Mocks Flashcards
Describe Cardiac Tamponade
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
List the causes of Hypovolaemic Shock
Ruptured aortic aneurysm, severe burns, vomiting, bleeding from trauma
ECG changes in V1-V4 indicate which artery is affected?
Left anterior descending
ECG changes in II, III, aVF indicate which artery is affected?
Right coronary
ECG changes in I, aVL, V5-V6 indicate which artery is affected?
Left circumflex
What ECG changes would be seen in Mobitz type 1 heart block?
Increasing PR intervals then a drop in QRS (Wenckebach pattern) - AV node block
What ECG changes would be seen in Mobitz type 2 heart block?
Constant PR intervals then a drop in QRS - intra-nodal block
Describe Dressler’s syndrome, including symptoms and treatment
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
What changes would you see on an X-ray for Heart Failure
Alveolar oedema
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural Effusion
Which condition is indicated by the following description:
SOB worse lying down, pink frothy sputum, fine crackles on ausculation
Left Sided Heart Failure
Describe secondary prevention
Methods to detect and address an existing disease prior to the appearance of symptoms
What is the 1st and 2nd line treatment for Angina
1st line - Beta blocker or CCB
2nd line - add Nifedipine
What is the initial treatment for STEMI
Aspirin + Prasugrel/Ticagrelor/Clopidogrel with Unfractionated Heparin and PCI
What is the 1st and 2nd line treatment for Heart Failure?
1st line - loop Diuretic
2nd line - ACEi and Beta Blocker
What is the treatment for Pericarditis?
NSAIDs (paracetamol) + Colchicine
Define atherosclerosis
Accumulation of lipids, macrophages and smooth muscle cells in the intima of large and medium sized arteries
State the 4 features of the Tetrology of Fallot
Ventricular Septal Defect
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Describe 1st degree heart block
Usually asymptomatic, long PR interval, delayed AV conduction
Describe 3rd degree heart block
Complete block/absence of AV conduction, P waves and QRS complexes independent
Define embolism
A blocked vessel caused by a foreign body e.g. blood clot or an air bubble
Define thrombosis
Formation of a blood clot inside a blood vessel that obstructs flow
Define infarction
Cell death due to a reduced or absent blood supply
Define ischaemia
Restriction in blood supply to tissues causing a shortage of oxygen that is needed for cell function
What is secreted from the Zona Glomerulosa?
Mineralocorticoids e.g. aldosterone
What is secreted from the Zona Fasciculata?
Glucocorticoids e.g. cortisol
What is secreted from the Zona Reticularis?
Androgens (sex hormones)
What is secreted from the Adrenal Medulla and from what cells?
Catecholamines (adrenaline and noradrenaline) are secreted from the Chromaffin cells
Describe the effects of insulin
It is secreted from pancreatic beta cells in the islets of langerhans and cause a decresae in glycogenolysis
State the thyroid test results in Grave’s
Low TSH, high T3/4 (primary hyperthyroidism)
Describe the Synacthen test
Short ACTH stimulation test - patient is given ACTH and if cortisol levels remain low, this is diagnostic for Addison’s
What is the gold standard test for Carcinoid Syndrome?
Elevated serum Chromogranin A ( + octreoscan)
What is the immediate management for DKA?
Isotonic saline + insulin. Give potassium if levels are below 5.5 within the first 24 hours
What is secreted from the anterior pituitary?
FSH, LH, ACTH, TSH, Prolactin, GH
What is the function of glucagon?
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
What is the function of PTH in response to low serum calcium?
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
Describe the physiology of corticosteroid withdrawal in Crohn’s
Long term corticosteroids suppress adrenal glands leading to adrenal atrophy. When stopped abruptly it causes symptoms of adrenal insufficiency
List the cancers that cause of SIADH
Small cell carcinoma, prostate cancer, pancreatic cancer, lymphomas, cancer of the thymus
What are the signs/symptoms of hyperkalaemia? (9)
Muscle weakness, cramping, paraesthesia, irritability/anxiety, palpitations, abdo cramping, diarrhoea, dyspnoea, hyperreflexia
What are the complications of acromegaly?
Obstructive sleep apnoea, T2DM, cardiomyopathy, IHD, colorectal cancer
What is the 1st and 2nd line treatment for acromegaly?
1st line - transphenoidal surgery to remove pituitary adenoma
2nd line - somatostatin analogues, GH antagonists, dopamine agonists, external radiotherapy
List 5 differential diagnoses for hyperparathyroidism
DM, DI, SIADH, primary polydipsia, hypercalcaemia
What are the symptoms of hyperparathyroidism?
Bones - pain/fractures
Stones - biliary/renal
Groans - constipation, abdo pain, pancreatitis
Moans - depression
Thrones - polyuria, polydipsia
Cushing’s causes
Syndrome: glucocorticoid use/corticosteroids
Disease: Pituitary adenoma
What is the first line investigation for hyperaldosteronism and expected results?
Aldosterone Renin Ratio
Primary: normal/low renin, high aldosterone
Secondary: high renin, high aldosterone
U&Es show hyperkalaemia
Describe 2 hypocalcaemia clinical signs
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
What causes Carcinoid Syndrome?
Metastasis of carcinoid tumours arising from neuroendocrine cells that secrete high levels of serotonin
What are the symptoms and signs of Carcinoid Syndrome?
Symptoms - cutaneous flushing, recurrent diarrhoea, abdo cramps, asthma-like wheezing
Signs - erythema, pellagra skin lesions, hepatomegaly, pulmonary systolic and diastolic heart murmur
State the treatment for hyperthyroidism and describe it’s function
Carbimazole
Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, this decreases thyroid hormone production
State the symptoms of Phaeochromocytoma and what causes it
Symptoms - hypertension, tachycardia, diaphoresis, hypertensive retinopathy, pallor, diabetes
Caused by excess secretion of metanephrine and methoctramine
Describe mitral regurgitation murmur
Pan systolic, high pitch whistle, radiates to axilla
Describe mitral stenosis murmur
Mid diastolic, low pitch rumbling, presents with malar flush and AF
Describe aortic regurgitation murmur
Early diastolic, soft crescendo with collapsing pulse (Corrigan’s)
Describe aortic stenosis murmur
Ejection systolic, crescendo-decrescendo high pitch, radiates to carotids, slow rising pulse, exertional syncope
State the 1st line and gold standard investigations for Coeliac Disease
1st line - serology for tissue transglutaminase (TTG) antibodies (IgA)
Duodenal biopsy - gold standard, endoscopically will show villous atrophy, crypt hyperplasia and increased epithelial WBCs
Define Diverticulitis, diverticular disease, diverticulosis and diverticular stricture
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
State which cancers cause enlargened cervical lymph nodes
Hodgekin’s and non-Hodgkin’s lymphoma
State which cancers cause enlargened mediastinal lymph nodes
Lung cancer, Hodgkin’s and non-Hodgkin’s lymphoma
State which cancers cause enlargened Supraclavicular (Virchow’s) lymph nodes
Stomach cancer
State which cancers cause enlargened inguinal lymph nodes
Testicular and ovarian cancer
State which cancers cause enlargened axillary lymph nodes
Breast cancer
State 4 causes of peptic ulcers and describe their pathophysiology
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
What is the most common site of colorectal cancer
Rectum then next most common is sigmoid colon then caecum
State the stages in Marsh Classification for Coeliac
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
State 5 types of diarrhoea
Secretory, osmotic, exudative, inflammatory, dystentery
Describe the symptoms of inflammatory diarrhoea
Severe very watery diarrhoea, blood in stool, fever, abdo pain, tenesmus (needing to poo often but can’t)
List 7 red flags for cancer in diarrhoea
Rectal bleeding, abdo mass, family history, anaemia, unintentional weight loss, age over 60, change in bowel habit for more than 6 weeks
What findings would you expect to see on a small bowel obstruction radiograph?
Dilated jejunum and/or ileum
Absence of gas in bowel (gas shadows) distal to obstruction
What is the initial management for small bowel obstruction?
