MSRA Revision Gold Flashcards
1
Q
Which pneumonia is usually preceded by recent influenza infection?
A
Staphylococcus aureus pneumonia
2
Q
What type of organism is pneumocystis jirovecii?
A
Fungus
3
Q
Which pneumonia is commoner in people with COPD?
A
Hemophilus influenza pneumonia
4
Q
In which of the pneumonias can autoimmune hemolytic anemia and erythema multiforme be seen?
A
Mycoplasma pneumoniae
5
Q
What are the atypical pneumonias?
A
✓ Mycoplasma pneumoniae
✓ Legionella pneumophila
6
Q
Which pneumonia is usually associated with infected air conditioning units?
A
Legionella pneumophila pneumonia
7
Q
Which of the pneumonias is usually associated with lymphopenia and hyponatremia?
A
Legionella pneumophila pneumonia
8
Q
Which of the pneumonias is classically seen in alcoholics?
A
Klebsiella pneumoniae
9
Q
Which of the pneumonias usually has no chest signs?
A
Pneumocystis jirovecii pneumonia
10
Q
Describe idiopathic interstitial pneumonia?
A
Non-infective pneumonias
11
Q
Common example of idiopathic interstitial pneumonia is?
A
Cryptogenic organising pneumonia
12
Q
What is a possible lung complication of rheumatoid arthritis?
A
Cryptogenic organising pneumonia
13
Q
What is a possible lung complication of amiodarone therapy?
A
Cryptogenic organising pneumonia
14
Q
Timeframe of hospital-acquired pneumonia?
A
Developing 48hours or more after admission
15
Q
Classical X-ray finding in pneumonia?
A
Consolidation
16
Q
What defines confusion in the CURB-65 assessment?
A
Abbreviated mental test score of <= 8/10
17
Q
What defines Respiratory abnormality in the CURB-65 assessment?
A
Respiratory rate > 30
18
Q
Which CURB-65 value is treated at home?
A
0
19
Q
Is there a difference between severe asthma and life-threatening asthma?
A
Yes
20
Q
Give one feature of life-threatening asthma?
A
Silent chest
21
Q
What are the classification of acute asthma exacerbation?
A
✓ Moderate
✓ Severe
✓ Life-threatening
22
Q
What are the PEFR classes of acute asthma exacerbation?
A
✓ 50-75% best or predicted
✓ 33-50%
✓ <33%
23
Q
In which acute asthma exacerbation is SPO2 less than 92%?
A
Life-threatening
24
Q
In which acute asthma exacerbation category is pCO2 normal?
A
Life-threatening
25
Which vaccinations are given to COPD patients?
✓ Influenza vaccine
✓ Pneumococcal vaccine
26
What are the general management choices for COPD?
✓ Smoking cessation
✓ Vaccination protection
✓ Pulmonary rehabilitation
✓ Bronchodilator therapy
27
What is the first line medical treatment for COPD?
Short acting beta2 agonist (SABA) or Short acting muscarinic antagonist (SAMA)
28
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%)
29
Investigation of choice for idiopathic pulmonary fibrosis?
High resolution CT scan
30
Which ICS is used in the classification of steroid dose in asthma?
Budesonide
31
What is MART in asthma therapy?
Maintenance and reliever therapy that is combined (ICS + LABA).
32
What is the acronym for the treatment steps in asthma?
SILL
✓ SABA
✓ ICS
✓ LTRA
✓ LABA
✓ MART
33
What are the features of Churg-Strauss syndrome?
✓ Sinusitis
✓ Asthma
✓ Hematuria
✓ Eosinophilia
34
What features are common to Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) and Granulomatosis with polyangiitis (Wegenger's granulomatosis)?
✓ Vasculitis
✓ Sinusitis
✓ Dyspnoea
35
Diagnostic modality for COPD?
Spirometry
36
Red-currant jelly sputum in an alcoholic/diabetic is seen in which pneumonia type?
Klebsiella pneumoniae
37
Paraneoplastic syndrome associated with small cell lung carcinoma?
Hyponatremia from SIADH
38
Bupropion is contraindicated in what condition?
Epilepsy
39
What are the nicotine replacement medications?
✓ Bupropion
✓ Varenicline
40
What are the common side effects of nicotine replacement therapy?
Nausea, vomiting, headache and flu-like symptoms
41
How does Varenicline work?
Nicotine receptor partial agonist
42
When should nicotine replacement therapy medication be started?
1-2 weeks before target date to stop
43
How long should Varenicline treatment continue?
12 weeks
44
Which of the nicotine replacement therapy medications has been shown to be more effective?
Varenicline
45
In what situations should Varenicline be used with caution?
History of depression or self harm
46
Are the nicotine replacement medications (Varenicline and bupropion) contraindicated in pregnancy and breastfeeding?
Yes
47
Which of the nicotine replacement medications is relatively contraindicated in patients with eating disorders?
Bupropion
48
What is Bupropion mechanism of action?
NDRI (Norepinephrine and dopamine reuptake inhibitor) and nicotinic antagonist
49
Which of the nicotine replacement medications has some risk of causing seizures?
Bupropion
50
How are pregnant women tested for smoking?
CO (Carbon monoxide) detectors
51
What is the first line intervention for pregnant women to quit smoking?
Cognitive behavioural therapy, motivational interviewing or structured self help
52
Regarding paraneoplastic syndromes, what are the usual lung syndromes?
✓ Hyponatremia from SIADH (small cell)
✓ Hypercalcemia from PTH-rp (squamous cell)
53
What are the key treatment modalities for Granulomatosis with polyangiitis?
✓ Steroids
✓ Cyclophosphamide
✓ Plasma exchange
54
Which of the vasculitides is associated with a saddle-shape nose deformity?
Granulomatosis with polyangiitis
55
What is the usual cause of palpable purpuric rash over the buttocks?
Henoch-Schonlein purpura
56
What are the key question points for silicosis?
✓ Foundry worker
✓ Upper zone interstitial lymph nodes
✓ 'Egg-shell' calcification of the hilar lymph nodes
57
What is the normal PaO2 on air?
> 10kPa
58
Which nerve supplies the deltoid muscle?
Axillary nerve
59
Which nerve supplies serrratus anterior?
Long thoracic nerve
60
Damage of which nerve results in winged scapula?
Long thoracic nerve
61
What are the LOAF muscles?
✓ Lateral two lumbricals
✓ Opponens pollis
✓ Abductor pollis brevis
✓ Flexor pollis brevis
62
What nerve supplies the LOAF muscles?
Median nerve
63
What is the function of musculocutaneous nerve?
Elbow flexion and supination
64
What injury commonly damages the axillary nerve?
Humeral neck fracture
65
Which nerve flexes the wrist?
Ulnar nerve
66
Which nerve supplies the thenar muscles?
Median nerve
67
Which nerve extends the forearm, wrist, fingers, and thumb?
Radial nerve
68
Which of the brachial plexus palsies is associated with Horner's syndrome?
Klumpke's palsy
69
What is the feared complication of displaced fractures of the femoral neck?
Avascular necrosis
70
What are the usual tests for development dysplasia of the hip?
Barlow's test and Ortolani's test
71
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
72
Which of the childhood hip conditions commonly affects obese boys in their early teenage years?
Slipped Upper Femoral Epiphysis
73
Which of the hip conditions affecting children is a degenerative condition due to avascular necrosis of the femoral head?
Perthes disease
74
What ages are usually affected by Perthes disease?
4-8 years
75
Which hip condition affecting children commonly follows a viral infection?
Transient synovitis (irritable hip)
76
What is the commonest cause of hip pain in children?
Transient synovitis
77
Which nerve adducts the thigh?
Obturator nerve
78
What is the preferred treatment for undisplaced intracapsular hip fracture?
Internal fixation or hemiarthroplasty if unfit
79
Positive Trendelenburg test is usually found in which nerve injury of the leg?
Superior gluteal nerve
80
Which nerve injury causes 'can't rise from a seat, can't climb stairs'?
Inferior gluteal nerve
81
What are the 4 As of ankylosing spondylitis?
✓ Anterior uveitis
✓ Apical fibrosis
✓ Aortic regurgitation
✓ Achilles tendonitis
82
Which medications cause rhabdomyolysis?
