Mock Tests Missed Points Flashcards
What are the four conditions for tetralogy of Fallot
Overriding aorta
Right ventricular hypertrophy
Pulmonary stenosis
Ventricular septal defect
What does CHADS Vasc stand for
Congestive HF
HTN
Age ≥75 (x2)
Diabetes
Stroke (x2)
Vascular disease
Age 65-74
Sex Category female
What is a collapsing pulse associated with
Aortic regurgitation
What are the murmur sounds
Aortic stenosis is the correct answer as it produces an ejection systolic crescendo decrescendo murmur (and a slow rising, narrow pulse pressure), heard loudest on expiration.
Mitral regurgitation produces an apical pansystolic murmur.
Aortic regurgitation produces an early diastolic decrescendo murmur (and a collapsing pulse)
Mitral stenosis produces an apical mid diastolic rumble.
Pulmonary stenosis produces an ejection systolic murmur heard loudest on inspiration.
ECG change seen in right bundle branch block
MarroW
V1……V6
R wave (M)
Slurred S wave (W)
Reading for HTN
Stage 1= >140/90.
Stage 2= >160/100.
Severe HTN= >180/110
Ambulatory readings
135/85= Stage 1 HTN.
150/95 =Stage 2 HTN.
Signs of infective endocarditis
Janeway lesions
Osler nodes
Roth spots
Splinter haemorrhages
What is typical presentation of IBS
Generalised abdominal pain which gets better after passing wind and/or defecation, bloating and changes in bowel habits typically suggest a case of IBS
Typical Px presentation of Crohn’s
Pain on the right side of the abdomen along with bloody stools and other extra-intestinal features such as mouth ulcers, erythema nodosum and episcleritis although these aren’t always the case
Typical Px presentation of UC
UC only affects the colon so it you tend to get pain in the lower left quadrant of the abdomen instead of generalised abdominal pain. Also, there is blood and mucus in the stool too
Explain Mallory Weiss tears
Mallory Weiss tears occur when there is a tear in the mucosal lining at the oesophagogastric junction due to a sudden increase in intra-abdominal pressure.
Things such as recurrent retching, vomiting etc. can force stomach contents into the oesophagus, dilate it and tear it resulting in haematemesis
First line medication for GORD
PPIs
Omeprazole
Other meds later on inc; H2 antagonist Rantidine
Most common cause of peptic ulcers and its MoA
H. Pylori
Lives in gastric mucus, secretes urease which splits urea in stomach into CO2 + ammonia.
Ammonia + H+→ammonium.
Ammonium, proteases, phospholipases and vacuolating cytotoxin A damages gastric epithelium.
_Causes inflammatory response reducing mucosal defence→mucosal damage_
Also causes increased acid secretion
i. Gastrin release (from G cells)→more acid secretion
ii. Triggers release of histamine→more acid secretion
iii. Increases parietal cells mass→more acid secretion
iv. Decreases somatostatin (released from D cells)→more acid secretion
How can NSAIDS cause peptic ulcers
Recurrent NSAID use is a common cause of peptic ulcers
a. Mucus secretion stimulated by prostaglandins
b. COX-1 needed for prostaglandin synthesis
c. NSAIDs inhibit COX-1
d. No COX-1 = mucous isn’t secreted
e. Reduced mucosal defence→mucosal damage
Give 4 causes of peptic ulcers
H. Pylori
Reduced stomach acid
NSAIDs
Mucosal ischaemia
Does autoimmune gastritis cause peptic ulcers
No
How are h.pylori infections Tx
Clithromycin
Amoxicillin
+ PPI; omeprazole
Remember as CAP
Give 4 risk factors for GORD
GORD is caused by relaxation of the lower oesophageal sphincter causing gastric acid, pepsin, bile etc. to flow back into the oesophagus - so risk factors should affect lower oesophageal sphincter
Obesity
Hiatus hernia
Smoking
Pregnancy
not recurrent endoscopies
patient comes in with abdominal pain, bloating, constipation. You examine the abdomen and discover a hard mass in the left iliac fossa and carry out a digital rectal examination which shows an empty rectum. What is this
Large bowel obstruction
1st line investigation for large bowl obstruction
Abdominal X-ray
What is achalasia
Condition in which the lower oesophageal sphincter fails to open during swallowing causing a back-up of food into the oesophagus
- not a possible complication of GORD
Which type of ulcer ause pain several hours after eating, pain gets better when eating
Duodenal ulcers
Give 4 features of UC
Continuous
Affects from rectum to ileocaecal joint
Affects males and female equally
Smoking is protective
Weaker genetic link than Crohn’s
PANCA +ve
40-year-old man presents with smelly, floaty stools and diarrhoea. He has lost 7lb and has a rash on his elbows. He has a family history of Type 1 diabetes. What is the most likely diagnosis?
