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Phase 2a Basic Knowledge > Mock Tests Missed Points > Flashcards

Mock Tests Missed Points Flashcards

1
Q

What are the four conditions for tetralogy of Fallot

A

Overriding aorta
Right ventricular hypertrophy
Pulmonary stenosis
Ventricular septal defect

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2
Q

What does CHADS Vasc stand for

A

Congestive HF
HTN
Age ≥75 (x2)
Diabetes
Stroke (x2)

Vascular disease
Age 65-74
Sex Category female

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3
Q

What is a collapsing pulse associated with

A

Aortic regurgitation

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4
Q

What are the murmur sounds

A

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.

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5
Q

ECG change seen in right bundle branch block

A

MarroW
V1……V6

R wave (M)
Slurred S wave (W)

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6
Q

Reading for HTN

A

Stage 1= >140/90.
Stage 2= >160/100.
Severe HTN= >180/110

Ambulatory readings
135/85= Stage 1 HTN.
150/95 =Stage 2 HTN.

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7
Q

Signs of infective endocarditis

A

Janeway lesions
Osler nodes
Roth spots
Splinter haemorrhages

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8
Q

What is typical presentation of IBS

A

Generalised abdominal pain which gets better after passing wind and/or defecation, bloating and changes in bowel habits typically suggest a case of IBS

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9
Q

Typical Px presentation of Crohn’s

A

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

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10
Q

Typical Px presentation of UC

A

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

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11
Q

Explain Mallory Weiss tears

A

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

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12
Q

First line medication for GORD

A

PPIs
Omeprazole

Other meds later on inc; H2 antagonist Rantidine

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13
Q

Most common cause of peptic ulcers and its MoA

A

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

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14
Q

How can NSAIDS cause peptic ulcers

A

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

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15
Q

Give 4 causes of peptic ulcers

A

H. Pylori
Reduced stomach acid
NSAIDs
Mucosal ischaemia

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16
Q

Does autoimmune gastritis cause peptic ulcers

A

No

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17
Q

How are h.pylori infections Tx

A

Clithromycin
Amoxicillin
+ PPI; omeprazole

Remember as CAP

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18
Q

Give 4 risk factors for GORD

A

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

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19
Q

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

A

Large bowel obstruction

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20
Q

1st line investigation for large bowl obstruction

A

Abdominal X-ray

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21
Q

What is achalasia

A

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
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22
Q

Which type of ulcer ause pain several hours after eating, pain gets better when eating

A

Duodenal ulcers

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23
Q

Give 4 features of UC

A

Continuous
Affects from rectum to ileocaecal joint
Affects males and female equally
Smoking is protective
Weaker genetic link than Crohn’s
PANCA +ve

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24
Q

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?

A

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

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25
Q

Give 4 risk factors for oesophageal cancer

A

Achalasia
Alcohol
Obesity
Smoking

not spicy foods

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26
Q

What’s gold standard investigation of bowel cancer

A

Colonoscopy

2nd line: double contrast barium enema; to avoid perforation risk

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27
Q

Where are majority of colon cancers found

A

Distal colon

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28
Q

1st line Tx for coeliacs

A

Gluten-free diet

Rare to not be solved; persistence of Sx = refractory coeliacs
- give prednisolone

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29
Q

Give 4 risk foctors/causes of diverticulum

A

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

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30
Q

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?