Statins
83
What type of crystals is normal in urine?
Hyaline cast
84
What type of cast is seen in chronic kidney disease?
Granular casts
85
Which kind of casts indicate glomerular inflammation?
White and red cell casts
86
Describe the crystals in pseudogout?
Weakly-positively birefringent rhomboid shaped crystals
87
Which age group does pseudogout affect predominantly?
Elderly
88
What are the risk factors for pseudogout in the young? (<60)
✓ Acromegaly
✓ Hyperparathyroidism
✓ Wilson's disease
✓ Hemochromatosis
✓ Low magnesium, low phosphate
89
What are the most commonly affected joints in pseudogout?
✓ Knee
✓ Wrist
✓ Shoulder
90
X-ray finding of chondrocalcinosis or linear calcifications of the meniscus and articular cartilage of the knee is seen in?
Pseudogout
91
What is the treatment of pseudogout?
NSAIDS or steroids as for gout (intra-articular, intramuscular, oral)
92
Which arthritis affects large weight bearing joints as well as DIP & PIP joints?
Osteoarthritis
93
Does osteoarthritis have a sex predilection?
No. Similar incidence in men and women
94
What are the x-ray findings common to both osteoarthritis and rheumatoid arthritis?
Loss of joint space
95
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
96
Summarily, what happens in Paget's disease of the bone?
Increased and uncontrolled bone turnover
97
Is Paget's disease of the bone primarily a disorder of osteoblasts or osteoclasts?
Osteoclasts
98
Which bones are most commonly affected in Paget's disease of the bone?
Skull, spine/pelvis, and long bones of the lower extremities
99
Which sex has a higher incidence of Paget's disease of the bone?
Males
100
Which condition presents with morning stiffness involving the muscles?
Polymyalgia rheumatica
101
Two closely related inflammatory disorders to remember?
✓ Polymyalgia rheumatica
✓ Temporal arteritis
102
Which muscle region does polymyalgia rheumatica commonly affect?
Proximal limb muscles
103
The antibody most associated with rheumatoid arthritis?
Anti-cyclic citrullinated peptide antibody
104
Bamboo spine is seen in what condition?
Ankylosing spondylitis
105
Which type of glands does Sjogren's syndrome affect?
Exocrine glands
106
Sjogren's syndrome increases the risk for which malignancy?
Lymphoid malignancy
107
What is the classic triad of symptoms in Behcet's syndrome?
✓ Anterior uveitis
✓ Mucosal ulcers
✓ Genital ulcers
108
Which autoimmune disease is commoner in males?
Behcet's syndrome
109
What is the biochemical findings in osteomalacia?
✓ Low calcium
✓ Low phosphate
✓ High ALP
✓ High PTH
110
Medications known to cause pulmonary fibrosis include?
✓ Methotrexate
✓ Bleomycin
111
What enzyme does methotrexate inhibit its action?
Dihydrofolate reductase
112
Which enzyme is essential for synthesis of purines and pyrimidines?
Dihydrofolate reductase
113
What are the side effects of methotrexate?
✓ Mucositis
✓ Myelosuppression
✓ Pneumonitis
✓ Pulmonary fibrosis
✓ Liver fibrosis
114
How frequently is methotrexate taken?
Weekly
115
How long after methotrexate use can pregnancy be considered for both sexes?
6 months
116
HLA B27 is associated with which conditions?
✓ Ankylosing spondylitis
✓ Anterior uveitis
✓ Reactive arthritis
117
Which HLA is associated with rheumatoid arthritis?
HLA-DR4
118
Which chromosomes gene code for HLA antigens?
Chromosome 6
119
What type of hypersensitivity is anaphylaxis?
Type 1
120
Important side effect of bisphosphonate?
Osteonecrosis of the jaw
121
What exactly does bisphosphonates do?
Inhibits osteoclast activity thereby decreasing demineralisation activities
122
What is the usual cause of granulomatous thickening of the aortic arch?
Takayasu's arteritis
123
Which antibody is commonly associated with ulcerative colitis?
P-ANCA
124
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)
125
What medications are known to cause reactivation of tuberculosis?
✓ Infliximab
✓ Corticosteroids
126
What is the current guidance on treatment of rheumatoid arthritis?
DMARD monotherapy ± short course of bridging prednisolone
127
What type of hypersensitivity is graft versus host disease?
Type IV (delayed hypersensitivity)
128
What is the treatment of choice in chronic fatigue syndrome?
Graded exercise therapy
129
Which of the bone disorders have the four usual lab parameters (calcium, phosphate, ALP, PTH) normal?
✓ Osteoporosis
✓ Osteopetrosis
✓ Osteogenesis imperfecta
130
Which of the bone disorders have only one abnormal value (elevated ALP)
Paget's disease of the bone
131
The important conditions associated with HLA-DR4 are?
✓ Rheumatoid arthritis
✓ Type 1 DM
132
How is osteogenesis imperfecta inherited?
Autosomal dominant
133
What is the treatment of choice for Raynaud's disease?
Nifedipine
134
An important correlation of polyarteritis nodosa?
Positive hepatitis B serology
135
Is azathioprine safe to use in pregnancy?
Yes
136
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)
137
What is the primary issue in osteomalacia?
Vitamin D deficiency
138
What is the primary treatment for osteomalacia?
Vitamin D supplementation
139
What is the commonest ocular manifestation of rheumatoid arthritis?
Keratoconjunctivitis sicca
140
Which eye condition primarily affects the peripheral retina resulting in tunnel vision?
Retinitis pigmentosa
141
Conditions in children causing strawberry tongue?
✓ Scarlet fever
✓ Kawasaki disease
142
One indication for use of aspirin in children?
Kawasaki disease
143
What type of viruses cause croup?
Parainfluenza viruses
144
What causes scarlet fever?
Erythrogenic toxins produced by Group A haemolytic streptococci (Streptococcus pyogenes)
145
What is the treatment for scarlet fever?
Oral penicillin V
146
Is scarlet fever a notifiable disease?
Yes
147
How bad are the complications of scarlet fever?
✓ Acute glomerulonephritis
✓ Otitis media
✓ Rheumatic fever
✓ Invasive complications
148
What endocrine disorder is associated with cystic fibrosis?
Diabetes mellitus
149
Causes of a marfanoid habitus include?
✓ Homocystinuria
✓ Marfan syndrome
150
What causes Homocystinuria?
Deficiency of cystathione beta synthase
151
Cystic fibrosis is associated with short stature?
True
152
Is Down's syndrome associated with Hirschprung disease?
Yes
153
Which syndrome is associated with a bicuspid aortic valve?
Turner's syndrome
154
Conditions that cause recurrent chest infections include?
✓ Cystic fibrosis
✓ Down syndrome
155
An omphalomesenteric band is associated with what condition?
Meckel's diverticulum
156
What is the mode of inheritance of Duchene muscular dystrophy?
X-linked recessive
157
A cause of coronary artery aneurysm to remember is?
Kawasaki disease
158
Another name for hypogonadotrophic hypogonadism is?
Kallman syndrome
159
Why are statins not coprescribed with macrolides (such as clarithromycin)?
Increased risk of rhabdomyolysis
160
Which breast cancer medication is a monoclonal antibody directed against the HER2/neu receptor?
Trastuzumab
161
Common side effects of Trastuzumab are?
✓ Flu-like symptoms
✓ Diarrhoea
162
Why is an echocardiogram usually performed before starting patients on Trastuzumab?
Because of its cardiotoxicity
163
How does Ciprofloxacin affect the QT interval?
Lengthens it
164
Both loop and thiazide diuretics cause hypokalemia?
True
165
The calcium channel blockers Diltiazem and Verapamil cause heart failure true or false?
True
166
Which of the calcium channel blockers have more peripheral vascular effects than cardiac?
Dihidropyridines (Nifedipine, Amlodipine)
167
The calcium channel blockers Diltiazem and Verapamil are negatively inotropic?
True
168
What is the antidote for aspirin poisoning?
Bicarbonate
169
Which medications precipitate digoxin toxicity?
Loop diuretics
170
What are the two types of heparin?
✓ Unfractionated heparin
✓ Low molecular weight heparin
171
Does protamine sulfate reverse the effect of LMWH?
