Mock Paper Flashcards
Pharamacological Mx for pregnant woman with pre-existing diabetes?
Current guidelines for managing patients with pre-existing diabetes advise that metformin should be continued, but all other oral hypoglycaemic agents should be stopped and replaced with insulin such as isophane insulin. If patients are already established, and have good blood sugar control, on a long-acting analogue, such as insulin glargine, then this may continue.
Indication for pacemaker
Daytime pauses of more than __ seconds?? especially if symptomatic
Nocturnal pauses is not an indication.
Mx for Idiopathic intracranial hypertension?
Obese, morning headache, worse when straining on toilet or lifting heavy objects, papilooedema
Acetazolamide.
DMARD for psoriasis?
Methotrexate.
Ciclosporin is alternative.
If does not respond then for TNF antagonist. Infliximab.
Mx for BPH?
First line: Alpha blockers
- Doxazosin
- Tamsulosin
- Alfuzosin
Over longer term, 5 alpha reductase inhibitor can be added to reduce prostate size. (Finasteride)
Abx for ESBL producing E.Coli?
Fosfomycin.
McArdle’s disease?
Glycogen storage disease type 5.
Aerobic or weight lifting exercise leads to rhabdomyolysis and dark urine due to myoglobinuria.
Metabolic abnormality seen in ethylene glycol poisoning?
Metabolic acidosis with raised anion gap.
Fomipezole is main antidote.
Other causes of metabolic acidosis with raised anion gap is ketoacidosis and lactic acidosis.
Types of cholesterol diseases?
Familial hypercholesterolaemia (FH) is inherited in an autosomal dominant fashion.
Patients still have significantly raised low-density lipoprotein (LDL) cholesterol levels and are at risk of atherosclerotic disease and, therefore, will require treatment.
Criteria for a definitive diagnosis of FH are total cholesterol greater than 7.5 mmol/l or LDL cholesterol level of greater than 4.9 mmol/l, alongside either tendon xanthomas in the patient or in first-/second-degree relatives or DNA evidence of a genetic defect.
Abetalipoproteinaemia condition associated with low levels of cholesterol.
Familial combined hyperlipidaemia both cholesterol and triglyceride levels are raised.
Maintenance medication for Crohn’s disease?
Azathioprine is first line.
Mercaptopurine.
Mx for TOxoplasmosis?
Cerebral toxoplasmosis accounts for around 50% of cerebral lesions in patients with HIV.
constitutional symptoms, headache, confusion, drowsiness.
CT: usually single or multiple ring-enhancing lesions, mass effect may be seen.
Mx:
Pyrimethamine plus sulphadiazine for at least 6 weeks.
Immunosuppressed patients may also develop a chorioretinitis secondary to toxoplasmosis..
Treatment for HUS?
Plasma Exchange.
Mx for aspirin overdose?
- Activated charcoal if presents within first hour.
- Urinary alkalinization with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine.
- Haemodialysis
Mx for hidradenitis suppurativa?
Topical Clindaymicin and PO Doxycycline.
Hidradenitis suppurativa (HS), also called acne inversa, is a chronic inflammatory skin condition that affects apocrine gland-bearing skin in the axillae, groin, and under the breasts. It is characterised by persistent or recurrent boil-like nodules and abscesses that culminate in a purulent discharge, sinuses, and scarring.
Diabetes medication that can reduce recurrence of renal stones?
SGLT 2.
Types of lung cancer typical location?
Small cell lung cancer:
Central location
Squamous cell lung cancer:
Typically central
Bronchial carcinoid:
Single intrabronchial lesion.
Usually found in younger patients.
Not associated with smoking.
Tend to present with pneumonia due to bronchial obstruction or with haemopytsis.
Adenocarcinoma:
Typically peripheral
most common type of lung cancer in non-smokers
Large cell lung carcinoma:
Typically peripheral
anaplastic, poorly differentiated tumours with a poor prognosis
Bacilius cereus food poisoning
Under-cooked or reheated rice is most classically associated with B. cereus.
Symptoms of non bloody diarrhoea and vomiting.
Incubation period is only a few hours.
Absence of fever and abdominal pain.
Shigella
Dysentry causing bloody diarrhoea.
Abdominal pain and fever typically present.
Incubation period tends to be days.
Typically affects travellers.
Camplyobacter
Typically from undercooked poultry.
Incubation period 2 - 4 days.
E.coli
Common cause of traveller’s diarrhoea.
Incubation period of days.
Giardia lamblia
Usually history of foreign travel or drinking untreated water from lakes.
- Bloating, excessive flatulence, steatorrhea, weight loss and symptoms of malabsorption.
Tx: Metronidazole.
Interpreting fertility tests.
PCOS - Hyperandrogenism with a raised testosterone level.
Pregnancy - Prolactin level would be high between 1700 to 8500. During pregnancy LH and FSH are also suppressed.
Premature ovarian failure - Menopausal symptoms before the age of 40.
Prolactinoma - Expect very high prolactin levels which may cause suppression of FSH and LH. Headache and bitemporal hemianopia may also be present.
Congenital adrenal hyperplasia - Raised 17-hydroxyprogesterone (17-OHP)
Transverse myelitis?
Transverse myelitis is a rare neuro-immune condition that causes focal inflammation of the spinal cord. A typical patient presents with acute or subacute symptoms below the level of the lesion, including sensory impairment, motor weakness and bladder or bowel dysfunction.
It can occur as an independent post-infectious complication but also as part of the neuroinflammatory disease spectrum that includes multiple sclerosis and or neuromyelitis optica spectrum disorder.