A

Haemorrhoids

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31
Q

What other finding if commonly seen in a typical Px with Crohn’s

A

Anaemia due to iron + folate deficiency - malabsorption

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32
Q

What’s the most common cause of AKIs

A

Acute tubular necrosis

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33
Q

Give 5 causes of AKI

A

Acute tubular necrosis
Hypovolaemia
Nephrotoxins
Prostate hyperplasia
Sepsis

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34
Q

What are the different stages for glomerular filtration rate

A

Remember the clock analogy

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35
Q

Give 4 sig risk factors for CKD

A

Diabetes
FHx of CKD
Old age
Recurrent UTIs

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36
Q

Causative organisms of pyelonephritis

A

remember KEEPSs

Klebsiella
E. Coli
Enterococcus
Proteus mirabilis
Staphlococus saprophyticus

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37
Q

Most common cause of pyelonephritis

A

Escherichia coli

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38
Q

What test is commonly used for chlamydia

A

Nuclei acid amplification test

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39
Q

Signs of infection in a urine dipstick result

A

Leukocytes and nitrites

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40
Q

What is prostatitis characterised by

A

Pelvic and perineal pain lasting > 3months.

Trauma causing nerve damage in LUT is risk factor for prostatitis

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41
Q

First line for LUT infection and its pregnancy SE

A

Nitrofurantoin

Should be avoided in 3rd trimester - causes neonatal haemolysis

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42
Q

Risk of using trimethoprim in pregnancy

A

Teratogenic in first trimester - inhibits folate synthesis

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43
Q

What does budd-chiari syndrome present with

A

Abdo pain
Ascites
Liver enlargement

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44
Q

What’s reiters syndrome

A

Reactive arthritis

Triad of… CANT SEE CANT PEE CANT CLIMB A TREE

Conjunctivitis, urethritis, arthritis

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45
Q

What’s saints triad

A

Diverticulosis, cholelithiasis, hiatus hernia

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46
Q

Name 4 complications of polycystic kidney disease

A

Subarachnoid haemorrhage
Kidney stones
Polycystic liver disease
CVD

not nephrotic syndrome

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47
Q

5 types of malaria pathogen species

A

Plasmodium falciparum - severe Sx
Plasmodium ovale
Plasmodium vivax
Plasmodium malariae
Plasmodium knowlesi

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48
Q

Which species of female only mosquito can transmit malaria

A

Anopheles gambiae

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49
Q

Urgent gold standard tx for TTP

A

Plasma exchange
- you treat without confirmed diagnosis because MEDICAL EMERGANCY.

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50
Q

What’s hydroxycarbamide

A

Bone marrow suppression.
- polycythaemia Vera
- sometimes sickle cell disease (vaso-occlusive crisis prevention)

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51
Q

TTP signs and sx

A

PENTAD:

Microangiopathic haemolytic anaemia,
Low platelets,
AKI,
Neurological Sx
Fever

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52
Q

In ttp what’s seen on the blood film

A

Schistocytes

blood fragments

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53
Q

When is FRAX tool used

A

Gives 10 Yr probability of a fracture

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54
Q

When is HAS BLED score used

A

Risk of major bleed for Px on anticoagulation.

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55
Q

When is QRISK3 used

A

Risk of getting stroke or heart attack in next 10 yrs

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56
Q

Give 4 complications of chemotherapy

A

Alopecia
Pancytopenia
Infertility
Secondary malignancies
Nausea & GI disturbances

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57
Q

What’s thrombo-prophylaxis regimen for px who’ve had suregry/hip replacement

A

LMWH (Delteparin) acutely + apixaban/compression stocking until discharge

+ low dose aspirin for further 28 days

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58
Q

Tx for severe/complicated malaria

A

IV artesunate

2nd line: IV quinine + doxycycline

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59
Q

Treatment of uncomplicated malaria/Non falciparum malaria

A

Oral chloroquine

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60
Q

Which 2 malaria species can lie dormant

A

Plasmodium ovale
Plasmodium vivax

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61
Q

Tx of dormant malaria

A

Primaquine

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62
Q

Is malaria notifiable

A

Yes
Public health England

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63
Q

Outcomes of acute inflammation

A

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

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64
Q

Which cancer doesn’t metastasise

A

Basal cell carcinoma

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65
Q

Name of cancers: straited muscle

A

Rhabdomyoma (benign)
Rhabdomyosarcoma (malignant)

