Mock 2 Flashcards
What is the CHADS VASc score used for?
Assessing stroke risk and anticoagulation need in AF patients
Which parameter isn’t in the scoring system used to calculate the stroke risk in patients with Atrial Fibrillation? A. Age B. Blood Pressure C. Congestive Heart Failure D. Diabetes E. Family History
Family History
What is an irregularly irregular pulse seen in?
AF
What is pulses paradoxus?
When the BP drops significantly during inspiration
What is radio-radial delay?
Where pulse is significantly stronger in one arm than the other
What condition is radio-radial delay seen in?
Coarctation of the aorta
What produces early diastolic decrescendo murmur?
Aortic regurgitation
What produces ejection systolic crescendo murmur heard loudest on expiration?
Aortic stenosis
What causes pan systolic murmur?
Mitral regurgitation
What causes mid-diastolic murmur?
Mitral stenosis
What causes an ejection systolic murmur heart loudest on inspiration?
Pulmonary stenosis
What are the 3 cardinal signs of HF?
- SOB
- Fatigue
- Ankle oedema
What does an R wave resemble on an ECG?
An M
What does a slurred S wave resemble on an ECG?
A W
What are the 6 Ps of critical ischaemia?
Pain Pallor Paralysis Paraesthesia Perishingly cold Pulselessness
What are the 4 features of teratology of fallow?
- RVH
- VSD
- Overriding aorta
- Stenosis of pulmonary outflow track
Think of the VSD overloading the already narrow Pulmonary outflow tract- which causes RVH
What is stage 1 clinical HTN?
More than 140/90
What is stage 2 clinical HTN?
More than 160/100
What is severe HTN?
More than 180/100
Give 5 signs of infective endocarditis
- Splinter haemorrhages
- Osler’s nodes
- Janeway lesions
- Roth spots
- Fever
What are xanthelasma?
Cholesterol deposits around the eyes
What usually presents with pale smelly stools that are hard to flush away?
Coeliac disease
What presents with generalised abdominal pain which gets better after passing wind/defecation and bloating + change in bowel habit?
IBS - A type of functional bowel disorder
What side of the abdomen does crohns pain usually present with?
Right side (cRohns)
What presents with RS abdomen pain, bloody stools, mouth ulcers?
Crohns
Where would you get abdominal pain in UC?
LLQ
What behaviours increase the likelihood of developing a Mallory-Weiss tear?
Retching and vomiting
A 35 year-old-male comes to the A&E department because he has been vomiting blood. He said he had been having some abdominal pain, feeling very nauseous and had been retching several times a day before finally vomiting this morning and it had blood in it. He hasn’t noticed any weight loss, fevers or any other systemic symptoms. He drinks 2/3 pints every evening and has been eating/drinking as normal. He doesn’t take any prescribed or over the counter medication. What is the most likely diagnosis?
A. Peptic ulcer rupture
B. Oesophagealmalignancy
C. Gastroesophagealrefluxdisease D. Achalasia
E. Mallory Weiss tear
Mallory Weiss tear
What is sulfasalazine used to treat?
UC and Crohns
What is omeprazole?
A PPI
What is a first line medication for GORD?
PPI e.g. omeprazole
What is ranitidine?
A H2 antagonist
Give 4 causes of peptic ulcers
H.pylori
Increased acid production
NSAID use
Mucosal ischaemia
What could present with middle/upper abdominal pain, vomiting, constipation and bloating?
Small bowel obstruction
HINT - Previous surgery causing adhesions
How do you treat H.Pylori infection?
REMEMBER WITH CAP
TRIPLE THERAPY OF:
Clarithromycin/Metronidazole
Amoxicillin
PPI e.g. omeprazole/lansoprazole
Give 4 risk factors for developing GORD
Obesity
Hiatus hernia
Smoking
Pregnancy
What is the first line investigation in large bowel obstruction?
Abdominal X-Ray
What is a potential diagnosis for left iliac fossa mass, abdominal pain, bloating and constipation?
Large bowel obstruction
What is achalasia?
The LOS doesn’t open in swallowing causing a backup of food in the oesophagus
Give 3 consequences of untreated GORD
Barretts oesophagus
Oesophagitis
Oesophageal ulcers
How do duodenal ulcers present?
They cause pain several hours after eating- pain gets better after eating
Why do people with duodenal ulcers get pain hours after eating?
Stomach acid in the duodenum
Which has a stronger genetic link, Crohns or UC?
Crohns
Which sex is affected more in Crohns and UC?
UC is 50/50
Crohns - females affected more
What is dermatitis herpetiformis?
The dermatological manifestation of coeliac disease - often seen as a rash on extensor surfaces e.g. elbow
What is the first line treatment for coeliac?
Gluten free diet
Give 4 risk factors for oesophageal cancer
Achalasia - due to increase in vomiting
Alcohol
Obesity
Smoking
What is the gold standard investigation in bowel cancer?
Colonoscopy
Where is colon cancer most likely to be seen?
Distal colon
Why is it easier to detect distal colon cancer?
The closer the cancer is to the outside of the body the more visible the blood and mucus is
Pt presents with umbilical pain that has migrated to RIF- with fever and vomiting - diagnosis?
Appendicitis
Straining to go to the toilet and blood when wiping - no weight loss - diagnosis?