Coeliacs disease
You see steatorrhoea + presence of a rash; some coeliac patients present with skin changes in the extensor surface known as Dermatitis Herpetiformis, this is an immunological response to gluten which manifests in the skin + fHx of autoimmune conditions increase likelihood
Give 4 risk factors for oesophageal cancer
Achalasia
Alcohol
Obesity
Smoking
not spicy foods
What’s gold standard investigation of bowel cancer
Colonoscopy
2nd line: double contrast barium enema; to avoid perforation risk
Where are majority of colon cancers found
Distal colon
1st line Tx for coeliacs
Gluten-free diet
Rare to not be solved; persistence of Sx = refractory coeliacs
- give prednisolone
Give 4 risk foctors/causes of diverticulum
Smoking
NSAIDs
Obesity
Low fibre diet - fibre softens stools and makes them larger so if low fibre diet there is more pressure on the intestinal wall to pass faeces, which results in the colonic mucosa being pushed through the gaps in the muscular wall where arteries penetrate.
not alcohol
A 48-year-old female complains of bright red rectal bleeding which can be found upon wiping, she has been constipated recently and admits to straining. She feels tired but has not noticed any weight loss. What would the likely diagnosis be?
Haemorrhoids
What other finding if commonly seen in a typical Px with Crohn’s
Anaemia due to iron + folate deficiency - malabsorption
What’s the most common cause of AKIs
Acute tubular necrosis
Give 5 causes of AKI
Acute tubular necrosis
Hypovolaemia
Nephrotoxins
Prostate hyperplasia
Sepsis
What are the different stages for glomerular filtration rate
Remember the clock analogy
Give 4 sig risk factors for CKD
Diabetes
FHx of CKD
Old age
Recurrent UTIs
Causative organisms of pyelonephritis
remember KEEPSs
Klebsiella
E. Coli
Enterococcus
Proteus mirabilis
Staphlococus saprophyticus
Most common cause of pyelonephritis
Escherichia coli
What test is commonly used for chlamydia
Nuclei acid amplification test
Signs of infection in a urine dipstick result
Leukocytes and nitrites
What is prostatitis characterised by
Pelvic and perineal pain lasting > 3months.
Trauma causing nerve damage in LUT is risk factor for prostatitis
First line for LUT infection and its pregnancy SE
Nitrofurantoin
Should be avoided in 3rd trimester - causes neonatal haemolysis
Risk of using trimethoprim in pregnancy
Teratogenic in first trimester - inhibits folate synthesis
What does budd-chiari syndrome present with
Abdo pain
Ascites
Liver enlargement
What’s reiters syndrome
Reactive arthritis
Triad of… CANT SEE CANT PEE CANT CLIMB A TREE
Conjunctivitis, urethritis, arthritis
What’s saints triad
Diverticulosis, cholelithiasis, hiatus hernia
Name 4 complications of polycystic kidney disease
Subarachnoid haemorrhage
Kidney stones
Polycystic liver disease
CVD
not nephrotic syndrome
5 types of malaria pathogen species
Plasmodium falciparum - severe Sx
Plasmodium ovale
Plasmodium vivax
Plasmodium malariae
Plasmodium knowlesi
Which species of female only mosquito can transmit malaria
Anopheles gambiae
Urgent gold standard tx for TTP
Plasma exchange
- you treat without confirmed diagnosis because MEDICAL EMERGANCY.
What’s hydroxycarbamide
Bone marrow suppression.
- polycythaemia Vera
- sometimes sickle cell disease (vaso-occlusive crisis prevention)
TTP signs and sx
PENTAD:
Microangiopathic haemolytic anaemia,
Low platelets,
AKI,
Neurological Sx
Fever
In ttp what’s seen on the blood film
Schistocytes
blood fragments
When is FRAX tool used
Gives 10 Yr probability of a fracture
When is HAS BLED score used
Risk of major bleed for Px on anticoagulation.