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66
Q

Name of cancers: smooth muscle

A

Leiomyoma (benign)
Leiomyosarcoma (malignant)

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67
Q

Name of cancers: cartilage

A

Chondroma (benign)
Chondrosarcoma (malignant)

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68
Q

Name of cancers: bone

A

Osteoma (benign)
Osteosarcoma (malignant)

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69
Q

Name of cancers: Adipocytes

A

Lipoma (benign)
Liposarcoma (malignant)

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70
Q

Name of cancers: non glandular

A

Papilloma (benign)
Carcinoma (malignant)

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71
Q

Name of cancers: glandular

A

Adenoma (benign)
Adenocarcinoma (malignant)

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72
Q

Burkitts lymphoma

A

B cell malignancy caused by EBV

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73
Q

Kaposi sarcoma

A

Vascular endothelial malignancy; HIV associated

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74
Q

Ewing sarcoma

A

Bone malignancy

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75
Q

Teratoma

A

Cancer of all 3 embryonic germ layers

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76
Q

What are the 4 outcomes of inflammation

A

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

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77
Q

Give examples of the 2 types of granulomas

A

aggregate of epitheloid histocytes

Central necrosis… (caseating granuloma) - TB
No central necrosis… (non-caseating granuloma) - Sarcoidosis, Crohn’s, Vasculitis

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78
Q

Metaplasia of Barrett’s oesophagus

A

Stratified squamous —> Simple columnar

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79
Q

Define budd-chiari syndrome

A

An obstruction of the Hepatic vein via either a tumour or a thrombus, resulting in Hepatic ischaemia and eventual liver failure

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80
Q

Define haemochromatosis

A

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**

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81
Q

Define Wilson’s

A

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

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82
Q

What’s given for alcohol withdrawal

A

Chlordiazepoxide

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83
Q

What’s desferroxamine given in

A

Iron chelating agent
For iron overdose

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84
Q

Is diarrhoea a characteristic finding of upper GI bleeds

A

No

Coffee-ground vomit
Melaena
Hypotension
Tachycardia

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85
Q

What are the Sx of pancreatitis

A

GET SMASHED
Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion venom
Hyperlipidaemia
Emboli
Drugs

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86
Q

If Px has ruq pain made worse on eating fatty foods what could it be

A

Biliary colic
Or
Ascending cholangitis

So to differentiate… remember ascending cholangitis = charcots triad

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87
Q

Which cancers metastases to the bone

A

Breast
Lung
Thyroid
Kidney
Prostate

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88
Q

What is aledronic acid

A

Bisphosphonate
- remember when taking; have in morning and stay upright for 30 mins after —> Can cause oesophagitis

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89
Q

Which drug can cause haemolytic anaemia

A

Sulfasalazine
DMARD; used in severe RA

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90
Q

What’s Sjögren’s syndrome

A

Immune destruction of exocrine glands
presents with arthritis, dry eyes and dry mouth

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91
Q

What test is used in Sjögren’s syndrome

A

Schirmer’s test;
a small strip of paper in the eye to measure tear production

+ lacrimal gland biopsy
+ antibody testing

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92
Q

What is the severe form of psoriatic arthritis and what do u see

A

XRay image; Pencil in cup

Arthritis mutilans - severe form of psoriatic arthritis

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93
Q

When are periarticular erosions seen

A

Gout

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94
Q

Which msk condition is one of the only to preferentially affect young men

A

Ankylosing spondylitis
1st line Tx : whilst other tests are going on - NSAIDS; ibuprofen

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95
Q

What is given in gout Tx

A

Acute
NSAIDs + ppi
Cholcicine

long-term
Allopurinol - xanthine oxidase inhibitors

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96
Q

Give 4 clinical features of Parkinson’s

A

Fine tremor
Rigidity
Brisk reflexes
Small handwriting

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97
Q

Ascending paralysis from lower limbs is seen in what condition

A

Guilin barre syndrome

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98
Q

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???

