Mock Paper questions Flashcards
What is CHADS VASc made up of and what is it used for
CHADS-VASc is used to calculate stroke risk and anticoagulation need in patients with AF
CHADS VASC= Congestive HF, Hypertension, Age (+75), Diabetes, Stroke/TIA/THromboembolism
Vascular disease, Age (65-74), Sex Category (female= 1)
state the pulse for a- aortic regurgitation b- atrial fibrillation c- pulsus paradox d- radio-radial delay
a- collapsing pulse
b- irregularly irregular
c- rapid drop in BP during inspiration seen in Asthma, COPD, blood loss etc
d- pulse significantly stronger in one arm than the other, seen in coarctation of aorta
heart sounds for a- aortic regurgitation b- aortic stenosis c- mitral regurgitation d- mitral stenosis e- pulmonary stenosis
a- early diastolic decrescendo murmur (and collapsing pulse)
b- ejection systolic crescendo decrescendo murmur
c- apical pansystolic murmur
d- apical mid diastolic rumble
e- ejection systolic murmur heard loudest on inspiration
first line of hypertension treatment for
a- patient under 55
b- patient over 55
c- patient who is afro-carribbean
a- ace inhibitor (rampiril) or ARB (candesartan)
b and c- calcium channel blocker (amlodipine)
4 features of tetralogy of fallot
ventricular septal defect
pulmonary stenosis
hypertrophy of right ventricle
overriding aorta
what are the clinic readings for the stages of hypertension?
stage 1= >140/90
stage 2= >160/100
stage 3 (severe)= 1>80/110
what are the distinctive signs of endocarditis
splinter haemorrhages osler's node janeaway lesions roth spots fever
what is xanthelasma and when would you see it
lipid deposits around the eyes, seen in dyslipidemia (too much lipid in bloodstream)
differential/typical presentations of: a- Coeliac disease b- IBS c- Crohn's d- Ulcerative colitis e- Infective gastroenteritis
a- pale smelly stools which are hard to flush away, generalised abdominal pain and bloating, diarrhoea and weight loss
b- general abdominal pain which gets better after passing wind/defecation, bloating and changes in bowel habits
c- pain on right side of badomen along with bloody stools and other features such as mouth ulcers
d- pain in lower left quadrant (UC only affects the colon) and blood and mucus in the stool
e- Diarrhoea and abdominal pain + signs of infection e.g. foreign travel, fever and vomiting
first and second line medication for GORD
first line= PPI e.g. omeprazole
second line= H2 antagonists e.g. Ranitidine
sulfasalazine use
treatment of ulcerative colitis
symptoms of peptic ulcer rupture
epigastric pain, pain eating/when hungry, pain relieved by eating, medication use e.g. NSAIDs
4 ways H pylori affects acid secretion in the stomach
1- causes G cells to release more gastrin
2- triggers release of histamine which causes more acid secretion
3- increases parietal cell mass- more gastric acid production (HCl)
4- decreases somatostatin release from D cells- more acid secretion
how does h pylori cause peptic ulcers
h pylori secrets urease which splits urea in stomach into CO2+ and ammonia.
Ammonia and H+ = ammonium
Ammonium, proteases, phospholipases and vacuolating cytotoxin A damage gastric epithelium. Causes inflammatory response, reducing mucosal defence and causing mucosal damage
how does recurrent NSAID use cause peptic ulcers
mucus secretion is stimulated by prostaglandins, and COX-1 is needed for prostaglandin synthesis. NSAIDs inhibit COX-1 -> less mucus secretion -> reduced mucosal defence
presentation for small bowel obstruction
intermittent colicky pain
early onset vomiting
some abdominal distension
presentation for large bowel obstruction
continuous abdominal pain
pain lower down the abdomen e.g. in Left iliac fossa
vomiting
marked abdominal distension
first line investigation for bowel obstruction
x ray abdomen
duodenal ulcer symptoms and how is it different from peptic ulcers?
duodenal ulcers cause abdominal pain several hours after eating due to the presence of acid from the stomach in the duodenum. pain caused by gastric ulcers is relieved by eating
inflammation- differences between ulcerative colitis and crohn’s
Ulcerative colitis; continuous inflammation from the rectum to the ileocecal valve, does not extent proximal to the ileocecal valve. Smoking is protective
Crohn’s: anywhere in the gastrointestinal tract, skip lesions, trasmural inflammation cobblestone appearance. Smoking is a risk factor
gold standard investigation for bowel cancer
colonoscopy
which of proximal/distal colon cancer is
- more common
- more dangerous
- distal more common
- proximal more dangerous
is pANCA raised in UC or Crohn’s?
pANCA (anti-neutrophilic cytoplasmic antibody) is always negative in Crohn’s but may be positive in Ulcerative colitis
What might investigation results show in crohn’s disease?