‘drip and suck’ - nil-by-mouth, insert NG tube, IV fluids and correct electrolyte disturbances
Urinary catheter, analgesia, anti-emetics
What test would you carry out for suspected H. pylori infection?
Serology - look for IgG antibodies
C-urea breath test - ingest C-urea then measure CO2
Stool antigen testing - immunoassay
4 symptoms of haemorrhoids
Bright red bleeding, discomfort/pain, pruritus ani, mucus discharge
State and differentiate the 2 haemorrhoid types
Internal - arise internally, painless, covered in mucus, can prolapse
External - form at anal opening, painful, covered with skin
Define haemorrhoids
Swelling and inflammation of veins in the rectum and anus
5 complications of diverticulitis
Large bowel perforation, fistula formation, large bowel obstruction, bleeding, mucosal inflammation (mimics Crohn’s)
What is the treatment for Varices (1st line and 2nd line if contraindicated)
1st line - IV Terlipressin (vasodilator)
Contraindicated in IHD so give IV somatostatin
7 tests for appendicitis (gold standard, other and exclusionary)
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
Describe each stage in the Gleason pattern
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)
Describe Henoch-Schoenlein Purpura
Presents with rash, abdo pain, arthralgia and glomerulonephritis
Most common in males 3-15 after an upper respiratory tract infection
State the 1st line drug for urinary urgency incontinence and describe its function
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
What causes brain haemorrhage in PKD patients
Ruptured berry aneurysm
What diet should a patient with CKD follow?
Low protein, phosphate, potassium and sodium diet
State 5 types of renal cancer
Renal cell carcinoma (most common), urothelial carcinoma, transitional cell carcinoma, sarcomas, Wilm’s tumour (in kids)
What are the symptoms of renal cell carcinoma?
Haematuria, palpable abdo mass, loin pain, anorexia, weight loss, varicocele, enlarged lymph nodes
Describe the physiology of hypertension in renal cell carcinoma
Increased renin secretion causes and increase in RAAS activity and therefor increases BP
Define hydrocele
Abnormal collection of fluid within the remnants of the processus vaginalis
State 4 types of urinary incontinence
Stress, urgency, functional, overflow
State 5 types of nephrotic syndromes
Minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, amyloidosis, advanced renal disease
What is the mainstay treatment for nephrotic syndromes
Glucocorticoids with ACEi and prophylactic anticoagulation
State 4 types of diuretic and their mechanism of action/where they act
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
Where are the 3 most common sites of renal stone formation?
Pelviureteric junction
Pelvic brim
Vesicoureteric junction
What type of bacteria is neisseria gonorrhoeae
gram negative diplococci
What is the treatment for gonorrhoea
Ceftriaxone and Azithromycin
What drug is contraindicated in G6PD deficiency?
Nitrofurantoin - causes drug-induced oxidative crisis
State 4 causes of thrombocytopenia
HIV, alcohol abuse, myeloma, heparin
What test is diagnostic for sickle cell anaemia and what would you see on bloods?
Hb electrophoresis
Bloods show low haemoglobin and high reticulocyte count
Describe the pathology of hereditary spherocytosis
Caused by defects in red cell membranes that result in them having an increased permeability to sodium
State and describe the 5 stages of malaria
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
What is the mechanism of action of Imatinib?
Acts by inhibition of tyrosine kinase which stops excessive cellular replication of eosinophils, neutrophils and basophils
Treats CML
State 5 findings in blood tests in multiple myeloma and the gene associated
Anaemia, hypercalcaemia, increased creatinine, increased urea, monoclonal proteins in serum
Associated with MGUS gene
State 4 long term complications of ABVD chemotherapy and what it treats
Infertility, cardiomyopathy, peripheral neuropathy lung damage
Treats Hodgkin’s lymphoma
What condition would you see Auer rods in?
AML
Describe Haemophilia A pathophysiology
X linked recessive disease, deficiency in factor 8
5 symptoms of thrombocytopenia
Easy bruising, epistaxis, menorrhagia, purpura, gum bleeding
9 symptoms of malaria
fever, sweats, chills, myalgia, fatigue, diarrhoea, vomiting, abdo discomfort
Protazoa causing malaria relapse
P. ovale, P. vivax
Chromosomal abnormality associated with multiple myeloma
translocation between chromosome 11 and 14
Multiple myeloma criteria for characterisation
Monoclonal protein in serum or urine
Lytic bone lesions
Excess plasma cells in bone marrow
6 treatments for AML
Blood transfusion
BM transfusion
Allopurinol
IV antibiotics
Chemo
Steroids
CLL symptoms
Enlarged, rubbery, non-tender lymph nodes
Sweating
Anorexia
Usually asymptomatic
CLL treatment
Chemo
Rituximab
Ibrutinib
Complication of CLL
Richter’s syndrome - aggressive lymphoma
3 tests and their results used for Hodgkin’s lymphoma
FBC - anaemia, high ESR
CXR - wide mediastinum
Blood film - Reed-Sternberg cells
What is the function of G6PD
Protects RBCs against oxidative damage
4 symptoms of G6PD deficiency
Fatigue, palpitations, SOB, pallor
6 DVT symptoms
Pain, Pallor, Perishingly cold, Pulselessness, Paralysis, Paraesthesia
State the items on the Well’s score
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
Pathophysiology of Disseminated Intravascular Coagulation
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
What is the sepsis 6 to manage sepsis
Give fluids, broad spectrum ABx, O2 if reguired
Take bloods, urine output, lactate levels
State the 3 types of haemophilia with inheritance pattern and factor deficiency
A - X linked recessive, factor 8 deficiency
B - X linked recessive, factor 9 deficiency
C - autosomal recessive, factor 11 deficiency
Define platelet count and how it is affected in haemophilia
> 450,000 platelets/microliter blood = thromboytosis
<150,000 = thrombocytopenia
Normal in haemophilia
Define bleeding time and how it is affected in haemophilia
Assesses platelet function/ability to clot
Normal in haemophilia
Define PT and how it is affected in haemophilia
Prothrombin time - assesses integrity of extrinsic factors 2,5,7,10 and fibrinogen
Normal in haemophilia
Define APTT and how it is affected in haemophilia
Activated partial thromboplastin time - assesses functionality of intrinsic pathway
Increased in haemophilia
Define thrombin time and how it is affected in haemophilia
Assesses fibrin formation from fibrinogen in plasma, normal levels are <20 secs
Normal or increased in haemophilia
Define fibrin degradation products and how it is affected in haemophilia
Diagnoses disseminated intravascular coagulation
Normal in haemophilia
Define D-dimer and how it is affected in haemophilia
Assesses degradation products of crosslinked fibrin, normal levels are <250ng/ml
Normal in haemophilia
What is the function of N-acetyl cysteine in paracetamol overdose?
Replenishes the supply of glutathione that conjugates NAPQI to non-toxic compounds
What tests are conducted for cholangitis
Contrast-enhanced dynamic CT - diagnostic
Bloods show leukocytosis and raised ALP/CRP/bilirubin
What are the 7 symptoms of haemochromatosis
fatigue, weakness, abdo pain, erectile dysfunctoin, skin bronzing, hepatomegaly
What tests are used in haemochromatosis (1st line, gold standard and other)
Ferritin levels - 1st line
Liver biopsy - gold standard
Genetic testing - HFE gene chrom 6
How would a patient with hepatocellular carcinoma present
Weight loss, fatigue, fever, dark stools, pale urine, raised alpha fetoprotein, raised CRP
5 causes of hepatocellular carcinoma
alcohol, fatty liver, haemochromatosis, wilson’s, hepatitis
11 causes of pancreatitis
Idiopathic
Gallstonees
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Spider bite
Hyperlipidaemia, hypothermia, hypercalcaemia
ERCP
Drugs
What is the pathophysiology of hepatitis
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
2 signs of Wilson’s disease
Kayser-Fleischer rings - build up on copper in iris
Neurological signs - build up of copper in CNS
Describe Murphy’s sign and what condition it is present in
Press hand on abdomen, patient inhales, pain = positive
Shows acute cholecystitis
What blood test results would be seen in Paget’s disease
Raised ALP, everything else normal (PTH, calcium, phosphate, vit D)
What drug increases risk of gout and why
Thiazide diuretics as they increase urate reabsorption in proximal tubules
6 causes of reactive arthritis
Chlamydia (most common), gonorrhoea, campylobacter jejuni (2nd most common - after stomach bug), shigella, salmonella, E. coli
7 risk factors for septic arthritis
> 80, pre-existing joint disorder, DM, immunosuppression, recent joint surgery, prosthetic joint, penetrating trauma
What antibodies are associated with SLE and are the sensitive or specific?