A

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

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99
Q

Clinical features of cauda equina

A

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.

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Perfectly
100
Q

When is neostigmine + pyridostigmine used

A

ACh-estarase inhibitor; Blocks active site of acetylcholinesterase, increasing the amount of Ach available to the post-synaptic membrane

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101
Q

Give 4 causes/ risk factors for developing peripheral neuropathies

A

Diabetes

Immunocompromised state; Hep C viral infection, diphtheria, leprosy, HIV, Lyme disease can all cause neuropathies

Connective tissue disorders

Alcoholism

102
Q

Commonest cause of COPD exacerbation

A

Bacterial; Haemophilus influenza
Viral; rhinovirus

103
Q

In acute COPD exacerbation what’s first line management

A

ABG

104
Q

State the severity of asthma

A

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

105
Q

Side effect of salbutamol / SABA

A

Hypokalaemia

106
Q

Side effect of inhaled corticosteroids

A

Oral candida
Stunted growth in children

107
Q

Give 2 examples of inhaled corticosteroids

A

Beclamethasone
Proprionate

108
Q

Define asthma

A

Chronic reversible obstructive airway disease
airway hyper-responsiveness + inflamed bronchioles

109
Q

Types of asthma

A

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

110
Q

Asthmatic triggers

A

Infection
Allergen
Cold
Exercise
Drugs; beta blocker / aspirin

111
Q

What atopic triad

A

Atopic rhinitis, asthma, eczema

Known as Atopy

112
Q

Pathophysiology of asthma

A

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

113
Q

Sx of asthma

A

Wheeze
Dry Cough
Chest tightness
Sob

Episodic with triggers and diurnal variation
Often younger Px

114
Q

Investigation and Dx of asthma

A

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

115
Q

Tx of asthma

A

SABA
SABA + ICS
Assess inhaler technique and compliance before progressing with Tx
SABA + ICS + LTRA
SABA + ICS + LABA ± LTRA
Increase ICS

116
Q

Drug names of asthmatic drug classes

A

SABA salbutamol
ICS Beclamethasone / Proprionate
LTRA Montelukast
LABA Salmeterol

117
Q

Tx for asthma exacerbations

A

Remember O SHIT B

O2

Nebulised _S_ABA
_H_ydrocortisone (ICS)
_I_V Magnesium sulfate
IV _T_heophylline

BiPAP

118
Q

Which type of lung cancer is seen most commonly in non-smokers

A

Adenocarcinoma

119
Q

Which lung cancer is highly associated with asbestos exposure

A

Mesothelioma
Deaths from mesothelioma must be sent to the HM Coroner.

120
Q

Characteristic of PE

A

pleuritic chest pain (worse on deep breaths),
shortness of breath
haemoptysis.

121
Q

What’s curb65

A

Score estimates mortality of community-acquired pneumonia

Confusion
Urea > 7
RR ≥ 30
BP < 90/60
65 />

122
Q

MoA for spironolactone

A

Inhibition of aldosterone receptors in distal tubules

123
Q

When is ABCD2 used

A

Stroke risk after a TIA

124
Q

Give 3 scenarios of htn that should make u think of conns

A

hypertension associated with hypokalaemia,
hypertension despite being on 3 or more antihypertensives,
hypertension before 40 years

125
Q

U waves are seen in which electrolyte disturbance

A

Hypokalaemia

126
Q

Give 4 cause of Hypercalcaemia

A

Thyrotoxicosis
Hyperparathyroidism
Malignancy
Familial benign hypocalciuric Hypercalcaemia
Sarcoidosis

127
Q

Whats carcinoid syndrome

A

paraneoplastic syndrome that has a classical triad of:
cardiac involvement,
diarrhoea
flushing.

