congenital heart defects (40-50%, see below)
duodenal atresia
Hirschsprung's disease
83
What are some cardiac complications of Down's syndrome?
multiple cardiac problems may be present
endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)
ventricular septal defect (c. 30%)
secundum atrial septal defect (c. 10%)
tetralogy of Fallot (c. 5%)
isolated patent ductus arteriosus (c. 5%)
84
First line treatment for nocturnal enuresis?
Enuresis alarm is generally the first-line recommendation for nocturnal enuresis where general management advice has not helped and if the family are willing to try it. This is a device that detects the moisture of urine, which triggers the alarm (by sound or vibration) and wakes the child to go to the toilet. They have a high success rate when used consistently. A review will usually take place after 4 weeks to see if there has been any improvement.
85
Bone protection for patients started on long term steroid therapy
Start oral alendronate + ensure calcium and vitamin D replete. This is because the National Institute for Health and Care Excellence (NICE) guidelines in the UK recommend that patients over the age of 65 who are starting long-term corticosteroid therapy should be co-prescribed a bisphosphonate, such as alendronate, to prevent glucocorticoid-induced osteoporosis. In addition, ensuring adequate intake of calcium and vitamin D is important to support bone health.
86
What virus causes bronchiolitis?
Respiratory synctial virus
87
88
89
At what age is the neonatal blood spot screening test typically performed in the United Kingdom
The correct answer is Between fifth and ninth day of life. The neonatal blood spot screening test, also known as the 'heel prick' test, is typically performed between the fifth and ninth day of life in the United Kingdom. This timing allows for optimal detection of the five rare but serious health conditions that this test screens for: sickle cell disease, cystic fibrosis, congenital hypothyroidism, phenylketonuria (PKU), and medium-chain acyl-CoA dehydrogenase deficiency (MCADD). Performing the test within this timeframe ensures that any necessary treatment can be started as soon as possible while minimising the chance of false positive results.
89
How do you treat methanol poisoning?
Ethanol
89
How do you treat Digoxin poisoning?
Digoxin specific antibody fragment
89
What is transient synovitis?
Transient synovitis is sometimes referred to as irritable hip. It generally presents as acute hip pain following a recent viral infection. It is the commonest cause of hip pain in children. The typical age group is 3-8 years.
Features
limp/refusal to weight bear
groin or hip pain
a low-grade fever is present in a minority of patients
high fever should raise the suspicion of other causes such as septic arthritis
90
what is dactylitis
A 'sausage-shaped' digit is a classical description of dactylitis. It would be unusual for gout to affect the middle toe, the vast majority of cases occur in the first metatarsophalangeal joint.
91
Causes of jaundice in the first 24 hours of the newborn?
Causes of jaundice in the first 24 hrs
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
92
What medication causes frequent thyroid function abnormalities?
Amiodarone frequently causes abnormalities in thyroid function tests and may cause both hypothyroidism and hyperthyroidism.
93
Which heart failure medication does not improve mortality?
Furosemide
94
How does optic neuritis present?
Optic neuritis presents with subacute unilateral vision loss and retro-orbital pain that is worse on eye movements. Colour desaturation is also common. A relative afferent pupillary defect is a common examination finding.
95
How does anterior uveitis present?
Anterior uveitis causes a red, painful eye with blurred vision, photophobia, and watering of the eye. A red eye with an unreactive or distorted pupil would be evident on examination.
96
AF treatment guidelines
offer rate or rhythm control if the onset of the arrhythmia is less than 48 hours, and start rate control if it is more than 48 hours or is uncertain
97
What is Cholesteatoma?
Cholesteatoma is a non-cancerous growth of squamous epithelium that is 'trapped' within the skull base causing local destruction. It is most common in patients aged 10-20 years. Being born with a cleft palate increases the risk of cholesteatoma around 100 fold.
98
What is cataplexy?
The correct answer in this case is cataplexy. Cataplexy is a sudden and transient episode of muscle weakness, typically triggered by strong emotions such as laughter, anger or surprise. It is often associated with narcolepsy, a sleep disorder that causes excessive daytime sleepiness and fragmented night-time sleep. The patient's symptoms of leg weakness following bouts of laughter and brief collapse are characteristic of cataplexy.
99
What chemotherapy agent causes cardiotoxicity?