ANA - sensitive
anti-dsDNA - specific
What is the treatment for osteoporosis and how do you take it?
Alendronate (bisphosphonate) - take once a week on an empty stomach and remain upright for 30 mins after taking
What is the treatment for gout (acute and preventing relapse)
Acute - high dose NSAIDs + corticosteroids + Colchicine
Allopurinol prevents future attacks
Describe the 3 stages of Paget’s disease
Lytic - excessive osteoclastic resorption
Mixed - excessive resorption and disorganised bone formation
Blastic - osteoblasts lay down excess disorganised weak bone
6 complications of Paget’s
Skull thickening, osteosarcoma, fractures, tibial bowing, deafness, high output cardiac failure
What is the treatment for Paget’s
Bisphosphonates
Describe chronic granulomatous large vessel vasculitis
Inflammation affecting carotid arteries and its branches (temporal)
What is the urgent treatment for chronic granulomatous large vessel vasculitis
Corticosteroids to prevent blindness
What are the 5 diagnostic criteria for chronic granulomatous large vessel vasculitis
Age >50, temporal artery abnormality (tender/ decreased pulsation), new onset headache, abnormal temporal artery biopsy, ESR >50mm/hr
10 signs of SLE
Discoid rash, pleuritis, peritonitis, myocarditis, oral ulcers, alopecia, photosensitivity, anaemia, migraine, seizures
How do you treat the symptoms of arthralgia in SLE
Hydroxychloroquine +/- NSAIDs +/- corticosteroids
What are the symptoms of anti-phospholipid syndrome
CLOT
Coagulation
Livedo reticularis
Obstetric issues (miscarriage)
Thrombocytopenia
What antibodies are associated with anti-phospholipid syndrome
Lupus anticoagulant
Anti-cardiolipin
Anti-beta 2 GPI
What gene is associated with anti-phospholipid syndrome
HLA-DR7
What is Wernicke encephalopathy, what are the symptoms and what causes it
Complication of chronic alcoholism caused by vit B1 deficiency
Symptoms - changes in mental status, gait, oculomotor dysfunction
What are the symptoms of Horner’s syndrome
Anhidrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)
What causes Horner’s syndrome?
Pancoast tumour in lung causes damage to sympathetic nerves
What are the symptoms and levels associated in Brown-Sequard syndrome
Ipsilateral proprioceptive, vibration and motor loss at level of lesion
Contralateral pain and temp loss 1-2 levels below lesion
What area is affected in a stroke impacting the:
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
ACA - contralateral leg, foot, genitals
MCA - contralateral arm, hand, shoulder, face
PCA - vision and coordination
What is the treatment for subarachnoid haemorrhage?
Nimodipine (CCB) prevents vasospasm , give ASAP
What is the 1st line investigation for MS and what will it show
MRI head - shows multiple plaques of CNS demyelination
What is the 1st line treatment for acute migraine and class
Sumatriptan (serotonin 5-HT1 receptor agonist) - vasoconstrictor
What symptoms would you expect of a lesion at:
Optic chiasm
Trochlear nerve
Oculomotor nerve
Optic nerve
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
What treatment is used for tonic-clonic seizures
Sodium valporate although if patient of child bearing age give Lamotrigine or Carbamazepine
What is the treatment for myoclonic seizures
Topiramate
6 Contraindications to receiving a lumbar puncture
Signs of raised ICP, coagulopathy, focal neurology, cardiovascular compromise, infection at site of LP, decreased GCS
What drugs are used for prophylaxis for someone who has close contact with a meningitis patient
Rifampicin or ciprofloxacin
What is the name of the phenomenon where a patient feels a curtain coming down on their eyes
Amaurosis fugax
What is the acute treatment for cluster headaches and prophylaxis
Acute - 100% O2 and SC Sumatriptan
Prophylaxis - CCB
Describe encephalitis and state the most common cause
Inflammation of the brain parenchyma usually caused by a virus (most commonly Herpes Simplex type 1)
What is the diagnostic investigation for encephalitis
LP with CSF viral PCR testing
What is the treatment for encephalitis
IV Acyclovir
What is the treatment for migraine
Analgesia - paracetamol
Triptan - Sumatriptan
3 risk factors for Alzheimers
Down syndrome, decreased physical or cognitive activity, depression/loneliness
What would you see on an Alzheimers MRI (4)
Extracellular deposition of beta amyloid plaques
Tau neurofibrillary tangles
Damaged synapses
Cortical atrophy (hippocampus)
What is the treatment (and class) for Alzheimers
Rivastigmine - Acetylcholinesterase (ACH inhibitor)
State 3 drugs to treat Parkinson’s and explain their mechanism of action
Levodopa - dopamine precursor
Dopamine agonists
COMT inhibitor (Rasagiline) / MAO-B inhibitor (Selegiline) - inhibit enzymatic breakdown of dopamine
What is the treatment for Guillain Barre syndrome
IV immunoglobulins - decrease duration and severity of paralysis
Plasma exchange - filter out antibodies
LMW Heparin - reduce risk of venous thrombosis
What are the 2 main differentials for epilepsy
Syncope, non-ectopic seizure
What is the treatment for increased ICP (extradural/subdural haemorrhage)
IV mannitol
State and describe the 2 clinical tests for carpal tunnel syndrome
Phalen’s test - can only maximally flex wrist for 1 min
Tinel’s test - tapping on median nerve at wrist induces tingling
What type of collagen are antibodies targeting in Goodpasture’s
IV (basement membranes)
What type of hypersensitivity reaction is Goodpastures
II (antibody-mediated immune reaction)
What is the treatment for Asthma (4 stages)
1 occasional symptoms - SABA (sallbutamol)
2 mild - add inhaled corticosteroid (beclomethasone)
3 moderate - add LABA (salmeterol)
4 severe - add omalizumab
5 things on TB CXR
Gohn complex, Gohn focus, dense homogenous opacity, hilar lymphadenopathy, pleural effusion
What type of lesion is found in TB
Caseating granuloma lesion
4 antibiotics to treat TB
Rifampicin, Isoniazide, Pyrazinamide, Ethambutol
What is the pathophysiology of asthma
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
What lesion is found in sarcoidosis
Noncaseating granuloma lesion
5 extrapulmonary signs of sarcoidosis
Erythema nodosum, polyarthritis, lupus pernio, uveitis, arrhythmias
5 causes of bronchiectasis
Cystic fibrosis, post-infectious, idiopathic, immunodeficiency, airway obstruction
3 signs of bronchiectasis
Coarse crackles on inspiration, large airway rhonchi, wheeze
4 complications of bronchiectasis
Empyema, lung abscess, pneumothorax, respiratory failure
What is the first line and gold standard investigations for bowel obstruction
1st line - abdo XR
Gold standard - abdo CT
4 causes of diverticulum
Low fibre diet, smoking, obesity, NSAIDs
4 symptoms of prostatitis
Pelvic or perineal pain lasting > 3 months, polyuria, dysuria, pain on ejaculation
What is trimethoprim contraindicated in and why?