- Raised ESR and CRP (IBD)
- Iron and folate deficiency anaemia- commonly due to malabsorption
4 causes of AKI
1 acute tubular necrosis- most common cause, tubular epithelial cells die impairing kidney ability to filter waste products
2- nephrotoxins- cause intrinsci/renal AKI, kidneys are directly damaged impairing their ability to function
3- prostate hyperplasia- causes post-renal AKI; urinary tract is obstructed, increasing intra-tubular pressure and decreasing GFR and thus increasing urea and creatinine remaining in the blood
4- sepsis- prerenal cause of AKI; bp falls leading to renal hypoperfusion and decreased GFR which causes a rise in serum urea and creatinine
what are the GFRs for the different stages of CKD?
stage 1- >90ml/min with evidence of renal damage
stage 2- 60-89 ml/min with evidence of renal damage
stage 3a- 45-59 ml/min with/without renal damage
stage 3b- 30-44 ml/min with/without renal damage
stage 4- 15-29 ml/min with/without renal damage
stage 5- <15ml/min, established renal failure
5 organisms which cause pyelonephritis and the most common one
coagulase negative staph, enterococcus, e.coli (most common), Klebsiella, proteus
best investigation in the management of pyelonephritis
midstream urine microscopy, culture and sensitivity
characteristic symptoms of chronic prostatitis
pelvic or perineal pain lasting longer than 3 months is the key symptom. Also trauma causing nerve damage in the lower urinary tract is a risk factor for chronic prostatitis.
which UTI drug is teratogenic and which is first line in pregnancy?
trimethoprim can be teratogenic, nitrofurantoin is first line in pregnant women
what is retiers syndrome? what is the reiters triad?
reactive arthritis. triad is conjunctivitis, urethritis and arthritis
4 possible complications of polycystic kidney disease
1- PKD causes hypertension, which can result in cardiovascular disease.
2- Kidney stones may form in those with PKD as urine travels more slowly in the kidneys of these patients allowing more time for stones to develop.
3- Polycystic liver disease can occur as people with PKD develop cysts in other organs.
4- PKD is associated with Berry’s aneurysms and if they rupture results in a subarachnoid haemorrhage.
What are the stages of the Ann Arbor staging system?
I Confined to single lymph node region.
II Involvement of two or more nodal areas on the same side of the diaphragm.
III Involvement of nodes on both sides of the diaphragm.
IV Spread beyond the lymph nodes, e.g. liver or bone marrow.
Each stage is either ‘a’—no systemic symptoms other than pruritus; or ‘b’—presence of b symptoms: loss of appetite, weight loss and drenching night sweats.
treatment for DVT
acute management with a LMWH (e.g. deltaparin) or Fondaparinux followed by maintenance treatment for 6 months with an oral anticoagulant (e.g. warfarin)
describe the mechanism of action and uses for
- rituximab
- trastuzumab
- adalimumab
- rituximab is a monoclonal antibody used to treat non-hodgkin lymphoma, chronic lymphocytic leukemia etc. Rituximab stcks to CD20 proteins on the surface of B Cells and immune cells then pick them out and kill them
- Adalimumab is a biological disease modifier used to treat rheumatoid arthritis and other chronic conditions mediated by tnf-alpha, inhibiting its actions. also used in the treatment of psoriatic arthritis, ankylosing spondylitis
- Trastuzumab is a targeted cancer drug which treatds cancers with a large amount of the protein human epidermal growth factor receptor 2 (HER2) e.g. early breast cancer, advanced breast cancer and stomach cancer.
Malaria treatment
- uncomplicated
- severe/complicated
- second line severe/complicated
- uncomplicated = chloroquine
- severe/complicated= IV artesunate
- 2nd line severe/complicated= IV quinine and doxycycline
- transferrin- job
- ferritin- jon
- ferritin= mainly in body cells, with little circulating in blood. Protein that stores iron and releases it when your body needs it
- transferrin is a protein which combines with ferritin to transport it to where new blood cells are made
4 signs of liver failure
- asterixis (liver flap)
- dupuytren’s contractures (progressive shortening and thickening of the palmar fascia causing finger contractures)
- leukonychia (white nails)
- spider naevi (small swollen blood vessels beneath the skin)
GET SMASHED- pancreatitis causes?
gall stones, ethanol excess, trauma, steroids, mumps, autoimmunity, scorpion venom, hyperlipidemia (or hypercalcaemia/hypothermia), ERCP and drugs
4 common signs of an upper GI bleed
coffee ground vomit (haematemesis)
hypotension
Malaena (black stools)
tachycardia
first line treatment for alcohol withdrawal
Chlordiazepoxide
Wernickes encephalopathy is caused by a deficiency in vitamin
B1 (thiamine)
Folate and vitamin D deficiencies are common causes of
macrocytic anaemia
