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Phase 2a > Mocks > Flashcards

Mocks Flashcards

1
Q

Describe Cardiac Tamponade

A

It is a complication of pericarditis characterised by an accumulation of a large amount of fluid in the pericardial cavity that compresses the heart and reduces cardiac function

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2
Q

List the causes of Hypovolaemic Shock

A

Ruptured aortic aneurysm, severe burns, vomiting, bleeding from trauma

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3
Q

ECG changes in V1-V4 indicate which artery is affected?

A

Left anterior descending

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4
Q

ECG changes in II, III, aVF indicate which artery is affected?

A

Right coronary

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5
Q

ECG changes in I, aVL, V5-V6 indicate which artery is affected?

A

Left circumflex

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6
Q

What ECG changes would be seen in Mobitz type 1 heart block?

A

Increasing PR intervals then a drop in QRS (Wenckebach pattern) - AV node block

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7
Q

What ECG changes would be seen in Mobitz type 2 heart block?

A

Constant PR intervals then a drop in QRS - intra-nodal block

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8
Q

Describe Dressler’s syndrome, including symptoms and treatment

A

Develops 2-10 weeks post MI - injury stimulates formation of antibodies against the heart muscle
Symptoms - fever, chest pain, pleural pain, pericardial rub
Treatment - aspirin, NSAID or steroids

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9
Q

What changes would you see on an X-ray for Heart Failure

A

Alveolar oedema
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural Effusion

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10
Q

Which condition is indicated by the following description:
SOB worse lying down, pink frothy sputum, fine crackles on ausculation

A

Left Sided Heart Failure

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11
Q

Describe secondary prevention

A

Methods to detect and address an existing disease prior to the appearance of symptoms

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12
Q

What is the 1st and 2nd line treatment for Angina

A

1st line - Beta blocker or CCB
2nd line - add Nifedipine

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13
Q

What is the initial treatment for STEMI

A

Aspirin + Prasugrel/Ticagrelor/Clopidogrel with Unfractionated Heparin and PCI

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14
Q

What is the 1st and 2nd line treatment for Heart Failure?

A

1st line - loop Diuretic
2nd line - ACEi and Beta Blocker

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15
Q

What is the treatment for Pericarditis?

A

NSAIDs (paracetamol) + Colchicine

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16
Q

Define atherosclerosis

A

Accumulation of lipids, macrophages and smooth muscle cells in the intima of large and medium sized arteries

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17
Q

State the 4 features of the Tetrology of Fallot

A

Ventricular Septal Defect
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta

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18
Q

Describe 1st degree heart block

A

Usually asymptomatic, long PR interval, delayed AV conduction

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19
Q

Describe 3rd degree heart block

A

Complete block/absence of AV conduction, P waves and QRS complexes independent

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20
Q

Define embolism

A

A blocked vessel caused by a foreign body e.g. blood clot or an air bubble

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21
Q

Define thrombosis

A

Formation of a blood clot inside a blood vessel that obstructs flow

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22
Q

Define infarction

A

Cell death due to a reduced or absent blood supply

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23
Q

Define ischaemia

A

Restriction in blood supply to tissues causing a shortage of oxygen that is needed for cell function

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24
Q

What is secreted from the Zona Glomerulosa?

A

Mineralocorticoids e.g. aldosterone

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25
Q

What is secreted from the Zona Fasciculata?

A

Glucocorticoids e.g. cortisol

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26
Q

What is secreted from the Zona Reticularis?

A

Androgens (sex hormones)

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27
Q

What is secreted from the Adrenal Medulla and from what cells?

A

Catecholamines (adrenaline and noradrenaline) are secreted from the Chromaffin cells

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28
Q

Describe the effects of insulin

A

It is secreted from pancreatic beta cells in the islets of langerhans and cause a decresae in glycogenolysis

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29
Q

State the thyroid test results in Grave’s

A

Low TSH, high T3/4 (primary hyperthyroidism)

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30
Q

Describe the Synacthen test

A

Short ACTH stimulation test - patient is given ACTH and if cortisol levels remain low, this is diagnostic for Addison’s

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31
Q

What is the gold standard test for Carcinoid Syndrome?

A

Elevated serum Chromogranin A ( + octreoscan)

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32
Q

What is the immediate management for DKA?

A

Isotonic saline + insulin. Give potassium if levels are below 5.5 within the first 24 hours

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33
Q

What is secreted from the anterior pituitary?

A

FSH, LH, ACTH, TSH, Prolactin, GH

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34
Q

What is the function of glucagon?

A

Secreted by alpha cells in response to decreased blood glucose concentration.
Acts on the liver to convert glycogen to glucose, stimulates lipolysis and forms glucose from lactic and amino acids.
Comprised of a single polypeptide chain of 29 amino acid residues

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35
Q

What is the function of PTH in response to low serum calcium?

A

It increases the activity of 1-a-hydroxylase enzyme which converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol
Indirectly stimulates osteoclasts and directly stimulates osteoblasts to resorb bone and release calcium
Increases calcium reabsorption in the kidneys and small intestines
Decreases phosphate reabsorption in kidneys

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36
Q

Describe the physiology of corticosteroid withdrawal in Crohn’s

A

Long term corticosteroids suppress adrenal glands leading to adrenal atrophy. When stopped abruptly it causes symptoms of adrenal insufficiency

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37
Q

List the cancers that cause of SIADH

A

Small cell carcinoma, prostate cancer, pancreatic cancer, lymphomas, cancer of the thymus

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38
Q

What are the signs/symptoms of hyperkalaemia? (9)

A

Muscle weakness, cramping, paraesthesia, irritability/anxiety, palpitations, abdo cramping, diarrhoea, dyspnoea, hyperreflexia

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39
Q

What are the complications of acromegaly?

A

Obstructive sleep apnoea, T2DM, cardiomyopathy, IHD, colorectal cancer

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40
Q

What is the 1st and 2nd line treatment for acromegaly?

A

1st line - transphenoidal surgery to remove pituitary adenoma
2nd line - somatostatin analogues, GH antagonists, dopamine agonists, external radiotherapy

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41
Q

List 5 differential diagnoses for hyperparathyroidism

A

DM, DI, SIADH, primary polydipsia, hypercalcaemia

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42
Q

What are the symptoms of hyperparathyroidism?

A

Bones - pain/fractures
Stones - biliary/renal
Groans - constipation, abdo pain, pancreatitis
Moans - depression
Thrones - polyuria, polydipsia

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43
Q

Cushing’s causes

A

Syndrome: glucocorticoid use/corticosteroids
Disease: Pituitary adenoma

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44
Q

What is the first line investigation for hyperaldosteronism and expected results?

A

Aldosterone Renin Ratio
Primary: normal/low renin, high aldosterone
Secondary: high renin, high aldosterone
U&Es show hyperkalaemia

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45
Q

Describe 2 hypocalcaemia clinical signs

A

Chvostek’s sign - tapping over facial nerve causes spasm of facial muscles
Trousseau’s sign - inflate BP cuff to 20mmHg above systolic for 5 mins and the hand will form a claw

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46
Q

What causes Carcinoid Syndrome?

A

Metastasis of carcinoid tumours arising from neuroendocrine cells that secrete high levels of serotonin

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47
Q

What are the symptoms and signs of Carcinoid Syndrome?

A

Symptoms - cutaneous flushing, recurrent diarrhoea, abdo cramps, asthma-like wheezing
Signs - erythema, pellagra skin lesions, hepatomegaly, pulmonary systolic and diastolic heart murmur

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48
Q

State the treatment for hyperthyroidism and describe it’s function

A

Carbimazole
Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, this decreases thyroid hormone production

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49
Q

State the symptoms of Phaeochromocytoma and what causes it

A

Symptoms - hypertension, tachycardia, diaphoresis, hypertensive retinopathy, pallor, diabetes
Caused by excess secretion of metanephrine and methoctramine

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50
Q

Describe mitral regurgitation murmur

A

Pan systolic, high pitch whistle, radiates to axilla

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51
Q

Describe mitral stenosis murmur

A

Mid diastolic, low pitch rumbling, presents with malar flush and AF

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52
Q

Describe aortic regurgitation murmur

A

Early diastolic, soft crescendo with collapsing pulse (Corrigan’s)

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53
Q

Describe aortic stenosis murmur

A

Ejection systolic, crescendo-decrescendo high pitch, radiates to carotids, slow rising pulse, exertional syncope

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54
Q

State the 1st line and gold standard investigations for Coeliac Disease

A

1st line - serology for tissue transglutaminase (TTG) antibodies (IgA)
Duodenal biopsy - gold standard, endoscopically will show villous atrophy, crypt hyperplasia and increased epithelial WBCs

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55
Q

Define Diverticulitis, diverticular disease, diverticulosis and diverticular stricture

A

Diverticulitis - inflammation of diverticulum
Diverticular disease - when diverticula cause symptoms
Diverticulosis - presence of diverticula (outpouchings of large intestine) which are asymptomatic
Diverticular stricture - complication of diverticulitis

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56
Q

State which cancers cause enlargened cervical lymph nodes

A

Hodgekin’s and non-Hodgkin’s lymphoma

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57
Q

State which cancers cause enlargened mediastinal lymph nodes

A

Lung cancer, Hodgkin’s and non-Hodgkin’s lymphoma

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58
Q

State which cancers cause enlargened Supraclavicular (Virchow’s) lymph nodes

A

Stomach cancer

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59
Q

State which cancers cause enlargened inguinal lymph nodes

A

Testicular and ovarian cancer

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60
Q

State which cancers cause enlargened axillary lymph nodes

A

Breast cancer

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61
Q

State 4 causes of peptic ulcers and describe their pathophysiology

A

Mucosal Ischaemia - insufficient blood flow causes gastric cell death meaning they do not produce mucin and ulcers from
NSAIDs - inhibit COX1 meaning there is no mucous secretion causing mucosal damage leading to ulcer formation
Bile reflux - strip away mucus layer leads to mucosal damage and ulcers
H. pylori - live in gastric mucous, secrete urease which splits urea to CO2 and ammonia. Ammonia combines with H+ to form ammonium. This causes an inflammatory response leading to decreased mucosal defence and ulcers

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62
Q

What is the most common site of colorectal cancer

A

Rectum then next most common is sigmoid colon then caecum

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63
Q

State the stages in Marsh Classification for Coeliac

A

1 - intraepithelial lymphocytes
2 - intraepithelial lymphocytes and crypt hyperplasia
3a - intraepithelial lymphocytes and partial/mild villous atrophy
3b - intraepithelial lymphocytes and subtotal/moderate villous atrophy
3c - intraepithelial villous atrophy and total villous atrophy

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64
Q

State 5 types of diarrhoea

A

Secretory, osmotic, exudative, inflammatory, dystentery

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65
Q

Describe the symptoms of inflammatory diarrhoea

A

Severe very watery diarrhoea, blood in stool, fever, abdo pain, tenesmus (needing to poo often but can’t)

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66
Q

List 7 red flags for cancer in diarrhoea

A

Rectal bleeding, abdo mass, family history, anaemia, unintentional weight loss, age over 60, change in bowel habit for more than 6 weeks

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67
Q

What findings would you expect to see on a small bowel obstruction radiograph?

