MSRA Revision Gold Flashcards
Which pneumonia is usually preceded by recent influenza infection?
Staphylococcus aureus pneumonia
What type of organism is pneumocystis jirovecii?
Fungus
Which pneumonia is commoner in people with COPD?
Hemophilus influenza pneumonia
In which of the pneumonias can autoimmune hemolytic anemia and erythema multiforme be seen?
Mycoplasma pneumoniae
What are the atypical pneumonias?
✓ Mycoplasma pneumoniae
✓ Legionella pneumophila
Which pneumonia is usually associated with infected air conditioning units?
Legionella pneumophila pneumonia
Which of the pneumonias is usually associated with lymphopenia and hyponatremia?
Legionella pneumophila pneumonia
Which of the pneumonias is classically seen in alcoholics?
Klebsiella pneumoniae
Which of the pneumonias usually has no chest signs?
Pneumocystis jirovecii pneumonia
Describe idiopathic interstitial pneumonia?
Non-infective pneumonias
Common example of idiopathic interstitial pneumonia is?
Cryptogenic organising pneumonia
What is a possible lung complication of rheumatoid arthritis?
Cryptogenic organising pneumonia
What is a possible lung complication of amiodarone therapy?
Cryptogenic organising pneumonia
Timeframe of hospital-acquired pneumonia?
Developing 48hours or more after admission
Classical X-ray finding in pneumonia?
Consolidation
What defines confusion in the CURB-65 assessment?
Abbreviated mental test score of <= 8/10
What defines Respiratory abnormality in the CURB-65 assessment?
Respiratory rate > 30
Which CURB-65 value is treated at home?
0
Is there a difference between severe asthma and life-threatening asthma?
Yes
Give one feature of life-threatening asthma?
Silent chest
What are the classification of acute asthma exacerbation?
✓ Moderate
✓ Severe
✓ Life-threatening
What are the PEFR classes of acute asthma exacerbation?
✓ 50-75% best or predicted
✓ 33-50%
✓ <33%
In which acute asthma exacerbation is SPO2 less than 92%?
Life-threatening
In which acute asthma exacerbation category is pCO2 normal?
Life-threatening
Which vaccinations are given to COPD patients?
✓ Influenza vaccine
✓ Pneumococcal vaccine
What are the general management choices for COPD?
✓ Smoking cessation
✓ Vaccination protection
✓ Pulmonary rehabilitation
✓ Bronchodilator therapy
What is the first line medical treatment for COPD?
Short acting beta2 agonist (SABA) or Short acting muscarinic antagonist (SAMA)
What are the features that suggest steroid responsiveness in COPD?
✓ History of atopy or asthma
✓ Raised eosinophil count
✓ Substantial variation in FEV1 (at least 400ml)
✓ Substantial diurnal variation in peak expiratory flow (at least 20%)
Investigation of choice for idiopathic pulmonary fibrosis?
High resolution CT scan
Which ICS is used in the classification of steroid dose in asthma?
Budesonide
What is MART in asthma therapy?
Maintenance and reliever therapy that is combined (ICS + LABA).
What is the acronym for the treatment steps in asthma?
SILL
✓ SABA
✓ ICS
✓ LTRA
✓ LABA
✓ MART
What are the features of Churg-Strauss syndrome?
✓ Sinusitis
✓ Asthma
✓ Hematuria
✓ Eosinophilia
What features are common to Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) and Granulomatosis with polyangiitis (Wegenger’s granulomatosis)?
✓ Vasculitis
✓ Sinusitis
✓ Dyspnoea
Diagnostic modality for COPD?
Spirometry
Red-currant jelly sputum in an alcoholic/diabetic is seen in which pneumonia type?
Klebsiella pneumoniae
Paraneoplastic syndrome associated with small cell lung carcinoma?
Hyponatremia from SIADH
Bupropion is contraindicated in what condition?
Epilepsy
What are the nicotine replacement medications?
✓ Bupropion
✓ Varenicline
What are the common side effects of nicotine replacement therapy?
Nausea, vomiting, headache and flu-like symptoms
How does Varenicline work?
Nicotine receptor partial agonist
When should nicotine replacement therapy medication be started?
1-2 weeks before target date to stop
How long should Varenicline treatment continue?
12 weeks
Which of the nicotine replacement therapy medications has been shown to be more effective?
Varenicline
In what situations should Varenicline be used with caution?
History of depression or self harm
Are the nicotine replacement medications (Varenicline and bupropion) contraindicated in pregnancy and breastfeeding?
Yes
Which of the nicotine replacement medications is relatively contraindicated in patients with eating disorders?
Bupropion
What is Bupropion mechanism of action?
NDRI (Norepinephrine and dopamine reuptake inhibitor) and nicotinic antagonist
Which of the nicotine replacement medications has some risk of causing seizures?
Bupropion
How are pregnant women tested for smoking?
CO (Carbon monoxide) detectors
What is the first line intervention for pregnant women to quit smoking?
Cognitive behavioural therapy, motivational interviewing or structured self help
Regarding paraneoplastic syndromes, what are the usual lung syndromes?
✓ Hyponatremia from SIADH (small cell)
✓ Hypercalcemia from PTH-rp (squamous cell)
What are the key treatment modalities for Granulomatosis with polyangiitis?
✓ Steroids
✓ Cyclophosphamide
✓ Plasma exchange
Which of the vasculitides is associated with a saddle-shape nose deformity?
Granulomatosis with polyangiitis
What is the usual cause of palpable purpuric rash over the buttocks?
Henoch-Schonlein purpura
What are the key question points for silicosis?
✓ Foundry worker
✓ Upper zone interstitial lymph nodes
✓ ‘Egg-shell’ calcification of the hilar lymph nodes
What is the normal PaO2 on air?
> 10kPa
Which nerve supplies the deltoid muscle?
Axillary nerve
Which nerve supplies serrratus anterior?
Long thoracic nerve
Damage of which nerve results in winged scapula?
Long thoracic nerve
What are the LOAF muscles?
✓ Lateral two lumbricals
✓ Opponens pollis
✓ Abductor pollis brevis
✓ Flexor pollis brevis
What nerve supplies the LOAF muscles?
Median nerve
What is the function of musculocutaneous nerve?
Elbow flexion and supination
What injury commonly damages the axillary nerve?
Humeral neck fracture
Which nerve flexes the wrist?
Ulnar nerve
Which nerve supplies the thenar muscles?
Median nerve
Which nerve extends the forearm, wrist, fingers, and thumb?
Radial nerve
Which of the brachial plexus palsies is associated with Horner’s syndrome?
Klumpke’s palsy
What is the feared complication of displaced fractures of the femoral neck?
Avascular necrosis
What are the usual tests for development dysplasia of the hip?
Barlow’s test and Ortolani’s test
What are the possible causes of hip problems in children?
✓ DDH
✓ Transient synovitis
✓ Perthes disease
✓ Slipped Upper Femoral Epiphysis (obese boys 10-15)
✓ JIA
✓ Septic arthritis
Which of the childhood hip conditions commonly affects obese boys in their early teenage years?
Slipped Upper Femoral Epiphysis
Which of the hip conditions affecting children is a degenerative condition due to avascular necrosis of the femoral head?
Perthes disease
What ages are usually affected by Perthes disease?
4-8 years
Which hip condition affecting children commonly follows a viral infection?
Transient synovitis (irritable hip)
What is the commonest cause of hip pain in children?
Transient synovitis
Which nerve adducts the thigh?
Obturator nerve
What is the preferred treatment for undisplaced intracapsular hip fracture?
Internal fixation or hemiarthroplasty if unfit
Positive Trendelenburg test is usually found in which nerve injury of the leg?
Superior gluteal nerve
Which nerve injury causes ‘can’t rise from a seat, can’t climb stairs’?
Inferior gluteal nerve
What are the 4 As of ankylosing spondylitis?
✓ Anterior uveitis
✓ Apical fibrosis
✓ Aortic regurgitation
✓ Achilles tendonitis
Which medications cause rhabdomyolysis?
Statins
What type of crystals is normal in urine?
Hyaline cast
What type of cast is seen in chronic kidney disease?
Granular casts
Which kind of casts indicate glomerular inflammation?
White and red cell casts
Describe the crystals in pseudogout?