When is QRISK3 used
Risk of getting stroke or heart attack in next 10 yrs
Give 4 complications of chemotherapy
Alopecia
Pancytopenia
Infertility
Secondary malignancies
Nausea & GI disturbances
What’s thrombo-prophylaxis regimen for px who’ve had suregry/hip replacement
LMWH (Delteparin) acutely + apixaban/compression stocking until discharge
+ low dose aspirin for further 28 days
Tx for severe/complicated malaria
IV artesunate
2nd line: IV quinine + doxycycline
Treatment of uncomplicated malaria/Non falciparum malaria
Oral chloroquine
Which 2 malaria species can lie dormant
Plasmodium ovale
Plasmodium vivax
Tx of dormant malaria
Primaquine
Is malaria notifiable
Yes
Public health England
Outcomes of acute inflammation
Resolution…returns to normal
Suppuration…pus formation
Organisation…Granulation tissue and fibrosis - cardiac tissue can’t resolve so reorganise into fibrosis tissue
Progression…excessive recurrent infection
Which cancer doesn’t metastasise
Basal cell carcinoma
Name of cancers: straited muscle
Rhabdomyoma (benign)
Rhabdomyosarcoma (malignant)
Name of cancers: smooth muscle
Leiomyoma (benign)
Leiomyosarcoma (malignant)
Name of cancers: cartilage
Chondroma (benign)
Chondrosarcoma (malignant)
Name of cancers: bone
Osteoma (benign)
Osteosarcoma (malignant)
Name of cancers: Adipocytes
Lipoma (benign)
Liposarcoma (malignant)
Name of cancers: non glandular
Papilloma (benign)
Carcinoma (malignant)
Name of cancers: glandular
Adenoma (benign)
Adenocarcinoma (malignant)
Burkitts lymphoma
B cell malignancy caused by EBV
Kaposi sarcoma
Vascular endothelial malignancy; HIV associated
Ewing sarcoma
Bone malignancy
Teratoma
Cancer of all 3 embryonic germ layers
What are the 4 outcomes of inflammation
Resolution… normal
Suppuration… pus formation
Organisation… granulation tissue and fibrosis
Cardiac and nerve cells never resolve… they reorganise into fibrotic tissue or progress into chronic
Progression… continuous damage leading to chronic inflammation
Give examples of the 2 types of granulomas
aggregate of epitheloid histocytes
Central necrosis… (caseating granuloma) - TB
No central necrosis… (non-caseating granuloma) - Sarcoidosis, Crohn’s, Vasculitis
Metaplasia of Barrett’s oesophagus
Stratified squamous —> Simple columnar
Define budd-chiari syndrome
An obstruction of the Hepatic vein via either a tumour or a thrombus, resulting in Hepatic ischaemia and eventual liver failure
Define haemochromatosis
autosomal recessive disorder of Iron metabolism which results in iron deposition in the joints, liver, heart, pancreas and skin
** with fatigue, slate grey skin, signs of liver failure and pancreatic failure**
Define Wilson’s
Autosomal recessive disorder of copper excretion, which results in excess deposition in the liver and CNS
Personality changes, tremor, ataxia, dysarthria and liver cirrhosis. Kaiser-Fleischer rings
Tx: Penicillamine
What’s given for alcohol withdrawal
Chlordiazepoxide
What’s desferroxamine given in
Iron chelating agent
For iron overdose
Is diarrhoea a characteristic finding of upper GI bleeds
No
Coffee-ground vomit
Melaena
Hypotension
Tachycardia
What are the Sx of pancreatitis
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperlipidaemia
Emboli
Drugs
If Px has ruq pain made worse on eating fatty foods what could it be
Biliary colic
Or
Ascending cholangitis
So to differentiate… remember ascending cholangitis = charcots triad
Which cancers metastases to the bone
Breast
Lung
Thyroid
Kidney
Prostate
What is aledronic acid
Bisphosphonate
- remember when taking; have in morning and stay upright for 30 mins after —> Can cause oesophagitis
Which drug can cause haemolytic anaemia
Sulfasalazine
DMARD; used in severe RA
What’s Sjögren’s syndrome
Immune destruction of exocrine glands
presents with arthritis, dry eyes and dry mouth
What test is used in Sjögren’s syndrome
Schirmer’s test;
a small strip of paper in the eye to measure tear production
+ lacrimal gland biopsy
+ antibody testing
What is the severe form of psoriatic arthritis and what do u see
XRay image; Pencil in cup
Arthritis mutilans - severe form of psoriatic arthritis
When are periarticular erosions seen
Gout
Which msk condition is one of the only to preferentially affect young men
Ankylosing spondylitis
1st line Tx : whilst other tests are going on - NSAIDS; ibuprofen
What is given in gout Tx
Acute
NSAIDs + ppi
Cholcicine
long-term
Allopurinol - xanthine oxidase inhibitors
Give 4 clinical features of Parkinson’s
Fine tremor
Rigidity
Brisk reflexes
Small handwriting
Ascending paralysis from lower limbs is seen in what condition
Guilin barre syndrome
Presents in A&E with extreme right-sided head pain and trouble seeing things with her right-eye. She struggles to dictate her history to you, claiming that she also has jaw pain too. She claims she is normally healthy but in the recent months has become more and more drained, with aches all over her body. She also mentions weak shoulders and hips. When you examine her, her right-side scalp is very painful to the touch. Her blood tests also came back and reveal a markedly raised ESR. What she got???