Haemorrhoids - straining loosens and bulks the spongy vascular tissue
What would you see when doing a blood test in a Crohns patient?
- Anaemia due to iron and folate deficiency
2. Raised ESR and CRP
What is the most common cause of AKIs?
Acute tubular necrosis
How can prostatic hyperplasia cause post-renal AKI?
It increases intra-tubular pressure, which decreases GFR - Causing rising urea and creatinine serum levels
Give 4 risk factors of CKD
Diabetes
FHx
Increasing age
Recurrent UTIs
Does pregnancy increase the risk of CKD?
No - but CKD increases the risk of pregnancy complications
What is the most common causative organism in pyelonephritis ?
E-coli
What is the best investigation to use in the management of pyelonephritis?
Midstream urine microscopy, culture and sensitivity
What is the first line treatment for UTIs in pregnancy?
Nitrofuratoin
Why is trimethoprim contraindicated in treating UTIs and pregnancy?
It inhibits folate synthesis
What is Charcot’s triad?
Fever, RUQ pain and jaundice
What is reiter’s syndrome?
Also known as reactive arthritis:
Conjunctivitis
Urethritis
Arthritis
Describe how PKD is usually passed on
Autosomal dominant
Give 4 complications of PKD
Cardiovascular disease
Kidney stones
Polycystic liver disease
Berry aneurysms leading to SAH
How do you differentiate between Hodgkin and Non-Hodgkin lymphoma?
HL has Reed-Sternberg cells
How do you differentiate acute myeloid leukaemia from other leukemias?
Auer rods are seen histologically In AML
Is the progesterone only pill a risk factor for DVT?
No- NICE actually recommends it for DVT risk women over the OCP
What is the immediate treatment for thrombotic thrombocytopenic purpura?
Plasma exchange ASAP
THIS IS A MEDICAL EMERGENCY DO NOT CONFIRM DIAGNOSIS FIRST
What should you NOT give in TTP?
Platelets
What score is used to asses for DVT?
DVT Wells score
When should suspected DVT lead to same day assessment and management?
A woman who is pregnant/ has given birth in the past 6 weeks
What score estimates major bleeding risk in patients on anticoagulants for AF?
HAS-BLED score
What score is used to calculate stroke/MI risk in the next 10 years?
QRISK
What is the treatment for a DVT?
LMWH and Oral anticoagulant e.g. warfarin
What is the first line treatment for severe/complicated malaria?
IV Artesunate
What is ferritin?
A protein that STORES iron - it is usually found in cells
What is transferrin?
A protein that combines with ferritin to transport iron i.e. a taxi for iron
What is the treatment for uncomplicated malaria?
Oral chloroquinine
What is hyperplasia?
Increased size of tissue due to an increase in the number of cells
What is hypertrophy?
Increased tissue size due to increase in constituent cell size
What is a granuloma?
An aggregate of epithelioid histiocytes
What is the definition of granulation tissue?
New connective tissue with microscopic blood vessels forming on a wound surface
What is Barretts oesophagus?
Metaplasia of stratified squamous cells to simple columnar cells in the distal oesophagus -usually as a result of GORD
What cancers spread to bone?
The 5 B's Brain Bronchus Byroid Bidney Brostate
What is the treatment for paracetamol overdose?
N-acetyl cystine
What is Horner’s syndrome?
A neurological condition characterised by unilateral loss of sweating, dilated pupil and drooping eyelid
What could be the diagnosis of somebody with raised ANA, anti-dsDNA and antiphospholipids?
Lupus
What is the first line treatment for alcohol/ drug withdrawal seizure?
Chlordiazepoxide
What is methadone used for?
Heroin addiction
What is Wernicke’s Encephalopathy caused by?
Vitamin B1/Thiamine deficiency in the brain of chronic alcoholics
What is a side effect of bisphosphonates?
Oesophagitis
What is sjorgen’s syndrome?
The immune destruction of exocrine glands presenting with arthritis, dry eyes and dry mouth
What is the test for sjorgen’s syndrome?
Schirmer’s test
What is the first line management of ankylosing spondylitis?
Ibuprofen
Knee/one joint affected pain with fever- diagnosis?
Pseudogout - often presents with mono arthritis of the knee
What is the first line treatment for gout?
Colchine or ibuprofen
What does a T score of -1 - -2.5 suggest?
Osteopenia
What does a T score of under -2.5 suggest?
Osteoporosis
What is osteomalacia?
The adult version of rickets - softening of bones due to vitamin D/ Calcium deficiency
What should a patient who has had their first seizure be offered on discharge?
Sodium valproate
What is intention tremor seen in?
Huntingtons disease
What is resting tremor seen in?
Parkinsons - it stabilises upon active movement of the body part
What is the first line treatment for giant cell arteritis?
Oral steroids
How does cauda equina syndrome present?
Inability to open bowels/urinate
Reduced anal tone
Saddle anaesthesia
Within what time frame should ischaemic stroke patients receive alteplase treatment after symptom onset?
Within 4.5 hours
What is the most common infective cause of COPD exacerbation?
Haemophilius influenzae
Give a sign of a life threatening asthma attack
SpO2 < 92%
What asthma medication is known to cause tachycardia and resting tremor?
Salbutamol inhaler