Weakly-positively birefringent rhomboid shaped crystals
Which age group does pseudogout affect predominantly?
Elderly
What are the risk factors for pseudogout in the young? (<60)
✓ Acromegaly
✓ Hyperparathyroidism
✓ Wilson’s disease
✓ Hemochromatosis
✓ Low magnesium, low phosphate
What are the most commonly affected joints in pseudogout?
✓ Knee
✓ Wrist
✓ Shoulder
X-ray finding of chondrocalcinosis or linear calcifications of the meniscus and articular cartilage of the knee is seen in?
Pseudogout
What is the treatment of pseudogout?
NSAIDS or steroids as for gout (intra-articular, intramuscular, oral)
Which arthritis affects large weight bearing joints as well as DIP & PIP joints?
Osteoarthritis
Does osteoarthritis have a sex predilection?
No. Similar incidence in men and women
What are the x-ray findings common to both osteoarthritis and rheumatoid arthritis?
Loss of joint space
What are the key question features in Paget’s disease of the bone?
✓ Elderly man
✓ Bone pains
✓ Deaf
✓ Raised ALP
✓ Skull x-ray shows thickened vault
Summarily, what happens in Paget’s disease of the bone?
Increased and uncontrolled bone turnover
Is Paget’s disease of the bone primarily a disorder of osteoblasts or osteoclasts?
Osteoclasts
Which bones are most commonly affected in Paget’s disease of the bone?
Skull, spine/pelvis, and long bones of the lower extremities
Which sex has a higher incidence of Paget’s disease of the bone?
Males
Which condition presents with morning stiffness involving the muscles?
Polymyalgia rheumatica
Two closely related inflammatory disorders to remember?
✓ Polymyalgia rheumatica
✓ Temporal arteritis
Which muscle region does polymyalgia rheumatica commonly affect?
Proximal limb muscles
The antibody most associated with rheumatoid arthritis?
Anti-cyclic citrullinated peptide antibody
Bamboo spine is seen in what condition?
Ankylosing spondylitis
Which type of glands does Sjogren’s syndrome affect?
Exocrine glands
Sjogren’s syndrome increases the risk for which malignancy?
Lymphoid malignancy
What is the classic triad of symptoms in Behcet’s syndrome?
✓ Anterior uveitis
✓ Mucosal ulcers
✓ Genital ulcers
Which autoimmune disease is commoner in males?
Behcet’s syndrome
What is the biochemical findings in osteomalacia?
✓ Low calcium
✓ Low phosphate
✓ High ALP
✓ High PTH
Medications known to cause pulmonary fibrosis include?
✓ Methotrexate
✓ Bleomycin
What enzyme does methotrexate inhibit its action?
Dihydrofolate reductase
Which enzyme is essential for synthesis of purines and pyrimidines?
Dihydrofolate reductase
What are the side effects of methotrexate?
✓ Mucositis
✓ Myelosuppression
✓ Pneumonitis
✓ Pulmonary fibrosis
✓ Liver fibrosis
How frequently is methotrexate taken?
Weekly
How long after methotrexate use can pregnancy be considered for both sexes?
6 months
HLA B27 is associated with which conditions?
✓ Ankylosing spondylitis
✓ Anterior uveitis
✓ Reactive arthritis
Which HLA is associated with rheumatoid arthritis?
HLA-DR4
Which chromosomes gene code for HLA antigens?
Chromosome 6
What type of hypersensitivity is anaphylaxis?
Type 1
Important side effect of bisphosphonate?
Osteonecrosis of the jaw
What exactly does bisphosphonates do?
Inhibits osteoclast activity thereby decreasing demineralisation activities
What is the usual cause of granulomatous thickening of the aortic arch?
Takayasu’s arteritis
Which antibody is commonly associated with ulcerative colitis?
P-ANCA
List the conditions associated with ANA antibody?
✓ Sjogren’s syndrome
✓ SLE
✓ Diffuse cutaneous systemic sclerosis (also anti-scl-70 antibodies)
✓ Limited cutaneous systemic sclerosis (anti-centromere antibodies)
What medications are known to cause reactivation of tuberculosis?
✓ Infliximab
✓ Corticosteroids
What is the current guidance on treatment of rheumatoid arthritis?
DMARD monotherapy ± short course of bridging prednisolone
What type of hypersensitivity is graft versus host disease?
Type IV (delayed hypersensitivity)
What is the treatment of choice in chronic fatigue syndrome?
Graded exercise therapy
Which of the bone disorders have the four usual lab parameters (calcium, phosphate, ALP, PTH) normal?
✓ Osteoporosis
✓ Osteopetrosis
✓ Osteogenesis imperfecta
Which of the bone disorders have only one abnormal value (elevated ALP)
Paget’s disease of the bone
The important conditions associated with HLA-DR4 are?
✓ Rheumatoid arthritis
✓ Type 1 DM
How is osteogenesis imperfecta inherited?
Autosomal dominant
What is the treatment of choice for Raynaud’s disease?
Nifedipine
An important correlation of polyarteritis nodosa?
Positive hepatitis B serology
Is azathioprine safe to use in pregnancy?
Yes
How is low vitamin D level (leading to decreased bone mineral content/bone softening) called in adult and growing children?
✓ Osteomalacia (adults)
✓ Rickets (growing children)
What is the primary issue in osteomalacia?
Vitamin D deficiency
What is the primary treatment for osteomalacia?
Vitamin D supplementation
What is the commonest ocular manifestation of rheumatoid arthritis?
Keratoconjunctivitis sicca
Which eye condition primarily affects the peripheral retina resulting in tunnel vision?
Retinitis pigmentosa
Conditions in children causing strawberry tongue?
✓ Scarlet fever
✓ Kawasaki disease
One indication for use of aspirin in children?
Kawasaki disease
What type of viruses cause croup?
Parainfluenza viruses
What causes scarlet fever?
Erythrogenic toxins produced by Group A haemolytic streptococci (Streptococcus pyogenes)
What is the treatment for scarlet fever?
Oral penicillin V
Is scarlet fever a notifiable disease?
Yes
How bad are the complications of scarlet fever?
✓ Acute glomerulonephritis
✓ Otitis media
✓ Rheumatic fever
✓ Invasive complications
What endocrine disorder is associated with cystic fibrosis?
Diabetes mellitus
Causes of a marfanoid habitus include?
✓ Homocystinuria
✓ Marfan syndrome
What causes Homocystinuria?
Deficiency of cystathione beta synthase
Cystic fibrosis is associated with short stature?
True
Is Down’s syndrome associated with Hirschprung disease?
Yes
Which syndrome is associated with a bicuspid aortic valve?
Turner’s syndrome
Conditions that cause recurrent chest infections include?
✓ Cystic fibrosis
✓ Down syndrome
An omphalomesenteric band is associated with what condition?
Meckel’s diverticulum
What is the mode of inheritance of Duchene muscular dystrophy?
X-linked recessive
A cause of coronary artery aneurysm to remember is?
Kawasaki disease
Another name for hypogonadotrophic hypogonadism is?
Kallman syndrome
Why are statins not coprescribed with macrolides (such as clarithromycin)?
Increased risk of rhabdomyolysis
Which breast cancer medication is a monoclonal antibody directed against the HER2/neu receptor?
Trastuzumab
Common side effects of Trastuzumab are?
✓ Flu-like symptoms
✓ Diarrhoea
Why is an echocardiogram usually performed before starting patients on Trastuzumab?
Because of its cardiotoxicity
How does Ciprofloxacin affect the QT interval?
Lengthens it
Both loop and thiazide diuretics cause hypokalemia?
True
The calcium channel blockers Diltiazem and Verapamil cause heart failure true or false?
True
Which of the calcium channel blockers have more peripheral vascular effects than cardiac?
Dihidropyridines (Nifedipine, Amlodipine)
The calcium channel blockers Diltiazem and Verapamil are negatively inotropic?
True
What is the antidote for aspirin poisoning?
Bicarbonate
Which medications precipitate digoxin toxicity?
Loop diuretics
What are the two types of heparin?
✓ Unfractionated heparin
✓ Low molecular weight heparin
Does protamine sulfate reverse the effect of LMWH?
Partially
Which medication is known to reduce seizure threshold?
Ciprofloxacin
Which antituberculous drug can cause gout?
