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Phase 3 > OSCE questions > Flashcards

OSCE questions Flashcards

1
Q

What colour would you expect ascitic fluid to be? and if there was infection what colour would you expect?

A

Clear/ Straw coloured for ascites

Cloudy for SBP

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2
Q

What does the WWC have to be over for diagnosis of SBP?

A

> 250 Microliters

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3
Q

What must the SAAG be in order for an exudate to be diagnosed?

A

<11g/L or 1.1g/dL

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4
Q

Name some causes of Transudate for ascites:

A

Cirrhosis
Bud chari syndrome
Extreme malnutrition
Alcohol hepatitis

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5
Q

Name some causes of exudate for ascites:

A

Malignancy
Infection
Inflammatory
pancreatitis

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6
Q

What biochemical results would you expect to see in bacterial meningitis?

A

High neutrophil count >100 cells per microliter
High protein >50mg/dL
Low glucose <40% serum

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7
Q

What biochemical results would you expect to see in viral meningitis and what pathogens are commonly attributed to the condition?

A

High Lymphocyte count >50-1000 cells
High protein >50mg/dL
Normal glucose

Enterovirus 
HSV2 
VZV
HIV 
Mumps
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8
Q

What is the biochemical finding seen in the CSF following a subarachnoid bleed, and how long till it shows?

A

Xanthochromia

12 hours

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9
Q

What is your immediate management of a subarachnoid bleed?

A

Fluid resuscitation
Ted X stockings
Nimodipine
Analgesia

Neurosurgical:

  • clipping
  • coils
  • stenting
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10
Q

What are the radiological findings of O/A and RA

A

O/A:

  • reduced joint space
  • Subchondral sclerosis
  • Osteophytes
  • subchondral cyst

RA:

  • reduced joint space
  • Joint erosion
  • osteoporosis
  • soft tissue swelling
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11
Q

Surgical intervention for acute critical limb ischemia:

A

angioplasty/ stenting
surgical by- pass
- femoral popliteal bypass
- aorto- iliac bypass

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12
Q

What is the long term management of someone with limb ischemia?

A

Aspirin
Anti-hypertensives - avoiding Beta blockers
Statins
Fibrates

Lifestyle changes:

  • smoking
  • diabetes control
  • activity levels
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13
Q

What are the treatment options for RA?

A

First line:
NSAIDs

Bridging:
- steroids

2nd Line:
DMARDs

Biological agents:

  • Infliximab
  • Tocilizumab
  • Rituximab
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14
Q

what are the antibodies screened for in MG?

A

ACh receptor auto-antibodies
muscle specific kinase receptor antibodies
low density lipoprotein receptor related antibodies

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15
Q

What is the treatment of MG?

A

Pyridostigmine
Immunosuppressive
rituximab
thyectomy

if there is a MG crisis:

  • ventilation
  • immunoglobulins
  • Plasma exchange - filtration
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16
Q

What is the biggest risk factor for a stroke?

A

Hypertension

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17
Q

What is the immediate treatment following a stroke?

A

Admission to stroke unit.
- Alteplase - within 4.5 hours of stroke
+
Aspirin

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18
Q

what is the subsequent treatment of stroke?

A

2 weeks aspirin 300mg

then switch to:
Clopidogrel 
\+ 
Simvastatin 
\+ 
anti HTN 
\+ 
Life style changes 
- stop smoking 
\+ 
Physiotherapy
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19
Q

What are the different types of stroke a person can have?