Giant cell arteritis
commonly occurs with polymyalgia rheumatica (she complained of weak shoulders and hips.)
Tx: steroids like Prednisolone; counteract the inflammation from the vasculitis
Clinical features of cauda equina
Inability to open bowels/urinate, reduced anal tone, saddle anaesthesia (numbness around pelvic girdle)
The syndrome is caused by a prolapsed disc going into the cauda equina and pressing on the sacral nerves there.
When is neostigmine + pyridostigmine used
ACh-estarase inhibitor; Blocks active site of acetylcholinesterase, increasing the amount of Ach available to the post-synaptic membrane
Give 4 causes/ risk factors for developing peripheral neuropathies
Diabetes
Immunocompromised state; Hep C viral infection, diphtheria, leprosy, HIV, Lyme disease can all cause neuropathies
Connective tissue disorders
Alcoholism
Commonest cause of COPD exacerbation
Bacterial; Haemophilus influenza
Viral; rhinovirus
In acute COPD exacerbation what’s first line management
ABG
State the severity of asthma
Moderate
PEF: 50-75%
Severe
PEF: 33-50%
RR > 25
HR > 110
Cant complete sentences in one breath
Life-threatening
PEF: <33%
SpO2 < 92%
PaO2 < 8kPa
Side effect of salbutamol / SABA
Hypokalaemia
Side effect of inhaled corticosteroids
Oral candida
Stunted growth in children
Give 2 examples of inhaled corticosteroids
Beclamethasone
Proprionate
Define asthma
Chronic reversible obstructive airway disease
airway hyper-responsiveness + inflamed bronchioles
Types of asthma
Allergic; 70%
IgE mediated
Extrinsic
T1 hypersensitivity
Due to environmental triggers - pollen, dust mould antigens
Non-allergic; 30%
Not IgE mediated
Intrinsic
Harder to Tx - associated with smoking
Asthmatic triggers
Infection
Allergen
Cold
Exercise
Drugs; beta blocker / aspirin
What atopic triad
Atopic rhinitis, asthma, eczema
Known as Atopy
Pathophysiology of asthma
Over-expressed tH2 cells in airways exposed to trigger
TH2 cytokine release; IgE production; eosinophil recruitment
IgE leads to mast cell degranulation (histamine, leukotrienes, tryptase release)
Bronchial constriction, mucus hypersecretion
Sx of asthma
Wheeze
Dry Cough
Chest tightness
Sob
Episodic with triggers and diurnal variation
Often younger Px
Investigation and Dx of asthma
1st line:
FeNO fractional exhaled nitric oxide > 40pbb
Spirometry FEV1:FVC < 0.7 - as it suggests obstruction
If after bronchodilator reversibility FEV1 improves >12% = asthma
If < 12% improved FEV1 = COPD
Tx of asthma
SABA
SABA + ICS
Assess inhaler technique and compliance before progressing with Tx
SABA + ICS + LTRA
SABA + ICS + LABA ± LTRA
Increase ICS
Drug names of asthmatic drug classes
SABA salbutamol
ICS Beclamethasone / Proprionate
LTRA Montelukast
LABA Salmeterol
Tx for asthma exacerbations
Remember O SHIT B
O2
Nebulised _S_ABA
_H_ydrocortisone (ICS)
_I_V Magnesium sulfate
IV _T_heophylline
BiPAP
Which type of lung cancer is seen most commonly in non-smokers
Adenocarcinoma
Which lung cancer is highly associated with asbestos exposure
Mesothelioma
Deaths from mesothelioma must be sent to the HM Coroner.
Characteristic of PE
pleuritic chest pain (worse on deep breaths),
shortness of breath
haemoptysis.