Pyrazinamide
List three medications that can cause gout?
✓ Loop diuretics
✓ Thiazide diuretics
✓ Pyrazinamide
Medications to avoid in the setting of a recent myocardial infarction include?
✓ Metformin
✓ Sildenafil
Which overdose has IV bicarbonate as antidote?
✓ Tricyclic antidepressants
✓ Salicylate
What is the risk with the use of Flumazenil (the antidote for benzodiazepines)?
Risk of seizures
What poison is hydroxycobalamine its antidote?
Cyanide
What is the antidote for lead poisoning?
Dimercaprol, calcium edetate
What medication causes yellow-green vision?
Digoxin
What medications can cause gynecomastia?
✓ Digoxin
✓ Spironolactone
The poisoning agent that causes hyperpyrexia is?
Carbon monoxide
Four drugs that precipitate digoxin toxicity include?
✓ Amiodarone
✓ Spironolactone
✓ Verapamil
✓ Diltiazem
List medications that can cause tremor?
✓ Lithium
✓ Ciclosporin
✓ Sodium valproate
Which medication is known to cause non-arteritic anterior ischaemic neuropathy?
Sildenafil
Indications for the use of phosphodiesterase type 5 inhibitors?
✓ Erectile dysfunction
✓ Pulmonary hypertension
What cancer does tamoxifen predispose to?
Endometrial cancer
How does alcohol intake affect P450?
✓ Acute intake (inhibitor)
✓ Chronic intake (inducer)
What ABG result is typical of aspirin poisoning?
Mixed metabolic acidosis and respiratory alkalosis
What is the effect of heparin on potassium levels?
Hyperkalemia
Two medications that can cause depression include?
✓ Corticosteroids
✓ Isotretinoin
List the medications that can cause pulmonary fibrosis?
✓ Methotrexate
✓ Amiodarone
✓ Nitrofurantoin
✓ Sulfasalazine
What is the treatment of choice for generalized anxiety disorder?
Sertraline
Examples of serotonin-noradrenaline reuptake inhibitors include?
✓ Duloxetine
✓ Venlafaxine
How is the half-life of lithium?
Long, being primarily excreted by the kidney
How does lithium affect the thyroid?
Hypothyroidism with thyroid enlargement
How does lithium affect the parathyroid gland?
Hyperparathyroidism and resultant hypercalcemia
Which medications increases the risk of ischaemic stroke?
✓ COCPs
✓ Antipsychotics
How does anastrozole affect the bone?
Osteoporosis
When is tamoxifen indicated in breast cancer?
Pre- and peri-menopausal women if ER positive
Which of the female reproductive cancers have incidence increased by early menarche?
✓ Breast cancer
✓ Ovarian cancer
✓ Endometrial cancer
What is the treatment of choice for chronic anal fissure?
Topical glyceryl trinitrate
Why are small bowel stomas spouted?
So that their irritant contents are not in contact with the skin
Which of the breast cancer medications is used in post-menopausal women if ER positive?
Anastrozole
An example of an aromatase inhibitor?
Anastrozole
Which cancers do COCPs predispose to?
✓ Breast cancer
✓ Cervical cancer
What hormone does nexplanon release?
Etonogestrel (a progestogen)
What is the most effective form of contraception?
Nexplanon. A form of implantable contraceptive
What is the failure rate of nexplanon?
0.07/100 women-years
Which of the contraceptive pills takes only 2 days to become effective?
Progestogen only pill
Which of the contraceptive pills has no pill free days?
Progestogen only pill
What is the mode of action of the progestogen only pill (except desogestrel)?
✓ Thickens cervical mucus
Which of the contraceptives inhibit ovulation and thickens cervical mucus?
✓ Implantable contraceptive (etonogestrel)
✓ Injectable contraceptive (depo povera)
✓ Desogestrel only pill
What is the primary mechanism of action of intrauterine system (levonorgestrel)
Prevents endometrial proliferation
What is the mechanism of action of COCP?
Inhibits ovulation
Hormone replacement therapy increases the risk of which cancer?
Breast cancer
Unopposed estrogen action predisposes to which cancer?
Endometrial cancer
Which female reproductive cancer has smoking and COCP as protective factors?
Endometrial cancer
Mutations to the BRCA2 gene predisposes to which cancer?
✓ Breast cancer
✓ Ovarian cancer
How does COCP help in reducing ovarian cancer risk?
By reducing the number of ovulations
What is the mechanism of action of oxybutynin?
Antimuscarinic
Which of the female reproductive cancers is high parity a risk factor for?
Cervical cancer
Which female reproductive cancer does PCOS predispose to?
Endometrial cancer
What causes tender erythematous lesions on the shins?
Erythema nodosum
What are the four major causes of erythema nodosum?
✓ Infections (TB)
✓ Systemic disease (Sarcoidosis, IBD, Behcet’s)
✓ Malignancy
✓ Drugs
Which of the tender leg lesions is associated SLE?
Pyoderma gangrenosum
Which antibodies are usually used to look for SLE?
ANA
Is pyoderma gangrenosum associated with rheumatoid arthritis?
Yes
Does the lesion of erythema nodosum heal with scarring?
No
What is the key physical characteristic of basal cell carcinoma?
Rolled edges
What is the size cut-off point for differentiating nodule from papule
5mm
Lupus pernio is seen in what condition?
Sarcoidosis
What is the character monicker for basal cell carcinoma?
Rodent ulcer
With regards to growth and metastasis, what is the characteristic of basal cell carcinoma?
Slow growth and rarely metastatic
What is the most common type of cancer in the western world?
Basal cell carcinoma
What type of referral is made for suspected BCC?
Routine referral
What topical cream options are there for BCC treatment?
✓ Imiquimod
✓ Fluorouracil
Does psoriatic nail changes reflect severity of the disease?
No
What is the first line treatment for hyperhidrosis?
Topical aluminium chloride
Which medications are options for treatment of hyperhidrosis in secondary care?
✓ Topical glycopyrrolate
✓ Botulinum toxin injections
What class of medications is glycopyrrolate?
Antimuscarinic
What parts of the body are most affected by vitiligo?
Peripheries
What is the phenomenon of new vitiligo lesions secondary to trauma called?
Koebner phenomenon
Which of the alopecia types is associated with vitiligo?
Alopecia areata
How useful is topical corticosteroids in vitiligo?
May reverse changes if applied early
What is the phototherapy of choice in the secondary care of Psoriasis?
Narrowband ultraviolet B light
What is the commonest body site for keloid scars?
Sternum
What category of disease is erythema multiforme?
Hypersensitivity reaction
What is the common trigger for erythema multiforme?
Infections
What is the common trigger for erythema multiforme?
Infections
Which condition has target lesions as a feature?
Erythema multiforme
What is erythema multiforme major?
Erythema multiforme with mucosal involvement
Which type of hair loss is caused by severe stress?
Telogen effluvium
What is a possible cause for telogen effluvium?
Pregnancy
Which type of hair loss causes well-circumscribed areas of total hair loss?
Alopecia areata
What defines scarring or non-scarring alopecia?
Destruction or preservation of the hair follicle
Common causes of erythema nodosum in females include?
✓ Pregnancy
✓ COCP use
Purple painful lesions on the shin should elicit possible diagnosis of?
Erythema nodosum
What are the usual inflammatory associations of Ulcerative colitis?
✓ large joint arthritis
✓ sacroilitis
✓ Pyoderma gangrenosum
What is pathergy?
Hyper reactivity of the skin in response to trauma
What condition commonly exhibits pathergy?
Pyoderma gangrenosum
What condition can cause both erythema nodosum and erythema gangrenosum?
Inflammatory bowel disease
What are the risk factors for capillary hemangiomas?
✓ Female infants
✓ Premature infants
✓ Infants of mother that had chorionic villus sampling
A brown nodule with a fissured greasy surface, well demarcated against the skin, and exhibiting the stuck-on appearance is classical of?
Seborrheic keratosis
What cancers can actinic keratoses predispose to?
Squamous cell carcinoma
What is the usual first symptom of rosacea?
Flushing of the skin
In what condition is rhinophyma seen?
Rosacea
What is the indication for dermatology referral in rosacea?
Presence of rhinophyma
What is the treatment for mild rosacea?
Topical metronidazole
What is the treatment for severe rosacea?