A

Dilated jejunum and/or ileum
Absence of gas in bowel (gas shadows) distal to obstruction

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68
Q

What is the initial management for small bowel obstruction?

A

‘drip and suck’ - nil-by-mouth, insert NG tube, IV fluids and correct electrolyte disturbances
Urinary catheter, analgesia, anti-emetics

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69
Q

What test would you carry out for suspected H. pylori infection?

A

Serology - look for IgG antibodies
C-urea breath test - ingest C-urea then measure CO2
Stool antigen testing - immunoassay

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70
Q

4 symptoms of haemorrhoids

A

Bright red bleeding, discomfort/pain, pruritus ani, mucus discharge

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71
Q

State and differentiate the 2 haemorrhoid types

A

Internal - arise internally, painless, covered in mucus, can prolapse
External - form at anal opening, painful, covered with skin

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72
Q

Define haemorrhoids

A

Swelling and inflammation of veins in the rectum and anus

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73
Q

5 complications of diverticulitis

A

Large bowel perforation, fistula formation, large bowel obstruction, bleeding, mucosal inflammation (mimics Crohn’s)

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74
Q

What is the treatment for Varices (1st line and 2nd line if contraindicated)

A

1st line - IV Terlipressin (vasodilator)
Contraindicated in IHD so give IV somatostatin

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75
Q

7 tests for appendicitis (gold standard, other and exclusionary)

A

CT - gold standaard, highly sensitive and specific
WCC - increased neutrophils
CRP - elevated showing inflammation
ESR - elevated showing inflammation
Ultrasound - detects inflammation/mass but need CT to diagnose
Pregnancy test - exclude ectopic pregnancy
Urinalysis - exclude UTI

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76
Q

Describe each stage in the Gleason pattern

A

1 - well formed and uniform distributed glands (3+3)
2 - predominantly well formed glands with minor poorly formed glands (3+4)
3 - predominantly poorly formed glands with minor well formed glands (4+3)
4 - poorly formed glands (4+4, 3+5, 5+3)
5 - lacks gland formation or has necrosis (4+5, 5+4, 5+5)

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77
Q

Describe Henoch-Schoenlein Purpura

A

Presents with rash, abdo pain, arthralgia and glomerulonephritis
Most common in males 3-15 after an upper respiratory tract infection

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78
Q

State the 1st line drug for urinary urgency incontinence and describe its function

A

Oxybutynin - Is an anti-muscarinic drug the decreases detrusor activity by inhibiting the action of acetylcholine which leads to smooth muscle relaxation. This causes an increase in bladder capacity and decrease in urgency/frequency

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79
Q

What causes brain haemorrhage in PKD patients

A

Ruptured berry aneurysm

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80
Q

What diet should a patient with CKD follow?

A

Low protein, phosphate, potassium and sodium diet

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81
Q

State 5 types of renal cancer

A

Renal cell carcinoma (most common), urothelial carcinoma, transitional cell carcinoma, sarcomas, Wilm’s tumour (in kids)

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82
Q

What are the symptoms of renal cell carcinoma?

A

Haematuria, palpable abdo mass, loin pain, anorexia, weight loss, varicocele, enlarged lymph nodes

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83
Q

Describe the physiology of hypertension in renal cell carcinoma

A

Increased renin secretion causes and increase in RAAS activity and therefor increases BP

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84
Q

Define hydrocele

A

Abnormal collection of fluid within the remnants of the processus vaginalis

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85
Q

State 4 types of urinary incontinence

A

Stress, urgency, functional, overflow

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86
Q

State 5 types of nephrotic syndromes

A

Minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, amyloidosis, advanced renal disease

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87
Q

What is the mainstay treatment for nephrotic syndromes

A

Glucocorticoids with ACEi and prophylactic anticoagulation

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88
Q

State 4 types of diuretic and their mechanism of action/where they act

A

Thiazide - early distal tubule, inhibition of Na+ and Cl- cotransports
Loop - loop of Henle, inhibition of Na+/K+/Cl- cotransporter
K+ sparring - late distal tubule and collecting duct, inhibition of Na+ reabsorption and K+ secretion, through aldosterone sensitive channels
Osmotic - proximal tubule, loop of Henle, collecting duct, inhibition of water and Na+ reabsorption

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89
Q

Where are the 3 most common sites of renal stone formation?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

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90
Q

What type of bacteria is neisseria gonorrhoeae

A

gram negative diplococci

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91
Q

What is the treatment for gonorrhoea

A

Ceftriaxone and Azithromycin

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92
Q

What drug is contraindicated in G6PD deficiency?

A

Nitrofurantoin - causes drug-induced oxidative crisis

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93
Q

State 4 causes of thrombocytopenia

A

HIV, alcohol abuse, myeloma, heparin

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94
Q

What test is diagnostic for sickle cell anaemia and what would you see on bloods?

A

Hb electrophoresis
Bloods show low haemoglobin and high reticulocyte count

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95
Q

Describe the pathology of hereditary spherocytosis

A

Caused by defects in red cell membranes that result in them having an increased permeability to sodium

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96
Q

State and describe the 5 stages of malaria

A

Oocysts - in gut wall of female Anopheles mosquito, not infective
Sporozoites - infective, transferred to human
Merozoites - sporozoites get into the live of human and mature to schizonts then rupture releasing merozoites
Hypnozoites - lay dormant in liver
Trophozoites - activated growing stage

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97
Q

What is the mechanism of action of Imatinib?

A

Acts by inhibition of tyrosine kinase which stops excessive cellular replication of eosinophils, neutrophils and basophils
Treats CML

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98
Q

State 5 findings in blood tests in multiple myeloma and the gene associated

A

Anaemia, hypercalcaemia, increased creatinine, increased urea, monoclonal proteins in serum
Associated with MGUS gene

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99
Q

State 4 long term complications of ABVD chemotherapy and what it treats

A

Infertility, cardiomyopathy, peripheral neuropathy lung damage
Treats Hodgkin’s lymphoma

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100
Q

What condition would you see Auer rods in?

A

AML

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101
Q

Describe Haemophilia A pathophysiology

A

X linked recessive disease, deficiency in factor 8

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102
Q

5 symptoms of thrombocytopenia

A

Easy bruising, epistaxis, menorrhagia, purpura, gum bleeding

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103
Q

9 symptoms of malaria

A

fever, sweats, chills, myalgia, fatigue, diarrhoea, vomiting, abdo discomfort

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104
Q

Protazoa causing malaria relapse

A

P. ovale, P. vivax

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105
Q

Chromosomal abnormality associated with multiple myeloma

A

translocation between chromosome 11 and 14

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106
Q

Multiple myeloma criteria for characterisation

A

Monoclonal protein in serum or urine
Lytic bone lesions
Excess plasma cells in bone marrow

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107
Q

6 treatments for AML

A

Blood transfusion
BM transfusion
Allopurinol
IV antibiotics
Chemo
Steroids

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108
Q

CLL symptoms

A

Enlarged, rubbery, non-tender lymph nodes
Sweating
Anorexia
Usually asymptomatic

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109
Q

CLL treatment

A

Chemo
Rituximab
Ibrutinib

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110
Q

Complication of CLL

A

Richter’s syndrome - aggressive lymphoma

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111
Q

3 tests and their results used for Hodgkin’s lymphoma

A

FBC - anaemia, high ESR
CXR - wide mediastinum
Blood film - Reed-Sternberg cells

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112
Q

What is the function of G6PD

A

Protects RBCs against oxidative damage

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113
Q

4 symptoms of G6PD deficiency

A

Fatigue, palpitations, SOB, pallor

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114
Q

6 DVT symptoms

A

Pain, Pallor, Perishingly cold, Pulselessness, Paralysis, Paraesthesia

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115
Q

State the items on the Well’s score

A

Clinical signs and symptoms of DVT = 3
No alternative diagnosis = 3
HR >100 beats/min = 1.5
Immobilisation >3 days = 1.5
Previous DVT or PE = 1.5
Haemoptysis = 1
Malignancy =1
PE unlikely if <4 marks, likely if >4

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116
Q

Pathophysiology of Disseminated Intravascular Coagulation

A

Tissue damage leads to release and activation of tissue factor leads to coagulation from intrinsic and extrinsic pathways causes thrombosis/clotting
Tissue Plasminogen Activator increases fibrinolysis which breaks down clots but increases risk of bleeding

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117
Q

What is the sepsis 6 to manage sepsis

A

Give fluids, broad spectrum ABx, O2 if reguired
Take bloods, urine output, lactate levels

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118
Q

State the 3 types of haemophilia with inheritance pattern and factor deficiency

A

A - X linked recessive, factor 8 deficiency
B - X linked recessive, factor 9 deficiency
C - autosomal recessive, factor 11 deficiency

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119
Q

Define platelet count and how it is affected in haemophilia

A

> 450,000 platelets/microliter blood = thromboytosis
<150,000 = thrombocytopenia
Normal in haemophilia

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120
Q

Define bleeding time and how it is affected in haemophilia

A

Assesses platelet function/ability to clot
Normal in haemophilia

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121
Q

Define PT and how it is affected in haemophilia

A

Prothrombin time - assesses integrity of extrinsic factors 2,5,7,10 and fibrinogen
Normal in haemophilia

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122
Q

Define APTT and how it is affected in haemophilia

A

Activated partial thromboplastin time - assesses functionality of intrinsic pathway
Increased in haemophilia

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123
Q

Define thrombin time and how it is affected in haemophilia

A

Assesses fibrin formation from fibrinogen in plasma, normal levels are <20 secs
Normal or increased in haemophilia

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124
Q

Define fibrin degradation products and how it is affected in haemophilia

A

Diagnoses disseminated intravascular coagulation
Normal in haemophilia

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125
Q

Define D-dimer and how it is affected in haemophilia

A

Assesses degradation products of crosslinked fibrin, normal levels are <250ng/ml
Normal in haemophilia

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126
Q

What is the function of N-acetyl cysteine in paracetamol overdose?