What’s curb65
Score estimates mortality of community-acquired pneumonia
Confusion
Urea > 7
RR ≥ 30
BP < 90/60
65 />
MoA for spironolactone
Inhibition of aldosterone receptors in distal tubules
When is ABCD2 used
Stroke risk after a TIA
Give 3 scenarios of htn that should make u think of conns
hypertension associated with hypokalaemia,
hypertension despite being on 3 or more antihypertensives,
hypertension before 40 years
U waves are seen in which electrolyte disturbance
Hypokalaemia
Give 4 cause of Hypercalcaemia
Thyrotoxicosis
Hyperparathyroidism
Malignancy
Familial benign hypocalciuric Hypercalcaemia
Sarcoidosis
Whats carcinoid syndrome
paraneoplastic syndrome that has a classical triad of:
cardiac involvement,
diarrhoea
flushing.
Its due to the tumour cells producing 5-HT
Gold standard Ix for coeliacs
Endoscopy with intestinal biopsy
Which antibodies are seen in coeliacs
IgA tissue transglutaminase
IgA endomysial antibody
Most common cause of peptic ulcers
H.pylori
Dx: Carbon-13 urea breath test or a stool antigen test
Tx: C.A.P = Clarithromycin, amoxicillin, PPI (omeprazole)
Loin to groin pain which comes and goes. Can’t get comfortable… what has he got and gold standard Dx for it?
Renal colic
Non-contrast CT kidney, ureter and bladder
Painless haematuria is a strong indication to which cancer
Bladder cancer
What is minimal change disease defined as
Minimal change disease is a type of nephrotic syndrome:
Hypoalbuminaemia,
Peripheral oedema
Proteinuria
+ hyperlipidaemia/lipiduria
MoA for loop diuretics
Ascending limb of the loop of Henle and inhibits the NaK2Cl channels
Name 2 things u might see in myeloma
Monoclonal antibodies
Bence-jones proteins
What side effects seen with amitriptyline
significant anticholinergic properties - decrease the effect of the parasympathetic nervous system
Blurred vision, confusion, dry mouth, urinary retention
Which Abx inhibit bacterial cell wall synthesis
Beta lactams; penicillin
Glycopeptides; vancomycin, teicoplainin
Cephalosporins; cephalexin, cefuroxime
Carbapenems
Name 1 food which inhibits warfarins effect
Spinach
Give 3 foods which increase warfarins effects
Grapefruit
Cranberries
Alcohol
- Remember high INR= haemorrhage, low INR= clotting*
What drug is licensed in uk to treat heroin
Methadone
Define pheochromocytoma
Tumour of the adrenal medulla, specifically chromaffin cells, which cause increased release of catecholamines (mainly adrenaline)
You want to block alpha receptors first rather than beta… if beta is blocked the catecholamine can bind to alpha giving a sympathetic affect still.
Give Phenoxybenzamine
What is a complication of clostridium difficile
Pseudomembranous colitis
4 organisms that cause atypical pneumonia
Contracted from infected birds – patient often owns a parrot
AKA Legionnaire’s disease
Chlamydia psittaci
Coxiella Burnetti
Legionella pneumophila
Mycoplasma pneumoniae
Management for TB
RIPE
Rifampcin
Isoniazid
For 6 months
Pyrazinamide
Ethambutol
For first 2 months of the 6 months
Give 4 symptoms of infective gastroenteritis
Bloody diarrhoea
Fever
Headache
Dehydration; Reduced skin turgor - severe cases
For staph aureus give which ABx
Flucloxacillin
Vancomycin (MRSA)
Could give… clarithromycin
Most commonly affect valve in infective endocarditis
Tricuspid
Most common cause of bacterial pneumonia
Streptococcus pneumoniae
Tx for osteoporosis
1st line:
Bisphosphonate (aledronic acid)
+ AdCal
2nd line:
Denosumab (monoclonal antibody to RANK ligand)
Mechanism of action of bisphosphonates
Inhibit bone resorption through the inhibition of enzyme (Farnesyl Pyrophosphate synthase) which reduces osteoclast activity
Tx for Ankylosing spondylitis
NSAIDS and physiotherapy
What does subarachnoid haemorrhage look like on CT
Subarachnoid haemorrhage which appears ‘star-shaped’ on a CT scan
What does subdural haemorrhage look like on CT
appears ‘sickle/crescent shaped’ on a CT scan and there is no lucid
period
What does extra-dural haemorrhage look like on CT
lemon shaped bleed and a lucid period following a head injury in the brain
- middle meningeal artery
Paraesthesia in palm and other Sx of carpal tunnel syndrome… what nerve is most likely affected
Median nerve
Sx of multiple sclerosis
Remember DEMYELINATION pneumonic
D-Diploplia
E-Eye movement painful
M-Motor: weakness and spasticity
Y-nYstagmus
E-Elevated temperature
L-Lhermitte’s phenomenon (electric shock down spine)
N-Neuropathic pain ( +Uhtoff’s phenomenon)
A-Ataxia
T-Talking slurred
I-Impotence
O-Overactive bladder
N-Numbness
What is used to Tx jerky movements / chorea in huntingtons
Risperidone
Haloperidol is used to treat psychosis in Huntington’s
What is sertraline
SSRI used to treat depression
Does dehydration cause a tension headache
No; dehydration headache is not the same as tension headache
Depression, lack of sleep, missed meals and stress are all known causes of tension headaches.