Oxytetracycline (systemic)
Does HIV predispose to seborrheic dermatitis?
Yes
Which fungus is typically taught to be the cause of seborrheic dermatitis?
Malassezia furfur
What conditions are usually associated with seborrheic dermatitis?
✓ HIV
✓ Parkinson’s disease
Which seborrheic dermatitis subtype does not have topical ketoconazole as the first line treatment?
Scalp seborrheic dermatitis (use preparations containing zinc pyrithione and tar)
Which skin condition is usually associated with coeliac disease?
Dermatitis herpetiformis
Are dermatitis herpetiformis lesions commoner in flexor or extensor surfaces?
Extensor surfaces
Are keloid scars commoner in flexor or extensor surfaces?
Extensor surfaces
What is the pathophysiologic cause of dermatitis herpetiformis?
Deposition of IgA in the dermis
Which ulcer types are amenable to compression bandaging?
Venous ulcers
What is a normal ABPI index reading?
0.9 - 1.2
What ABPI value reflects arterial disease?
< 0.9
(Also > 1.2 in arterial calcification such as in diabetics) false negative
What organism causes molluscum contagiosum?
Pox virus
Is molluscum contagiosum infectious?
Yes
Should molluscum contagiosum infection preclude school attendance?
No
How long does it take for molluscum contagiosum lesions to clear?
18 months
What is a predisposing condition for molluscum contagiosum infection?
Atopic eczema
What are the indications for specialist referral in the setting of molluscum contagiosum?
✓ Eyelid margin/ocular lesions (ophthalmologist)
✓ HIV positive with extensive lesions (HIV specialist)
✓ Adult with anogenital lesions (GUM clinic)
What is a known indication for brimonidine?
Predominant flushing symptoms in rosacea
What is the indication for dermatology referral in acne rosacea?
Rhinophyma
Does dietary modification help in acne?
No
Can milia affect adults?
Yes, though commoner in newborns
What are the management options for BCC?
✓ Surgery
✓ Curettage
✓ Cryotherapy
✓ Radiotherapy
✓ Topical cream
What is the timeframe for resolution of erythema nodosum lesions?
6 weeks
What are the infective causes of erythema nodosum?
✓ Tuberculosis
✓ Streptococci
✓ Brucellosis
What are the drug causes of erythema nodosum?
✓ Sulphonamides
✓ Penicillin
✓ COCPs
Can pregnancy cause erythema nodosum?
Yes
Can corticosteroids cause skin depigmentation?
Yes, especially in dark skins
How does corticosteroids affect hair growth?
Excessive hair growth at the site of application
What differentiates mycosis fungoides from eczema/Psoriasis?
Lesions feature more different colours
What are the skin lesions with flexural predilection?
✓ Lichen planus
✓ Eczema
Which skin lesions are usually described as being polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)?
Lichen planus
What are the nail features in lichen planus?
✓ longitudinal ridging
✓ Thinning of the nail plate
Can Lichen planus produce oral lesions?
Yes, in 50% of cases
A cause of koebner phenomenon?
Lichen planus
What are the drug causes for lichenoid drug eruptions?
✓ Quinin
✓ Gold
✓ Thiazides
What is the treatment of choice for lichen planus?
Potent topical steroids
What is the recommended mouth spray for oral lichen planus?
Benzydamine mouthwash
What is the first line antiviral medication in shingles?
Famciclovir or Valacyclovir
What is the most commonly affected dermatome in shingles?
T1 to L2
What is the first line analgesics in shingles?
PCM or NSAIDs
What causes pemphigus vulgaris?
Antibodies targeted at Desmolein 3
Which condition exhibits Nikolsky’s sign?
Pemphigus vulgaris
What is the first line treatment for pemphigus vulgaris?
Steroids
What skin condition is particularly seen in Ashkenazi Jews?
Pemphigus vulgaris
What are the skin conditions commonly associated with mucosal ulceration?
✓ Pemphigus vulgaris
✓ Erythema multiforme major
What are the drug causes for erythema multiforme major?
CAPONS
✓ Carbamazepine
✓ Allopurinol
✓ Penicillin
✓ Oral contraceptive pill
✓ Nevirapine/NSAIDs
✓ Sulphonamides
What is the first line therapy for plaque Psoriasis?
A potent corticosteroid + vitamin D analogue
What therapy is particularly useful in Psoriasis with joint involvement?
Methotrexate
What differentiates vitamin D analogues from corticosteroids in treating Psoriasis?
They can be used long-term as side effects are uncommon
Are dermatitis herpetiformis lesions usually flexural or extensor?
Extensor
What is the pathophysiologic cause for dermatitis herpetiformis
Deposition of IgA in the dermis
What is the management for dermatitis herpetiformis?
✓ Gluten free diet
✓ Dapsone
What is the oral medication of choice in treating acne in pregnancy?
Erythromycin
What are the three classes of topicals used in management of acne?
✓ Topical antibiotics
✓ Topical retinoids
✓ Benzoyl peroxide
What is the step up management for acne?
✓ Single topical therapy
✓ Combined topical therapy
✓ Oral antibiotics
✓ Oral isotretinoin
Can topical retinoid be used in pregnancy?
No. All retinoids (topical and oral) are contraindicated in pregnancy
What is the first line treatment for urticaria?
Non-sedating antihistamines
What skin condition is commonly seen in patients with Parkinson’s disease?
Seborrheic dermatitis
What is the most common cause of erythema multiforme?
Herpes simplex virus
What mineral deficiency causes red, crusted lesions (acrodermatitis)?
Zinc
Which mineral deficiency causes acrodermatitis?
Zinc
Which of the B vitamin deficiency causes angular cheilosis?
Vitamin B2 (riboflavin)
List five causes of scarring alopecia?
✓ Trauma
✓ Burns
✓ Lichen planus
✓ Discoid lupus
✓ Radiotherapy
✓ Tinea capitis
Fine medications that can cause alopecia?
✓ Cytotoxics
✓ OCPs
✓ Heparin
✓ Carbamazepine
✓ Colchicine
Which mineral deficiencies can cause alopecia?
✓ Zinc
✓ Iron
What dermatologic presentation in children warrants an immediate work-up to identify diagnosis?
Purpura
Purpura in children should raise suspicion of which conditions?
✓ ALL
✓ Meningococcal disease
What is the usual pathophysiologic cause of purpura?
Low platelets
Can cough cause petechiae?
Yes, by raising superior vena cava pressure
Differentiate the settings for Cushing’s and Curling’s ulcers?
✓ Cushing’s (severe head trauma)
✓ Curling’s (severe burns)
List three common skin disorders associated with pregnancy?
✓ Atopic eruption of pregnancy
✓ Polymorphic eruption of pregnancy
✓ Pemphigoid gestationis
Does vitiligo exhibit koebner phenomenon?
Yes
Which peripheral vasodilator has been shown to improve healing rate in venous ulcers?
Pentoxifylline oral
Which SLE skin manifestation typically has a lace-like appearance and brought on by cold?
Livedo reticularis
Which of the erythema is typically caused by heat exposure?
Erythema ab igne
Which eczema associated conditions in children is a medical emergency?
Eczema herpeticum
How is Eczema herpeticum treated?
IV antivirals (IV aciclovir)
What is the difference between hypertrichosis and hirsutism?
✓ Hirsutism (androgen-dependent hair growth in women)
✓ Hypertrichosis (androgen-independent hair growth)
Which of the eating disorders causes hypertrichosis?
Anorexia nervosa
Which of the facial dermatologic condition has no place for steroid use?
Acne rosacea
Is ongoing infection a common cause of non-healing leg ulcer?
No
What body sites are dermatitis herpetiformis lesions commonly seen?
✓ Knees
✓ Elbows
✓ Buttocks
What causes guttate Psoriasis?
Streptococcal upper respiratory tract infection
Which of the vascular birthmark do not spontaneously resolve?
Port wine stains
What type of hypersensitivity is allergic contact dermatitis?
Type IV
In what setting is allergic contact dermatitis usually typified?
On the head following hair dyes
What is the common precipitant of guttate Psoriasis?
Streptococcal infection
What is the the treatment for pityriasis rosae?
Self-limiting, resolves after around 6 weeks
Which cancer diagnosis should be considered in a patient with acanthosis nigricans?