Its due to the tumour cells producing 5-HT

128
Q

Gold standard Ix for coeliacs

A

Endoscopy with intestinal biopsy

129
Q

Which antibodies are seen in coeliacs

A

IgA tissue transglutaminase
IgA endomysial antibody

130
Q

Most common cause of peptic ulcers

A

H.pylori
Dx: Carbon-13 urea breath test or a stool antigen test
Tx: C.A.P = Clarithromycin, amoxicillin, PPI (omeprazole)

131
Q

Loin to groin pain which comes and goes. Can’t get comfortable… what has he got and gold standard Dx for it?

A

Renal colic

Non-contrast CT kidney, ureter and bladder

132
Q

Painless haematuria is a strong indication to which cancer

A

Bladder cancer

133
Q

What is minimal change disease defined as

A

Minimal change disease is a type of nephrotic syndrome:

Hypoalbuminaemia,
Peripheral oedema
Proteinuria

+ hyperlipidaemia/lipiduria

134
Q

MoA for loop diuretics

A

Ascending limb of the loop of Henle and inhibits the NaK2Cl channels

135
Q

Name 2 things u might see in myeloma

A

Monoclonal antibodies
Bence-jones proteins

136
Q

What side effects seen with amitriptyline

A

significant anticholinergic properties - decrease the effect of the parasympathetic nervous system

Blurred vision, confusion, dry mouth, urinary retention

137
Q

Which Abx inhibit bacterial cell wall synthesis

A

Beta lactams; penicillin
Glycopeptides; vancomycin, teicoplainin
Cephalosporins; cephalexin, cefuroxime
Carbapenems

138
Q

Name 1 food which inhibits warfarins effect

A

Spinach

139
Q

Give 3 foods which increase warfarins effects

A

Grapefruit
Cranberries
Alcohol

  • Remember high INR= haemorrhage, low INR= clotting*
140
Q

What drug is licensed in uk to treat heroin

A

Methadone

141
Q

Define pheochromocytoma

A

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

142
Q

What is a complication of clostridium difficile

A

Pseudomembranous colitis

143
Q

4 organisms that cause atypical pneumonia

A

Contracted from infected birds – patient often owns a parrot
AKA Legionnaire’s disease

Chlamydia psittaci
Coxiella Burnetti
Legionella pneumophila
Mycoplasma pneumoniae

144
Q

Management for TB

A

RIPE

Rifampcin
Isoniazid
For 6 months
Pyrazinamide
Ethambutol
For first 2 months of the 6 months

145
Q

Give 4 symptoms of infective gastroenteritis

A

Bloody diarrhoea
Fever
Headache
Dehydration; Reduced skin turgor - severe cases

146
Q

For staph aureus give which ABx

A

Flucloxacillin

Vancomycin (MRSA)
Could give… clarithromycin

147
Q

Most commonly affect valve in infective endocarditis

A

Tricuspid

148
Q

Most common cause of bacterial pneumonia

A

Streptococcus pneumoniae

149
Q

Tx for osteoporosis

A

1st line:
Bisphosphonate (aledronic acid)
+ AdCal

2nd line:
Denosumab (monoclonal antibody to RANK ligand)

150
Q

Mechanism of action of bisphosphonates

A

Inhibit bone resorption through the inhibition of enzyme (Farnesyl Pyrophosphate synthase) which reduces osteoclast activity

151
Q

Tx for Ankylosing spondylitis

A

NSAIDS and physiotherapy

152
Q

What does subarachnoid haemorrhage look like on CT

A

Subarachnoid haemorrhage which appears ‘star-shaped’ on a CT scan

153
Q

What does subdural haemorrhage look like on CT

A

appears ‘sickle/crescent shaped’ on a CT scan and there is no lucid
period

154
Q

What does extra-dural haemorrhage look like on CT

A

lemon shaped bleed and a lucid period following a head injury in the brain
- middle meningeal artery

155
Q

Paraesthesia in palm and other Sx of carpal tunnel syndrome… what nerve is most likely affected

A

Median nerve

156
Q

Sx of multiple sclerosis

A

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

157
Q

What is used to Tx jerky movements / chorea in huntingtons

A

Risperidone

Haloperidol is used to treat psychosis in Huntington’s

158
Q

What is sertraline

A

SSRI used to treat depression

159
Q

Does dehydration cause a tension headache

A

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.