A

Replenishes the supply of glutathione that conjugates NAPQI to non-toxic compounds

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127
Q

What tests are conducted for cholangitis

A

Contrast-enhanced dynamic CT - diagnostic
Bloods show leukocytosis and raised ALP/CRP/bilirubin

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128
Q

What are the 7 symptoms of haemochromatosis

A

fatigue, weakness, abdo pain, erectile dysfunctoin, skin bronzing, hepatomegaly

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129
Q

What tests are used in haemochromatosis (1st line, gold standard and other)

A

Ferritin levels - 1st line
Liver biopsy - gold standard
Genetic testing - HFE gene chrom 6

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130
Q

How would a patient with hepatocellular carcinoma present

A

Weight loss, fatigue, fever, dark stools, pale urine, raised alpha fetoprotein, raised CRP

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131
Q

5 causes of hepatocellular carcinoma

A

alcohol, fatty liver, haemochromatosis, wilson’s, hepatitis

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132
Q

11 causes of pancreatitis

A

Idiopathic
Gallstonees
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Spider bite
Hyperlipidaemia, hypothermia, hypercalcaemia
ERCP
Drugs

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133
Q

What is the pathophysiology of hepatitis

A

Liver injury causes an inflammatory response with infiltration of inflammatory cells and liver cell necrosis
If this is chronic it can lead to fibrosis and cirrhosis which cause chronic liver disease

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134
Q

2 signs of Wilson’s disease

A

Kayser-Fleischer rings - build up on copper in iris
Neurological signs - build up of copper in CNS

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135
Q

Describe Murphy’s sign and what condition it is present in

A

Press hand on abdomen, patient inhales, pain = positive
Shows acute cholecystitis

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136
Q

What blood test results would be seen in Paget’s disease

A

Raised ALP, everything else normal (PTH, calcium, phosphate, vit D)

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137
Q

What drug increases risk of gout and why

A

Thiazide diuretics as they increase urate reabsorption in proximal tubules

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138
Q

6 causes of reactive arthritis

A

Chlamydia (most common), gonorrhoea, campylobacter jejuni (2nd most common - after stomach bug), shigella, salmonella, E. coli

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139
Q

7 risk factors for septic arthritis

A

> 80, pre-existing joint disorder, DM, immunosuppression, recent joint surgery, prosthetic joint, penetrating trauma

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140
Q

What antibodies are associated with SLE and are the sensitive or specific?

A

ANA - sensitive
anti-dsDNA - specific

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141
Q

What is the treatment for osteoporosis and how do you take it?

A

Alendronate (bisphosphonate) - take once a week on an empty stomach and remain upright for 30 mins after taking

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142
Q

What is the treatment for gout (acute and preventing relapse)

A

Acute - high dose NSAIDs + corticosteroids + Colchicine
Allopurinol prevents future attacks

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143
Q

Describe the 3 stages of Paget’s disease

A

Lytic - excessive osteoclastic resorption
Mixed - excessive resorption and disorganised bone formation
Blastic - osteoblasts lay down excess disorganised weak bone

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144
Q

6 complications of Paget’s

A

Skull thickening, osteosarcoma, fractures, tibial bowing, deafness, high output cardiac failure

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145
Q

What is the treatment for Paget’s

A

Bisphosphonates

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146
Q

Describe chronic granulomatous large vessel vasculitis

A

Inflammation affecting carotid arteries and its branches (temporal)

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147
Q

What is the urgent treatment for chronic granulomatous large vessel vasculitis

A

Corticosteroids to prevent blindness

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148
Q

What are the 5 diagnostic criteria for chronic granulomatous large vessel vasculitis

A

Age >50, temporal artery abnormality (tender/ decreased pulsation), new onset headache, abnormal temporal artery biopsy, ESR >50mm/hr

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149
Q

10 signs of SLE

A

Discoid rash, pleuritis, peritonitis, myocarditis, oral ulcers, alopecia, photosensitivity, anaemia, migraine, seizures

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150
Q

How do you treat the symptoms of arthralgia in SLE

A

Hydroxychloroquine +/- NSAIDs +/- corticosteroids

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151
Q

What are the symptoms of anti-phospholipid syndrome

A

CLOT
Coagulation
Livedo reticularis
Obstetric issues (miscarriage)
Thrombocytopenia

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152
Q

What antibodies are associated with anti-phospholipid syndrome

A

Lupus anticoagulant
Anti-cardiolipin
Anti-beta 2 GPI

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153
Q

What gene is associated with anti-phospholipid syndrome

A

HLA-DR7

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154
Q

What is Wernicke encephalopathy, what are the symptoms and what causes it

A

Complication of chronic alcoholism caused by vit B1 deficiency
Symptoms - changes in mental status, gait, oculomotor dysfunction

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155
Q

What are the symptoms of Horner’s syndrome

A

Anhidrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)

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156
Q

What causes Horner’s syndrome?

A

Pancoast tumour in lung causes damage to sympathetic nerves

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157
Q

What are the symptoms and levels associated in Brown-Sequard syndrome

A

Ipsilateral proprioceptive, vibration and motor loss at level of lesion
Contralateral pain and temp loss 1-2 levels below lesion

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158
Q

What area is affected in a stroke impacting the:
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery

A

ACA - contralateral leg, foot, genitals
MCA - contralateral arm, hand, shoulder, face
PCA - vision and coordination

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159
Q

What is the treatment for subarachnoid haemorrhage?

A

Nimodipine (CCB) prevents vasospasm , give ASAP

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160
Q

What is the 1st line investigation for MS and what will it show

A

MRI head - shows multiple plaques of CNS demyelination

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161
Q

What is the 1st line treatment for acute migraine and class

A

Sumatriptan (serotonin 5-HT1 receptor agonist) - vasoconstrictor

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162
Q

What symptoms would you expect of a lesion at:
Optic chiasm
Trochlear nerve
Oculomotor nerve
Optic nerve

A

Optic chiasm - bitemporal hemianopia
Trochlear - eye goes up and in, hard to look down
Oculomotor - eye down and out with ptosis and mydriasis (pupil dilation)
Optic nerve - blindness or quadrantanopia/hemianopia

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163
Q

What treatment is used for tonic-clonic seizures

A

Sodium valporate although if patient of child bearing age give Lamotrigine or Carbamazepine

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164
Q

What is the treatment for myoclonic seizures

A

Topiramate

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165
Q

6 Contraindications to receiving a lumbar puncture

A

Signs of raised ICP, coagulopathy, focal neurology, cardiovascular compromise, infection at site of LP, decreased GCS

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166
Q

What drugs are used for prophylaxis for someone who has close contact with a meningitis patient

A

Rifampicin or ciprofloxacin

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167
Q

What is the name of the phenomenon where a patient feels a curtain coming down on their eyes

A

Amaurosis fugax

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168
Q

What is the acute treatment for cluster headaches and prophylaxis

A

Acute - 100% O2 and SC Sumatriptan
Prophylaxis - CCB

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169
Q

Describe encephalitis and state the most common cause

A

Inflammation of the brain parenchyma usually caused by a virus (most commonly Herpes Simplex type 1)

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170
Q

What is the diagnostic investigation for encephalitis

A

LP with CSF viral PCR testing

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171
Q

What is the treatment for encephalitis

A

IV Acyclovir

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172
Q

What is the treatment for migraine

A

Analgesia - paracetamol
Triptan - Sumatriptan

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173
Q

3 risk factors for Alzheimers

A

Down syndrome, decreased physical or cognitive activity, depression/loneliness

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174
Q

What would you see on an Alzheimers MRI (4)

A

Extracellular deposition of beta amyloid plaques
Tau neurofibrillary tangles
Damaged synapses
Cortical atrophy (hippocampus)

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175
Q

What is the treatment (and class) for Alzheimers

A

Rivastigmine - Acetylcholinesterase (ACH inhibitor)

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176
Q

State 3 drugs to treat Parkinson’s and explain their mechanism of action

A

Levodopa - dopamine precursor
Dopamine agonists
COMT inhibitor (Rasagiline) / MAO-B inhibitor (Selegiline) - inhibit enzymatic breakdown of dopamine

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177
Q

What is the treatment for Guillain Barre syndrome

A

IV immunoglobulins - decrease duration and severity of paralysis
Plasma exchange - filter out antibodies
LMW Heparin - reduce risk of venous thrombosis

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178
Q

What are the 2 main differentials for epilepsy

A

Syncope, non-ectopic seizure

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179
Q

What is the treatment for increased ICP (extradural/subdural haemorrhage)

A

IV mannitol

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180
Q

State and describe the 2 clinical tests for carpal tunnel syndrome

A

Phalen’s test - can only maximally flex wrist for 1 min
Tinel’s test - tapping on median nerve at wrist induces tingling

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181
Q

What type of collagen are antibodies targeting in Goodpasture’s

A

IV (basement membranes)

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182
Q

What type of hypersensitivity reaction is Goodpastures

A

II (antibody-mediated immune reaction)

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183
Q

What is the treatment for Asthma (4 stages)

A

1 occasional symptoms - SABA (sallbutamol)
2 mild - add inhaled corticosteroid (beclomethasone)
3 moderate - add LABA (salmeterol)
4 severe - add omalizumab

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184
Q

5 things on TB CXR

A

Gohn complex, Gohn focus, dense homogenous opacity, hilar lymphadenopathy, pleural effusion

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185
Q

What type of lesion is found in TB

A

Caseating granuloma lesion

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186
Q

4 antibiotics to treat TB

A

Rifampicin, Isoniazide, Pyrazinamide, Ethambutol

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187
Q

What is the pathophysiology of asthma

A

Narrowing of the airway, which is due to smooth muscle contraction, thickening of the airway wall by cellular infiltration and inflammation, and the presence of secretions within the airway lumen

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188
Q

What lesion is found in sarcoidosis

A

Noncaseating granuloma lesion

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189
Q

5 extrapulmonary signs of sarcoidosis

A

Erythema nodosum, polyarthritis, lupus pernio, uveitis, arrhythmias

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190
Q

5 causes of bronchiectasis

A

Cystic fibrosis, post-infectious, idiopathic, immunodeficiency, airway obstruction

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191
Q

3 signs of bronchiectasis

A

Coarse crackles on inspiration, large airway rhonchi, wheeze

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192
Q

4 complications of bronchiectasis

A

Empyema, lung abscess, pneumothorax, respiratory failure

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193
Q

What is the first line and gold standard investigations for bowel obstruction

A

1st line - abdo XR
Gold standard - abdo CT

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194
Q

4 causes of diverticulum

A

Low fibre diet, smoking, obesity, NSAIDs

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195
Q

4 symptoms of prostatitis

A

Pelvic or perineal pain lasting > 3 months, polyuria, dysuria, pain on ejaculation

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196
Q

What is trimethoprim contraindicated in and why?