Gastric cancer
What age is the peak incidence of vitiligo?
20-30 years
Which parts of the body are mostly affected in vitiligo?
The peripheries
What makes the treatment of scalp Psoriasis different from chronic plaque Psoriasis?
Treatment is with potent topical steroids (Topical betamethasone valerate)
What is the place of emollients in management of Psoriasis?
Reduce scale and pruritus only
What is the first line treatment for chronic plaque Psoriasis?
Potent corticosteroid + vitamin D analogue
What is the pathophysiologic cause of bullous pemphigoid?
Antibodies against hemidesmosomal proteins BP180 and BP230
What is the mainstay of treatment for lichen planus
Potent topical steroids
Which dermatologic condition has the classical dimple sign?
Dermatofibroma
What is the first line treatment for acne?
Topical retinoid or Benzoyl peroxide
A rapidly growing hand lesion in pregnancy is likely to be a?
Pyogenic granuloma
A mass with pearly, rolled edges suggest?
Basal cell carcinoma
Which basal cell carcinoma locations warrant an urgent referral?
Lesions around eyelid and nasal ala
What conditions make up sore throat?
✓ Pharyngitis
✓ Tonsillitis
✓ Laryngitis
What is the centor criteria value to warrant antibiotic use?
3 or more
What is the antibiotic of choice for sore throat?
Phenoxymethylpenicillin or Clarithromycin (if Penicillin allergy)
For how long should a sore throat requiring antibiotics be treated?
7 or 10 days
List three key question findings for otosclerosis?
✓ Family history
✓ Tinnitus
✓ Conductive hearing loss
What type of hearing loss does stickler syndrome cause?
Sensorineural hearing loss
What is the mode of inheritance for otosclerosis?
Autosomal dominant
What is the management for otosclerosis?
Hearing aid and Stapedectomy
Is geographic tongue benign?
Yes
Which sex has more glue ear?
Males
What is the commonest cause of conductive hearing loss in childhood?
Glue ear
How long is the wait period for a perforated eardrum to seal before ENT referral?
6-8 weeks
Which part of the ear does meniere’s disease affect?
Inner ear
Does meniere’s disease have a sex predilection?
No
What is the mnemonic for symptoms of meniere’s disease?
Voice Note HAT
✓ Vertigo
✓ Nystagmus
✓ Hearing loss
✓ Aural fullness
✓ Tinnitus
One ear condition to inform DVLA?
Meniere’s disease
What is the DVLA advice for meniere’s disease?
Cease driving until symptoms satisfactorily controlled
What is the treatment for acute attacks of meniere’s disease?
Buccal or intramuscular prochlorperazine
What is the medication for prevention of attacks of meniere’s disease?
Betahistine
Cervical rib is commoner in which sex?
Females
What is the treatment of choice for acute Tonsillitis?
Phenoxymethylpenicillin
What is a feared complication of acute tonsillitis?
Peritonsillar abscess
Does corticosteroid have a place in the management of tonsillitis?
Yes, can reduce severity and duration of pain
Does nasal polyp have a sex predilection?
Yes, commoner in males
List two syndromes associated with nasal polyps?
✓ Churg-Strauss syndrome
✓ Kartagener’s syndrome
What metabolic disorder is associated with nasal polyp?
Cystic fibrosis
What medication is known to cause nasal polyps?
Aspirin
What type of hearing loss does Otitis media cause?
Conductive hearing loss
Which ear condition is known to worsen during pregnancy?
Otosclerosis
Which cause of sensorineural hearing loss is usually age related?
Presbycusis
What is the pathophysiologic cause of otosclerosis?
Fixation of the stapes at the oval window
Can otosclerosis cause tinnitus?
Yes
What is the cut of day/duration for clinical decision making in suspected acute sinusitis?
10 days
What is the antibiotic of choice for acute sinusitis?
Phenoxymethylpenicillin
Which manoeuvre is for diagnosis of BPPV?
Dix-Hallpike manoeuvre
Vestibular rehabilitation (Brandt-Daroff exercises) is useful in which ear condition?
BPPV
What is the first line treatment for otitis externa?
Topical antibiotic or a combined topical antibiotic and steroid
Ear pain with a history of recent swimming suggests?
Otitis externa
Which dermatologic condition is usually associated with Otitis externa?
Seborrheic dermatitis
A cause of high-frequency hearing loss?
Presbycusis
Is presbycusis same as noise-related hearing loss?
No
What are the two classes of epistaxis?
✓ Anterior bleeds
✓ Posterior bleeds
How do you manage meniere’s disease in the GP?
Refer for ENT assessment to confirm diagnosis
What is the management of secondary post-tonsillectomy small bleed?
Admit for ENT review and antibiotic therapy
How important is post-tonsillectomy hemorrhage?
Immediate ENT review
How best can malignant Otitis externa be called/described?
Osteomyelitis of the temporal bone
What investigation is indicated in malignant Otitis externa?
CT scan of the temporal bone
How is malignant Otitis externa treated?
IV antibiotics (prolonged course)
What is the indication for referral in Otitis externa?
Failure of topical antibiotic therapy
Is tinnitus same as ringing in the ear?
Yes
Acoustic neuroma is associated with which type of neurofibromatosis?
Type 2
What are the LANAQ drugs?!
Drugs that cause tinnitus
✓ Loop diuretics
✓ Aspirin
✓ NSAIDs
✓ Aminoglycosides
✓ Quinine
Can impacted ear wax cause tinnitus?
Yes
List medications that can cause gingival hyperplasia?
✓ Ciclosporin
✓ Phenytoin
✓ Calcium channel blockers
What is one drug cause of Hirsutism?
Phenytoin
Which of the hematological cancer usually causes gingival hyperplasia?
AML
What is the peak year of incidence for glue ear?
2 years
Which cranial nerves are affected by acoustic neuroma?
V, VII and VIII
Which medication is used by ENT surgeons in all cases of sudden onset sensorineural hearing loss?
High dose oral corticosteroids
Medical condition spread by contact with urine of rats and cattle?
Weil’s disease (leptospirosis)
What organism causes Weil’s disease?
Leptospira interrogans
In what condition is antimitochondrial antibodies seen?
Primary biliary cirrhosis
What is the first line treatment for migraine in children aged 12-17?
PCM/NSAID
Which medications usually used in migraine are avoided in adolescents?
✓ Metoclopramide
✓ Aspirin
ABO incompatibility is what type of hypersensitivity?
Type II
Rheumatoid arthritis is what type of hypersensitivity reaction?
Type III
Chronic asthma is what type of hypersensitivity reaction?
Type IV
Define delayed puberty in a male?
Testicular volume <4 ml after 14 years of age
What are the signs of puberty in a male?
✓ Reddening of scrotal skin
✓ Growth of the testes
✓ Growth spurt
What timeframe can Prednisolone improve chances of recovery in Bell’s palsy?
Within 72 hours
What are the four indications for ENT referral in the setting of Bell’s palsy?
✓ Bilateral Bell’s palsy
✓ Recurrent Bell’s palsy
✓ Unclear diagnosis
✓ No improvement within 1 month
In what condition affecting the major blood vessels should ACE inhibitors be avoided?
Aortic stenosis
Global ST and PR segment changes is seen in?
Pericarditis
Which of the thyroid hormone disorders is associated with pericarditis?
Hypothyroidism
What is the most specific ECG marker for pericarditis?
PR depression
Which investigation should all patients with suspected acute pericarditis have?
Transthoracic echocardiogram
What is the first line treatment for acute pericarditis?
Combination of NSAID and colchicine
Medication to be avoided in patients taking a selective serotonin reuptake inhibitors?
Triptans
Why should triptans be avoided in patients taking SSRI?
Increased risk of serotonin syndrome
Which antidepressants is safest in the setting of recent myocardial infarction?
Sertraline
Which antidepressant is used for children when indicated?
Fluoxetine
The most common side effects of SSRIs are of which body systems?
Gastrointestinal
What medication increases the risk of gastrointestinal bleeding when using SSRIs?
NSAIDs
Which of the SSRIs causes QT prolongation?
Citalopram and Escitalopram
Which of the antidepressants is preferred for patients on warfarin/heparin?
Mirtazapine
Which of the antidepressants poses the least risk in abrupt discontinuation?