160
Q

Which pneumonia is typically associated with AIDS

A

Pneumocystis jirovecii

161
Q

Most appropriate action for Px with tension pneumothorax

A

immediate decompression via large bore canula

162
Q

Which drug class causes bronchodilation by blocking acetylcholine receptors leading to bronchial smooth muscle contraction

A

Long-acting muscarinic antagonists

163
Q

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?

A

Sarcoidosis
persistent rash (erythema nodosum) + bilateral hilar lymphadenopathy —> typical findings

Hypercalcaemia is a key finding in the diagnosis of sarcoidosis

164
Q

Antibody found in goodpastures

A

Anti- glomerular basement membrane

165
Q

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)

A

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.

166
Q

What vaccines are included for 6 in 1

A

diphtheria, tetanus, pertussis, polio, Hib and Hepatitis B.

At 8, 12 and 16 weeks

167
Q

What type of lung sound if heard in Px having an acute asthmatic attack

A

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.

168
Q

Tx for COPD

A

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

169
Q

Whats iprotropium bromide

A

SAMA

Short acting muscarinic antagonist

170
Q

Whats tiotropium bromide

A

LAMA

Long acting muscarinic antagonist

171
Q

Common site for lung cancer metastases

A

Adrenal glands
bone,
brain
liver

breast cancer commonly can metastasise to lung BUT lung cancer doesn’t commonly metastasise to breast tissue

172
Q

Give 3 bacterias that cause atypical pneumonia

A

Mycoplasma pneumonia
Chlamydophila pneumonia
Legionella pneumonia

173
Q

Whats commonest community acquired cause of pneumonia

A

Streptococcus pneumonia

174
Q

Whats commonest hospital acquired cause of pneumonia

A

Staphylococcus aureus

175
Q

Whats commonest cause of pneumonia in COPD Px

A

Haemophilus influenza

176
Q

Does klebsiella pneumonia cause typical or atypical pneumonia

A

Typical

177
Q

Give 4 organisms that cause typical pneumonia

A

Strep pneumonia
Staph aureus
Haemophilus influenza
Klebsiella pneumonia

178
Q

Common SE of pyrazinamide

A

Used in TB

Arthralgia

179
Q

Which disease is caused by chromosome 6 being affected

A

Hereditary haemochromatosis

180
Q

Which disease is caused by chromosome 7 being affected

A

Cystic fibrosis
In coding for the CFTR protein causing defective Cl- secretion and Na+ absorption.

181
Q

Which disease is caused by chromosome 13 being affected

A

Wilsons disease

182
Q

Which disease is caused by chromosome 14 being affected

A

Alpha -1- antitrypsin deficiency

183
Q

Which disease is caused by chromosome 21 trisomy being affected

A

Down syndrome

184
Q

Give 1 intentional and 4 unintentional reasons a Px might not adhere to medication

A

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

185
Q

What are WHOS’ 5 moments of hand hygiene

A

Before touching a patient
Before clean/aseptic procedure done
After body fluid exposure
After touching a patient
After touching a patient’s surroundings

186
Q

Tx for syphilis

A

1st line:
Benzathine penicillin (not C.I in pregnancy but doseage affected; but is if Px is allergic)

2nd line:
Azithromycin / doxycycline

187
Q

Give 4 co -locations of obesity

A

GORD
Obstructive sleep apnoea
Osteoarthritis
Pancreatitis

188
Q

Chemoprophylaxis of meningitis

A

Ciprofloxacin / Rifampcin

189
Q

Most common cause of work-related ill health

A

Stress, anxiety and depression

2nd; musculoskeletal disorders

190
Q

Define sensitivity

A

Proportion of patients who have disease and test positive

191
Q

Define specificity

A

Proportion of Px who don’t have the disease and test negative

192
Q

What term is used to describe “The proportion of patients who test positive who have the condition”