A

Teratogenic in first trimester as it inhibits folate synthesis
Treats UTI

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197
Q

4 complications of PKD

A

cardiovascular disease, kidney stones, polycystic liver disease, subarachnoid haemorrhage

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198
Q

What are the 5 organisms that cause malaria

A

Plasmodium falciparum
Plasmodium ovale
Plasmodium vivax
Plasmodium malariae
Plasmodium Knowlesi

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199
Q

6 signs/symptoms of TTP

A

haemolytic anaemia, decreased platelets, AKI, neurological symptoms, fever, schistocytes on film

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200
Q

What is the first line treatment for TTP

A

Urgent plasma exchange

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201
Q

What is the mechanism of action of Rituximab

A

It is a monoclonal antibody that targets CD20 proteins on B-cell surfaces to mark them for immune system to kill them
Treats NHL and CLL

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202
Q

What is the treatment for malaria that is:
Severe/complicated
Uncomplicated
Dormant

A

Complicated - IV artesunate
Uncomplicated - oral chloroquine
Dormant - oral primaquine

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203
Q

6 types of cell that are able to regenerate

A

pneumocytes, hepatocytes, osteocytes, gut/skin epithelial cells, blood cells

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204
Q

What is Rhabdomyoma and Rhabdomyosarcoma

A

Benign striated muscle neoplsam
Malignant

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205
Q

What is Leiomyoma and leiomyosarcoma

A

Benign smooth muscle neoplasm
Malignant

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206
Q

What immune cells are seen in acute inflammation

A

neutrophil polymorphs

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207
Q

What immune cells are seen in chronic inflammation

A

B lymphocytes, T lymphocytes, macrophages

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208
Q

What is the definition of a granuloma

A

an aggregate of epithelioid histiocytes

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209
Q

6 things in an atherosclerotic plaque

A

connective tissue, foam cells (low density lipoproteins), T lymphocytes, smooth muscle cells, cholesterol, lipid deposits

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210
Q

What are the signs/symptoms of primary biliary cholangitis

A

late presentation of lethergy, pruritis, jaundice, hepatomegaly

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211
Q

What is the main concern in alcohol withdrawal and how should you treat it

A

Seizures - chlordiazepoxide

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212
Q

What condition would you see pencil in cup deformity on XR

A

Psoriatic arthritis

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213
Q

What condition would you see bamboo spine deformity on XR

A

ankylosing spondylitis

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214
Q

What condition would you see periarticular erosions on XR

A

gout

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215
Q

What is the 1st line treatment for ankylosing spondylitis and how would you treat it if it were severe

A

1st line - NSAIDs e.g. ibuprofen
Severe - DMARDs and anti-TNFs

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216
Q

How would pseudogout present

A

acute onset, often in knee, red and swollen joint, often has history of IV fluids or parathyroidectomy

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217
Q

What do each DEXA scores show

A

< -2.5 = osteoporosis
-1 - -2.5 = osteopenia
> -1 = normal

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218
Q

4 clinical features of Parkinson’s

A

blank facial expression, small handwriting, rigidity, slow walking

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219
Q

3 clinical features of cauda equina syndrome

A

saddle anaesthesia, inability to open bowel/urinate, reduced anal tone

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220
Q

4 risk factors for peripheral neuropathy

A

DM, immunocompromised, SLE, vit B1 deficiency

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221
Q

What is the immediate treatment for acute ischaemic stroke? (mechanism and contraindications)

A

IV alteplase within 4.5hrs
Activates tissue plasminogen
Contraindicated in haemorrhage, clotting disorders, aneurysm

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222
Q

3 side effects of salbutamol inhaler

A

hypokalaemia, tachycardia, fine tremor

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223
Q

Define a papilloma

A

benign tumour of non-glandular, non-secretory epithelium

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224
Q

Define an adenoma

A

benign tumour of glandular or secretory epithelium

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225
Q

Define a carcinoma

A

malignant tumour of non-glandular, non-secretory epithelium

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226
Q

Define an adenocarcinoma

A

malignant tumour of glandular or secretory epithelium

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227
Q

Define a sarcoma

A

malignant tumour of connective tissue

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228
Q

Describe MHC-1 (major histocompatibility complex - 1)

A

found on all nucleated cells, display peptide fragments of proteins from within the cell to cytotoxic T cells leading to an immune system response

229
Q

Define pharmacodynamics and pharmacokinetics

A

Pharmacodynamics - what drug does to your body
Pharmacokinetics - what body does to drug

230
Q

State the characteristics of mycobacteria

A

slow growing, predominantly immobile, rod shaped, intracellular, gram positive

231
Q

What is the 1st and 2nd line treatment for phaeochromocytoma

A

1st line - alpha blockers (e.g. phenoxybenzamine or doxazosin)
2nd line - beta blockers

232
Q

6 features you expect to see in Klinefelter’s syndrome

A

learning difficulties, male, small testicles, raised LH+FSH, low testosterone, karyotype 47XXY

233
Q

What is annulus fibrosus

A

Structure in the heart that electrically isolates both atria from both ventricles

234
Q

What is the treatment for AF

A

Haemodynamically unstable - DC cardioversion + anticoagulation
Haemodynamically stable - beta blockers/CCB + anticoagulation

235
Q

What class is Verapamil and what is it contraindicated in

A

CCB, cardioselective so contraindicated in HF

236
Q

What artery supplies the AVN

A

Right coronary artery

237
Q

What is the mechanism of action of aspirin

A

non-selective inhibitor of COX-1 enzymes

238
Q

What condition has smudge cells

A

CLL

239
Q

What electrolyte imbalances are in tumour lysis syndrome

A

Hypocalcaemia
Hyperphosphatemia
Hyperuricaemia
Hyperkalaemia

240
Q

What is the mode of transmission for C. difficile

A

faeco-oral

241
Q

Where is the most common site for large bowel perforation

A

Caecum as it has the thinnest wall

242
Q

What area of the GI tract is most commonly affected in crohns

A

Ileum

243
Q

What is the most common organism cause of ascending cholangitis

A

E.coli

244
Q

3 causes of exudate ascites

A

Peritoneal carcinomatosis, pancreatitis, peritonitis

245
Q

5 causes of transudate ascites

A

HF, portal HTN, Budd-Chiari, low serum albumin/liver cirrhosis, nephrotic syndrome

246
Q

What are 3 signs of Ehler Danlos and pathophysiology

A

Joint hypermobility, increased skin elasticity, aortic regurgitaiton
Causes a decreased synthesis of type II collagen

247
Q

What type of hypersensitivity reaction is SLE

A

3

248
Q

What is the pathophysiology behind polyuria with ethanol

A

ethanol suppresses ADH secretion form the posterior pituitary gland

249
Q

4 types of renal stone

A

calcium oxalate, monosodium urate, struvite, cystine

250
Q

What would you see under electron microscopy in minimal change

A

fusion of podocytes and effacement of foot processes

251
Q

What are the nephrotoxic drugs

A

DAMN
Diuretics
ACEi/ARBs
Metformin
NSAIDs

252
Q

What are the 4 features of cushing’s reflex

A

Hypertension, bradycardia, irregular breathing, wide pulse pressure

253
Q

What equation explains cushing’s reflex

A

cerebral perfusion pressure (CCP) = mean arterial pressure (MAP) - intracranial pressure (ICP)

254
Q

Why does BP increase and HR decrease in increased ICP

A

SNS compensates for decreased O2 to brain by increasing BP which increases HR then the high BP activates carotid and aortic baroreceptors to activate PNS to decrease HR

255
Q

What meningitis organism is gram positive diplococci

A

Streptococcus pneumoniae

256
Q

What meningitis organism is gram negative diplococci

A

Neisseria meningitis

257
Q

4 signs of MS

A

positive babinski, hypertonia, ankle clonus, spasticity

258
Q

1st line treatment for myasthenia gravis

A

Pyridostigmine + prednisolone + azathioprine/methotrexate

259
Q

Treatment for myasthenia crisis

A

IV immunoglobulin and plasmapheresis

260
Q

What is the mechanism of action of pyridostigmine

A

Increases bioavailability of ACh in the synapse to compensate the autoimmune destruction of ACh receptors in MG

261
Q

What happens in chronic hypoxia due to COPD?