The presentation of transverse myelitis consists of motor, sensory and autonomic dysfunction with an acute or subacute onset below the level of the lesion. The symptoms are usually bilateral but can be unilateral. The most common first symptom is sensory change (39%), weakness (25%) and pain (22%) with autonomic dysfunction in the form of bladder and bowel symptoms being less frequent first symptoms.
Ix: MRI spinal cord
Transverse myelitis has a sensory level and limb weakness below the level of the lesion.
Mx for cat scratch fever?
Azithromycin.
Cat scratch disease is generally caused by the Gram negative rod Bartonella henselae
Features
fever
history of a cat scratch
regional lymphadenopathy
headache, malaise
Mx for hereditary haemochromatosis?
Venesection is first line treatment.
Desferrioxamine an iron chelating agent is used as second line therapy.
Mx for Trigeminal Neuralgia?
- Carbamazepine is first-line.
- Failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology.
Radioisotope scan of thyroid gland shows diffuse symmetrical uptake?
Graves disease.
Toxic adenoma - Hot Nodule on radioisotope scan.
De Quervain’s thyroiditis: Hyperthyroidism followed by euthyroidism followed by hypothyroidism. Painful goitre, radioisotope scan would show globally reduced uptake.
Medullary thyroid cancer:
Part of MEN 2.
Secretes Calcitonin.
Thyroxicosis is not a typical presentation of thyroid cancer.
Radioisotope scan would show cold nodule.
Toxic multinodular goitre:
Goitre would feel nodular on palpation.
Radioisotope scan would show patchy uptake.
Antihypertensive that can cause a photosensitive rash?
Thiazide diuretics (bendroflumethiazide) and thiazide like diuretics (indapamide).
Also SE of thiazide diuretics is postural hypotension!!
Mx for yellow frothy itchy vulval discharge?offensive vaginal odour
Trichomonas vaginalis.
Metronidazole.
Yellow grey discharge, pain on intercourse and pain when passing urine.
Chalmydia.
Doxycycline.
First line management for Hemiplegic migraine?
NSAIDs.
Triptans and ergotamine are not recommended due to theoretical risk that they may preciptate cerebral ischaemia.
Pt presents with visual loss in one eye, and lost of colour vision with pain. Optic disc swollen and there is RAPD?
Dx? Mx?
Acute demyelinating Optic Neuritis.
Which may be the first presentation of MS.
IV Methylprednisolone.
Leads to quicker resolution of symptoms.
Mx for acute gout flare in pt with renal impairment?
Prednisolone.
Avoid colchicine and NSAIDs.
Colchicine causes diarrhoea which will worsen renal function.
Mx for ethylene glycol poisoning?
metabolic acidosis with high anion gap and high osmolar gap.
Mx: Fomipezole
Kartagner syndrome?
aka Primary Ciliary Dyskinesia.
- Dextrocardia or complete situs inversus
- Bronchiectasis
- Recurrent sinusitis
- Subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
Mx for charcot’s foot?
immobilisation and offloading with total contact cast boot.
Single bullseye lesion.
Erythema chronicum migrans.
Prophylaxis of cluster headache?
VERAPAMIL.
Features of Glucagonoma?
- Diarrhoea
- Weight loss
- Hyperglycaemia
- Necrolytic skin rash
Large bore vs small bore chest drain?
In secondary pneumothorax it is appropriate to insert a small bore chest drain. Larger chest drains are usually reserved for traumatic injury where there is an accumulation of blood and the risk of occlusion of the chest drain is high.
Smooth mildy tender goitre?
GRAVES goitre can be mildly tender!!
Initial Mx for SIADH secondary to lung cancer?~
Fluid restriction.
Molluscum contagiosum caused by?
Pox virus.
Ix for chronic pancreatitis?
CT is more sensitive at detecting pancreatic calcification. Sensitivity is 80%, specificity is 85%.
functional tests: faecal elastase may be used to assess exocrine function if imaging inconclusive
Ix for hereditary spherocytosis?
Eosin-5-maleimide binding test.
Direct Antiglobulin Test (Coombs test) - Autoimmune haemolytic anaemia
Hb electrophoresis - Sickle cell Anaemia
ischaemic stroke presenting within 4.5 hrs?
thrombolysis with alteplase.
HF management, resting heart rate is >75bpm?
Start ivabradine in patients with HF with reduced ejection fraction and an increased resting heart rate >75bpm.
Ix to confirm Hodgkin’s lymphoma?
Lymph node excision biopsy.
Reed-Sternberg cells are diagnostic: these are large cells that are either multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli (thus giving an ‘owl’s eye’ appearance).
Treatment of acute schizophrenia?
Risperidone.
NICE recommends in acute situations atypical antipsychotics such as risperidone and olanzapine are preferred.
Benzodiazepines only have a role when acute sedation is required.
Vaginal discharge with gram negative diplococci?
Gonorrhea.
IM Ceftriaxone.
A test of cure 2 weeks after treatment is recommended.
Mx for lytic bone lesions in Myeloma?
IV Bisphosphonate.
Next step of management after NSAIDs for ankylosing spondylitis?
ANti TNF therapies.
Etanercept or Adalimumab.
Drug causes of reversible cerebral vasoconstriction syndrome?
Usually presents as a thunder clap headache.
Seen in patients taking SSRIs or SNRIs.
Features of cholesterol embolism?
The majority of cases are secondary to vascular surgery or angiography.
THINK PATIENTS POST PCI.
Other causes include severe atherosclerosis, particularly in large arteries such as the aorta
Features
- Eosinophilia
- Purpura
- Renal failure
- Livedo reticularis
Abx Mx of choice for legionella pneumonia?
- Confusion
- Lymphopaenia
- Hyponatraemia
- Deranged liver function tests
Mx; Erythromycin/Clarithromycin