Teratogenic in first trimester as it inhibits folate synthesis
Treats UTI
4 complications of PKD
cardiovascular disease, kidney stones, polycystic liver disease, subarachnoid haemorrhage
What are the 5 organisms that cause malaria
Plasmodium falciparum
Plasmodium ovale
Plasmodium vivax
Plasmodium malariae
Plasmodium Knowlesi
6 signs/symptoms of TTP
haemolytic anaemia, decreased platelets, AKI, neurological symptoms, fever, schistocytes on film
What is the first line treatment for TTP
Urgent plasma exchange
What is the mechanism of action of Rituximab
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
What is the treatment for malaria that is:
Severe/complicated
Uncomplicated
Dormant
Complicated - IV artesunate
Uncomplicated - oral chloroquine
Dormant - oral primaquine
6 types of cell that are able to regenerate
pneumocytes, hepatocytes, osteocytes, gut/skin epithelial cells, blood cells
What is Rhabdomyoma and Rhabdomyosarcoma
Benign striated muscle neoplsam
Malignant
What is Leiomyoma and leiomyosarcoma
Benign smooth muscle neoplasm
Malignant
What immune cells are seen in acute inflammation
neutrophil polymorphs
What immune cells are seen in chronic inflammation
B lymphocytes, T lymphocytes, macrophages
What is the definition of a granuloma
an aggregate of epithelioid histiocytes
6 things in an atherosclerotic plaque
connective tissue, foam cells (low density lipoproteins), T lymphocytes, smooth muscle cells, cholesterol, lipid deposits
What are the signs/symptoms of primary biliary cholangitis
late presentation of lethergy, pruritis, jaundice, hepatomegaly
What is the main concern in alcohol withdrawal and how should you treat it
Seizures - chlordiazepoxide
What condition would you see pencil in cup deformity on XR
Psoriatic arthritis
What condition would you see bamboo spine deformity on XR
ankylosing spondylitis
What condition would you see periarticular erosions on XR
gout
What is the 1st line treatment for ankylosing spondylitis and how would you treat it if it were severe
1st line - NSAIDs e.g. ibuprofen
Severe - DMARDs and anti-TNFs
How would pseudogout present
acute onset, often in knee, red and swollen joint, often has history of IV fluids or parathyroidectomy
What do each DEXA scores show
< -2.5 = osteoporosis
-1 - -2.5 = osteopenia
> -1 = normal
4 clinical features of Parkinson’s
blank facial expression, small handwriting, rigidity, slow walking
3 clinical features of cauda equina syndrome
saddle anaesthesia, inability to open bowel/urinate, reduced anal tone
4 risk factors for peripheral neuropathy
DM, immunocompromised, SLE, vit B1 deficiency
What is the immediate treatment for acute ischaemic stroke? (mechanism and contraindications)
IV alteplase within 4.5hrs
Activates tissue plasminogen
Contraindicated in haemorrhage, clotting disorders, aneurysm
3 side effects of salbutamol inhaler
hypokalaemia, tachycardia, fine tremor
Define a papilloma
benign tumour of non-glandular, non-secretory epithelium
Define an adenoma
benign tumour of glandular or secretory epithelium
Define a carcinoma
malignant tumour of non-glandular, non-secretory epithelium
Define an adenocarcinoma
malignant tumour of glandular or secretory epithelium
Define a sarcoma
malignant tumour of connective tissue
Describe MHC-1 (major histocompatibility complex - 1)
found on all nucleated cells, display peptide fragments of proteins from within the cell to cytotoxic T cells leading to an immune system response
Define pharmacodynamics and pharmacokinetics
Pharmacodynamics - what drug does to your body
Pharmacokinetics - what body does to drug
State the characteristics of mycobacteria
slow growing, predominantly immobile, rod shaped, intracellular, gram positive
What is the 1st and 2nd line treatment for phaeochromocytoma
1st line - alpha blockers (e.g. phenoxybenzamine or doxazosin)
2nd line - beta blockers
6 features you expect to see in Klinefelter’s syndrome
learning difficulties, male, small testicles, raised LH+FSH, low testosterone, karyotype 47XXY
What is annulus fibrosus
Structure in the heart that electrically isolates both atria from both ventricles
What is the treatment for AF
Haemodynamically unstable - DC cardioversion + anticoagulation
Haemodynamically stable - beta blockers/CCB + anticoagulation
What class is Verapamil and what is it contraindicated in
CCB, cardioselective so contraindicated in HF
What artery supplies the AVN
Right coronary artery
What is the mechanism of action of aspirin
non-selective inhibitor of COX-1 enzymes
What condition has smudge cells
CLL
What electrolyte imbalances are in tumour lysis syndrome
Hypocalcaemia
Hyperphosphatemia
Hyperuricaemia
Hyperkalaemia
What is the mode of transmission for C. difficile
faeco-oral
Where is the most common site for large bowel perforation
Caecum as it has the thinnest wall
What area of the GI tract is most commonly affected in crohns
Ileum
What is the most common organism cause of ascending cholangitis
E.coli
3 causes of exudate ascites
Peritoneal carcinomatosis, pancreatitis, peritonitis
5 causes of transudate ascites
HF, portal HTN, Budd-Chiari, low serum albumin/liver cirrhosis, nephrotic syndrome
What are 3 signs of Ehler Danlos and pathophysiology
Joint hypermobility, increased skin elasticity, aortic regurgitaiton
Causes a decreased synthesis of type II collagen
What type of hypersensitivity reaction is SLE
3
What is the pathophysiology behind polyuria with ethanol
ethanol suppresses ADH secretion form the posterior pituitary gland
4 types of renal stone
calcium oxalate, monosodium urate, struvite, cystine
What would you see under electron microscopy in minimal change
fusion of podocytes and effacement of foot processes
What are the nephrotoxic drugs
DAMN
Diuretics
ACEi/ARBs
Metformin
NSAIDs
What are the 4 features of cushing’s reflex
Hypertension, bradycardia, irregular breathing, wide pulse pressure
What equation explains cushing’s reflex
cerebral perfusion pressure (CCP) = mean arterial pressure (MAP) - intracranial pressure (ICP)
Why does BP increase and HR decrease in increased ICP
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
What meningitis organism is gram positive diplococci
Streptococcus pneumoniae
What meningitis organism is gram negative diplococci
Neisseria meningitis
4 signs of MS
positive babinski, hypertonia, ankle clonus, spasticity
1st line treatment for myasthenia gravis
Pyridostigmine + prednisolone + azathioprine/methotrexate
Treatment for myasthenia crisis
IV immunoglobulin and plasmapheresis
What is the mechanism of action of pyridostigmine
Increases bioavailability of ACh in the synapse to compensate the autoimmune destruction of ACh receptors in MG
What happens in chronic hypoxia due to COPD?