Which pneumonia is typically associated with AIDS
Pneumocystis jirovecii
Most appropriate action for Px with tension pneumothorax
immediate decompression via large bore canula
Which drug class causes bronchodilation by blocking acetylcholine receptors leading to bronchial smooth muscle contraction
Long-acting muscarinic antagonists
Woman presents with a dry cough and shortness of breath for the last 8 months. She also has a persistent rash on her shins (see picture below). A chest X ray shows bilateral hilar lymphadenopathy. A biopsy is done to confirm diagnosis. Which shows non- caseating granulomas with epithelioid cells. Whats her Dx? Which electrolyte disturbance is most indicative of the above diagnosis?
Sarcoidosis
persistent rash (erythema nodosum) + bilateral hilar lymphadenopathy —> typical findings
Hypercalcaemia is a key finding in the diagnosis of sarcoidosis
Antibody found in goodpastures
Anti- glomerular basement membrane
How to calculate alcohol units… standard bottle of Pinot Grigio contains 750ml and its alcohol by volume (ABV) is 12.5%. Mr smith drinks a quarter of a bottle every evening with his meal. How many units is he consuming each week? (to the nearest unit)
Units of alcohol is [ABV (%) x volume (ml)] / 1000.
Mr smith is drinking a quarter of a bottle each evening (750/4 = 187.5). Therefore, each evening he is drinking (187.5 x 12.5)/1000 = 2.34 units. So, in a week he is consuming 16.4 units (E). The maximum amount in a week recommended for both men and women is currently 14 units.
What vaccines are included for 6 in 1
diphtheria, tetanus, pertussis, polio, Hib and Hepatitis B.
At 8, 12 and 16 weeks
What type of lung sound if heard in Px having an acute asthmatic attack
Hyper-resonant to percussion is heard when lung is hyper-inflated with air: which happens in asthma attack
Dullness to percussion is heard when lung is fluid filled; like pleural effusion.
Tx for COPD
1st:
Conservative; smoking cessation + vaccines
Long-term management:
SABA / SAMA
SABA + LABA + LAMA (if SAMA was given first, replace with SABA for this step because SAMA and lama shouldn’t be given together but SABA and LABA can)
SABA + LABA + LAMA +ICS
Whats iprotropium bromide
SAMA
Short acting muscarinic antagonist
Whats tiotropium bromide
LAMA
Long acting muscarinic antagonist
Common site for lung cancer metastases
Adrenal glands
bone,
brain
liver
breast cancer commonly can metastasise to lung BUT lung cancer doesn’t commonly metastasise to breast tissue
Give 3 bacterias that cause atypical pneumonia
Mycoplasma pneumonia
Chlamydophila pneumonia
Legionella pneumonia
Whats commonest community acquired cause of pneumonia
Streptococcus pneumonia
Whats commonest hospital acquired cause of pneumonia
Staphylococcus aureus
Whats commonest cause of pneumonia in COPD Px
Haemophilus influenza
Does klebsiella pneumonia cause typical or atypical pneumonia
Typical
Give 4 organisms that cause typical pneumonia
Strep pneumonia
Staph aureus
Haemophilus influenza
Klebsiella pneumonia
Common SE of pyrazinamide
Used in TB
Arthralgia
Which disease is caused by chromosome 6 being affected
Hereditary haemochromatosis
Which disease is caused by chromosome 7 being affected
Cystic fibrosis
In coding for the CFTR protein causing defective Cl- secretion and Na+ absorption.