A

you get chronic hypoxia due to impaired gas exchange across alveoli which leads to compensatory increase in RBC production trying to maximise oxygen carrying capacity

262
Q

Would you see alkalosis or acidosis in acute asthma attack and why

A

Alkalosis from hyperventilating to counteract the bronchoconstriction means you breath out lots of CO2

263
Q

Explain the mechanism of action of the components of Co-amoxiclav

A

Amoxicillin - penicillin type antibiotic: prevents cell wall formation
Clavulanic acid - beta-lactamase inhibitor: increases amoxicillin effectiveness against some organisms

264
Q

What signs would you see in tension pneumothorax (3)

A

increased pressure on that side causes: reduced air entry, trachea deviating away, decreased tactile and vocal fremitus

265
Q

What is the acute management of MI

A

MONA
Morphine
Oxygen - if <94%
Nitrates
Aspirin

266
Q

What drugs should be offered after MI

A

BADS
Beta blockers (propranolol)
ACEi (ramipril) or ARB (candesartan)
Dual antiplatelet (clopidogrel and aspirin)
Statin (atorvostatin)

267
Q

4 types of microcytic anaemia

A

iron deficiency, beta thalassaemia, sideroblastic anaemia, anaemia of chronic disease

268
Q

What is the treatment for hereditary spherocytosis

A

splenectomy

269
Q

What would you see on a blood film for beta thalassaemia

A

large and small irregular hypochromic RBCs

270
Q

What makes malaria complicated

A

characterised by vascular occlusion causing specific organ related symptoms

271
Q

What is in Virchow’s triad

A

hypercoagulable state, venous stasis, vessel injury

272
Q

What is the gold standard investigation for phaeochromocytoma

A

elevated plasma free metanephrine

273
Q

How can you differentiate between large and small bowel obstruction

A

Large - constipation before vomiting
Small - vomiting before constipation

274
Q

Signs/symptoms of primary sclerosing cholangitis

A

Associated with UC
Signs - patchy inflammation, fibrosis, strictures in hepatic bile ducts
Symptoms - abdo pain, itchy skin, diarrhoea, jaundice, fatigue, fever

275
Q

What are the most common Abx to cause C. diff

A

Clindamycin, co-amoxiclav, aminopenicillins

276
Q

What is a faecal immunochemical test

A

home testing kit for colorectal cancer, detects small amounts of blood in stool

277
Q

Where does a mallory weiss tear occur

A

gastro-oesophageal junction

278
Q

What is the gold standard investigation for transitional cell carcinoma

A

cytoscopy

279
Q

6 things that would make a complicated UTI

A

pregnant, male, children, elderly, recurrent UTI, DM

280
Q

What is the treatment for chlamydia

A

Doxycycline (not if pregnant) or azithromycin or erythromycin

281
Q

What is the treatment for gonorrhoea

A

IM ceftriaxone with azithromycin

282
Q

What is the 1st line drug for BPH (with class, mechanism and S/E)

A

Tamsulosin - alpha 1-adrenergic receptor antagonist
Relaxes smooth muscle in prostate and bladder, increasing urinary flow
S/E - postural hypotension, retrograde ejaculation

283
Q

What is the 2nd line drug for BPH (with class, mechanism and S/E)

A

Finasteride - 5-a-reductase inhibitor
Inhibits conversion of testosterone to dihydrotestosterone which decreases prostate size
S/E - fatigue, erectile dysfunction

284
Q

What is the pathophysiology behind autoimmune hepatitis

A

T cell mediated response against liver cells

285
Q

Autoimmune Hep symptoms (5)

A

pruritus, jaundice, malaise, anorexia, nausea

286
Q

5 things blood tests show in autoimmune hep

A

Raised AST, ALT, ALP, IgG, positive ASMA

287
Q

1st and 2nd line drugs for autoimmune hep

A

Prednisolone
Azathioprine

288
Q

1st line Tx for alcohol withdrawal

A

chlordiazepoxide

289
Q

What is bacterial peritonitis/symptoms

A

complication of ascites, associated with cirrhosis
Symptoms - abdo pain, fever, hepatic encephalopathy, diarrhoea, SOB, sepsis

290
Q

What is the pathophysiology behind alpha 1 anti-trypsin deficiency

A

A1A normally inactivates elastase (elastase breaks down elastin). If patient gets a lung infection, neutrophils migrate to lungs and release elastase to breakdown bacteria. Elastase can’t be turned off so elastin in alveolar is broken down causing alveolar damage

291
Q

What causes Alpha 1 anti-trypsin deficiency

A

Genetic misfolding in SERPINA1 gene

292
Q

What would CXR show in A1AT deficiency

A

emphysema and flattened diaphragm

293
Q

What is a complication of A1AT deficiency

A

hepatitis

294
Q

What is Schober’s test

A

For ankylosing spondylitis, assesses mobility of spine

295
Q

What is the most common cause of osteomyelitis

A

staph aureus
Salmonella if patient has sickle cell

296
Q

What is Ewing’s sarcoma and what would you see on XR

A

cancer of bone and soft tissue, mainly affects children and young adults
XR - lytic bone lesions, onion skin appearance of periosteum

297
Q

What is chondrosarcoma and what would you see on XR

A

cancer of cartilage
XR - popcorn calcifications, lytic lesions

298
Q

What would you expect of ESR and CRP in SLE

A

raised ESR, normal CRP

299
Q

What are the risk factors for osteoporosis

A

SHATTERED
Steroids
Hyperthyroidism or Hyperparathyroidism
Alcohol or smoking
Thin
Testosterone decrease
Early menopause
Renal or liver failure
Erosive/inflammatory bone disease
DMT1 or Dietary calcium increase

300
Q

What is trigeminal neuralgia and what is the treatment

A

Unilateral facial pain, electric shock like shooting pain
Tx - Carbamazepine

301
Q

4 prophylactic drugs for migraine

A

beta blocker, amitriptyline, anticonvulsant (topiramate), botulinum toxin type A

302
Q

Signs and symptoms of progressive bulbar palsy

A

dysarthria, dysphagia, nasal regurgitation, choking, absent jaw jerk reflex
Form of MND affecting LMN CN9-12

303
Q

What sign would you see on a bronchiectasis CT

A

signet ring sign

304
Q

What is the most common cause of CAP

A

strep pneumoniae

305
Q

What is the most common cause of HAP

A

pseudomonas aeruginosa

306
Q

What is the gold standard test for PE

A

CT pulmonary angiography

307
Q

What type of cell would you see on microscopy in Hodgkin’s lymphoma

A

Reed-Sternberg cells / cells with mirror image nuclei

308
Q

What type of lymphocytes are affected in non-hodgkins lymphoma

A

B lymphocytes

309
Q

What virus is associated with NHL

A

EBV

310
Q

What are the 3 B symptoms

A

fever, weight loss, night sweats

311
Q

What is pancytopenia

A

Deficiency of all blood types: RBCs, WBCs, platelets

312
Q

How is chest pain in pericarditis different to MI pain

A

Pericarditis doesn’t radiate to jaw and teeth

313
Q

3 clinical features of pericarditis

A

pericardial rub, fever, sinus tachycardia

314
Q

What is the treatment for pericarditis, mechanism of action and how long should it be taken for

A

Colchicine
Inhibits migration of neutrophils to site of inflammation
Take for 6-8weeks

315
Q

What are the components of CHADSVAS score and points

A

Congestive HF = 1
Hypertension = 1
Age >75 =2
DM =1
Stroke =2
Vascular disease = 1
Age 65-74 = 1
Sex (female) = 1

316
Q

5 diagnostic tests and results for DKA

A

blood glucose >11.1 mmol/L
plasma ketones >3 mmol/L
ketonuria >2+ on dipstick
venous pH <7.35
HCO3- <15mmol/L

317
Q

6 risk factors for DKA

A

stopped insulin, infection, pancreatitis, undiagnosed DMT1, MI, surgery

318
Q

7 complications of DKA

A

hypotension, coma, cerebral oedema, hypothermia, death, DVT, pneumonia

319
Q

Which hepatitis is a notifiable disease

A

A

320
Q

What antibody and antigen is associated with hepB

A

AntiHB antibody
HBsAG (antigen)

321
Q

Why can hep D only cause disease in those with hep B

A

Hep D is an incomplete RNA virus and uses hepB surface antigens (HBsAg) to assemble

322
Q

What is the acute management for hep B (3)

A

avoid alcohol
vaccinate contacts
monitor liver function

323
Q

What genes are associated with SLE

A

HLA B8, HLA DR2, HLA DR3

324
Q

What is the diagnostic criteria for SLE

A

MD SOAP BRAIN (must have 4/11)
Malar rash
Discoid rash
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood disorder
Renal disease
ANA positive
Immunological disorder - anti-dsDNA
Neurological disorder

325
Q

5 lifestyle changes to manage SLE

A

decrease sunlight exposure, wear high factor suncream, loose weight if obese, smoking cessation, exercise

326
Q

What is the treatment for an acute SLE attack

A

IV cyclophosphamide and prednisolone

327
Q

What is the 1st line and gold standard investigation for renal stones

A

1st line - kidney ureter bladder ultrasound
gold standard - non-contrast CT KUB

328
Q

4 things that renal stones can be made out of

A

calcium oxalate, calcium phosphate, cysteine, uric acid

329
Q

Treatment for renal stones <1cm

A

analgesia (IV diclofenac), watch and wait for spontaneous passing

330
Q

Treatment for renal stones 1-2cm

A

extracorpeal shock wave lithotripsy (ESWL)

331
Q

4 things to reduce risk of getting another renal stone

A

overhydrate, decrease dietary calcium, decrease dietary salt, decrease BMI

332
Q

What is the diagnostic criteria for MS

A

2+ lesions disseminated by time and space AND exclusion of other similarly presenting conditions

333
Q

4 symptoms/signs of spinal cord lesion

A

numb/tingling limbs, leg weakness, bladder/sexual dysfunction, Lhermitte’s sign (electric shock down spine to limbs)

334
Q

What is the pathophysiology behind heat and MS

A

heat makes symptoms worse as the new myelin is less effective so heat impacts it more

335
Q

How can HIV be transmitted (3)

A

mother to child, IV drug use, contaminated blood/organs

336
Q

What type of virus is HIV

A

retrovirus subgroup lentivirus

337
Q

What results is diagnostic for AIDs

A

CD4 <200/microlitre

338
Q

What is the drug class and subgroups to treat HIV

A

highly active antiretroviral therapy (HAART)
Subgroups:
nucleoside reverse transcriptase inhibitors (NRTI)
nnon-nucleoside reverse transcriptase inhibitors (NNRTI)

339
Q

How do you differentiate between nephrogenic and cranial DI

A

IM desmopressin suppression test - if urine osmolarity stays the same its nephrogenic, if osmolarity increases its cranial

340
Q

What is the treatment for cranial DI

A

desmopressin (ADH analogue)

341
Q

What is the treatment for nephrogenic DI (and mechanism of action)

A

bendroflumethiazide - causes more Na+ secretion in DCT which causes increased water loss leading to decrease in GFR
NSAIDs - inhibit prostaglandins which stops their inhibition of ADH

342
Q

8 signs of pneumonia

A

fever, confusion, tachypnoea, tachycardia, hypotension, dull percussion, diminished chest expansion, pleural rub

343
Q

What does strep pneumoniae look like under stain/microscopy

A

gram positive bacilli chains, optochin sensitive

344
Q

What is the diagnostic test for STDs

A

first void urine and culture / NAAT (nucleic acid amplification test)

345
Q

What does gonorrhoea look like on microscopy

A

gram negative diplococci

346
Q

What is the treatment for gonorrhoea

A

IM azithromycin and ceftriaxone

347
Q

7 signs of Graves

A

Graves’s opthamopathy, tachycardia, hyperreflexia, Goitre, Clubbing, AF, Dyspnoea