Fluoxetine
Which of the antidepressants has a high incidence of discontinuation symptoms?
Paroxetine
What is the feared complication of using SSRIs in first trimester?
Risk of congenital heart defects
Which of the SSRIs has an increased risk of congenital malformations?
Paroxetine
What is the possible complication from using SSRIs in third trimester?
Persistent pulmonary hypertension of the newborn
Which antiplatelet is preferred for TIA and Ischaemic stroke?
Clopidogrel
What are the three antiplatelet medications that can be used for anticoagulation after Ischaemic stroke or TIA?
✓ Clopidogrel
✓ Aspirin
✓ Dipyridamole
What is the indication for carotid endarterectomy?
Stenosis greater than 70% or 50% (depending on criteria used)
How long after delivery should their be need for contraception?
After 21 days
Which emergency contraceptives can be used postpartum in a breastfeeding/non-breastfeeding woman?
Progesterone only EC (Levonelle and ellaOne)
What are the important timeframes for intrauterine device/system insertion postpartum?
Insert within first 48 hours or wait until after 4 weeks
How effective is lactational amenorrhea?
98% effective, provided use is perfect
✓ Exclusive (no supplement)
✓ Amenorrheic
✓ <6 months postpartum
How can COCP affect breastfeeding mothers?
It can reduce breast milk production
In the management of COPD, what is the next step after exhausting the usefulness of SABA/SAMA?
Assess for features suggesting steroid responsiveness
Is routine spirometric reversibility testing necessary in the diagnosis/assessment for therapy in COPD?
No
What are the inhaler options in the management of COPD after considering steroid responsiveness?
✓ LABA + LAMA (unresponsive)
✓ LABA + ICS (responsive)
In what circumstances should theophylline dose be reduced in the management of COPD?
Patient on macrolide or fluoroquinolone
What antibiotic is used commonly for prophylaxis in COPD patients?
Azithromycin
What are the precautions before starting COPD patients on Azithromycin antibiotic prophylaxis therapy?
✓ CT scan (exclude bronchiectasis)
✓ Sputum culture (exclude atypical infections/tuberculosis)
Peripheral edema, raised JVP, systolic parasternal heave, and loud P2 in a COPD patient suggests which complication?
Cor pulmonale
Which surgery is a part of treatment modalities for select COPD patients?
Lung volume reduction surgery
An example of an atypical antidepressant?
Mirtazapine
What is the mechanism of action of mirtazapine?
Blockage of alpha2-adrenergic receptors
Which antidepressant has beneficial effects on elderly patients?
Mirtazapine
✓ Appetite stimulant
✓ Sedation at small doses
The antidepressant with paradoxical dose effects on sleep?
Mirtazapine
What time of the day is mirtazapine preferably taken?
Evening (sedating)
What percentage of undescended testes is bilateral?
25%
Four complications of undescended testes?
✓ testicular cancer
✓ infertility
✓ torsion
✓ psychological
How does unilateral undescended testes differ from the bilateral form regarding urgency of referral?
✓ Unilateral (refer at 3 months, not later than 6 months)
✓ Bilateral (refer within 24 hours of birth, possible endocrine/genetic anomaly)
In rhabdomyolysis, what elements are released/increased?
✓ Creatinine kinase
✓ Phosphate
✓ Myoglobin
Why is calcium low in rhabdomyolysis?
Myoglobin binds calcium
What class of drug is Venlafaxine?
SNRI
What medications are preferred for panic disorders?
SSRIs (Paroxetine)
Which sex has a higher prevalence for panic disorder?
Females
In DKA, how should insulin be administered?
✓ Correction insulin infusion (fixed rate)
✓ Regular long lasting insulin (continued as usual)
✓ **stop short acting insulin
Why is insulin infusion given at a fixed rate in DKA?
Because emphasis is on correction of ketone levels and not glucose levels
Acute DKA is caused by uncontrolled lysis of which food class?
Lipid (lipolysis)
What is the dose of insulin in acute DKA?
0.1unit/kg/hour
What rate of potassium correction requires cardiac monitoring?
> 20 mmol/hour
What are the criteria to say DKA is resolved?
✓ Blood ketone < 0.6 mmol/l
✓ pH > 7.3
✓ Bicarbonate > 15 mmol/l
What is the indication for endocrinologist review in the setting of DKA?
Ketonemia and acidosis not yet resolved within 24 hours
What is a feared complication of DKA management in children/young adults?
Cerebral edema (from fluid correction)
On what days of bronchiolitis infection does the infection get worse before improving?
Day 3-5
What is a red flag sign to necessitate immediate hospital referral in bronchiolitis?
Grunting respiration
What virus causes bronchiolitis?
Respiratory syncytial virus
Are antibiotics used in the treatment of bronchiolitis?
No, it’s a viral infection
At what age is the peak incidence of bronchiolitis?
3-6 months
What is the most commonly injured ligament in inversion injuries of the ankle?
Anterior talofibular ligament
Which of the ankle ligaments functions to strengthen the medial longitudinal arch?
Calcaneonavicular ligament
Which is the weakest lateral ligament of the ankle?
Anterior talofibular ligament
Which ankle ligament is likely to be injured by direct blow or heavy object drop on the foot?
Lisfranc ligament
What is the antidote for dabigatran toxicity?
Idarucizumab
For how long should patients with provoked pulmonary embolism be treated/anticoagulated?
3 months
What defines provoked pulmonary embolism?
PE provoked by a temporary risk factor such as following a surgery
What is the first line treatment for PE?
DOACs (Apixaban and Rivaroxaban)
What is the choice of anticoagulant for suspected PE?
DOACs
What is the choice anticoagulant in the setting of PE and DOACs are unsuitable for use?
✓ LMWH followed by dabigatran/edoxaban or
✓ LMWH followed by a vitamin K antagonist (warfarin)
What is the minimum length of anticoagulation?
3 months
What is the choice of treatment for PE in the setting of hemodynamic instability?
Thrombolysis
What is the treatment option to consider for patients with repeat pulmonary embolisms?
IVC filter
What medication should be coprescribed for patients on strong opioids?
Laxative
What is the preferred opioid in mild to moderate renal impairment?
Oxycodone
What is the preferred opioid in severe renal impairment?
✓ Alfentanil
✓ Buprenorphine
✓ Fentanyl
List four agents that can be used in the treatment of metastatic bone pain?
✓ Opioids
✓ Bisphosphonates
✓ Radiotherapy
✓ Denosumab
Which of the opioid side effects tend to be transient?
✓ Nausea
✓ Drowsiness
Which of the opioid side effects tend to be persistent?
Constipation
Which childhood condition comes with a barking cough?
Croup
Which medication is a must for patients with croup?
Oral dexamethasone (Single dose of 0.15 mg/kg)
Which viruses are implicated the most in croup?
Parainfluenza viruses
In what condition is subglottic narrowing (‘steeple sign’) seen?
Croup
In what condition is ‘thumb sign’ seen?
Acute epiglottitis
What is the emergency treatment for croup?
✓ High flow oxygen
✓ Nebulised adrenaline
What is a key differentiating factor between adult BLS and pediatric BLS?
5 rescue breaths
On which artery is circulation assessed in infants?
Brachial/Femoral pulse
What are the usual exam features for primary hyperparathyroidism?
✓ Elderly woman with unquenchable thirst
✓ Inappropriately normal or raised parathyroid hormone level
What is the most common cause of primary hyperparathyroidism?
Solitary adenoma
What is the characteristic x-ray finding of hyperparathyroidism?
Pepperpot skull
What are the investigation findings in primary hyperparathyroidism?
✓ Raised calcium
✓ Low phosphate
✓ Raised or normal parathyroid hormone
What is the determining factor for treatment following a fragility fracture?
Age
>= 75 (start Bisphosphonates, without need for a Dexa scan)
<= 75 (do DEXA scan and assess risk for further fractures using FRAX assessment)
How does a raised INR relate to liver enzyme: inhibition/induction?
Inhibition
What is the mnemonic for liver enzyme inducers?
GRASS BC
✓ Griseofulvin
✓ Rifampicin
✓ Antiepileptics (Phenytoin, Carbamazepine)
✓ Smoking
✓ St. John’s wort
✓ Barbiturates (phenobarbitone)
✓ Chronic alcohol intake
Does pregnancy preclude the use of beta2 agonists or inhaled corticosteroids for asthma?