Partially
172
Which medication is known to reduce seizure threshold?
Ciprofloxacin
173
Which antituberculous drug can cause gout?
Pyrazinamide
174
List three medications that can cause gout?
✓ Loop diuretics
✓ Thiazide diuretics
✓ Pyrazinamide
175
Medications to avoid in the setting of a recent myocardial infarction include?
✓ Metformin
✓ Sildenafil
176
Which overdose has IV bicarbonate as antidote?
✓ Tricyclic antidepressants
✓ Salicylate
177
What is the risk with the use of Flumazenil (the antidote for benzodiazepines)?
Risk of seizures
178
What poison is hydroxycobalamine its antidote?
Cyanide
179
What is the antidote for lead poisoning?
Dimercaprol, calcium edetate
180
What medication causes yellow-green vision?
Digoxin
181
What medications can cause gynecomastia?
✓ Digoxin
✓ Spironolactone
182
The poisoning agent that causes hyperpyrexia is?
Carbon monoxide
183
Four drugs that precipitate digoxin toxicity include?
✓ Amiodarone
✓ Spironolactone
✓ Verapamil
✓ Diltiazem
184
List medications that can cause tremor?
✓ Lithium
✓ Ciclosporin
✓ Sodium valproate
185
Which medication is known to cause non-arteritic anterior ischaemic neuropathy?
Sildenafil
186
Indications for the use of phosphodiesterase type 5 inhibitors?
✓ Erectile dysfunction
✓ Pulmonary hypertension
187
What cancer does tamoxifen predispose to?
Endometrial cancer
188
How does alcohol intake affect P450?
✓ Acute intake (inhibitor)
✓ Chronic intake (inducer)
189
What ABG result is typical of aspirin poisoning?
Mixed metabolic acidosis and respiratory alkalosis
190
What is the effect of heparin on potassium levels?
Hyperkalemia
191
Two medications that can cause depression include?
✓ Corticosteroids
✓ Isotretinoin
192
List the medications that can cause pulmonary fibrosis?
✓ Methotrexate
✓ Amiodarone
✓ Nitrofurantoin
✓ Sulfasalazine
193
What is the treatment of choice for generalized anxiety disorder?
Sertraline
194
Examples of serotonin-noradrenaline reuptake inhibitors include?
✓ Duloxetine
✓ Venlafaxine
195
How is the half-life of lithium?
Long, being primarily excreted by the kidney
196
How does lithium affect the thyroid?
Hypothyroidism with thyroid enlargement
197
How does lithium affect the parathyroid gland?
Hyperparathyroidism and resultant hypercalcemia
198
Which medications increases the risk of ischaemic stroke?
✓ COCPs
✓ Antipsychotics
199
How does anastrozole affect the bone?
Osteoporosis
200
When is tamoxifen indicated in breast cancer?
Pre- and peri-menopausal women if ER positive
201
Which of the female reproductive cancers have incidence increased by early menarche?
✓ Breast cancer
✓ Ovarian cancer
✓ Endometrial cancer
202
What is the treatment of choice for chronic anal fissure?
Topical glyceryl trinitrate
203
Why are small bowel stomas spouted?
So that their irritant contents are not in contact with the skin
204
Which of the breast cancer medications is used in post-menopausal women if ER positive?
Anastrozole
205
An example of an aromatase inhibitor?
Anastrozole
206
Which cancers do COCPs predispose to?
✓ Breast cancer
✓ Cervical cancer
207
What hormone does nexplanon release?
Etonogestrel (a progestogen)
208
What is the most effective form of contraception?
Nexplanon. A form of implantable contraceptive
209
What is the failure rate of nexplanon?
0.07/100 women-years
210
Which of the contraceptive pills takes only 2 days to become effective?
Progestogen only pill
211
Which of the contraceptive pills has no pill free days?
Progestogen only pill
212
What is the mode of action of the progestogen only pill (except desogestrel)?
✓ Thickens cervical mucus
213
Which of the contraceptives inhibit ovulation and thickens cervical mucus?
✓ Implantable contraceptive (etonogestrel)
✓ Injectable contraceptive (depo povera)
✓ Desogestrel only pill
214
What is the primary mechanism of action of intrauterine system (levonorgestrel)
Prevents endometrial proliferation
215
What is the mechanism of action of COCP?
Inhibits ovulation
216
Hormone replacement therapy increases the risk of which cancer?
Breast cancer
217
Unopposed estrogen action predisposes to which cancer?
Endometrial cancer
218
Which female reproductive cancer has smoking and COCP as protective factors?
Endometrial cancer
219
Mutations to the BRCA2 gene predisposes to which cancer?
✓ Breast cancer
✓ Ovarian cancer
220
How does COCP help in reducing ovarian cancer risk?
By reducing the number of ovulations
221
What is the mechanism of action of oxybutynin?
Antimuscarinic
222
Which of the female reproductive cancers is high parity a risk factor for?
Cervical cancer
223
Which female reproductive cancer does PCOS predispose to?
Endometrial cancer
224
What causes tender erythematous lesions on the shins?
Erythema nodosum
225
What are the four major causes of erythema nodosum?
✓ Infections (TB)
✓ Systemic disease (Sarcoidosis, IBD, Behcet's)
✓ Malignancy
✓ Drugs
226
Which of the tender leg lesions is associated SLE?
Pyoderma gangrenosum
227
Which antibodies are usually used to look for SLE?
ANA
228
Is pyoderma gangrenosum associated with rheumatoid arthritis?
Yes
229
Does the lesion of erythema nodosum heal with scarring?
No
230
What is the key physical characteristic of basal cell carcinoma?
Rolled edges
231
What is the size cut-off point for differentiating nodule from papule
5mm
232
Lupus pernio is seen in what condition?
Sarcoidosis
233
What is the character monicker for basal cell carcinoma?
Rodent ulcer
234
With regards to growth and metastasis, what is the characteristic of basal cell carcinoma?
Slow growth and rarely metastatic
235
What is the most common type of cancer in the western world?
Basal cell carcinoma
236
What type of referral is made for suspected BCC?
Routine referral
237
What topical cream options are there for BCC treatment?
✓ Imiquimod
✓ Fluorouracil
238
Does psoriatic nail changes reflect severity of the disease?
No
239
What is the first line treatment for hyperhidrosis?
Topical aluminium chloride
240
Which medications are options for treatment of hyperhidrosis in secondary care?
✓ Topical glycopyrrolate
✓ Botulinum toxin injections
241
What class of medications is glycopyrrolate?
Antimuscarinic
242
What parts of the body are most affected by vitiligo?
Peripheries
243
What is the phenomenon of new vitiligo lesions secondary to trauma called?
Koebner phenomenon
244
Which of the alopecia types is associated with vitiligo?
Alopecia areata
245
How useful is topical corticosteroids in vitiligo?
May reverse changes if applied early
246
What is the phototherapy of choice in the secondary care of Psoriasis?
Narrowband ultraviolet B light
247
What is the commonest body site for keloid scars?
Sternum
248
What category of disease is erythema multiforme?
Hypersensitivity reaction
249
What is the common trigger for erythema multiforme?
Infections
249
What is the common trigger for erythema multiforme?
Infections
250
Which condition has target lesions as a feature?
Erythema multiforme
251
What is erythema multiforme major?
Erythema multiforme with mucosal involvement
252
Which type of hair loss is caused by severe stress?
Telogen effluvium
253
What is a possible cause for telogen effluvium?
Pregnancy
254
Which type of hair loss causes well-circumscribed areas of total hair loss?
Alopecia areata
255
What defines scarring or non-scarring alopecia?
Destruction or preservation of the hair follicle
256
Common causes of erythema nodosum in females include?
✓ Pregnancy
✓ COCP use
257
Purple painful lesions on the shin should elicit possible diagnosis of?
Erythema nodosum
258
What are the usual inflammatory associations of Ulcerative colitis?
✓ large joint arthritis
✓ sacroilitis
✓ Pyoderma gangrenosum
259
What is pathergy?
Hyper reactivity of the skin in response to trauma
260
What condition commonly exhibits pathergy?
Pyoderma gangrenosum
261
What condition can cause both erythema nodosum and erythema gangrenosum?
Inflammatory bowel disease
262
What are the risk factors for capillary hemangiomas?