A

TACS:
- contra - lateral hemiparesis

  • contra-lateral homonymous hemianopia
  • Higher cerebral dysfunction

PACS:
- 2/3 or higher dysfunction

PCS:

  • Cranial nerve palsy
  • Pupil disorders
  • Cerebellar dysfunction
  • isolated homonymous hemianopia

Lacunar:

  • pure sensory
  • pure motor
  • ataxia hemiparesis
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20
Q

What are the main types of MS:

A

Relapsing remitting
Secondary progressive
Primary Progressive

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21
Q

Name Some symptoms of MS:

A 
Weakness 
Optic neuritis
Scanning speech 
clumsiness 
Painful shocks  
bowel/ bladder dysfunction 
depression 
fatigue

Uhthoff’s phenomenon
- worse after hot shower

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22
Q

Diagnostic criteria for MS and investigations:

A

> 2 attacks of demyelination disseminated by time and space

MRI - t2 weighted

LP - Oligoclonal IgG bands

Visual Evoked Responses

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23
Q

Treatment of MS:

A

Relapse:
- Methylprednisolone
+
- PPI

1st line:

  • Interferon beta
  • glatiramer acetate

2nd line:

  • Fingolimod
  • natalizumab
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24
Q

What is the pathological feature behind migraines?

A

Trigeminovascular system

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25
Q

Management of migraines:

A

Avoid triggers

High dose Aspirin

Triptans

Anti-emetics

Prophylaxis

  • propranolol
  • amitriptyline
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26
Q

Name some causes of cushing’s syndrome:

A

Cushing’s disease - adenoma in the pituitary gland

Adrenal adenoma

Iatrogenic

Paraneoplastic effect
- small cell

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27
Q

What are the diagnostic tests for cushing’s?

A
  1. late night cortisol salivary sample.
  2. Dexamethasone suppression test:

first low dose of 1mg
- no effect if cushing syndrome

this then leads onto the second dose which is:
High dose of 8mg.
- if cushing’s disease it will suppress CRH and ACTH reducing cortisol

  • if adenoma will reduce ACTH but not cortisol
  • if paraneoplastic neither will be reduced.
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28
Q

What is the treatment of cushing’s syndrome?

A

Removal of tumour:

  • transsphenoidal approach
  • removal of adrenal
  • cancer removal

Ketoconazole can also be used

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29
Q

What diagnostic tests can be done to diagnosis Pheochromocytoma?

and how is it treated?

A

24 hour adrenaline measurement

plasma free metadrenalines

Urinary analysis of:

  • adrenaline
  • Metaadrenaline
  • Metanoradrenaline

Treatment:
Alpha blockers
Beta blockers
Removal of tumour - adrenalectomy

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30
Q

What is the treatment of hyperthyroidism?

A

1st line:
Carbimazole
- prevents thyroperoxidase
Block and replace or titrate

2nd line:
Propylthiouracil
- blocks 5’ iodinase

beta blockers
- propranolol - non cardioselective

Thyroid storm:

  • beta blockers
  • antiarrhythmic drugs
  • fluid resuscitation
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31
Q

What treatments are available for acromegaly?

A

Transsphenoidal removal of tumour

Dopamine agonists
- bromocriptine

somatostatin agonists
- octreotide

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32
Q

What investigations should be done into adrenal insufficiency?

A

Diagnostic:
- Short synacthen test

Blood osmolality
- hyponatremia

Hyperkalemia

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33
Q

What is the treatment of adrenal insufficiency?

A

Hydrocortisone
- start when even suspected.

Fludrocortisone

Emergency ID tag
Steroid card

Addisonian Crisis:

  • IV hydrocortisone
  • IV fluids
  • Glucose
  • Electrolyte management
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34
Q

What are the two major causes of hyperaldosteronism, and how can they be biochemically differentiated?

and what is the management?

A

Primary:
- adenoma

Secondary:
- renal artery stenosis

Primary:
- low renin, high aldosteronism

Secondary:
- High renin, high aldosteronism

Management:

  • Spironolactone
  • Eplerenone

Surgery

  • removal of tumour
  • angioplasty of tumour
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35
Q

List some sign of peritonitis:

A

Guarding
Absent bowel sounds
Pyrexial
Extreme tenderness

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36
Q

Name some causes of abdominal distention:

A

Ascites
Constipation
Fat
Pregnancy

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37
Q

Name some causes of hepatomegaly:

A 
Alcoholic liver disease 
Fatty liver disease 
Right sided heart failure 
Hepatocellular carcinoma 
Lymphoma 
Leukemia
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38
Q

Name some causes of splenomegaly:

A

Haematological disorders:

  • leukemia
  • Myeloproliferative disorders
  • haemolytic anaemias

Infections:

  • mononucleosis
  • TB

Portal Hypertension

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39
Q

Name some causes that will cause a drastic rise in the ALT and AST:

A

Hep A
Hep E
Toxins
Ischemia

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40
Q

List some symptoms of aortic stenosis, and what pulse would you expect to feel?