348
Q

Graves investigations

A

Thyroid function test
Thyroid ultrasound
Iodine thyroid scan

349
Q

Graves treatment

A

Carbimazole
Radioiodine therapy
Thyroidectomy

350
Q

Liver failure signs (8)

A

Spider naevi, Clubbing, Jaundice, Palmar erythema, Bruising, Oedema, Anorexia, ascites

351
Q

Alcoholic liver disease stages

A

alcoholic fatty liver, alcoholic hepatitis, alcoholic cirrhosis

352
Q

3 complications of liver cirrhosis

A

Hepatocellular carcinoma, Oesophageal varices, Portal hypertension

353
Q

Why does liver failure lead to ascites

A

Low albumin and portal hypertension mean oncotic pressure is lower than hydrostatic pressure leading to fluid leaking into abdominal cavity

354
Q

Differences between epileptic and non epileptic seizures

A

Epileptic - eyes open, incontinence, tongue biting
Non-epileptic - eyes closed, hip thrusting, lasts longer

355
Q

Pathophysiology of an epileptic seizure

A

Excessive, unsynchronized neuronal discharges causes paroxysmal changes in behaviour, sensation and cognitive processes

356
Q

Define infective endocarditis

A

Inflammation of the endocardium/ heart valves due to infection

357
Q

What would be seen on infective endocarditis echocardiogram

A

Vegetations on the heart valves

358
Q

5 signs of infective endocarditis

A

Splinter haemorrhages, Osler’s nodes, Roth spots, Janeway lesions, murmur

359
Q

Infective endocarditis RF (7)

A

IV drug user, elderly, prosthetic heart valves, poor dental hygiene, cardiac surgery, pacemaker, congenital heart disease

360
Q

Diagnostic criteria for GCA

A

Age > 50
Temporal artery tenderness
New headache
Giant cells/ neutrophils on temporal artery biopsy

361
Q

GCA treatment

A

Corticosteroids e.g. Prednisolone
Methotrexate
Monitor and reduce likelihood of osteoporosis

362
Q

Describe lymphoma

A

A malignant tumour causing proliferation of lymphocytes mainly in lymph nodes

363
Q

7 symptoms of hodgkins lymphoma

A

Enlarged lymph nodes
General B symptoms i.e weight loss, night sweats, malaise, fatigue
Hepato/ splenomegaly
Easy bruising
Anaemia
Frequent infections
Enlarged abdomen

364
Q

2 drugs and their class for treating BPH

A

5-Alpha reductase inhibitors- Finasteride
Alpha blockers- Tamsulosin

365
Q

4 prostate cancer investigations

A

PSA test
Trans-rectal ultrasound guided biopsy
Ultrasound
DRE

366
Q

UTI organisms and their staining (5)

A

Klebsiella pneumoniae- gram –ve cocci
Escherichia coli- gram –ve rod (lactose- fermenting)
Enterococcus- gram +ve cocci (catalase –ve, non-haemolytic, group D Lancefield)
Proteus mirabilis- gram –ve rod
Staphylococcus saprophiticus- gram +ve cocci (catalase +ve, coagulase –ve)

367
Q

What would a patient have to show to prove gillick competency

A

That she can understand the information given to her
Can she retain the information
Can she communicate her decision and reasons for it

368
Q

5 fraser guidlines

A

He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
He/she cannot be persuaded to tell her parents or to allow the doctor to tell them
He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
His/her physical or mental health is likely to suffer unless he/she received the advice or treatment
The advice or treatment is in the young person’s best interests.

369
Q

2 types of COPD and their pathophysiology

A

Emphysema - Inflammation causes loss of elastic recoil of alveoli, causing air trapping and lower gas transfer
Chronic bronchitis - Inflammation causes mucociliary dysfunction, leading to lower ventilation

370
Q

What genetic disease is a cause of both COPD and liver cirrhosis

A

Alpha-1 anti-trypsin deficiency

371
Q

3 cardinal symptoms of COPD

A

Productive cough/ sputum production
Dyspnoea
Chronic cough

372
Q

What two signs found through lung function tests indicate COPD?

A

FEV1/FVC < 0.7
FEV1 < 80% of predicted value

373
Q

HTN tests (and results) other then BP

A

urinalysis - haematuria
bloods - raised serum creatinine
fundoscopy - retinal haemorrhage
ECG - left ventricular hypertrophy

374
Q

What can lead precipitate a thyroid storm and what hormone changes cause it

A

precipitate - stress, infection, surgery
caused by rapid T4 increase

375
Q

4 drugs for thyroid crisis

A

oral carbimazole
oral propranolol
oral potassium iodine (blocks release of thyroid hormone)
IV/IM hydrocortisone (inhibits peripheral conversion of T4 to T3)

376
Q

What type of anaemia is in myeloma and what electrolyte is raised

A

normochromic normocytic anaemia
raised calcium

377
Q

What cancer is associated with chronic hepatits

A

hepatocellular carcinoma

378
Q

2 drugs for chronic hepatitis

A

SC pegylated interferon-alpha 2A/B
Oral ribavirin

379
Q

3 characteristics of osteoarthritis that can be used to differentiate
between rheumatoid arthritis.

A

Asymmetrical joints affected
Absence of systemic features
Morning stiffness <30mins

380
Q

4 signs of brainstem compression.

A

Ipsilateral pupil dilation
Coma
Bilateral limb weakness
Deep / irregular breathing

381
Q

3 characteristics of asthma

A

Airflow limitation
Airway hyper-responsiveness
Bronchial inflammation

382
Q

What makes LABAs last longer in tissues?

A

They are lipophilic

383
Q

Lifestyle adjustments to manage peptic ulcers

A

Reduce stress
Avoid irritating foods
Stop smoking

384
Q

Define ulcer

A

Breach of the mucosal surface

385
Q

3 classes of drug to treat acromegaly and an example of each

A

somatostatin analogue - IM octreotide
GH receptor antagonist - SC pegvisomant
dopamine agonist - oral cabergoline

386
Q

Mitral stenosis risk factors (2)

A

Rheumatic fever
Untreated streptococcus infections

387
Q

2 surgical treatments for mitral stenosis

A

Percutaneous mitral balloon valvotomy
Mitral valve replacement

388
Q

4 features of microcytic anaemia on blood film

A

Small red blood cells
Pale red blood cells (hypochromic)
Variation in red blood cell shape (poikilocytosis)
Variation in red blood cell size (anisocytosis)

389
Q

4 blood tests to diagnose iron deficiency anaemia

A

Serum ferritin
Serum iron
Serum soluble transferrin receptors
Reticulocyte count

390
Q

Class and drug to treat iron deficiency and 4 side effects

A

oral iron - ferrous sulphate
Nausea
Abdominal discomfort
Diarrhoea/ constipation
Black stools

391
Q

7 causes of GORD

A

Lower oesophageal sphincter hypotension
Hiatus hernia
Abdominal obesity
Gastric acid hypersecretion
Slow gastric emptying
Drugs e.g. Calcium Channel Blockers, Nitrates or Anti-muscarinic)
Systemic Sclerosis

392
Q

4 GORD differential diagnoses

A

Coronary artery disease
Biliary colic
Peptic ulcer disease
Malignancy

393
Q

3 pharmacological and 4 surgical treatments for osteoarthritis

A

Paracetamol, NSAIDs, Intra-articular corticosteroid injections
Arthroscopy, Arthroplasty, Osteotomy, Fusion

394
Q

6 causes of hydrocele

A

Patent processus vaginalis
Testis tumour
Trauma
Infection
Testicular torsion
Generalised oedema

395
Q

2 differentials for hydrocele

A

Testicular torsion
Strangulated hernia

396
Q

2 blood tests to differentiate testicular cancer and hydrocele

A

Serum alpha-fetoprotein
Serum hCG (human chorionic gonadotropin)

397
Q

5 causes of epilepsy

A

Idiopathic
Cortical scarring due to head injury/ cerebrovascular disease/ CNS infection
Brain tumour
Dementia
Alcohol withdrawal

398
Q

5 causes of epilepsy

A

Idiopathic
Cortical scarring due to head injury/ cerebrovascular disease/ CNS infection
Brain tumour
Dementia
Alcohol withdrawal

399
Q

6 risk factors for epilepsy

A

Family history
Premature born babies who are small for their age
Abnormal blood vessels in brain
Dementia
Use of drugs e.g. cocaine
Stroke/ brain tumour/ infection

400
Q

5 risk factors for asthma

A

Personal history of atopy
Family history of asthma or atopy
Obesity
Premature birth
Inner-city environment

401
Q

6 features of a life threatening asthma attack

A

Silent chest
Confusion
Exhaustion
Cyanosis/ Pa02 < 8kPa
Bradycardia
PEFR < 33%

402
Q

6 causes of IBS

A

Depression
Anxiety
Psychological stress
Trauma
Sexual, physical or verbal abuse
Eating disorders

403
Q

What is the name of the criteria to diagnose IBS and describe it

A

Rome III Diagnostic Criteria
Symptoms for over 3 months
Abdo pain/discomfort
Improvement with defecation; and/or
Onset associated with a change in frequency of stool; and/or
Onset associated with a change in form (appearance) of stool.

404
Q

3 organisms that cause IE

A

Staphylococcus Aureus
Pseudomonas Aeruginosa
Streptococcus Viridans

405
Q

Name for criteria to diagnose IE

A

Modified Dukes Criteria

406
Q

5 functions of the liver

A

Glucose metabolism
Fat metabolism
Detoxification + excretion of: bilirubin/ ammonia/ drugs/ hormones/ pollutants
Protein synthesis: albumin/ clotting factors
Defence against infection

407
Q

2 types of billiary colic

A

Cholesterol biliary colic/ gallstone
Bile pigment biliary colic/ gallstone

408
Q

5 gallstones risk factors

A

Fat, Fertile, Forty, Female, Family history

409
Q

4 treatments for gallstones

A

Stone dissolution
Shock wave lithotripsy
Laparoscopic cholecystectomy/ Gallbladder removal
Analgesia

410
Q

1st line treatment for hyperthyroidism

A

beta blockers

411
Q

5 precipitating factors for gout

A

Trauma
Surgery
Starvation
Infection
Diuretics

412
Q

What makes crystals in pseudogout

A

Calcium Pyrophosphate

413
Q

What causes B12 deficiency in pernicious anaemia

A

Atrophic gastritis

414
Q

State 2 major criteria and 5 minor criteria in the modified dukes criteria

A

Major:
Blood cultures +ve >12 hours apart
Evidence of endocardial involvement (ECHO)
Minor:
Fever >38oC
Evidence from microbiology (+ve blood cultures not meeting major criteria)
Vascular phenomena (e.g. Emboli, Janeway lesions)
Evidence from immunology (E.g. Roth spots, Osler’s nodes, glomerulonephritis)
Risk groups – predisposing factors (e.g. prosthetic valve, IVDU, valvular disease)

415
Q

What type of hypersensitivity is hypersensitivity pneumonitis?