No
Which of the eye conditions do flashes and floaters signify?
Vitreous/retinal detachment
Define transient monocular visual loss?
Sudden, transient loss of vision that lasts less than 24 hours
How is amaurosis fugax treated?
As TIA
Aspirin 300mg
What causes Ischaemic optic neuropathy?
Occlusion of the short posterior ciliary arteries
What are the usual causes of central retinal vein occlusion?
✓ Glaucoma
✓ Polycythemia
✓ Hypertension
Cherry red spot on a pale retina is a feature of?
Central retinal artery occlusion
What is the usual question features for idiopathic intracranial hypertension?
Young obese female with headaches, and finding of papilloedema with normal neurological findings
What is another name for idiopathic intracranial hypertension?
Pseudomotor cerebri
What medications are associated with pseudomotor cerebri?
✓ Lithium
✓ COCPs
✓ Tetracycline
✓ Vitamin A
✓ Steroids
Which nerve palsy may be seen in idiopathic intracranial hypertension?
6th nerve palsy
Which of the medications used in the management of idiopathic intracranial hypertension can be used to bring about weight loss too?
Topiramate
What is the management of idiopathic intracranial hypertension?
✓ Weight loss
✓ Diuretics
✓ Topiramate
✓ Surgery (optic nerve decompression)
The dermatologic condition caused by over exposure to infrared radiation is?
Erythema ab igne
What type of cancer does erythema ab igne predispose to?
Squamous cell cancer
What is the recommended salt intake in the UK?
Less than 6g/day
At what age should a blood pressure of greater than or equal to 135/85 warrant treatment?
<80 plus risk factors
In which orthopaedic condition causing back pain do patients find it easier to walk uphill rather than downhill?
Spinal stenosis
What is the treatment for lumbar spinal stenosis?
Laminectomy
What happens pathologically in Perthes disease?
Avascular necrosis of the femoral head
At what age is avascular necrosis commoner?
4-8 years of age
What is the physical characteristics for children with slipped upper femoral epiphysis?
Overweight or tall thin adolescents
What is the management of Perthes disease in patients less than 6 years?
Observation
Which of the emergency contraception can be used up to 5 days after the earliest ovulation date or within 120 hours following intercourse?
Copper IUD
What is the mechanism of action for levonorgestrel?
✓ Stop ovulation
✓ Prevent implantation
What dose of levonorgestrel should be used for patients with BMI >26 or weight over 70kg?
Double dose
How effective is levonorgestrel as emergency contraception?
84% if used within 72 hours
Can levonorgestrel be used more than once in a menstrual cycle?
Yes
How soon can hormonal contraception be started after using levonorgestrel for emergency contraception?
Immediately
What is the mechanism of action of ulipristal (EllaOne)?
Selective progesterone receptor modulator
How does ulipristal work?
Inhibition of ovulation
Is concomitant use of levonorgestrel with ulipristal recommended?
No
How soon after ulipristal use should hormonal contraception be used?
At least after 5 days
Can ulipristal be used more than once in a cycle?
Yes
How does emergency contraception use affect breastfeeding?
✓ Ulipristal (delay for one week before breastfeeding)
✓ Levonorgestrel (no affectation)
What is the most effective emergency contraception?
Copper IUD
How effective is copper IUD as emergency contraception?
99% effective
Is antibiotic coverage necessary when using copper IUD?
If the patient is considered to be at high risk of STI
Which shoulder pathology is characterized by a painful arc of abduction on examination between 90 and 120 degrees?
Subacromial impingement
What is another name for subacromial impingement?
Painful arc syndrome
What is the common cause of most styes?
Staphylococcus bacteria
A firm painless lump in the eyelid most likely represents?
A meibomian cyst (chalazion)
Another name for a chalazion is?
Meibomian cyst
What is the management of styes?
Hot compress and analgesia
In what cases will stye management require topical antibiotic use?
Associated conjunctivitis
What is the management of a chalazion?
Many resolve spontaneously, some require surgical drainage
What is the advice regarding breastfeeding in HIV positive patients in the UK?
Do not breastfeed
What is the recommendation regarding mode of delivery in HIV positive women?
✓ Vaginal delivery if viral load < 50 copies/ml at 36 weeks
✓ Otherwise, CS
What is the special precaution in managing HIV positive women during CS in the UK?
Zidovudine infusion should be started 4 hours before beginning of the CS
What is the recommendation regarding therapy for newborns of HIV positive mothers?
✓ Oral zidovudine (if viral load <50 copies/ml)
✓ Otherwise triple ART
How long is treatment for HIV exposed neonates?
4-6 weeks
Which STI produces strawberry cervix (erythematous cervix with punctate lesions)?
Trichomonas vaginalis
What are the key features of Trichomonas vaginalis infection?
✓ Offensive green/yellow discharge
✓ Strawberry cervix
Most useful diagnostic modality for ankylosing spondylitis?
Plain x-ray of sacroiliac joints
What investigation should be requested if ankylosing spondylitis is suspected and x-ray is not suggestive?
MRI
In what instances are the usual medications used for rheumatoid arthritis useful in managing ankylosing spondylitis?
Peripheral joint involvement
In what situations should a suspected TIA warrant imaging?
Patient on warfarin, a DOAC, or has a bleeding disorder
How long do TIA symptoms take to resolve?
Typically 1 hour
What are the contraindications to the use of the traditional treatment modality (antithrombotic therapy, aspirin 300) in the setting of a TIA?
✓ Patient has a bleeding disorder
✓ Patient already on low-dose aspirin (continue until reviewed by specialist)
What is the recommended antithrombotic therapy for patients who have a TIA or a stroke?
✓ Clopidogrel (first line)
✓ Aspirin + Dipyridamole (patients who cannot tolerate Clopidogrel)
Which worm usually presents with itchy bottom worse at night?
Threadworm
What is the treatment for pinworm?
Mebendazole for patient and all household members (single dose)
At what age should a diagnosis of new iron-deficiency anaemia warrant urgent colorectal cancer pathway referral?
Age >= 60
What is the best timing for starting anticoagulation following a TIA or stroke?
✓ TIA (immediately once hemorrhage is excluded)
✓ Stroke (2 weeks later)
Is azathioprine used for management of acute flare of ulcerative colitis?
No, for maintenance treatment
Which of the IBD is treated with methotrexate?
Ulcerative colitis
Which condition has the M rule?
Primary biliary cholangitis
✓ IgM
✓ anti-mitochondrial antibodies
✓ Middle aged females
Test of cure cervical smear is performed when?
6 months after treatment
What is Russell’s sign?
Scars over the metacarpophalangeal joints due to the fingers scraping the front teeth during induced vomiting in patients with bulimia nervosa
What is the management of bulimia nervosa?
Referral for specialist care
What are the conditions that make expectant management of miscarriage inappropriate?
✓ Increased risk of bleeding
✓ Previous adverse experiences associated with pregnancy
✓ increased risk of the side effects of hemorrhage
✓ Evidence of infection
Which antibiotic is usually prescribed for COPD patients for prophylaxis?
Azithromycin
What is the reversal agent for dabigatran?
Idarucizumab
What are the criteria for performing alteplase thrombolysis following acute ischemic stroke?
✓ Ability to be administered within 4.5 hours of onset of stroke symptoms
✓ Hemorrhage has been definitely excluded
Which medication used in the treatment of rheumatoid arthritis show hypersensitivity similar to that with aspirin?
Sulfasalazine
Three medications with cross-sensitivity include?
✓ Aspirin
✓ Sulfasalazine
✓ Sulphonamides
What are the two key medications in management of angina?
✓ Beta blockers
✓ Nifedipine
What causes hyperacute kidney rejection?
Preexisting antibodies (such as ABO antibodies)
What is the most common type of organ transplant rejection?
Acute T-cell medicated rejection
What is the treatment for acute antibody-mediated rejection?
3-5 plasma exchange sessions daily
What is the treatment for Acute T-cell mediated rejection?
IV methylprednisolone
What chromosome codes HLA?
Chromosome 6
What type of hypersensitivity reaction is hyperacute graft rejection?
Type II hypersensitivity
Which of the graft rejection type has no remedial treatment?