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
Would you see alkalosis or acidosis in acute asthma attack and why
Alkalosis from hyperventilating to counteract the bronchoconstriction means you breath out lots of CO2
Explain the mechanism of action of the components of Co-amoxiclav
Amoxicillin - penicillin type antibiotic: prevents cell wall formation
Clavulanic acid - beta-lactamase inhibitor: increases amoxicillin effectiveness against some organisms
What signs would you see in tension pneumothorax (3)
increased pressure on that side causes: reduced air entry, trachea deviating away, decreased tactile and vocal fremitus
What is the acute management of MI
MONA
Morphine
Oxygen - if <94%
Nitrates
Aspirin
What drugs should be offered after MI
BADS
Beta blockers (propranolol)
ACEi (ramipril) or ARB (candesartan)
Dual antiplatelet (clopidogrel and aspirin)
Statin (atorvostatin)
4 types of microcytic anaemia
iron deficiency, beta thalassaemia, sideroblastic anaemia, anaemia of chronic disease
What is the treatment for hereditary spherocytosis
splenectomy
What would you see on a blood film for beta thalassaemia
large and small irregular hypochromic RBCs
What makes malaria complicated
characterised by vascular occlusion causing specific organ related symptoms
What is in Virchow’s triad
hypercoagulable state, venous stasis, vessel injury
What is the gold standard investigation for phaeochromocytoma
elevated plasma free metanephrine
How can you differentiate between large and small bowel obstruction
Large - constipation before vomiting
Small - vomiting before constipation
Signs/symptoms of primary sclerosing cholangitis
Associated with UC
Signs - patchy inflammation, fibrosis, strictures in hepatic bile ducts
Symptoms - abdo pain, itchy skin, diarrhoea, jaundice, fatigue, fever
What are the most common Abx to cause C. diff
Clindamycin, co-amoxiclav, aminopenicillins
What is a faecal immunochemical test
home testing kit for colorectal cancer, detects small amounts of blood in stool
Where does a mallory weiss tear occur
gastro-oesophageal junction
What is the gold standard investigation for transitional cell carcinoma
cytoscopy
6 things that would make a complicated UTI
pregnant, male, children, elderly, recurrent UTI, DM
What is the treatment for chlamydia
Doxycycline (not if pregnant) or azithromycin or erythromycin
What is the treatment for gonorrhoea
IM ceftriaxone with azithromycin
What is the 1st line drug for BPH (with class, mechanism and S/E)
Tamsulosin - alpha 1-adrenergic receptor antagonist
Relaxes smooth muscle in prostate and bladder, increasing urinary flow
S/E - postural hypotension, retrograde ejaculation
What is the 2nd line drug for BPH (with class, mechanism and S/E)
Finasteride - 5-a-reductase inhibitor
Inhibits conversion of testosterone to dihydrotestosterone which decreases prostate size
S/E - fatigue, erectile dysfunction
What is the pathophysiology behind autoimmune hepatitis
T cell mediated response against liver cells
Autoimmune Hep symptoms (5)
pruritus, jaundice, malaise, anorexia, nausea
5 things blood tests show in autoimmune hep
Raised AST, ALT, ALP, IgG, positive ASMA
1st and 2nd line drugs for autoimmune hep
Prednisolone
Azathioprine
1st line Tx for alcohol withdrawal
chlordiazepoxide
What is bacterial peritonitis/symptoms
complication of ascites, associated with cirrhosis
Symptoms - abdo pain, fever, hepatic encephalopathy, diarrhoea, SOB, sepsis
What is the pathophysiology behind alpha 1 anti-trypsin deficiency
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
What causes Alpha 1 anti-trypsin deficiency
Genetic misfolding in SERPINA1 gene
What would CXR show in A1AT deficiency
emphysema and flattened diaphragm
What is a complication of A1AT deficiency
hepatitis
What is Schober’s test
For ankylosing spondylitis, assesses mobility of spine
What is the most common cause of osteomyelitis
staph aureus
Salmonella if patient has sickle cell
What is Ewing’s sarcoma and what would you see on XR
cancer of bone and soft tissue, mainly affects children and young adults
XR - lytic bone lesions, onion skin appearance of periosteum
What is chondrosarcoma and what would you see on XR
cancer of cartilage
XR - popcorn calcifications, lytic lesions
What would you expect of ESR and CRP in SLE
raised ESR, normal CRP
What are the risk factors for osteoporosis
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
What is trigeminal neuralgia and what is the treatment
Unilateral facial pain, electric shock like shooting pain
Tx - Carbamazepine
4 prophylactic drugs for migraine
beta blocker, amitriptyline, anticonvulsant (topiramate), botulinum toxin type A
Signs and symptoms of progressive bulbar palsy
dysarthria, dysphagia, nasal regurgitation, choking, absent jaw jerk reflex
Form of MND affecting LMN CN9-12
What sign would you see on a bronchiectasis CT
signet ring sign
What is the most common cause of CAP
strep pneumoniae
What is the most common cause of HAP
pseudomonas aeruginosa
What is the gold standard test for PE
CT pulmonary angiography
What type of cell would you see on microscopy in Hodgkin’s lymphoma
Reed-Sternberg cells / cells with mirror image nuclei
What type of lymphocytes are affected in non-hodgkins lymphoma
B lymphocytes
What virus is associated with NHL
EBV
What are the 3 B symptoms
fever, weight loss, night sweats
What is pancytopenia
Deficiency of all blood types: RBCs, WBCs, platelets
How is chest pain in pericarditis different to MI pain
Pericarditis doesn’t radiate to jaw and teeth
3 clinical features of pericarditis
pericardial rub, fever, sinus tachycardia
What is the treatment for pericarditis, mechanism of action and how long should it be taken for
Colchicine
Inhibits migration of neutrophils to site of inflammation
Take for 6-8weeks
What are the components of CHADSVAS score and points
Congestive HF = 1
Hypertension = 1
Age >75 =2
DM =1
Stroke =2
Vascular disease = 1
Age 65-74 = 1
Sex (female) = 1
5 diagnostic tests and results for DKA
blood glucose >11.1 mmol/L
plasma ketones >3 mmol/L
ketonuria >2+ on dipstick
venous pH <7.35
HCO3- <15mmol/L
6 risk factors for DKA
stopped insulin, infection, pancreatitis, undiagnosed DMT1, MI, surgery
7 complications of DKA
hypotension, coma, cerebral oedema, hypothermia, death, DVT, pneumonia
Which hepatitis is a notifiable disease
A
What antibody and antigen is associated with hepB
AntiHB antibody
HBsAG (antigen)
Why can hep D only cause disease in those with hep B
Hep D is an incomplete RNA virus and uses hepB surface antigens (HBsAg) to assemble
What is the acute management for hep B (3)
avoid alcohol
vaccinate contacts
monitor liver function
What genes are associated with SLE
HLA B8, HLA DR2, HLA DR3
What is the diagnostic criteria for SLE
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
5 lifestyle changes to manage SLE
decrease sunlight exposure, wear high factor suncream, loose weight if obese, smoking cessation, exercise
What is the treatment for an acute SLE attack
IV cyclophosphamide and prednisolone
What is the 1st line and gold standard investigation for renal stones
1st line - kidney ureter bladder ultrasound
gold standard - non-contrast CT KUB
4 things that renal stones can be made out of
calcium oxalate, calcium phosphate, cysteine, uric acid
Treatment for renal stones <1cm
analgesia (IV diclofenac), watch and wait for spontaneous passing
Treatment for renal stones 1-2cm
extracorpeal shock wave lithotripsy (ESWL)
4 things to reduce risk of getting another renal stone
overhydrate, decrease dietary calcium, decrease dietary salt, decrease BMI
What is the diagnostic criteria for MS
2+ lesions disseminated by time and space AND exclusion of other similarly presenting conditions
4 symptoms/signs of spinal cord lesion
numb/tingling limbs, leg weakness, bladder/sexual dysfunction, Lhermitte’s sign (electric shock down spine to limbs)
What is the pathophysiology behind heat and MS
heat makes symptoms worse as the new myelin is less effective so heat impacts it more
How can HIV be transmitted (3)
mother to child, IV drug use, contaminated blood/organs
What type of virus is HIV
retrovirus subgroup lentivirus
What results is diagnostic for AIDs
CD4 <200/microlitre
What is the drug class and subgroups to treat HIV
highly active antiretroviral therapy (HAART)
Subgroups:
nucleoside reverse transcriptase inhibitors (NRTI)
nnon-nucleoside reverse transcriptase inhibitors (NNRTI)
How do you differentiate between nephrogenic and cranial DI
IM desmopressin suppression test - if urine osmolarity stays the same its nephrogenic, if osmolarity increases its cranial