Which disease is caused by chromosome 13 being affected
Wilsons disease
Which disease is caused by chromosome 14 being affected
Alpha -1- antitrypsin deficiency
Which disease is caused by chromosome 21 trisomy being affected
Down syndrome
Give 1 intentional and 4 unintentional reasons a Px might not adhere to medication
Intentional
Patient preference
Unintentional
Patient cannot pay
Patient cannot understand the instructions
Patient has encountered problems during the course of treatment
Patient has forgotten to take the medication
What are WHOS’ 5 moments of hand hygiene
Before touching a patient
Before clean/aseptic procedure done
After body fluid exposure
After touching a patient
After touching a patient’s surroundings
Tx for syphilis
1st line:
Benzathine penicillin (not C.I in pregnancy but doseage affected; but is if Px is allergic)
2nd line:
Azithromycin / doxycycline
Give 4 co -locations of obesity
GORD
Obstructive sleep apnoea
Osteoarthritis
Pancreatitis
Chemoprophylaxis of meningitis
Ciprofloxacin / Rifampcin
Most common cause of work-related ill health
Stress, anxiety and depression
2nd; musculoskeletal disorders
Define sensitivity
Proportion of patients who have disease and test positive
Define specificity
Proportion of Px who don’t have the disease and test negative
What term is used to describe “The proportion of patients who test positive who have the condition”
Positive predicted value
What term is used to describe “The proportion of patients who test negative who do not have the condition”
Negative predicted value
Define 1º prevention and give examples of it
Reduce initial occurrence of the disease
Statin use in Px with qrisk3 > 10%
Immunisation programmes
Define 2) prevention and give an example
To Tx in order to stop disease from progressing
Antiplatelet therapy after an MI
Define tertiary prevention and give an example
Reduce the impact of an ongoing problem and improve quality of life
Diabetic eye screening
Give 4 uk screening programmes
Breast cancer screening
Cervical screening programme
Abdominal aortic aneurysm programme
Newborn and infant physical examination
Does prostate cancer have a screening programme
No
PSA blood test is not considered good enough to be used to accurately determine whether men are at risk of prostate cancer and thus cause men to be investigated unnecessarily
Give 4 cardinal Sx of cerebellar stroke
Headache
Ataxia
Vertigo
Vomiting
Whats ABCD2 used for
risk assessment tool to determine the likelihood of someone having a stroke following from a TIA.
Age (>60 years old) (1pt)
BP (>140/90) (1pt)
Clinical features (Unilateral weakness (2pt); speech disturbances without weakness),
Diabetes (1pt)
Duration (>60 (2pt) or less than 60 minutes (1pt)).
Give 5 cancers that commonly metastasise in the brain
Lung
Breast
Skin
Kidney
Bowel
What can trigger Sx of giant cell/temporal arteritis
Change in temperature, shaving, combing hair / eating
Start steroid Tx and do temporal biopsy within 14 days of starting Tx + bloods.
What nerve is responsible for carpel tunnel syndrome
Median nerve
What nerve root does the median nerve originate from
C5-T1
Give 4 xRay features of rheumatoid
‘LESS’-
loss of joint space
erosions
soft tissue swelling
soft bones (osteopenia)
XRay findings of osteoarthritis
‘LOSS’
loss of joint space
osteophyte formation
Subchondral sclerosis
subchondral cysts
MoA for naproxen
Non-selective inhibitor of COX 1 and COX 2 enzymes
MoA for methotrexate
Inhibits dihydrofolate reductase enzyme (this enzyme normally converts folic acid to FH4 which is required for DNA and protein synthesis).
Give types of seronegative spondyloarthropathies
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
Juvenile idiopathic arthritis
IBD related arthritis
Hand signs of RA
Boutonniere deformity of the thumb
swan neck deformity
symmetrical swollen joints
ulnar deviation
T- scores used in osteoporosis
Normal= -1 < T.
Osteopenia = T score between -1 and -2.5.
Osteoporosis = T score ≤ 2.5
Which arthritis is can’t see can’t pee can’t climb a tree used for
Reactive arthritis
Which bacteria is Gram +ve cocci, catalase +ve, coagulase +ve
Staph aureus
Which scoring system/tool is used for upper GI bleeding
Glasgow-blatchford
Most common type of hepatitis in travellers
Hep A
Give 5 causes of ascites
Heart failure
Acute pancreatitis
Malignancy
Hypoalbuminaemia
Meig’s syndrome
-sound = shifting dullness and fluid thrill.
What are the risk factors for acute cholecystitis
Same as gallstones
4Fs; fat, female, forties, fertile
+ COCP
What Sx is fibroproliferative disorder affecting the palmar fascia mainly of the 4th and 5th fingers.