A

3

416
Q

3 signs and 3 symptoms of hypersensitivity pneumonitis

A

symptoms:
Increasing dyspnoea
Weight loss
Exertional dyspnoea
signs:
Finger clubbing (50%)
Type I respiratory failure
Cor pulmonale

417
Q

7 examples of secondary headaches

A

Meningitis
Encephalitis
Giant cell arthritis (GCA)
Medication overuse
Venous thrombosis
Tumour
Subarachnoid haemorrhage (SAH)

418
Q

What happens when histamine is released in asthma that contributes to airway narrowing

A

Bronchoconstriction
Mucus production

419
Q

What is the triad of pyelonephritis symptoms

A

Loin pain
High Fever
Pyuria

420
Q

2 things increased on urine dipstick in pyelonephritis

A

Nitrites
Leukocytes

421
Q

What is the eye pathology in graves called and give 6 features of it

A

thyroid eye disease
optic nerve straightened, upper eyelid retraction, lid lag, periorbital swelling, conjunctival oedema, proptosis

422
Q

What is the name of the treatment regime for graves and what drugs are involved

A

block and replace
carbimazole
levothyroxine

423
Q

3 things you might see on ECG after STEMI

A

Bundle branch blocks, pathological Q waves, arrhythmias

424
Q

3 inherited causes of liver failure

A

Haemochromatosis, wilsons, alpha-1-antitrypsin deficiency

425
Q

Define inflammation

A

local physiological response to tissue damage

426
Q

4 outcomes of acute inflammation

A

Resolution, suppuration, repair/organisation, chronic inflammation

427
Q

6 pre-renal causes of AKI

A

Shock, hypovolaemia, hypotension, Renal artery thrombosis, sepsis, renal hypoperfusion

428
Q

8 renal causes of AKI

A

Acute tubular necrosis, Nephrotoxins, Glomerulonephritis, Acute interstitial nephritis, Infection, Vasculitis, Malignant hypertension, Autoimmune disease

429
Q

4 post-renal causes of AKI

A

BPH, Kidney stones, Cancer, Blood clot

430
Q

Emergency complication of GCA

A

Arteritic anterior ischaemic optic neuropathy

431
Q

Gonorrhoea under microscopy

A

gram negative diplococci

432
Q

6 features of ankylosing spondylitis / conditions associated with it

A

Psoriasis, enthesitis, dactylitis, crohn’s, ulcerative colitis, eye involvement

433
Q

4 signs seen on ankylosing spondylitis X ray

A

sacroiliitis (1st sign), enthesitis, syndesmophytes fusing to make bamboo spine, Dagger sign (single central line down spine)

434
Q

2 Histological findings in parkinsons

A

Lewy bodies, degeneration of dopaminergic neurons

435
Q

3 features of parkinsons gait

A

shuffling, reduced arm swing, slow to get going

436
Q

4 classes of drug to treat parkinsons and their mechanism of action

A
  • L-Dopa - dopamine precursor able to cross BBB. Converted to dopamine with Dopa Decarboxylase in CNS
  • Dopamine agonists (Ropinirole, Bromocriptine, Pramipexole, Rotigotine) mimics action of dopamine, supports L-dopa
  • COMT (Catechol-O-methyl transferase) inhibitor (Rasagiline) - inhibit enzymatic breakdown of dopamine
  • MAO-B (monoamine oxidase-b) inhibitor (Selegiline) - inhibit enzymatic breakdown of dopamine
437
Q

3 specific questions of history taking to support a HF diagnosis

A

Does he have a history of coronary artery disease (arrhythmia or MI), orthopnoea, fatigue

438
Q

3 tests for HF + gold standard

A

ECG, blood test, chest XR, echocardiogram (gold standard)

439
Q

How do beta blockers treat HF

A

Beta blocker (bisoprolol): counteracts the compensatory sympathetic response to heart failure that leads to increase heart failure and vasoconstriction.

440
Q

How do ACEi treat HF

A

ACE inhibitor (ramipril): counteracts the stimulation of the Renin Angiotensin Aldosterone System (RAAS) that leads to vasoconstriction and retention of sodium and water

441
Q

1st line treatment for HF

A

Loop diuretics (furosemide or bumetanide)

442
Q

8 symptoms of renal colic

A

Haematuria, rigors, dysuria, urinary retention, foul smelling urine, urgency, left flank to groin pain, N&V

443
Q

8 signs/symptoms of ankylosing spondilitis

A

Iritis, uveitis, enthesis, fatigue, sleep disturbance, asymmetrical oligoarthritis, sacroiliitis, lower back pain relieved with exercise

444
Q

what 2 conditions come under COPD

A

Emphysema, chronic bronchitis

445
Q

4 stages of pharmacokinetics

A

Absorption, metabolism, distribution, elimination

446
Q

Define hyperosmolar hyperglycaemic state

A

A condition of extreme hyperglycaemia associated with dehydration, altered mental status, headache, fatigue and blurred vision

447
Q

Herpes zoster treatment

A

Aciclovir

448
Q

4 causes of SIADH

A

alcohol withdrawal, head injury, pneumonia, small cell lung cancer

449
Q

Describe PTH, calcium and phosphate in primary/secondary/tertiary hyperparathyroidism

A

primary - high PTH, high calcium, low phosphate
secondary - high PTH, low calcium, high phosphate
tertiary - high PTH, high calcium, high phosphate

450
Q

4 types of cardiomyopathy

A

HARD
Hypertrophic
Dilated
Arrhythmogenic
Restrictive

451
Q

STEMI tx

A

PCI within 2 hours
if after 2 hours give fibrinolysis and IV Tenecteplase

452
Q

Diagnostic criteria for postural hypotension

A

sytolic drop of >20mm/Hg or drop below 90 when going from lying (for 5 mins) to standing

453
Q

Postural hypotension tx (1 pharma, 3 lifestyle)

A

Fludrocortisone
Hydrate, exercise, salty meals

454
Q

Most common cause of small bowel obstruction

A

surgical adhesions

455
Q

most common cause of large bowel obstruction

A

malignancy

456
Q

UC treatments

A

1st line (mild) - 5-aminosalicyclic acid (sulfasalazine, mesalazine)
2nd line (moderate) - oral prednisolone
3rd line (severe) - IV hydrocortisone
4th line (very severe) - colectomy, definitive

457
Q

What condition has Philadelphia chromosomes

A

CML

458
Q

What is Asterixis and what conditions do you see it in

A

hand jerk when arms outstretched and wrists extended
seen in liver failure and t2 resp failure

459
Q

What is Kussmaul breathing and what condition do you see it in

A

deep laboured breathing, form of hyperventilation
seen in DKA

460
Q

definition of acute liver failure

A

INR greater than 1.5
Onset of less than 26 weeks duration
Mental alteration without pre-existing cirrhosis
No previous liver disease

461
Q

4 liver cancer risk factors

A

Hepatitis B infection
Chronic alcohol use
Aflatoxin exposure
Non-alcoholic Fatty Liver Disease

462
Q

What condition presents with severe pneumonia and travel to somewhere like spain

A

legionnaires disease
transmits through air con
caused my legionella pneumophila

463
Q

what is a beta haemolytic gram positive strep with lancefield group A

A

s. pyogenes

464
Q

what is a beta haemolytic gram positive strep with lancefield group B

A

s. agalactiae

465
Q

what is strep pneumoniae (gram, shape, haemolytic)

A

gram positive diplococci, alpha haemolytic, optochin sensitive

466
Q

describe tests for staph aureus

A

gram positive cocci in clusters coagulase positive

467
Q

describe neisseria meningitidis

A

gram negative diplococci

468
Q

what bacteria are gram negative bacilli

A

E.coli, Klebsiella, Enterobacter

469
Q

What agar grows micobacterium

A

Lowenstein-Jensen

470
Q

what test differentiates staph and strep

A

catalase test
staph are catalase +ve, strep are -ve

471
Q

3 stool tests in diarrhoea

A

stool culture, faecal calprotectin, faecal occult blood

472
Q

2 findings in UC on microscopy

A

crypt abscesses, ulceration

473
Q

2 main histopathological findings in parkinsons

A

presence of Lewy Bodies
loss of dopaminergic neurones

474
Q

What virus has owl eyes intranuclear inclusions

A

Cytomegalovirus (CMV)

475
Q

1st and 2nd line treatment for severe hyperkalaemia

A

1st - Calcium gluconate
2nd - insulin and dextrose

476
Q

Immediate management of guillain barre syndrome with decreased FVC

A

urgent ITU admission

477
Q

What is turners syndrome

A

Female condition causing short stature, primary amenorrhoea, high FSH, high LH

478
Q

What blood product do you give in DIC

A

Cryoprecipitate

479
Q

What does TLR1 sense?

A

Lipopeptides

480
Q

What do TLR2 sense?

A

Lipoproteins, lipoteichoic acid

481
Q

What does TLR3 sense?

A

double-stranded RNA

482
Q

What do TLR4 sense?

A

Lipopolysaccharides

483
Q

What do TLR5 sense?