A

Breathlessness
Syncope/ presyncope
angina
dizziness

Narrow Pulse pressure
Low volume
slow rising

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41
Q

List some causes of finger clubbing:

A 
Carcinoma of the bronchus 
Interstitial lung disease 
fibrosing alveolitis 
cyanotic congenital heart 
infective endocarditis 
IBD - ulcerative colitis 
idiopathic 
familial 
Liver cirrhosis
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42
Q

Name the dermatomal patterns of the upper limb at distal ends:

A 
C4 - top shoulder 
C5 - regimental area 
C6 - tip of thumb 
C7 - middle finger 
C8 - little finger 
T1 - inside of forearm
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43
Q

What stain can be used for haemochromatosis of the liver?

A

Prussian blue

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44
Q

How is Hep B managed?

A

Interferon alpha

Nucleotide analogues

Fibroscan

Lifestyle advice

  • stop smoking
  • stop drinking
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45
Q

What is a useful biochemical marker for assessing if someone has had an upper G.I bleed?

A

Urea

- rising rapidly

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46
Q

What scoring system can be used to establish whether someone has had an upper G.I bleed? and what does it include?
and what scoring system is used once endoscopy has been done to determine likely hood of survival and rebleed?

A

Glasgow Blatchford Score:

  • Hb
  • rise in urea
  • drop in blood pressure
  • HR
  • melena
  • Syncope

Rockall score

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47
Q

What investigations would you want to do when considering DKA?

A 
Plasma glucose 
ABG 
Plasma Ketones 
Urinalysis 
- ketones 
- glucose 
U&amp;Es
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48
Q

What is your initial treatment of DKA?

A 
Fluids 
Insulin 
Glucose 
K+ 
Bicarb 
treat underlying infection
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49
Q

Orthopedically if someone presents with a shorten externally rotated limb, what is the pathology?

A

Broken Hip

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50
Q

Following an infection, how long does Gullia Barre syndrome take to present, what investigations can be done and what is the medical management?

A

~4 weeks post infection

Diagnosis is Brighton’s criteria

  • bilateral flaccid weakness
  • loss of reflexes
  • LP studies

EMG studies
LP - raised protein

Treatment:

  • IV immunoglobulins
  • Plasma exchange
  • Supportive care - ventilation
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51
Q

What are the symptoms of coeliac disease? and what antibodies tested for in coeliac disease?

A 
Diarrhea 
failure to thrive 
Fatigue 
Weight loss 
Mouth Ulcer 
Anaemia 
Dermatitis Herpetiformis

tTG
Endomysial Antibodies
Anti - Deamidated gliadin peptide antibodies
- endoscopy biopsy

Treatment:
- Gluten free diet

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52
Q

What symptoms would you expect to see with leukaemia and what investigations would you carry out?

A 
Fatigue 
Fever 
Anaemia 
Night sweats 
Bruising - petechiae 
Purpuric Rash 
Abnormal bleeding - epistaxis, bleeding gums
Gum hypertrophy 
recurrent infections 
Abdominal pain - hepatosplenomegaly 
Lymphadenopathy 
Headaches - if CNS involvement 
FBC 
Blood film 
LDH 
Bone marrow aspirate 
LP - if CNS involvement
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53
Q

What is the defective gene in CML and how is it treated?

A

BCR ABL - 9:22 chromosome.

Imatinib

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54
Q

What tests could you order in suspected inflammatory arthritis?