✓ Female infants
✓ Premature infants
✓ Infants of mother that had chorionic villus sampling
263
A brown nodule with a fissured greasy surface, well demarcated against the skin, and exhibiting the stuck-on appearance is classical of?
Seborrheic keratosis
264
What cancers can actinic keratoses predispose to?
Squamous cell carcinoma
265
What is the usual first symptom of rosacea?
Flushing of the skin
266
In what condition is rhinophyma seen?
Rosacea
267
What is the indication for dermatology referral in rosacea?
Presence of rhinophyma
268
What is the treatment for mild rosacea?
Topical metronidazole
269
What is the treatment for severe rosacea?
Oxytetracycline (systemic)
270
Does HIV predispose to seborrheic dermatitis?
Yes
271
Which fungus is typically taught to be the cause of seborrheic dermatitis?
Malassezia furfur
272
What conditions are usually associated with seborrheic dermatitis?
✓ HIV
✓ Parkinson's disease
273
Which seborrheic dermatitis subtype does not have topical ketoconazole as the first line treatment?
Scalp seborrheic dermatitis (use preparations containing zinc pyrithione and tar)
274
Which skin condition is usually associated with coeliac disease?
Dermatitis herpetiformis
275
Are dermatitis herpetiformis lesions commoner in flexor or extensor surfaces?
Extensor surfaces
276
Are keloid scars commoner in flexor or extensor surfaces?
Extensor surfaces
277
What is the pathophysiologic cause of dermatitis herpetiformis?
Deposition of IgA in the dermis
278
Which ulcer types are amenable to compression bandaging?
Venous ulcers
279
What is a normal ABPI index reading?
0.9 - 1.2
280
What ABPI value reflects arterial disease?
< 0.9
(Also > 1.2 in arterial calcification such as in diabetics) false negative
281
What organism causes molluscum contagiosum?
Pox virus
282
Is molluscum contagiosum infectious?
Yes
283
Should molluscum contagiosum infection preclude school attendance?
No
284
How long does it take for molluscum contagiosum lesions to clear?
18 months
285
What is a predisposing condition for molluscum contagiosum infection?
Atopic eczema
286
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)
287
What is a known indication for brimonidine?
Predominant flushing symptoms in rosacea
288
What is the indication for dermatology referral in acne rosacea?
Rhinophyma
289
Does dietary modification help in acne?
No
290
Can milia affect adults?
Yes, though commoner in newborns
291
What are the management options for BCC?
✓ Surgery
✓ Curettage
✓ Cryotherapy
✓ Radiotherapy
✓ Topical cream
292
What is the timeframe for resolution of erythema nodosum lesions?
6 weeks
293
What are the infective causes of erythema nodosum?
✓ Tuberculosis
✓ Streptococci
✓ Brucellosis
294
What are the drug causes of erythema nodosum?
✓ Sulphonamides
✓ Penicillin
✓ COCPs
295
Can pregnancy cause erythema nodosum?
Yes
296
Can corticosteroids cause skin depigmentation?
Yes, especially in dark skins
297
How does corticosteroids affect hair growth?
Excessive hair growth at the site of application
298
What differentiates mycosis fungoides from eczema/Psoriasis?
Lesions feature more different colours
299
What are the skin lesions with flexural predilection?
✓ Lichen planus
✓ Eczema
300
Which skin lesions are usually described as being polygonal in shape, with a 'white-lines' pattern on the surface (Wickham's striae)?
Lichen planus
301
What are the nail features in lichen planus?
✓ longitudinal ridging
✓ Thinning of the nail plate
302
Can Lichen planus produce oral lesions?
Yes, in 50% of cases
303
A cause of koebner phenomenon?
Lichen planus
304
What are the drug causes for lichenoid drug eruptions?
✓ Quinin
✓ Gold
✓ Thiazides
305
What is the treatment of choice for lichen planus?
Potent topical steroids
306
What is the recommended mouth spray for oral lichen planus?
Benzydamine mouthwash
307
What is the first line antiviral medication in shingles?
Famciclovir or Valacyclovir
308
What is the most commonly affected dermatome in shingles?
T1 to L2
309
What is the first line analgesics in shingles?
PCM or NSAIDs
310
What causes pemphigus vulgaris?
Antibodies targeted at Desmolein 3
311
Which condition exhibits Nikolsky's sign?
Pemphigus vulgaris
312
What is the first line treatment for pemphigus vulgaris?
Steroids
313
What skin condition is particularly seen in Ashkenazi Jews?
Pemphigus vulgaris
314
What are the skin conditions commonly associated with mucosal ulceration?
✓ Pemphigus vulgaris
✓ Erythema multiforme major
315
What are the drug causes for erythema multiforme major?
CAPONS
✓ Carbamazepine
✓ Allopurinol
✓ Penicillin
✓ Oral contraceptive pill
✓ Nevirapine/NSAIDs
✓ Sulphonamides
316
What is the first line therapy for plaque Psoriasis?
A potent corticosteroid + vitamin D analogue
317
What therapy is particularly useful in Psoriasis with joint involvement?
Methotrexate
318
What differentiates vitamin D analogues from corticosteroids in treating Psoriasis?
They can be used long-term as side effects are uncommon
319
Are dermatitis herpetiformis lesions usually flexural or extensor?
Extensor
320
What is the pathophysiologic cause for dermatitis herpetiformis
Deposition of IgA in the dermis
321
What is the management for dermatitis herpetiformis?
✓ Gluten free diet
✓ Dapsone
322
What is the oral medication of choice in treating acne in pregnancy?
Erythromycin
323
What are the three classes of topicals used in management of acne?
✓ Topical antibiotics
✓ Topical retinoids
✓ Benzoyl peroxide
324
What is the step up management for acne?
✓ Single topical therapy
✓ Combined topical therapy
✓ Oral antibiotics
✓ Oral isotretinoin
325
Can topical retinoid be used in pregnancy?
No. All retinoids (topical and oral) are contraindicated in pregnancy
326
What is the first line treatment for urticaria?
Non-sedating antihistamines
327
What skin condition is commonly seen in patients with Parkinson's disease?
Seborrheic dermatitis
328
What is the most common cause of erythema multiforme?
Herpes simplex virus
329
What mineral deficiency causes red, crusted lesions (acrodermatitis)?
Zinc
330
Which mineral deficiency causes acrodermatitis?
Zinc
331
Which of the B vitamin deficiency causes angular cheilosis?
Vitamin B2 (riboflavin)
332
List five causes of scarring alopecia?
✓ Trauma
✓ Burns
✓ Lichen planus
✓ Discoid lupus
✓ Radiotherapy
✓ Tinea capitis
333
Fine medications that can cause alopecia?
✓ Cytotoxics
✓ OCPs
✓ Heparin
✓ Carbamazepine
✓ Colchicine
334
Which mineral deficiencies can cause alopecia?
✓ Zinc
✓ Iron
335
What dermatologic presentation in children warrants an immediate work-up to identify diagnosis?
Purpura
336
Purpura in children should raise suspicion of which conditions?
✓ ALL
✓ Meningococcal disease
337
What is the usual pathophysiologic cause of purpura?
Low platelets
338
Can cough cause petechiae?
Yes, by raising superior vena cava pressure
339
Differentiate the settings for Cushing's and Curling's ulcers?
✓ Cushing's (severe head trauma)
✓ Curling's (severe burns)
340
List three common skin disorders associated with pregnancy?
✓ Atopic eruption of pregnancy
✓ Polymorphic eruption of pregnancy
✓ Pemphigoid gestationis
341
Does vitiligo exhibit koebner phenomenon?
Yes
342
Which peripheral vasodilator has been shown to improve healing rate in venous ulcers?
Pentoxifylline oral
343
Which SLE skin manifestation typically has a lace-like appearance and brought on by cold?
Livedo reticularis
344
Which of the erythema is typically caused by heat exposure?
Erythema ab igne
345
Which eczema associated conditions in children is a medical emergency?
Eczema herpeticum
346
How is Eczema herpeticum treated?
IV antivirals (IV aciclovir)
347
What is the difference between hypertrichosis and hirsutism?