What is the treatment for cranial DI
desmopressin (ADH analogue)
What is the treatment for nephrogenic DI (and mechanism of action)
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
8 signs of pneumonia
fever, confusion, tachypnoea, tachycardia, hypotension, dull percussion, diminished chest expansion, pleural rub
What does strep pneumoniae look like under stain/microscopy
gram positive bacilli chains, optochin sensitive
What is the diagnostic test for STDs
first void urine and culture / NAAT (nucleic acid amplification test)
What does gonorrhoea look like on microscopy
gram negative diplococci
What is the treatment for gonorrhoea
IM azithromycin and ceftriaxone
7 signs of Graves
Graves’s opthamopathy, tachycardia, hyperreflexia, Goitre, Clubbing, AF, Dyspnoea
Graves investigations
Thyroid function test
Thyroid ultrasound
Iodine thyroid scan
Graves treatment
Carbimazole
Radioiodine therapy
Thyroidectomy
Liver failure signs (8)
Spider naevi, Clubbing, Jaundice, Palmar erythema, Bruising, Oedema, Anorexia, ascites
Alcoholic liver disease stages
alcoholic fatty liver, alcoholic hepatitis, alcoholic cirrhosis
3 complications of liver cirrhosis
Hepatocellular carcinoma, Oesophageal varices, Portal hypertension
Why does liver failure lead to ascites
Low albumin and portal hypertension mean oncotic pressure is lower than hydrostatic pressure leading to fluid leaking into abdominal cavity
Differences between epileptic and non epileptic seizures
Epileptic - eyes open, incontinence, tongue biting
Non-epileptic - eyes closed, hip thrusting, lasts longer
Pathophysiology of an epileptic seizure
Excessive, unsynchronized neuronal discharges causes paroxysmal changes in behaviour, sensation and cognitive processes
Define infective endocarditis
Inflammation of the endocardium/ heart valves due to infection
What would be seen on infective endocarditis echocardiogram
Vegetations on the heart valves
5 signs of infective endocarditis
Splinter haemorrhages, Osler’s nodes, Roth spots, Janeway lesions, murmur
Infective endocarditis RF (7)
IV drug user, elderly, prosthetic heart valves, poor dental hygiene, cardiac surgery, pacemaker, congenital heart disease
Diagnostic criteria for GCA
Age > 50
Temporal artery tenderness
New headache
Giant cells/ neutrophils on temporal artery biopsy
GCA treatment
Corticosteroids e.g. Prednisolone
Methotrexate
Monitor and reduce likelihood of osteoporosis
Describe lymphoma
A malignant tumour causing proliferation of lymphocytes mainly in lymph nodes
7 symptoms of hodgkins lymphoma
Enlarged lymph nodes
General B symptoms i.e weight loss, night sweats, malaise, fatigue
Hepato/ splenomegaly
Easy bruising
Anaemia
Frequent infections
Enlarged abdomen
2 drugs and their class for treating BPH
5-Alpha reductase inhibitors- Finasteride
Alpha blockers- Tamsulosin
4 prostate cancer investigations
PSA test
Trans-rectal ultrasound guided biopsy
Ultrasound
DRE
UTI organisms and their staining (5)
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)
What would a patient have to show to prove gillick competency
That she can understand the information given to her
Can she retain the information
Can she communicate her decision and reasons for it
5 fraser guidlines
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.
2 types of COPD and their pathophysiology
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
What genetic disease is a cause of both COPD and liver cirrhosis
Alpha-1 anti-trypsin deficiency
3 cardinal symptoms of COPD
Productive cough/ sputum production
Dyspnoea
Chronic cough
What two signs found through lung function tests indicate COPD?
FEV1/FVC < 0.7
FEV1 < 80% of predicted value
HTN tests (and results) other then BP
urinalysis - haematuria
bloods - raised serum creatinine
fundoscopy - retinal haemorrhage
ECG - left ventricular hypertrophy
What can lead precipitate a thyroid storm and what hormone changes cause it
precipitate - stress, infection, surgery
caused by rapid T4 increase
4 drugs for thyroid crisis
oral carbimazole
oral propranolol
oral potassium iodine (blocks release of thyroid hormone)
IV/IM hydrocortisone (inhibits peripheral conversion of T4 to T3)
What type of anaemia is in myeloma and what electrolyte is raised
normochromic normocytic anaemia
raised calcium
What cancer is associated with chronic hepatits
hepatocellular carcinoma
2 drugs for chronic hepatitis
SC pegylated interferon-alpha 2A/B
Oral ribavirin
3 characteristics of osteoarthritis that can be used to differentiate
between rheumatoid arthritis.
Asymmetrical joints affected
Absence of systemic features
Morning stiffness <30mins
4 signs of brainstem compression.
Ipsilateral pupil dilation
Coma
Bilateral limb weakness
Deep / irregular breathing
3 characteristics of asthma
Airflow limitation
Airway hyper-responsiveness
Bronchial inflammation
What makes LABAs last longer in tissues?
They are lipophilic
Lifestyle adjustments to manage peptic ulcers
Reduce stress
Avoid irritating foods
Stop smoking
Define ulcer
Breach of the mucosal surface
3 classes of drug to treat acromegaly and an example of each
somatostatin analogue - IM octreotide
GH receptor antagonist - SC pegvisomant
dopamine agonist - oral cabergoline
Mitral stenosis risk factors (2)
Rheumatic fever
Untreated streptococcus infections
2 surgical treatments for mitral stenosis
Percutaneous mitral balloon valvotomy
Mitral valve replacement
4 features of microcytic anaemia on blood film
Small red blood cells
Pale red blood cells (hypochromic)
Variation in red blood cell shape (poikilocytosis)
Variation in red blood cell size (anisocytosis)
4 blood tests to diagnose iron deficiency anaemia
Serum ferritin
Serum iron
Serum soluble transferrin receptors
Reticulocyte count
Class and drug to treat iron deficiency and 4 side effects
oral iron - ferrous sulphate
Nausea
Abdominal discomfort
Diarrhoea/ constipation
Black stools
7 causes of GORD
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
4 GORD differential diagnoses
Coronary artery disease
Biliary colic
Peptic ulcer disease
Malignancy
3 pharmacological and 4 surgical treatments for osteoarthritis
Paracetamol, NSAIDs, Intra-articular corticosteroid injections
Arthroscopy, Arthroplasty, Osteotomy, Fusion
6 causes of hydrocele
Patent processus vaginalis
Testis tumour
Trauma
Infection
Testicular torsion
Generalised oedema
2 differentials for hydrocele
Testicular torsion
Strangulated hernia
2 blood tests to differentiate testicular cancer and hydrocele
Serum alpha-fetoprotein
Serum hCG (human chorionic gonadotropin)
5 causes of epilepsy
Idiopathic
Cortical scarring due to head injury/ cerebrovascular disease/ CNS infection
Brain tumour
Dementia
Alcohol withdrawal
5 causes of epilepsy
Idiopathic
Cortical scarring due to head injury/ cerebrovascular disease/ CNS infection
Brain tumour
Dementia
Alcohol withdrawal
6 risk factors for epilepsy
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
5 risk factors for asthma
Personal history of atopy
Family history of asthma or atopy
Obesity
Premature birth
Inner-city environment
6 features of a life threatening asthma attack
Silent chest
Confusion
Exhaustion
Cyanosis/ Pa02 < 8kPa
Bradycardia
PEFR < 33%
6 causes of IBS
Depression
Anxiety
Psychological stress
Trauma
Sexual, physical or verbal abuse
Eating disorders
What is the name of the criteria to diagnose IBS and describe it
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.
3 organisms that cause IE
Staphylococcus Aureus
Pseudomonas Aeruginosa
Streptococcus Viridans
Name for criteria to diagnose IE
Modified Dukes Criteria
5 functions of the liver
Glucose metabolism
Fat metabolism
Detoxification + excretion of: bilirubin/ ammonia/ drugs/ hormones/ pollutants
Protein synthesis: albumin/ clotting factors
Defence against infection
2 types of billiary colic
Cholesterol biliary colic/ gallstone
Bile pigment biliary colic/ gallstone
5 gallstones risk factors
Fat, Fertile, Forty, Female, Family history
4 treatments for gallstones
Stone dissolution
Shock wave lithotripsy
Laparoscopic cholecystectomy/ Gallbladder removal
Analgesia
1st line treatment for hyperthyroidism
beta blockers
5 precipitating factors for gout
Trauma
Surgery
Starvation
Infection
Diuretics
What makes crystals in pseudogout
Calcium Pyrophosphate
What causes B12 deficiency in pernicious anaemia
Atrophic gastritis
State 2 major criteria and 5 minor criteria in the modified dukes criteria
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)
What type of hypersensitivity is hypersensitivity pneumonitis?