A

Positive predicted value

193
Q

What term is used to describe “The proportion of patients who test negative who do not have the condition”

A

Negative predicted value

194
Q

Define 1º prevention and give examples of it

A

Reduce initial occurrence of the disease

Statin use in Px with qrisk3 > 10%
Immunisation programmes

195
Q

Define 2) prevention and give an example

A

To Tx in order to stop disease from progressing

Antiplatelet therapy after an MI

196
Q

Define tertiary prevention and give an example

A

Reduce the impact of an ongoing problem and improve quality of life

Diabetic eye screening

197
Q

Give 4 uk screening programmes

A

Breast cancer screening
Cervical screening programme
Abdominal aortic aneurysm programme
Newborn and infant physical examination

198
Q

Does prostate cancer have a screening programme

A

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

199
Q

Give 4 cardinal Sx of cerebellar stroke

A

Headache
Ataxia
Vertigo
Vomiting

200
Q

Whats ABCD2 used for

A

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)).

201
Q

Give 5 cancers that commonly metastasise in the brain

A

Lung
Breast
Skin
Kidney
Bowel

202
Q

What can trigger Sx of giant cell/temporal arteritis

A

Change in temperature, shaving, combing hair / eating

Start steroid Tx and do temporal biopsy within 14 days of starting Tx + bloods.

203
Q

What nerve is responsible for carpel tunnel syndrome

A

Median nerve

204
Q

What nerve root does the median nerve originate from

A

C5-T1

205
Q

Give 4 xRay features of rheumatoid

A

‘LESS’-
loss of joint space
erosions
soft tissue swelling
soft bones (osteopenia)

206
Q

XRay findings of osteoarthritis

A

‘LOSS’
loss of joint space
osteophyte formation
Subchondral sclerosis
subchondral cysts

207
Q

MoA for naproxen

A

Non-selective inhibitor of COX 1 and COX 2 enzymes

208
Q

MoA for methotrexate

A

Inhibits dihydrofolate reductase enzyme (this enzyme normally converts folic acid to FH4 which is required for DNA and protein synthesis).

209
Q

Give types of seronegative spondyloarthropathies

A

Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
Juvenile idiopathic arthritis
IBD related arthritis

210
Q

Hand signs of RA

A

Boutonniere deformity of the thumb
swan neck deformity
symmetrical swollen joints
ulnar deviation

211
Q

T- scores used in osteoporosis

A

Normal= -1 < T.
Osteopenia = T score between -1 and -2.5.
Osteoporosis = T score ≤ 2.5

212
Q

Which arthritis is can’t see can’t pee can’t climb a tree used for

A

Reactive arthritis

213
Q

Which bacteria is Gram +ve cocci, catalase +ve, coagulase +ve

A

Staph aureus

214
Q

Which scoring system/tool is used for upper GI bleeding

A

Glasgow-blatchford

215
Q

Most common type of hepatitis in travellers

A

Hep A

216
Q

Give 5 causes of ascites

A

Heart failure
Acute pancreatitis
Malignancy
Hypoalbuminaemia
Meig’s syndrome

-sound = shifting dullness and fluid thrill.

217
Q

What are the risk factors for acute cholecystitis

A

Same as gallstones

4Fs; fat, female, forties, fertile

+ COCP

218
Q

What Sx is fibroproliferative disorder affecting the palmar fascia mainly of the 4th and 5th fingers.

A

Dupuytrens contracture

219
Q

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

A

Spontaneous bacterial peritonitis

220
Q

Most common causative agents of spontaneous bacterial peritonitis

A

Klebsiella pneumoniae
Strep pneumoniae
E.coli

221
Q

1st line for suspected gallstones

A

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.