✓ Hirsutism (androgen-dependent hair growth in women)
✓ Hypertrichosis (androgen-independent hair growth)
348
Which of the eating disorders causes hypertrichosis?
Anorexia nervosa
349
Which of the facial dermatologic condition has no place for steroid use?
Acne rosacea
350
Is ongoing infection a common cause of non-healing leg ulcer?
No
351
What body sites are dermatitis herpetiformis lesions commonly seen?
✓ Knees
✓ Elbows
✓ Buttocks
352
What causes guttate Psoriasis?
Streptococcal upper respiratory tract infection
353
Which of the vascular birthmark do not spontaneously resolve?
Port wine stains
354
What type of hypersensitivity is allergic contact dermatitis?
Type IV
355
In what setting is allergic contact dermatitis usually typified?
On the head following hair dyes
356
What is the common precipitant of guttate Psoriasis?
Streptococcal infection
357
What is the the treatment for pityriasis rosae?
Self-limiting, resolves after around 6 weeks
358
Which cancer diagnosis should be considered in a patient with acanthosis nigricans?
Gastric cancer
359
What age is the peak incidence of vitiligo?
20-30 years
360
Which parts of the body are mostly affected in vitiligo?
The peripheries
361
What makes the treatment of scalp Psoriasis different from chronic plaque Psoriasis?
Treatment is with potent topical steroids (Topical betamethasone valerate)
362
What is the place of emollients in management of Psoriasis?
Reduce scale and pruritus only
363
What is the first line treatment for chronic plaque Psoriasis?
Potent corticosteroid + vitamin D analogue
364
What is the pathophysiologic cause of bullous pemphigoid?
Antibodies against hemidesmosomal proteins BP180 and BP230
365
What is the mainstay of treatment for lichen planus
Potent topical steroids
366
Which dermatologic condition has the classical dimple sign?
Dermatofibroma
367
What is the first line treatment for acne?
Topical retinoid or Benzoyl peroxide
368
A rapidly growing hand lesion in pregnancy is likely to be a?
Pyogenic granuloma
369
A mass with pearly, rolled edges suggest?
Basal cell carcinoma
370
Which basal cell carcinoma locations warrant an urgent referral?
Lesions around eyelid and nasal ala
371
What conditions make up sore throat?
✓ Pharyngitis
✓ Tonsillitis
✓ Laryngitis
372
What is the centor criteria value to warrant antibiotic use?
3 or more
373
What is the antibiotic of choice for sore throat?
Phenoxymethylpenicillin or Clarithromycin (if Penicillin allergy)
374
For how long should a sore throat requiring antibiotics be treated?
7 or 10 days
375
List three key question findings for otosclerosis?
✓ Family history
✓ Tinnitus
✓ Conductive hearing loss
376
What type of hearing loss does stickler syndrome cause?
Sensorineural hearing loss
377
What is the mode of inheritance for otosclerosis?
Autosomal dominant
378
What is the management for otosclerosis?
Hearing aid and Stapedectomy
379
Is geographic tongue benign?
Yes
380
Which sex has more glue ear?
Males
381
What is the commonest cause of conductive hearing loss in childhood?
Glue ear
382
How long is the wait period for a perforated eardrum to seal before ENT referral?
6-8 weeks
383
Which part of the ear does meniere's disease affect?
Inner ear
384
Does meniere's disease have a sex predilection?
No
385
What is the mnemonic for symptoms of meniere's disease?
Voice Note HAT
✓ Vertigo
✓ Nystagmus
✓ Hearing loss
✓ Aural fullness
✓ Tinnitus
386
One ear condition to inform DVLA?
Meniere's disease
387
What is the DVLA advice for meniere's disease?
Cease driving until symptoms satisfactorily controlled
388
What is the treatment for acute attacks of meniere's disease?
Buccal or intramuscular prochlorperazine
389
What is the medication for prevention of attacks of meniere's disease?
Betahistine
390
Cervical rib is commoner in which sex?
Females
391
What is the treatment of choice for acute Tonsillitis?
Phenoxymethylpenicillin
392
What is a feared complication of acute tonsillitis?
Peritonsillar abscess
393
Does corticosteroid have a place in the management of tonsillitis?
Yes, can reduce severity and duration of pain
394
Does nasal polyp have a sex predilection?
Yes, commoner in males
395
List two syndromes associated with nasal polyps?
✓ Churg-Strauss syndrome
✓ Kartagener's syndrome
396
What metabolic disorder is associated with nasal polyp?
Cystic fibrosis
397
What medication is known to cause nasal polyps?
Aspirin
398
What type of hearing loss does Otitis media cause?
Conductive hearing loss
399
Which ear condition is known to worsen during pregnancy?
Otosclerosis
400
Which cause of sensorineural hearing loss is usually age related?
Presbycusis
401
What is the pathophysiologic cause of otosclerosis?
Fixation of the stapes at the oval window
402
Can otosclerosis cause tinnitus?
Yes
403
What is the cut of day/duration for clinical decision making in suspected acute sinusitis?
10 days
404
What is the antibiotic of choice for acute sinusitis?
Phenoxymethylpenicillin
405
Which manoeuvre is for diagnosis of BPPV?
Dix-Hallpike manoeuvre
406
Vestibular rehabilitation (Brandt-Daroff exercises) is useful in which ear condition?
BPPV
407
What is the first line treatment for otitis externa?
Topical antibiotic or a combined topical antibiotic and steroid
408
Ear pain with a history of recent swimming suggests?
Otitis externa
409
Which dermatologic condition is usually associated with Otitis externa?
Seborrheic dermatitis
410
A cause of high-frequency hearing loss?
Presbycusis
411
Is presbycusis same as noise-related hearing loss?
No
412
What are the two classes of epistaxis?
✓ Anterior bleeds
✓ Posterior bleeds
413
How do you manage meniere's disease in the GP?
Refer for ENT assessment to confirm diagnosis
414
What is the management of secondary post-tonsillectomy small bleed?
Admit for ENT review and antibiotic therapy
415
How important is post-tonsillectomy hemorrhage?
Immediate ENT review
416
How best can malignant Otitis externa be called/described?
Osteomyelitis of the temporal bone
417
What investigation is indicated in malignant Otitis externa?
CT scan of the temporal bone
418
How is malignant Otitis externa treated?
IV antibiotics (prolonged course)
419
What is the indication for referral in Otitis externa?
Failure of topical antibiotic therapy
420
Is tinnitus same as ringing in the ear?
Yes
421
Acoustic neuroma is associated with which type of neurofibromatosis?
Type 2
422
What are the LANAQ drugs?!
Drugs that cause tinnitus
✓ Loop diuretics
✓ Aspirin
✓ NSAIDs
✓ Aminoglycosides
✓ Quinine
423
Can impacted ear wax cause tinnitus?
Yes
424
List medications that can cause gingival hyperplasia?
✓ Ciclosporin
✓ Phenytoin
✓ Calcium channel blockers
425
What is one drug cause of Hirsutism?
Phenytoin
426
Which of the hematological cancer usually causes gingival hyperplasia?
AML
427
What is the peak year of incidence for glue ear?
2 years
428
Which cranial nerves are affected by acoustic neuroma?
V, VII and VIII
429
Which medication is used by ENT surgeons in all cases of sudden onset sensorineural hearing loss?
High dose oral corticosteroids
430
Medical condition spread by contact with urine of rats and cattle?
Weil's disease (leptospirosis)
431
What organism causes Weil's disease?
Leptospira interrogans
432
In what condition is antimitochondrial antibodies seen?
Primary biliary cirrhosis
433
What is the first line treatment for migraine in children aged 12-17?
PCM/NSAID
434
Which medications usually used in migraine are avoided in adolescents?
✓ Metoclopramide
✓ Aspirin
435
ABO incompatibility is what type of hypersensitivity?
Type II
436
Rheumatoid arthritis is what type of hypersensitivity reaction?
Type III
437
Chronic asthma is what type of hypersensitivity reaction?
Type IV
438
Define delayed puberty in a male?
Testicular volume <4 ml after 14 years of age
439
What are the signs of puberty in a male?
✓ Reddening of scrotal skin
✓ Growth of the testes
✓ Growth spurt
440
What timeframe can Prednisolone improve chances of recovery in Bell's palsy?