A

Flagellin

484
Q

What cancer is a sjogrens patient at risk of developing

A

lymphoma

485
Q

1st line treatment for angina

A

glyceryl tinitrate (GTN) spray + Beta blocker OR CCB

486
Q

5 modifiable risk factors for angina

A

hypertension, DMT2, smoking, increased cholesterol, obesity

487
Q

5 extra-articular manifestations of ankylosing spondylitis

A

anterior uveitis, IBD, apical lung fibrosis, aortic regurgitation, amyloidosis

488
Q

4 signs on ankylosing spondylitis on XR

A

bamboo spine, ossification, fusion of joints, subchondral sclerosis

489
Q

Ankylosing spondylitis treatment

A

NSAIDs
Steroids during flare ups
Anti-TNF (infliximab)

490
Q

3 medications in acute asthma attack

A

salbutamol
Ipratropium Bromide Nebuliser
Oral prednisolone or IV Hydrocortisone

491
Q

Treatment for asthma

A
  1. SABA - salbutamol
  2. add ICS - beclomethasone
  3. add Leukotriene Receptor Antagonists (LTRA) - montelukast
  4. LABA - salmeterol
  5. Maintenance and Reliever Therpay (MART)
492
Q

5 indicators of good asthma control

A

no night-time symptoms
inhaler used no more than 3 times a week
No breathing difficulties, cough or wheeze on most days
able to exercise without symptoms
normal lung function tests

493
Q

Precipitants of migraine (7)

A

Chocolate
Cheese
Oral contraceptive
Caffine
Alcohol
Anxiety
Exercise
Travel
Smoking

494
Q

3 drugs for migraine prophylaxis

A

Propranolol
Topiramate
Amitriptyline

495
Q

Mechanism of action of adrenaline

A

Stimulation of beta adrenergic receptors

496
Q

5 physiological responses to histamine

A

vasodilation, bronchoconstriction, increased vascular permeability, tachycardia, hypotension, maximise blood glucose levels in the brain

497
Q

What drug maintains remission in Crohns

A

Azathioprine

498
Q

What is the treatment for haemochromatosis

A

therapeutic phlebotomy

499
Q

1st line investigation for testicular torsion for high pain score

A

surgical exploration and untwisting if required

500
Q

1st line investigation for testicular torsion for low pain score

A

Duplex ultrasound to check blood flow

501
Q

gold standard investigation for portal hypertension

A

hepatic venous pressure gradient

502
Q

What is the karyotype of turners

A

45 XO

503
Q

What can be given as prophylaxis of tumour lysis syndrome (with leukaemia chemo)

A

allopurinol

504
Q

What is the most common cause of pneumonia in HIV patients

A

Pneumocystis jirovecii (fungus)
Tx - Co-trimoxazole

505
Q

What hypersensitivity is coeliac

A

4

506
Q

Prophylaxis of sickle cell crisis

A

Hydroxycarbamide - increases HbF conc

507
Q

1st line investigation for renal cell carcinoma

A

CT urogram

508
Q

what is cut to relieve pressure on median nerve in carpal tunnel

A

transverse carpal ligament

509
Q

Treatment for severe or persistent tonsillitis

A

Phenoxymethylpenicillin QDS 10 days

510
Q

7 symptoms of chronic limb ischaemia

A

hair loss, atrophic skin, brittle nails, ulcers, numbness in feet, absent distal pulses, intermittent claudication

511
Q

arterial vs venous ulcer

A

Arterial - distal extremities, lateral malleolus, pale, minimally exudative, skin thin, absence of hair

Venous - gaiter area, lower calf to medial malleolus, irregular shape, granular appearance, hardening of skin, firm oedema

512
Q

Where can you hear an ejection systolic murmur on the chest

A

Over aortic valve - 2nd intercostal space, left sternal border
(aortic stenosis)

513
Q

6 features of a fib ECG

A

irregularly irregular rhythm
absent P waves
Variable ventricular rate
absence of baseline
QRS complex <120ms
fibrillatory waves

514
Q

What gene, chromosome and protein channel is affected in CF

A

F508 deletion on chrom 7
CFTR gene
CFTR protein

515
Q

3 diagnostic test for CF

A

sweat electrolyte test
heel-prick for newborns
genetic screening

516
Q

4 causes of exudative effusions

A

lung cancer
pneumonia
TB
Rheumatoid arthritis

517
Q

5 causes of transudative effusion

A

congestive cardiac failure
liver cirrhosis
hypoalbuminaemia
nephrotic syndrome
hypothyroidism

518
Q

2 investigations and results for pleural effusion

A

CXR - blunting of costophrenic angle, fluid in lung fissures, tracheal and mediastinal deviation if severe
pleural tap - transudate = clear, exudate = cloudy, lymphatic = milky

519
Q

3 treatments for pleural effusion

A

therapeutic aspiration
chest drain
diuretics

520
Q

4 bones that can be affected in pagets

A

skull, vertebrae, pelvis, femur

521
Q

3 features of Beck’s triad and what it shows

A

associated with pericardial tamponade
hypotension, distended jugular veins, muffled heart sounds

522
Q

4 investigations for cardiac tamponade

A

ECG, echocardiogram, CXR, cardiac enzymes

523
Q

Lump on neck, worse after drinking alcohol - what is it

A

hodgkins lymphoma

524
Q

what is the mechanism of action of beta lactam antibiotics

A

bind transpeptidase enzymes and block cross linking of peptidoglycans in cell wall

525
Q

What do you need to do in regard to DVLA after TIA

A

dont need to inform them but should stop driving for 1 month

526
Q

What is the treatment for uncomplicated UTI (inc route and how long)

A

nitrofurantoin PO for 3 days

527
Q

What ECG changes would you see in Conns

A

flat T, prolonged QT, ST depression
(hypokalaemia)

528
Q

How does Cushings affect menstrual cycle

A

can cause amenorrhoea (no period) or oligomenorrhoea (irregular period)

529
Q

presents with unexplained weight gain, bruising, purple stretch marks on abdomen

A

cushings disease

530
Q

Child with distal femur pain has bone cancer, what type

A

osteosarcoma - most common primary bone tumour in kids and YA
Ewing’s also affects kids but less common and more affects proximal bones

531
Q

what causes LIF pain and tenderness

A

acute diverticulitis

532
Q

What is the most common cause of reactive arthritis

A

chlamydia pneumoniae

533
Q

what is the 1st, 2nd and 3rd line treatment for UC

A

1st line - 5-aminosalicyclic acid (sulfasalazine, mesalazine, olsalazine)
2nd line - prednisolone if not responding or severe
3rd line - colectomy

534
Q

what is the 1st, 2nd and 3rd line treatment for crohns

A

1st line - oral prednisolone
2nd line - IV hydrocortisone
3rd line - anti-tumour necrosis factor (anti-TNF) e.g. infliximab

535
Q

what is used to maintain remission in crohns

A

azathioprine

536
Q

4 things to prevent migraine

A

acupuncture
propranolol
topiramate
amitriptyline

537
Q

presents with ankle swelling, normal BNP, pmh hypertension, what is the cause

A

side effect of CCB

538
Q

when should you be seen by a specialist after TIA

A

If ABCD2 below 4 then within 7 days
4-6 then within 24 hours
6+ then immediately

539
Q

23 y/o right sided chest pain, worse on inhilation, hyper resonant percussion on right side, central trachea
what is the diagnosis and what is the 1st line treatment

A

spontaneous pneumothorax
needle aspiration

540
Q

4 features of parkinsons tremor

A

asymmetrical, worse at rest, improves with purposeful movement, ‘pill rolling’ (between thumb and fingers)

541
Q

diagnostic investigation for DVT

A

ultrasound

542
Q

weakness and numbness in foot, foot drop, no dorsiflexion - what nerve

A

common peroneal

543
Q

What is Brudzinski’s test

A

Lying the patient supine and flexing their neck a positive test involves the patient involuntarily flexing their hip and knee

544
Q

differentiate chronic bronchitis and emphysema

A

sputum - a little in emphysema, loads of prurulent sputum in CB
age - emphysema generally older
body - thin in emphysema, obese in cb
CXR - small heart, hyperinflated lungs and flat diaphragm in emphysema, ventricular hypertrophy in CB

545
Q

what is the most specific marker for liver damage

A

alt

546
Q

treatment for pernicious anaemia

A

IM hydroxocobalamin

547
Q

what is the variation of angina with coronary artery spasm at rest

A

Prinzmetal’s angina

548
Q

what is 1st line treatment for angina

A

GTN Glyceryl trinitrate spray + beta blocker + CCB

549
Q

what is the rash in coeliac called

A

dermatitis herpetiformis

550
Q

Define anaphylaxis

A

a severe type 1 hypersensitivity reaction to an antigen that is rapid and acute in onset
characterised by life-threatening airway, breathing and/or circulatory problems

551
Q

what type of immunoglobulin is involved in anaphylaxis

A

IgE

552
Q

what is the mechanism of action of adrenaline

A

stimulates beta adrenergic receptors

553
Q

6 physiological responses to histamine

A

increased vascular permeability, vasodilation, tachycardia, hypotension, increased mucous secretion, airway oedema

554
Q

5 steps in immediate management of anaphylaxis

A

1 - remove trigger agent
2 - IM adrenaline 0.5mg
3 - oxygen
4 - placement - on back with legs elevated (to preserve circulation)
5 - IV fluids + antihistamines + beta agonists + vasopressin

555
Q

where should adrenaline be injected

A

anterolateral aspect of the middle third of the thigh

556
Q

what investigation can confirm the diagnosis of anaphylaxis

A

Mast Cell Tryptase blood test - marker protein seen immediately and up to 4 hours after reaction

557
Q

what test can determine trigger of anaphylaxis

A

RAST test - blood sample measures specific IgE antibodies to suspected allergens

558
Q

2 characteristics of anaesthesia to make it effective

A

low protein binding - to enable a high initial plasma conc
high lipid solubility - enhances potency and rapid diffusion through cell membranes

559
Q

3 reasons why you might need to use a secondary dose of anaesthesia

A

first dose has short half life so keep them asleep
prevents resp distress from decreased muscle tone and resting lung volume
adjuvant agents can improve speed of onset and duration

560
Q

define agonist

A

a compound that binds to a receptor and activates it

561
Q

define antagonist

A

a compound that reduces the effect of an agonist

562
Q

define a competitive antagonist

A

a medication that binds reversibly to the same receptor site where an agonist binds but does not activate it

563
Q

define non-competitive antagonist

A

reversibly binding to allosteric site and causes the shape of the receptor to alter so ligand cant recognise it as a binding site

564
Q

4 things a drug can target

A

ion channels
enzymes
carrier molecules
receptors

565
Q

define bioavailability

A

the amount of an administered drug that reaches the systemic circulation

566
Q

define first pass metabolism

A

the concentration of the drug which is lost during absorption before reaching systemic circulation

567
Q

6 physical properties a drug should have

A

non-flammable at room temp
stable in light
low latent heat of vaporisation
long shelf life
environmentally friendly
cheap and easy to manufacture

568
Q

6 biological properties a drug should have

A

non-irritant
fast onset
high potency
minimal side effects
no biotransformation
non-toxic to handle

Phase 2a (15 decks)

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