222
Q

Which infection would cause neutropenia

A

AIDS infection

223
Q

Which cancer may cause neutrophilic

A

Chronic myeloid leukaemia

224
Q

Which condition is acute lymphoblastic anaemia associated with

A

Down syndrome

The facies that could be listed in the question- small chin, slanted eyes
Rememebr ALL commonly seen in small children

225
Q

If you think patient has iron define I envy anaemia what do u need to look out for when answering for management?

A

Double check Px age .. red flag in > 60yr olds / post-menopausal women

An urgent (2 week wait) colonoscopy is needed to rule out malignancy.

226
Q

What disease does parvovirus b19 cause and what else can it precitate

A

Fifth disease

In people with sickle cell, it can precipitate sickle cell crisis

227
Q

What is used to define CKD

A

Rememebr the clock for eGFR

measurements >3 months apart with an eGFR <60

228
Q

Side effect of carbimazole

A

Used in Hyperthyroidism

Agranulocytosis;

229
Q

Side effect of gentamicin

A

Ototoxicity

230
Q

Most common type of renal cell carcinoma

A

Clear cell

Papillary only accounts for 10-15%

231
Q

What types of cells might be seen in chronic lymphoid leukaemia

A

Smudge cells

232
Q

What type of drug class is Goserelin and when can it be used

A

GnRH agonist

Used in Tx for prostate cancer

233
Q

What is drug class of finasteride and when can it be used

A

5 alpha reductase inhibitor

2nd line for BPH Tx

234
Q

What is drug class of oxybutanin and when can it be used

A

Anti cholinergic

1st line Tx for overactive bladder

235
Q

Tx for acute pulmonary oedema

A

High flow oxygen, IV furosemide, IV morphine / GTN.
Then notifying your senior and an urgent CXR.

236
Q

Give reasons for why a uti can be complicated

A

Male
Pregnant women
Child
Immunocompromised
Recurrent UTIs
Kidney structural abnormality

237
Q

What inherited disease is associated with Subarachnoid haemorrhages

A

Autosomal dominant polycystic kidney disease

associated with formation of berry aneurysms; its rupture —> SAH

238
Q

What is Tx/management for severe Hypercalcaemia

A

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

239
Q

Give 5 causes of long term steroid use

A

Immunosuppression
Diabetes mellitus
Proximal muscle weakness
Osteoporosis
Skin thinning and bruising

240
Q

What type of Arrythmias is Wolff-Parkinson’s white

A

Supraventricular tachycardia
caused when by an accessory pathway causing a re-entrant loop

241
Q

ECG findings of WPW syndrome

A

Wide QRS, short PR and a classical delta wave (slurred upstroke to the QRS)

242
Q

3 features of coeliacs seen on endoscopy are…

A

Villus atrophy
Crypt hyperplasia
Lymphocytic infiltration

243
Q

Give 4 extra intestinal Sx in Px with UC

A

Arthritis
Conjunctivitis
Clubbing
Pyoderma gangrenosum

244
Q

Give 3 tests that can be done for h.pylori

A

Carbon 13 urea breath test (1st line)
Stool antigen test

Endoscopy (most accurate but too invasive)

245
Q

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

A

Loperamide;
Anti-motility - useful for thee diarrhoea

246
Q

If terminal ileum is damaged/resected, which vitamin will be affected and why

A

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

247
Q

ECG changes for atrial fibrillation

A

Absent p waves
Narrow qrs complex
Irregularly irregular rhythm

248
Q

Which electrolyte disturbance gives you U waves

A

Hypokalaemia

249
Q

ECG changes for Hyperkalaemia

A

Absent p waves
Prolonged PR interval
Tall tented t waves
Wide qrs

go, go long, go tall, go wide

250
Q

Types of cardiomyopathy

A

Dilated
Restrictive
Hypertrophic

Phase 2a Basic Knowledge (13 decks)

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