Dupuytrens contracture
Px presents with developed ascites secondary to liver cirrhosis and Sx inc… severe abdominal pain, worsening ascites, fever, vomiting and rigors. Whats he most likely got
Spontaneous bacterial peritonitis
Most common causative agents of spontaneous bacterial peritonitis
Klebsiella pneumoniae
Strep pneumoniae
E.coli
1st line for suspected gallstones
LFTs + USS
MRCP is considered if the ultrasound has not detected common bile duct stones but the bile duct is dilated and/or liver function test results are abnormal.
Which infection would cause neutropenia
AIDS infection
Which cancer may cause neutrophilic
Chronic myeloid leukaemia
Which condition is acute lymphoblastic anaemia associated with
Down syndrome
The facies that could be listed in the question- small chin, slanted eyes
Rememebr ALL commonly seen in small children
If you think patient has iron define I envy anaemia what do u need to look out for when answering for management?
Double check Px age .. red flag in > 60yr olds / post-menopausal women
An urgent (2 week wait) colonoscopy is needed to rule out malignancy.
What disease does parvovirus b19 cause and what else can it precitate
Fifth disease
In people with sickle cell, it can precipitate sickle cell crisis
What is used to define CKD
Rememebr the clock for eGFR
measurements >3 months apart with an eGFR <60
Side effect of carbimazole
Used in Hyperthyroidism
Agranulocytosis;
Side effect of gentamicin
Ototoxicity
Most common type of renal cell carcinoma
Clear cell
Papillary only accounts for 10-15%
What types of cells might be seen in chronic lymphoid leukaemia
Smudge cells
What type of drug class is Goserelin and when can it be used
GnRH agonist
Used in Tx for prostate cancer
What is drug class of finasteride and when can it be used
5 alpha reductase inhibitor
2nd line for BPH Tx
What is drug class of oxybutanin and when can it be used
Anti cholinergic
1st line Tx for overactive bladder
Tx for acute pulmonary oedema
High flow oxygen, IV furosemide, IV morphine / GTN.
Then notifying your senior and an urgent CXR.
Give reasons for why a uti can be complicated
Male
Pregnant women
Child
Immunocompromised
Recurrent UTIs
Kidney structural abnormality
What inherited disease is associated with Subarachnoid haemorrhages
Autosomal dominant polycystic kidney disease
associated with formation of berry aneurysms; its rupture —> SAH
What is Tx/management for severe Hypercalcaemia
IV fluids (rehydration),
bisphosphonates (inhibit osteoclasts - prevent bone resorption therefore reduce Ca in blood as bone not broken down)
measurement of U&E/Ca
prednisolone
Give 5 causes of long term steroid use
Immunosuppression
Diabetes mellitus
Proximal muscle weakness
Osteoporosis
Skin thinning and bruising
What type of Arrythmias is Wolff-Parkinson’s white
Supraventricular tachycardia
caused when by an accessory pathway causing a re-entrant loop
ECG findings of WPW syndrome
Wide QRS, short PR and a classical delta wave (slurred upstroke to the QRS)
3 features of coeliacs seen on endoscopy are…
Villus atrophy
Crypt hyperplasia
Lymphocytic infiltration
Give 4 extra intestinal Sx in Px with UC
Arthritis
Conjunctivitis
Clubbing
Pyoderma gangrenosum
Give 3 tests that can be done for h.pylori
Carbon 13 urea breath test (1st line)
Stool antigen test
Endoscopy (most accurate but too invasive)
If Px has IBS; history of diarrhoea and abdominal bloating and discomfort that is only relieved by defecation. Bloods are normal. What medication might be useful
Loperamide;
Anti-motility - useful for thee diarrhoea
If terminal ileum is damaged/resected, which vitamin will be affected and why
Irinsic factor is a protein secreted by the stomach that joins to vitamin B12 and moves to through the small intestine to the terminal ileum where it is absorbed. Following the surgery, the patient no longer has a terminal ileum to absorb the intrinsic factor-b12 complex. Therefore, they will require Vitamin B12 supplements
ECG changes for atrial fibrillation
Absent p waves
Narrow qrs complex
Irregularly irregular rhythm
Which electrolyte disturbance gives you U waves
Hypokalaemia
ECG changes for Hyperkalaemia
Absent p waves
Prolonged PR interval
Tall tented t waves
Wide qrs
go, go long, go tall, go wide
Types of cardiomyopathy
Dilated
Restrictive
Hypertrophic