A

Rh factor
Anti CCP
HLA B27 testing
ESR levels

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55
Q

What are the symptoms of Multiple Myeloma?

A

Bone Pain

Hypercalcemia symptoms - mood, stomach pain, Kidney Stones

Renal dysfunction
- bence jones protein

Anamia

Infections

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56
Q

What investigations should be ordered in suspected myeloma? and how is the diagnosis made?

A

Urine electrophoresis - bence jones proteins
Serum free light chain assay
Serum Immunoglobulins
Serum electrophoresis

Bone marrow biopsy

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57
Q

What is the treatment for Hodgkin’s lymphoma?

A

Doxorubicin
Bleomycin
Vinblastine
Dacarbazine

(ABVD)

58
Q

What is the diagnostic criteria for nephrotic syndrome?

and what investigations would you want to order?

A

> 3.5g protein loss
<30g of albumin serum
oedema

Pro-coagulable
hyperlipidaemia

Investigations:

  • urine analysis
  • protein- creatinine ratio
  • U&Es
  • FBC
  • Serology
  • Imaging
59
Q

What nephritic syndrome occurs weeks after the infection?

A

Post strep glomerulonephritis

60
Q

Common Drug interaction to be aware off:

A

Metformin and Cimetindine

Warfarin and Aspirin

ACE inh and Metaformin

ACE and K+ sparing diuretics

Gentamicin and Loop diuretics

Statins and Macrolides

Thiazides and PPIs

61
Q

What abnormality is being looked for in cervical screening? What is used to analyse the smear and what is the next step if there is an abnormality seen?

A

Dyskaryosis
- koilocytes

Colposcopy - with 5% acetic acid

62
Q

What is the margins for melanoma removal?

A 
<1mm= 1cm margin 
>1mm = 2cm margin
63
Q

Name a specific chemotherapy agent used for melanomas:

A

Vemurafenib

64
Q

What investigations would one want to do for suspected endocarditis? and what Antibiotic regimen for infective endocarditis:

A

Echocardigram
3 sets of blood cultures
CRP and FBC

Native valve:

  • flucloxacillin
  • gentamicin
  • amoxicillin
  • 4 weeks

Prosthetic:

  • vancomycin
  • gentamicin
  • 5 weeks

Viridans:

  • Benzylpenicillin
  • Gentamicin
65
Q

What is your long term management following an M.I?

A 
Beta Blockers 
Aspirin 
Statins 
ACE inhib 
Ticagrelor 
\+/- 
Eplerenone (diabetics and Heart failure)

Lifestyle changes - smoking

66
Q

Management of NSTEMI?

A

Aspirin
Heparin
Clopidogrel

67
Q

Investigations and treatment of meningitis:

A

CT if signs of:

  • raised ICP
  • neurological deficits
  • Papilloedema
  • seizure
  • over 60

Lumbar Puncture.
Blood cultures
Throat swaps

S.Pneumonia

  • Ceftriaxone - 10-14 days
  • dexamethasone - 4 days

N. Meningitidis:

  • ceftriaxone - 7 days
  • dexamethasone - 4 days
Listeria monocytogenes 
- Ceftriaxone - 21 days 
\+ 
Amoxicillin - 21 days 
\+ 
Dexamethasone

Ciprofloxacin to family and friends `

68
Q

Management of heart failure:

A 
Beta blockers + ACE inhib 
\+
Mineralocorticoid 
\+ 
Sacubitril and Valsartan
\+
ICD or Ivabradine 
\+ 
Digoxin
69
Q

What is an important investigation into heart failure?

A

Presence of natriuretic peptides

70
Q

List some features of severe and life threatening asthma:

A 
Severe:
PEF - 33-50% 
tachy >110
Tachy >25 
inability to complete sentences 
Life threatening:
PEF <33% 
Stats 92% 
silent chest 
reduced GCS 
Normal PaCO2 
arrhythmia
71
Q

Management of asthma attack:

A

Oxygen - >94%
Nebulised: salbutamol and Ipratropium
Steroids - prednisolone
+/- antibiotics

IV magnesium
+
Senior help

ICU
+
IV salbutamol

72
Q

What investigations would be done into a women presenting with postmenopausal bleeding?