Within 72 hours
441
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
442
In what condition affecting the major blood vessels should ACE inhibitors be avoided?
Aortic stenosis
443
Global ST and PR segment changes is seen in?
Pericarditis
444
Which of the thyroid hormone disorders is associated with pericarditis?
Hypothyroidism
445
What is the most specific ECG marker for pericarditis?
PR depression
446
Which investigation should all patients with suspected acute pericarditis have?
Transthoracic echocardiogram
447
What is the first line treatment for acute pericarditis?
Combination of NSAID and colchicine
448
Medication to be avoided in patients taking a selective serotonin reuptake inhibitors?
Triptans
449
Why should triptans be avoided in patients taking SSRI?
Increased risk of serotonin syndrome
450
Which antidepressants is safest in the setting of recent myocardial infarction?
Sertraline
451
Which antidepressant is used for children when indicated?
Fluoxetine
452
The most common side effects of SSRIs are of which body systems?
Gastrointestinal
453
What medication increases the risk of gastrointestinal bleeding when using SSRIs?
NSAIDs
454
Which of the SSRIs causes QT prolongation?
Citalopram and Escitalopram
455
Which of the antidepressants is preferred for patients on warfarin/heparin?
Mirtazapine
456
Which of the antidepressants poses the least risk in abrupt discontinuation?
Fluoxetine
457
Which of the antidepressants has a high incidence of discontinuation symptoms?
Paroxetine
458
What is the feared complication of using SSRIs in first trimester?
Risk of congenital heart defects
459
Which of the SSRIs has an increased risk of congenital malformations?
Paroxetine
460
What is the possible complication from using SSRIs in third trimester?
Persistent pulmonary hypertension of the newborn
461
Which antiplatelet is preferred for TIA and Ischaemic stroke?
Clopidogrel
462
What are the three antiplatelet medications that can be used for anticoagulation after Ischaemic stroke or TIA?
✓ Clopidogrel
✓ Aspirin
✓ Dipyridamole
463
What is the indication for carotid endarterectomy?
Stenosis greater than 70% or 50% (depending on criteria used)
464
How long after delivery should their be need for contraception?
After 21 days
465
Which emergency contraceptives can be used postpartum in a breastfeeding/non-breastfeeding woman?
Progesterone only EC (Levonelle and ellaOne)
466
What are the important timeframes for intrauterine device/system insertion postpartum?
Insert within first 48 hours or wait until after 4 weeks
467
How effective is lactational amenorrhea?
98% effective, provided use is perfect
✓ Exclusive (no supplement)
✓ Amenorrheic
✓ <6 months postpartum
468
How can COCP affect breastfeeding mothers?
It can reduce breast milk production
469
In the management of COPD, what is the next step after exhausting the usefulness of SABA/SAMA?
Assess for features suggesting steroid responsiveness
470
Is routine spirometric reversibility testing necessary in the diagnosis/assessment for therapy in COPD?
No
471
What are the inhaler options in the management of COPD after considering steroid responsiveness?
✓ LABA + LAMA (unresponsive)
✓ LABA + ICS (responsive)
472
In what circumstances should theophylline dose be reduced in the management of COPD?
Patient on macrolide or fluoroquinolone
473
What antibiotic is used commonly for prophylaxis in COPD patients?
Azithromycin
474
What are the precautions before starting COPD patients on Azithromycin antibiotic prophylaxis therapy?
✓ CT scan (exclude bronchiectasis)
✓ Sputum culture (exclude atypical infections/tuberculosis)
475
Peripheral edema, raised JVP, systolic parasternal heave, and loud P2 in a COPD patient suggests which complication?
Cor pulmonale
476
Which surgery is a part of treatment modalities for select COPD patients?
Lung volume reduction surgery
477
An example of an atypical antidepressant?
Mirtazapine
478
What is the mechanism of action of mirtazapine?
Blockage of alpha2-adrenergic receptors
479
Which antidepressant has beneficial effects on elderly patients?
Mirtazapine
✓ Appetite stimulant
✓ Sedation at small doses
480
The antidepressant with paradoxical dose effects on sleep?
Mirtazapine
481
What time of the day is mirtazapine preferably taken?
Evening (sedating)
482
What percentage of undescended testes is bilateral?
25%
483
Four complications of undescended testes?
✓ testicular cancer
✓ infertility
✓ torsion
✓ psychological
484
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)
485
In rhabdomyolysis, what elements are released/increased?
✓ Creatinine kinase
✓ Phosphate
✓ Myoglobin
486
Why is calcium low in rhabdomyolysis?
Myoglobin binds calcium
487
What class of drug is Venlafaxine?
SNRI
488
What medications are preferred for panic disorders?
SSRIs (Paroxetine)
489
Which sex has a higher prevalence for panic disorder?
Females
490
In DKA, how should insulin be administered?
✓ Correction insulin infusion (fixed rate)
✓ Regular long lasting insulin (continued as usual)
✓ **stop short acting insulin
491
Why is insulin infusion given at a fixed rate in DKA?
Because emphasis is on correction of ketone levels and not glucose levels
492
Acute DKA is caused by uncontrolled lysis of which food class?
Lipid (lipolysis)
493
What is the dose of insulin in acute DKA?
0.1unit/kg/hour
494
What rate of potassium correction requires cardiac monitoring?
> 20 mmol/hour
495
What are the criteria to say DKA is resolved?
✓ Blood ketone < 0.6 mmol/l
✓ pH > 7.3
✓ Bicarbonate > 15 mmol/l
496
What is the indication for endocrinologist review in the setting of DKA?
Ketonemia and acidosis not yet resolved within 24 hours
497
What is a feared complication of DKA management in children/young adults?
Cerebral edema (from fluid correction)
498
On what days of bronchiolitis infection does the infection get worse before improving?
Day 3-5
499
What is a red flag sign to necessitate immediate hospital referral in bronchiolitis?
Grunting respiration
500
What virus causes bronchiolitis?
Respiratory syncytial virus
501
Are antibiotics used in the treatment of bronchiolitis?
No, it's a viral infection
502
At what age is the peak incidence of bronchiolitis?
3-6 months
503
What is the most commonly injured ligament in inversion injuries of the ankle?
Anterior talofibular ligament
504
Which of the ankle ligaments functions to strengthen the medial longitudinal arch?
Calcaneonavicular ligament
505
Which is the weakest lateral ligament of the ankle?
Anterior talofibular ligament
506
Which ankle ligament is likely to be injured by direct blow or heavy object drop on the foot?
Lisfranc ligament
507
What is the antidote for dabigatran toxicity?
Idarucizumab
508
For how long should patients with provoked pulmonary embolism be treated/anticoagulated?
3 months
509
What defines provoked pulmonary embolism?
PE provoked by a temporary risk factor such as following a surgery
510
What is the first line treatment for PE?
DOACs (Apixaban and Rivaroxaban)
511
What is the choice of anticoagulant for suspected PE?
DOACs
512
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)
513
What is the minimum length of anticoagulation?
3 months
514
What is the choice of treatment for PE in the setting of hemodynamic instability?
Thrombolysis
515
What is the treatment option to consider for patients with repeat pulmonary embolisms?
IVC filter
516
What medication should be coprescribed for patients on strong opioids?
Laxative
517
What is the preferred opioid in mild to moderate renal impairment?
Oxycodone
518
What is the preferred opioid in severe renal impairment?
✓ Alfentanil
✓ Buprenorphine
✓ Fentanyl
519
List four agents that can be used in the treatment of metastatic bone pain?
✓ Opioids
✓ Bisphosphonates
✓ Radiotherapy
✓ Denosumab
520
Which of the opioid side effects tend to be transient?
✓ Nausea
✓ Drowsiness
521
Which of the opioid side effects tend to be persistent?
Constipation
522
Which childhood condition comes with a barking cough?
Croup
523
Which medication is a must for patients with croup?
Oral dexamethasone (Single dose of 0.15 mg/kg)
524
Which viruses are implicated the most in croup?
Parainfluenza viruses
525
In what condition is subglottic narrowing ('steeple sign') seen?
Croup
526
In what condition is 'thumb sign' seen?
Acute epiglottitis
527
What is the emergency treatment for croup?
✓ High flow oxygen
✓ Nebulised adrenaline
528
What is a key differentiating factor between adult BLS and pediatric BLS?