Hyperacute rejection
How soon does hyperacute graft rejection occur?
Minutes to hours
What is the management for secondary dysmenorrhoea?
Refer to gynecology
What causes Ramsay Hunt syndrome?
Reactivation of the Varicella zoster virus in the geniculate ganglion of the seventh cranial nerve
What is the treatment for Ramsay Hunt syndrome?
Oral aciclovir and corticosteroids
Should asymptomatic bacteriuria in catheterised patients be treated?
No
What is the Nitrofurantoin dosing for UTI in pregnant women and men?
100 mg bd for 7 days
What are the indications for urine culture after suspected UTI in non-pregnant women?
✓ Age > 65 years
✓ Visible or non-visible haematuria
What is the difference in the management options for asymptomatic bacteriuria in pregnant women and catheterised patients?
Treat the former, but not the later
Give the indications for IV adenosine and IV amiodarone respectively?
✓ IV Adenosine (supraventricular tachycardia, ie regular narrow complex tachycardia)
✓ IV Amiodarone (Ventricular tachycardia, regular broad complex tachycardia) without adverse features
When is synchronized cardioversion indicated?
Ventricular tachycardia with adverse features
What are the adverse features in peri-arrest rhythms?
✓ Shock
✓ Syncope
✓ Myocardial ischaemia
✓ Heart failure
Maximum number of shocks in DC cardioversion for peri-arrest rhythms with adverse features?
3 (after that seek expert help)
What is the first line treatment for regular narrow complex tachycardia?
Vagal manoeuvre (before IV Adenosine)
What is the first line treatment for chronic heart failure?
ACE-inhibitor and beta-blocker
What is the second line treatment (add-on) drug in chronic heart failure?
Aldosterone antagonist (Spironolactone)
Which test must be done prior to commencing Azathioprine treatment?
Check thiopurine methyltransferase deficiency (TPMT)
What is the function of thiopurine methyltransferase?
Metabolizes thiopurine medications such as azathioprine and mercaptopurine
Is azathioprine safe in pregnancy?
Yes
What should you do to the dose of azathioprine if it has to be used with allopurinol?
Reduce it’s dose
Which medications can exacerbate plaque Psoriasis?
✓ Beta blockers
✓ Antimalarials
✓ Lithium
✓ NSAIDs
Which infection can trigger guttate psoriasis?
Streptococcal infection
Factors that can cause psoriasis exacerbation?
✓ Trauma
✓ Alcohol
✓ medications
✓ withdrawal of systemic steroids
Is hand preference in an infant (before 12 months) normal?
No. Could be an indicator of cerebral palsy
At what point should unsmiling children be referred?
10 weeks
What is the maximum time a child can be allowed to sit supported?
12 months
At what age is a child expected to start sharing toys?
3 years
What medications are used in ER+ve breast cancer?
✓ Tamoxifen
✓ Anastrozole
What is the patient characteristics for tamoxifen and anastrozole therapy in ER+ve breast cancer?
✓ Pre or peri-menopausal (Tamoxifen)
✓ Postmenopausal (Anastrozole)
How does radiotherapy help in the management of patients with breast cancer?
May reduce the risk of recurrence by around two-thirds
What is a contraindication for Trastuzumab?
Patients with a history of heart disorders
Which breast cancer patients benefit from Trastuzumab?
HER2 positive cancers
How many sample confirmation of azoospermia is necessary before patient is safe to have intercourse without protection?
2×
Which is a more effective method of sterilisation, male or female?
Male
What is the failure rate of male sterilisation?
1 per 2,000
What is the success rate of vasectomy reversal?
✓ 55% within 10 years
✓ 25% after 10 years
Which two tests must adult patients with suspected asthma have?
✓ FeNO test
✓ Spirometry with a bronchodilator reversibility test
What features differentiates scarlet fever from Kawasaki disease?
✓ Lip is spared of rash
✓ No conjunctivitis
✓ Evidence of URTI such as purulent tonsils
In what condition is phenoxymethylpenicillin indicated?
Scarlet fever
What is a feared complication of Kawasaki disease?
Coronary artery aneurysm
How is Kawasaki disease diagnosed?
Clinically
What is the treatment of Kawasaki disease?
✓ Aspirin
✓ Intravenous immunoglobulin
How does hyperthyroidism affect the bones?
Increases osteoclast activity leading to osteoporosis
Which mechanism explains most complications seen in thyroid disorders?
Metabolism
After what time should thyroid hormone levels be checked after dose adjustments?
After 8-12 weeks
What is the therapeutic goal in managing thyroid hormone levels?
Normalisation of TSH levels
Which medications can interact with levothyroxine if given within 4 hours?
Iron, calcium carbonate
Apart from antibiotics, risk factors for C. difficile infection include?
Proton pump inhibitors
What differentiates C. difficile infection from exposure?
✓ C difficile infection (C difficile toxin)
✓ C difficile exposure (antigen)
What is the drug of choice for C difficile infection?
Vancomycin
What is the second line therapy for C difficile infection or recurrent episode (within 12 weeks)?
Fidaxomicin
What is the treatment for local anaesthetic toxicity?
IV 20% lipid emulsion
What is the advantage of combining adrenaline to some local anaesthetic agents?
It allows use of increased doses of the local anaesthetic agent
What is the colour coding for the inhalers?
✓ Blue inhaler (SABA)
✓ Brown inhaler (ICS)
How much dose reduction is ok with inhaled steroids at a time as per asthma management?
25-50 %
What is the hematological management of acute limb ischemia?
IV heparin
How long after treatment for pneumonia should a patient have repeat chest X-ray?
6 weeks after clinical resolution
What is the first line medication for community acquired pneumonia?
Amoxicillin
A 2 year old boy with a three day history of vomiting and profuse watery diarrhoea is most likely a diagnosis of?
Rotavirus infection
40 year old overweight alcoholic woman presenting with upper abdominal pain worse after eating and radiating through to her back is suggestive of?
Pancreatitis
Another name for herpes simplex keratitis?
Dendritic ulcer
Features of dendritic ulcer (herpes simplex keratitis)?
✓ Watery eyes
✓ Pain
✓ Redness
✓ Blurring of vision
Which medication should be used for nasal blockage secondary to allergy between Xylometazoline and Beclomethasone?
Beclomethasone (steroid)
What class of drug is Xylometazoline?
Decongestant/antihistamine
Which of the alopecia types is common following chemotherapy?
Anagen effluvium
What are the vaccine recommendations for patients with heart failure?
✓ Annual influenza vaccine
✓ One-off Pneumococcal vaccine
What is a strong indication for use of digoxin in heart failure?
Coexisting atrial fibrillation
What saturation indicates oxygen prescription?
Saturation < 94%
What necessitates careful consideration with respect to using nitrate in ACS?
Hypotension
What is the QRS duration cut off for narrow complex tachycardia and broad complex tachycardia?
120ms
What is the treatment of choice for Torsades de Pointes?
Magnesium sulfate
Describe the ECG features in Torsades de Pointes?
✓ Polymorphic ventricular tachycardia
✓ prolonged QTc interval
In the setting of PE, in what condition is V/Q scan preferred to CTPA?
If there is renal impairment
In the management of hypertension what determines addition of Spironolactone or beta-blocker?
Potassium levels
Which patients should receive one shock followed by two minutes of CPR?
Unwitnessed patients in VF/pulseless VT
Which of the peri-arrest rhythms requires IV adrenaline?
✓ Pulseless electrical activity
✓ Asystole
What are the adverse features in arrhythmias that change management?
✓ Syncope
✓ Myocardial ischaemia
✓ Heart failure
✓ Shock
Another name for defibrillation?
Unsynchronized cardioversion
What is the preferred diagnostic modality for suspected aortic dissection?
CT angiography chest/abdomen/pelvis
Describe the usefulness of the different investigations for suspected aortic dissection?
✓ CT angiography (1st choice if stable)
✓ Transoesophageal echocardiogram (1st choice if unstable)
What are the two types of classification schemes for aortic dissection?
✓ Stanford
✓ DeBakey
What are the management options for the different types of aortic dissection?
✓ Type A (surgical management)
✓ Type B (conservative)
What distinguishes type A aortic dissection from type B aortic dissection?
Type A (ascending aorta)
Type B (descending aorta)