Doxorubicin is an anthracycline chemotherapeutic agent that is known to cause dose-dependent cardiotoxicity. This cardiotoxicity can manifest as congestive heart failure, which may explain the patient's increasing shortness of breath, third heart sound, and displaced apex beat. The risk of cardiotoxicity increases with higher cumulative doses of doxorubicin.
100
Vincristin side effect
Vincristine: Peripheral neuropathy (reversible) , paralytic ileus
Vinblastine: myelosuppression
101
Bleomycin side effects
Lung fibrosis
102
Impaired glucose tolerance test
Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
103
Glaucoma vs Uveitis
Red eye - glaucoma or uveitis?
glaucoma: severe pain, haloes, 'semi-dilated' pupil
uveitis: small, fixed oval pupil, ciliary flush
104
TIA management
A patient who presents to their GP within 7 days of a clinically suspected TIA should have 300mg aspirin immediately (and be referred for specialist review within 24h)
105
What is used for cluster headaches prophylaxis?
Verapamil
106
Gonorrhoea Tx
Intramuscular ceftriaxone is the first-line treatment for gonorrhoea. The patient would present with urethral discharge.
107
First line tx of trigeminal neuralgia
Carbamazepine
108
Antidote for Warfarin
The antidote for warfarin is vitamin K.
109
Antidote for dabigatran
The antidote for dabigatran is idarucizumab.
110
What chromosome does Huntington's disease affect?
Huntington's disease is due to a defect in the huntingtin gene on chromosome 4. H has 4 arms.
Autosomal dominant
111
Metoclopramide side effects
Adverse effects
extrapyramidal effects
acute dystonia e.g. oculogyric crisis
this is particularly a problem in children and young adults
diarrhoea
hyperprolactinaemia
tardive dyskinesia
parkinsonism
112
Erythema migrans
Erythema migrans is a red non-itchy rash that is classically associated with Lyme disease and develops a bulls eye appearance as it increases in size
113
What causes shingles?
Herpes zoster, also known as shingles, is caused by the reactivation of latent varicella-zoster virus (the same virus that causes chickenpox). It typically presents as a unilateral rash along a dermatome and would be an unusual cause for genital lesions unless it involves sacral dermatomes which is less common. Furthermore, Herpes zoster does not commonly present with systemic flu-like symptoms or dysuria.
114
How do you treat Trichomonas
oral metronidazole for 5-7 days, although the BNF also supports the use of a one-off dose of 2g metronidazole
115
How do differentiate between scleritis and episcleritis
Scleritis is painful, episcleritis is not painful
116
Difference between Graves's disease and Subacute (de quervens) thyroiditis.
De quervens is painful tender goitre.
117
How to diagnose optic neuritis
MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases
118
MSRA treatment
Nasal mupirocin + chlorhexidine for the skin.
119
How do you treat cellulitis for pen allergic patients
Clarithromycin Oral
120
Most common cause of IECOPD
Haemophilus influenze
121
Haemochromatosis monitoring
Ferritin and transferrin saturation
122
Stroke management secondary
Once an ischaemic stroke is confirmed the patient should be given aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily long-term. A statin should also be offered if the patient is not already on statin therapy.
123
Side effect of carbegoline
Pulmonary fibrosis
124
Pneumocystis jiroveci pneumonia (PJP) how to treat?
Pneumocystis jiroveci penumonia is treated with co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole
125
Which organism causes syphillus
Treponema pallidum.
126
What is most commonly associated with smoking during pregnancy
Increased risk of pre-term labour
127
What causes erythema nodosum?
Causes
infection
streptococci
tuberculosis
brucellosis
systemic disease
sarcoidosis
inflammatory bowel disease
Behcet's
malignancy/lymphoma
drugs
penicillins
sulphonamides
combined oral contraceptive pill
pregnancy
128
What is puerperal pyrexia?
Puerperal pyrexia may be defined as a temperature of > 38ºC in the first 14 days following delivery.
Causes:
endometritis: most common cause
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism
129
What is used to treat infertility in PCOS?
Clomifene
130
Breast cancer referral
The UK National Institute for Health and Care Excellence (NICE) guidelines recommend considering referral for genetic testing if there are close relatives diagnosed with breast cancer before the age of 40.
131