5 rescue breaths
529
On which artery is circulation assessed in infants?
Brachial/Femoral pulse
530
What are the usual exam features for primary hyperparathyroidism?
✓ Elderly woman with unquenchable thirst
✓ Inappropriately normal or raised parathyroid hormone level
531
What is the most common cause of primary hyperparathyroidism?
Solitary adenoma
532
What is the characteristic x-ray finding of hyperparathyroidism?
Pepperpot skull
533
What are the investigation findings in primary hyperparathyroidism?
✓ Raised calcium
✓ Low phosphate
✓ Raised or normal parathyroid hormone
534
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)
535
How does a raised INR relate to liver enzyme: inhibition/induction?
Inhibition
536
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
537
Does pregnancy preclude the use of beta2 agonists or inhaled corticosteroids for asthma?
No
538
Which of the eye conditions do flashes and floaters signify?
Vitreous/retinal detachment
539
Define transient monocular visual loss?
Sudden, transient loss of vision that lasts less than 24 hours
540
How is amaurosis fugax treated?
As TIA
Aspirin 300mg
541
What causes Ischaemic optic neuropathy?
Occlusion of the short posterior ciliary arteries
542
What are the usual causes of central retinal vein occlusion?
✓ Glaucoma
✓ Polycythemia
✓ Hypertension
543
Cherry red spot on a pale retina is a feature of?
Central retinal artery occlusion
544
What is the usual question features for idiopathic intracranial hypertension?
Young obese female with headaches, and finding of papilloedema with normal neurological findings
545
What is another name for idiopathic intracranial hypertension?
Pseudomotor cerebri
546
What medications are associated with pseudomotor cerebri?
✓ Lithium
✓ COCPs
✓ Tetracycline
✓ Vitamin A
✓ Steroids
547
Which nerve palsy may be seen in idiopathic intracranial hypertension?
6th nerve palsy
548
Which of the medications used in the management of idiopathic intracranial hypertension can be used to bring about weight loss too?
Topiramate
549
What is the management of idiopathic intracranial hypertension?
✓ Weight loss
✓ Diuretics
✓ Topiramate
✓ Surgery (optic nerve decompression)
550
The dermatologic condition caused by over exposure to infrared radiation is?
Erythema ab igne
551
What type of cancer does erythema ab igne predispose to?
Squamous cell cancer
552
What is the recommended salt intake in the UK?
Less than 6g/day
553
At what age should a blood pressure of greater than or equal to 135/85 warrant treatment?
<80 plus risk factors
554
In which orthopaedic condition causing back pain do patients find it easier to walk uphill rather than downhill?
Spinal stenosis
555
What is the treatment for lumbar spinal stenosis?
Laminectomy
556
What happens pathologically in Perthes disease?
Avascular necrosis of the femoral head
557
At what age is avascular necrosis commoner?
4-8 years of age
558
What is the physical characteristics for children with slipped upper femoral epiphysis?
Overweight or tall thin adolescents
559
What is the management of Perthes disease in patients less than 6 years?
Observation
560
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
561
What is the mechanism of action for levonorgestrel?
✓ Stop ovulation
✓ Prevent implantation
562
What dose of levonorgestrel should be used for patients with BMI >26 or weight over 70kg?
Double dose
563
How effective is levonorgestrel as emergency contraception?
84% if used within 72 hours
564
Can levonorgestrel be used more than once in a menstrual cycle?
Yes
565
How soon can hormonal contraception be started after using levonorgestrel for emergency contraception?
Immediately
566
What is the mechanism of action of ulipristal (EllaOne)?
Selective progesterone receptor modulator
567
How does ulipristal work?
Inhibition of ovulation
568
Is concomitant use of levonorgestrel with ulipristal recommended?
No
569
How soon after ulipristal use should hormonal contraception be used?
At least after 5 days
570
Can ulipristal be used more than once in a cycle?
Yes
571
How does emergency contraception use affect breastfeeding?
✓ Ulipristal (delay for one week before breastfeeding)
✓ Levonorgestrel (no affectation)
572
What is the most effective emergency contraception?
Copper IUD
573
How effective is copper IUD as emergency contraception?
99% effective
574
Is antibiotic coverage necessary when using copper IUD?
If the patient is considered to be at high risk of STI
575
Which shoulder pathology is characterized by a painful arc of abduction on examination between 90 and 120 degrees?
Subacromial impingement
576
What is another name for subacromial impingement?
Painful arc syndrome
577
What is the common cause of most styes?
Staphylococcus bacteria
578
A firm painless lump in the eyelid most likely represents?
A meibomian cyst (chalazion)
579
Another name for a chalazion is?
Meibomian cyst
580
What is the management of styes?
Hot compress and analgesia
581
In what cases will stye management require topical antibiotic use?
Associated conjunctivitis
582
What is the management of a chalazion?
Many resolve spontaneously, some require surgical drainage
583
What is the advice regarding breastfeeding in HIV positive patients in the UK?
Do not breastfeed
584
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
585
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
586
What is the recommendation regarding therapy for newborns of HIV positive mothers?
✓ Oral zidovudine (if viral load <50 copies/ml)
✓ Otherwise triple ART
587
How long is treatment for HIV exposed neonates?
4-6 weeks
588
Which STI produces strawberry cervix (erythematous cervix with punctate lesions)?
Trichomonas vaginalis
589
What are the key features of Trichomonas vaginalis infection?
✓ Offensive green/yellow discharge
✓ Strawberry cervix
590
Most useful diagnostic modality for ankylosing spondylitis?
Plain x-ray of sacroiliac joints
591
What investigation should be requested if ankylosing spondylitis is suspected and x-ray is not suggestive?
MRI
592
In what instances are the usual medications used for rheumatoid arthritis useful in managing ankylosing spondylitis?
Peripheral joint involvement
593
In what situations should a suspected TIA warrant imaging?
Patient on warfarin, a DOAC, or has a bleeding disorder
594
How long do TIA symptoms take to resolve?
Typically 1 hour
595
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)
596
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)
597
Which worm usually presents with itchy bottom worse at night?
Threadworm
598
What is the treatment for pinworm?
Mebendazole for patient and all household members (single dose)
599
At what age should a diagnosis of new iron-deficiency anaemia warrant urgent colorectal cancer pathway referral?
Age >= 60
600
What is the best timing for starting anticoagulation following a TIA or stroke?
✓ TIA (immediately once hemorrhage is excluded)
✓ Stroke (2 weeks later)
601
Is azathioprine used for management of acute flare of ulcerative colitis?
No, for maintenance treatment
602
Which of the IBD is treated with methotrexate?
Ulcerative colitis
603
Which condition has the M rule?
Primary biliary cholangitis
✓ IgM
✓ anti-mitochondrial antibodies
✓ Middle aged females
604
Test of cure cervical smear is performed when?
6 months after treatment
605
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
606
What is the management of bulimia nervosa?
Referral for specialist care
607
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
608
Which antibiotic is usually prescribed for COPD patients for prophylaxis?
Azithromycin
609
What is the reversal agent for dabigatran?
Idarucizumab
610
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
611
Which medication used in the treatment of rheumatoid arthritis show hypersensitivity similar to that with aspirin?
Sulfasalazine
612
Three medications with cross-sensitivity include?
✓ Aspirin
✓ Sulfasalazine
✓ Sulphonamides
613
What are the two key medications in management of angina?
✓ Beta blockers
✓ Nifedipine
614
What causes hyperacute kidney rejection?
Preexisting antibodies (such as ABO antibodies)
615
What is the most common type of organ transplant rejection?
Acute T-cell medicated rejection
616
What is the treatment for acute antibody-mediated rejection?
3-5 plasma exchange sessions daily
617
What is the treatment for Acute T-cell mediated rejection?
IV methylprednisolone
618
What chromosome codes HLA?
Chromosome 6
619
What type of hypersensitivity reaction is hyperacute graft rejection?
Type II hypersensitivity
620
Which of the graft rejection type has no remedial treatment?
Hyperacute rejection
621
How soon does hyperacute graft rejection occur?
Minutes to hours
622
What is the management for secondary dysmenorrhoea?
Refer to gynecology
623
What causes Ramsay Hunt syndrome?