3
3 signs and 3 symptoms of hypersensitivity pneumonitis
symptoms:
Increasing dyspnoea
Weight loss
Exertional dyspnoea
signs:
Finger clubbing (50%)
Type I respiratory failure
Cor pulmonale
7 examples of secondary headaches
Meningitis
Encephalitis
Giant cell arthritis (GCA)
Medication overuse
Venous thrombosis
Tumour
Subarachnoid haemorrhage (SAH)
What happens when histamine is released in asthma that contributes to airway narrowing
Bronchoconstriction
Mucus production
What is the triad of pyelonephritis symptoms
Loin pain
High Fever
Pyuria
2 things increased on urine dipstick in pyelonephritis
Nitrites
Leukocytes
What is the eye pathology in graves called and give 6 features of it
thyroid eye disease
optic nerve straightened, upper eyelid retraction, lid lag, periorbital swelling, conjunctival oedema, proptosis
What is the name of the treatment regime for graves and what drugs are involved
block and replace
carbimazole
levothyroxine
3 things you might see on ECG after STEMI
Bundle branch blocks, pathological Q waves, arrhythmias
3 inherited causes of liver failure
Haemochromatosis, wilsons, alpha-1-antitrypsin deficiency
Define inflammation
local physiological response to tissue damage
4 outcomes of acute inflammation
Resolution, suppuration, repair/organisation, chronic inflammation
6 pre-renal causes of AKI
Shock, hypovolaemia, hypotension, Renal artery thrombosis, sepsis, renal hypoperfusion
8 renal causes of AKI
Acute tubular necrosis, Nephrotoxins, Glomerulonephritis, Acute interstitial nephritis, Infection, Vasculitis, Malignant hypertension, Autoimmune disease
4 post-renal causes of AKI
BPH, Kidney stones, Cancer, Blood clot
Emergency complication of GCA
Arteritic anterior ischaemic optic neuropathy
Gonorrhoea under microscopy
gram negative diplococci
6 features of ankylosing spondylitis / conditions associated with it
Psoriasis, enthesitis, dactylitis, crohn’s, ulcerative colitis, eye involvement
4 signs seen on ankylosing spondylitis X ray
sacroiliitis (1st sign), enthesitis, syndesmophytes fusing to make bamboo spine, Dagger sign (single central line down spine)
2 Histological findings in parkinsons
Lewy bodies, degeneration of dopaminergic neurons
3 features of parkinsons gait
shuffling, reduced arm swing, slow to get going
4 classes of drug to treat parkinsons and their mechanism of action
- 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
3 specific questions of history taking to support a HF diagnosis
Does he have a history of coronary artery disease (arrhythmia or MI), orthopnoea, fatigue
3 tests for HF + gold standard
ECG, blood test, chest XR, echocardiogram (gold standard)
How do beta blockers treat HF
Beta blocker (bisoprolol): counteracts the compensatory sympathetic response to heart failure that leads to increase heart failure and vasoconstriction.
How do ACEi treat HF
ACE inhibitor (ramipril): counteracts the stimulation of the Renin Angiotensin Aldosterone System (RAAS) that leads to vasoconstriction and retention of sodium and water
1st line treatment for HF
Loop diuretics (furosemide or bumetanide)
8 symptoms of renal colic
Haematuria, rigors, dysuria, urinary retention, foul smelling urine, urgency, left flank to groin pain, N&V
8 signs/symptoms of ankylosing spondilitis
Iritis, uveitis, enthesis, fatigue, sleep disturbance, asymmetrical oligoarthritis, sacroiliitis, lower back pain relieved with exercise
what 2 conditions come under COPD
Emphysema, chronic bronchitis
4 stages of pharmacokinetics
Absorption, metabolism, distribution, elimination
Define hyperosmolar hyperglycaemic state
A condition of extreme hyperglycaemia associated with dehydration, altered mental status, headache, fatigue and blurred vision
Herpes zoster treatment
Aciclovir
4 causes of SIADH
alcohol withdrawal, head injury, pneumonia, small cell lung cancer
Describe PTH, calcium and phosphate in primary/secondary/tertiary hyperparathyroidism
primary - high PTH, high calcium, low phosphate
secondary - high PTH, low calcium, high phosphate
tertiary - high PTH, high calcium, high phosphate
4 types of cardiomyopathy
HARD
Hypertrophic
Dilated
Arrhythmogenic
Restrictive
STEMI tx
PCI within 2 hours
if after 2 hours give fibrinolysis and IV Tenecteplase
Diagnostic criteria for postural hypotension
sytolic drop of >20mm/Hg or drop below 90 when going from lying (for 5 mins) to standing
Postural hypotension tx (1 pharma, 3 lifestyle)
Fludrocortisone
Hydrate, exercise, salty meals
Most common cause of small bowel obstruction
surgical adhesions
most common cause of large bowel obstruction
malignancy
UC treatments
1st line (mild) - 5-aminosalicyclic acid (sulfasalazine, mesalazine)
2nd line (moderate) - oral prednisolone
3rd line (severe) - IV hydrocortisone
4th line (very severe) - colectomy, definitive
What condition has Philadelphia chromosomes
CML
What is Asterixis and what conditions do you see it in
hand jerk when arms outstretched and wrists extended
seen in liver failure and t2 resp failure
What is Kussmaul breathing and what condition do you see it in
deep laboured breathing, form of hyperventilation
seen in DKA
definition of acute liver failure
INR greater than 1.5
Onset of less than 26 weeks duration
Mental alteration without pre-existing cirrhosis
No previous liver disease
4 liver cancer risk factors
Hepatitis B infection
Chronic alcohol use
Aflatoxin exposure
Non-alcoholic Fatty Liver Disease
What condition presents with severe pneumonia and travel to somewhere like spain
legionnaires disease
transmits through air con
caused my legionella pneumophila
what is a beta haemolytic gram positive strep with lancefield group A
s. pyogenes
what is a beta haemolytic gram positive strep with lancefield group B
s. agalactiae
what is strep pneumoniae (gram, shape, haemolytic)
gram positive diplococci, alpha haemolytic, optochin sensitive
describe tests for staph aureus
gram positive cocci in clusters coagulase positive
describe neisseria meningitidis
gram negative diplococci
what bacteria are gram negative bacilli
E.coli, Klebsiella, Enterobacter
What agar grows micobacterium
Lowenstein-Jensen
what test differentiates staph and strep
catalase test
staph are catalase +ve, strep are -ve
3 stool tests in diarrhoea
stool culture, faecal calprotectin, faecal occult blood
2 findings in UC on microscopy
crypt abscesses, ulceration
2 main histopathological findings in parkinsons
presence of Lewy Bodies
loss of dopaminergic neurones
What virus has owl eyes intranuclear inclusions
Cytomegalovirus (CMV)
1st and 2nd line treatment for severe hyperkalaemia
1st - Calcium gluconate
2nd - insulin and dextrose
Immediate management of guillain barre syndrome with decreased FVC
urgent ITU admission
What is turners syndrome
Female condition causing short stature, primary amenorrhoea, high FSH, high LH
What blood product do you give in DIC
Cryoprecipitate
What does TLR1 sense?
Lipopeptides
What do TLR2 sense?
Lipoproteins, lipoteichoic acid
What does TLR3 sense?
double-stranded RNA
What do TLR4 sense?
Lipopolysaccharides
What do TLR5 sense?