Reactivation of the Varicella zoster virus in the geniculate ganglion of the seventh cranial nerve
624
What is the treatment for Ramsay Hunt syndrome?
Oral aciclovir and corticosteroids
625
Should asymptomatic bacteriuria in catheterised patients be treated?
No
626
What is the Nitrofurantoin dosing for UTI in pregnant women and men?
100 mg bd for 7 days
627
What are the indications for urine culture after suspected UTI in non-pregnant women?
✓ Age > 65 years
✓ Visible or non-visible haematuria
628
What is the difference in the management options for asymptomatic bacteriuria in pregnant women and catheterised patients?
Treat the former, but not the later
629
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
630
When is synchronized cardioversion indicated?
Ventricular tachycardia with adverse features
631
What are the adverse features in peri-arrest rhythms?
✓ Shock
✓ Syncope
✓ Myocardial ischaemia
✓ Heart failure
632
Maximum number of shocks in DC cardioversion for peri-arrest rhythms with adverse features?
3 (after that seek expert help)
633
What is the first line treatment for regular narrow complex tachycardia?
Vagal manoeuvre (before IV Adenosine)
634
What is the first line treatment for chronic heart failure?
ACE-inhibitor and beta-blocker
635
What is the second line treatment (add-on) drug in chronic heart failure?
Aldosterone antagonist (Spironolactone)
636
Which test must be done prior to commencing Azathioprine treatment?
Check thiopurine methyltransferase deficiency (TPMT)
637
What is the function of thiopurine methyltransferase?
Metabolizes thiopurine medications such as azathioprine and mercaptopurine
638
Is azathioprine safe in pregnancy?
Yes
639
What should you do to the dose of azathioprine if it has to be used with allopurinol?
Reduce it's dose
640
Which medications can exacerbate plaque Psoriasis?
✓ Beta blockers
✓ Antimalarials
✓ Lithium
✓ NSAIDs
641
Which infection can trigger guttate psoriasis?
Streptococcal infection
642
Factors that can cause psoriasis exacerbation?
✓ Trauma
✓ Alcohol
✓ medications
✓ withdrawal of systemic steroids
643
Is hand preference in an infant (before 12 months) normal?
No. Could be an indicator of cerebral palsy
644
At what point should unsmiling children be referred?
10 weeks
645
What is the maximum time a child can be allowed to sit supported?
12 months
646
At what age is a child expected to start sharing toys?
3 years
647
What medications are used in ER+ve breast cancer?
✓ Tamoxifen
✓ Anastrozole
648
What is the patient characteristics for tamoxifen and anastrozole therapy in ER+ve breast cancer?
✓ Pre or peri-menopausal (Tamoxifen)
✓ Postmenopausal (Anastrozole)
649
How does radiotherapy help in the management of patients with breast cancer?
May reduce the risk of recurrence by around two-thirds
650
What is a contraindication for Trastuzumab?
Patients with a history of heart disorders
651
Which breast cancer patients benefit from Trastuzumab?
HER2 positive cancers
652
How many sample confirmation of azoospermia is necessary before patient is safe to have intercourse without protection?
2×
653
Which is a more effective method of sterilisation, male or female?
Male
654
What is the failure rate of male sterilisation?
1 per 2,000
655
What is the success rate of vasectomy reversal?
✓ 55% within 10 years
✓ 25% after 10 years
656
Which two tests must adult patients with suspected asthma have?
✓ FeNO test
✓ Spirometry with a bronchodilator reversibility test
657
What features differentiates scarlet fever from Kawasaki disease?
✓ Lip is spared of rash
✓ No conjunctivitis
✓ Evidence of URTI such as purulent tonsils
658
In what condition is phenoxymethylpenicillin indicated?
Scarlet fever
659
What is a feared complication of Kawasaki disease?
Coronary artery aneurysm
660
How is Kawasaki disease diagnosed?
Clinically
661
What is the treatment of Kawasaki disease?
✓ Aspirin
✓ Intravenous immunoglobulin
662
How does hyperthyroidism affect the bones?
Increases osteoclast activity leading to osteoporosis
663
Which mechanism explains most complications seen in thyroid disorders?
Metabolism
664
After what time should thyroid hormone levels be checked after dose adjustments?
After 8-12 weeks
665
What is the therapeutic goal in managing thyroid hormone levels?
Normalisation of TSH levels
666
Which medications can interact with levothyroxine if given within 4 hours?
Iron, calcium carbonate
667
Apart from antibiotics, risk factors for C. difficile infection include?
Proton pump inhibitors
668
What differentiates C. difficile infection from exposure?
✓ C difficile infection (C difficile toxin)
✓ C difficile exposure (antigen)
669
What is the drug of choice for C difficile infection?
Vancomycin
670
What is the second line therapy for C difficile infection or recurrent episode (within 12 weeks)?
Fidaxomicin
671
What is the treatment for local anaesthetic toxicity?
IV 20% lipid emulsion
672
What is the advantage of combining adrenaline to some local anaesthetic agents?
It allows use of increased doses of the local anaesthetic agent
673
What is the colour coding for the inhalers?
✓ Blue inhaler (SABA)
✓ Brown inhaler (ICS)
674
How much dose reduction is ok with inhaled steroids at a time as per asthma management?
25-50 %
675
What is the hematological management of acute limb ischemia?
IV heparin
676
How long after treatment for pneumonia should a patient have repeat chest X-ray?
6 weeks after clinical resolution
677
What is the first line medication for community acquired pneumonia?
Amoxicillin
678
A 2 year old boy with a three day history of vomiting and profuse watery diarrhoea is most likely a diagnosis of?
Rotavirus infection
679
40 year old overweight alcoholic woman presenting with upper abdominal pain worse after eating and radiating through to her back is suggestive of?
Pancreatitis
680
Another name for herpes simplex keratitis?
Dendritic ulcer
681
Features of dendritic ulcer (herpes simplex keratitis)?
✓ Watery eyes
✓ Pain
✓ Redness
✓ Blurring of vision
682
Which medication should be used for nasal blockage secondary to allergy between Xylometazoline and Beclomethasone?
Beclomethasone (steroid)
683
What class of drug is Xylometazoline?
Decongestant/antihistamine
684
Which of the alopecia types is common following chemotherapy?
Anagen effluvium
685
What are the vaccine recommendations for patients with heart failure?
✓ Annual influenza vaccine
✓ One-off Pneumococcal vaccine
686
What is a strong indication for use of digoxin in heart failure?
Coexisting atrial fibrillation
687
What saturation indicates oxygen prescription?
Saturation < 94%
688
What necessitates careful consideration with respect to using nitrate in ACS?
Hypotension
689
What is the QRS duration cut off for narrow complex tachycardia and broad complex tachycardia?
120ms
690
What is the treatment of choice for Torsades de Pointes?
Magnesium sulfate
691
Describe the ECG features in Torsades de Pointes?
✓ Polymorphic ventricular tachycardia
✓ prolonged QTc interval
692
In the setting of PE, in what condition is V/Q scan preferred to CTPA?
If there is renal impairment
693
In the management of hypertension what determines addition of Spironolactone or beta-blocker?
Potassium levels
694
Which patients should receive one shock followed by two minutes of CPR?
Unwitnessed patients in VF/pulseless VT
695
Which of the peri-arrest rhythms requires IV adrenaline?
✓ Pulseless electrical activity
✓ Asystole
696
What are the adverse features in arrhythmias that change management?
✓ Syncope
✓ Myocardial ischaemia
✓ Heart failure
✓ Shock
697
Another name for defibrillation?
Unsynchronized cardioversion
698
What is the preferred diagnostic modality for suspected aortic dissection?
CT angiography chest/abdomen/pelvis
699
Describe the usefulness of the different investigations for suspected aortic dissection?
✓ CT angiography (1st choice if stable)
✓ Transoesophageal echocardiogram (1st choice if unstable)
700
What are the two types of classification schemes for aortic dissection?
✓ Stanford
✓ DeBakey
701
What are the management options for the different types of aortic dissection?
✓ Type A (surgical management)
✓ Type B (conservative)
702
What distinguishes type A aortic dissection from type B aortic dissection?
Type A (ascending aorta)
Type B (descending aorta)