Flagellin
What cancer is a sjogrens patient at risk of developing
lymphoma
1st line treatment for angina
glyceryl tinitrate (GTN) spray + Beta blocker OR CCB
5 modifiable risk factors for angina
hypertension, DMT2, smoking, increased cholesterol, obesity
5 extra-articular manifestations of ankylosing spondylitis
anterior uveitis, IBD, apical lung fibrosis, aortic regurgitation, amyloidosis
4 signs on ankylosing spondylitis on XR
bamboo spine, ossification, fusion of joints, subchondral sclerosis
Ankylosing spondylitis treatment
NSAIDs
Steroids during flare ups
Anti-TNF (infliximab)
3 medications in acute asthma attack
salbutamol
Ipratropium Bromide Nebuliser
Oral prednisolone or IV Hydrocortisone
Treatment for asthma
- SABA - salbutamol
- add ICS - beclomethasone
- add Leukotriene Receptor Antagonists (LTRA) - montelukast
- LABA - salmeterol
- Maintenance and Reliever Therpay (MART)
5 indicators of good asthma control
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
Precipitants of migraine (7)
Chocolate
Cheese
Oral contraceptive
Caffine
Alcohol
Anxiety
Exercise
Travel
Smoking
3 drugs for migraine prophylaxis
Propranolol
Topiramate
Amitriptyline
Mechanism of action of adrenaline
Stimulation of beta adrenergic receptors
5 physiological responses to histamine
vasodilation, bronchoconstriction, increased vascular permeability, tachycardia, hypotension, maximise blood glucose levels in the brain
What drug maintains remission in Crohns
Azathioprine
What is the treatment for haemochromatosis
therapeutic phlebotomy
1st line investigation for testicular torsion for high pain score
surgical exploration and untwisting if required
1st line investigation for testicular torsion for low pain score
Duplex ultrasound to check blood flow
gold standard investigation for portal hypertension
hepatic venous pressure gradient
What is the karyotype of turners
45 XO
What can be given as prophylaxis of tumour lysis syndrome (with leukaemia chemo)
allopurinol
What is the most common cause of pneumonia in HIV patients
Pneumocystis jirovecii (fungus)
Tx - Co-trimoxazole
What hypersensitivity is coeliac
4
Prophylaxis of sickle cell crisis
Hydroxycarbamide - increases HbF conc
1st line investigation for renal cell carcinoma
CT urogram
what is cut to relieve pressure on median nerve in carpal tunnel
transverse carpal ligament
Treatment for severe or persistent tonsillitis
Phenoxymethylpenicillin QDS 10 days
7 symptoms of chronic limb ischaemia
hair loss, atrophic skin, brittle nails, ulcers, numbness in feet, absent distal pulses, intermittent claudication
arterial vs venous ulcer
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
Where can you hear an ejection systolic murmur on the chest
Over aortic valve - 2nd intercostal space, left sternal border
(aortic stenosis)
6 features of a fib ECG
irregularly irregular rhythm
absent P waves
Variable ventricular rate
absence of baseline
QRS complex <120ms
fibrillatory waves
What gene, chromosome and protein channel is affected in CF
F508 deletion on chrom 7
CFTR gene
CFTR protein
3 diagnostic test for CF
sweat electrolyte test
heel-prick for newborns
genetic screening
4 causes of exudative effusions
lung cancer
pneumonia
TB
Rheumatoid arthritis
5 causes of transudative effusion
congestive cardiac failure
liver cirrhosis
hypoalbuminaemia
nephrotic syndrome
hypothyroidism
2 investigations and results for pleural effusion
CXR - blunting of costophrenic angle, fluid in lung fissures, tracheal and mediastinal deviation if severe
pleural tap - transudate = clear, exudate = cloudy, lymphatic = milky
3 treatments for pleural effusion
therapeutic aspiration
chest drain
diuretics
4 bones that can be affected in pagets
skull, vertebrae, pelvis, femur
3 features of Beck’s triad and what it shows
associated with pericardial tamponade
hypotension, distended jugular veins, muffled heart sounds
4 investigations for cardiac tamponade
ECG, echocardiogram, CXR, cardiac enzymes
Lump on neck, worse after drinking alcohol - what is it
hodgkins lymphoma
what is the mechanism of action of beta lactam antibiotics
bind transpeptidase enzymes and block cross linking of peptidoglycans in cell wall
What do you need to do in regard to DVLA after TIA
dont need to inform them but should stop driving for 1 month
What is the treatment for uncomplicated UTI (inc route and how long)
nitrofurantoin PO for 3 days
What ECG changes would you see in Conns
flat T, prolonged QT, ST depression
(hypokalaemia)
How does Cushings affect menstrual cycle
can cause amenorrhoea (no period) or oligomenorrhoea (irregular period)
presents with unexplained weight gain, bruising, purple stretch marks on abdomen
cushings disease
Child with distal femur pain has bone cancer, what type
osteosarcoma - most common primary bone tumour in kids and YA
Ewing’s also affects kids but less common and more affects proximal bones
what causes LIF pain and tenderness
acute diverticulitis
What is the most common cause of reactive arthritis
chlamydia pneumoniae
what is the 1st, 2nd and 3rd line treatment for UC
1st line - 5-aminosalicyclic acid (sulfasalazine, mesalazine, olsalazine)
2nd line - prednisolone if not responding or severe
3rd line - colectomy
what is the 1st, 2nd and 3rd line treatment for crohns
1st line - oral prednisolone
2nd line - IV hydrocortisone
3rd line - anti-tumour necrosis factor (anti-TNF) e.g. infliximab
what is used to maintain remission in crohns
azathioprine
4 things to prevent migraine
acupuncture
propranolol
topiramate
amitriptyline
presents with ankle swelling, normal BNP, pmh hypertension, what is the cause
side effect of CCB
when should you be seen by a specialist after TIA
If ABCD2 below 4 then within 7 days
4-6 then within 24 hours
6+ then immediately
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
spontaneous pneumothorax
needle aspiration
4 features of parkinsons tremor
asymmetrical, worse at rest, improves with purposeful movement, ‘pill rolling’ (between thumb and fingers)
diagnostic investigation for DVT
ultrasound
weakness and numbness in foot, foot drop, no dorsiflexion - what nerve
common peroneal
What is Brudzinski’s test
Lying the patient supine and flexing their neck a positive test involves the patient involuntarily flexing their hip and knee
differentiate chronic bronchitis and emphysema
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
what is the most specific marker for liver damage
alt
treatment for pernicious anaemia
IM hydroxocobalamin
what is the variation of angina with coronary artery spasm at rest
Prinzmetal’s angina
what is 1st line treatment for angina
GTN Glyceryl trinitrate spray + beta blocker + CCB
what is the rash in coeliac called
dermatitis herpetiformis
Define anaphylaxis
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
what type of immunoglobulin is involved in anaphylaxis
IgE
what is the mechanism of action of adrenaline
stimulates beta adrenergic receptors
6 physiological responses to histamine
increased vascular permeability, vasodilation, tachycardia, hypotension, increased mucous secretion, airway oedema
5 steps in immediate management of anaphylaxis
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
where should adrenaline be injected
anterolateral aspect of the middle third of the thigh
what investigation can confirm the diagnosis of anaphylaxis
Mast Cell Tryptase blood test - marker protein seen immediately and up to 4 hours after reaction
what test can determine trigger of anaphylaxis
RAST test - blood sample measures specific IgE antibodies to suspected allergens
2 characteristics of anaesthesia to make it effective
low protein binding - to enable a high initial plasma conc
high lipid solubility - enhances potency and rapid diffusion through cell membranes
3 reasons why you might need to use a secondary dose of anaesthesia
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
define agonist
a compound that binds to a receptor and activates it
define antagonist
a compound that reduces the effect of an agonist
define a competitive antagonist
a medication that binds reversibly to the same receptor site where an agonist binds but does not activate it
define non-competitive antagonist
reversibly binding to allosteric site and causes the shape of the receptor to alter so ligand cant recognise it as a binding site
4 things a drug can target
ion channels
enzymes
carrier molecules
receptors
define bioavailability
the amount of an administered drug that reaches the systemic circulation
define first pass metabolism
the concentration of the drug which is lost during absorption before reaching systemic circulation
6 physical properties a drug should have
non-flammable at room temp
stable in light
low latent heat of vaporisation
long shelf life
environmentally friendly
cheap and easy to manufacture
6 biological properties a drug should have
non-irritant
fast onset
high potency
minimal side effects
no biotransformation
non-toxic to handle