A

FBC - establish anaemia
Trans-vaginal ultrasound
Biopsy of endometrium

*postmenopausal bleeding is endometrial cancer until proven otherwise.

73
Q

What is needed when checking a prescription:

A 
Name, DOB of patient and address.
Black Ink 
Capital letters 
Drug, dose and instructions 
No short hand for micrograms, units or nano-litres
Minimum dosing interval 
Signature of doctor 
GMC No. 
Address of practice

Check for:
- unnecessary decimals (3mg vs 3.0mg)

74
Q

List some AIDS defining illnesses:

A 
Kaposi Sarcoma 
Pneumocystis Jiroveci Pneumonia 
Burkitt's lymphoma 
TB 
Candidiasis of esophagus
75
Q

How is AIDS monitored?

and how is AIDs treated?

A

CD4 levels
Viral Load

HAART - high active antiretroviral treatment
Prophylaxis cotrimoxazole - PCP
Frequent Cervical smears

76
Q

What investigations are carried out for TB?

A

Culture stains with Ziehl Neelsen staining

Mantoux test / PDD test

77
Q

What can be put into place when an adult is seen to lack capacity?

A 
Adults with Incapacity Act 2000 
- benefit of the adult 
- minimum intervention 
- present past wishes 
Consultation with adult
78
Q

What can be used to address the use of contraceptives in children under the age of 16?

A

Fraser guidelines

79
Q

What are the DVLA restrictions around certain diseases:

A

Diabetes:
car: inform
Lorry: banned until checked

Seizure:
car: 6 months
Lorry: 5 years

Stroke:
Car: 1 month
Lorry: 1 year

M.I
Car: 1 week
Lorry: 6 weeks

Hypoglycaemic:
>1 episode in 12 months. Must notify DVLA

80
Q

How long does endoscopy take and what are the complications?

A

~10mins. Allow 2 hours mins. Day procedure - go home after 30mins

Complications:

  • sedation
  • bleeding
  • sore throat
  • damage to crown or teeth
  • aspirate pneumonia
  • perforation
81
Q

What are the typical pathogens associated with CAP Pneumonia?

A

S. Pneumonia
H. Influenza
Moraxella Catarrhalis

Atypicals:
Legionella Pneumophila
Mycoplasma Pneumonia
Chlamydia Psittaci

82
Q

What are HAP pathogens?

A

S. Aureus
E. Coli
Pseudomonas

83
Q

Outline CURB65 and name the antibiotics given:

A 
Confusion 
Urea >7 
Respiratory >30 
Blood pressure <90
65 years old

CURB <2 = PO amoxicillin
CURB >3 = IV Clarithromycin + IV co-amoxiclav

84
Q

Outline your management of exacerbation of COPD:

A 
Cultures 
Chest x-ray 
ABG 
FBC 
CRP

Treatment:

  • oxygen - 88-92%
  • Nebulised salbutamol
  • Antibiotics - amoxicillin (+IV + clarithromycin)
  • Low dose steroids
85
Q

What would your typical investigations be for COPD in a non- exacerbation setting?

A

Spirometry

  • reversibility - 15% change/ <400ml of change
  • FEV1/ FVC ratio <0.7

Chest x-ray

Sputum

FBC - polycythemia?

86
Q

What investigations would you do when asthma is suspected?

A

PEAK Flow
Histamine Provocation test - >20% drop
Scratch test

87
Q

What factors may exacerbate Myasthenia gravis?

A

Gentamicin, opiates, Beta blockers

88
Q

What laboratory investigations would you want to do in someone presenting with abdominal pain?

A

**consider Pregnancy test
FBC
CRP
Amylase

89
Q

In diarrhea what investigations would you like to complete?

A

Stool cultures
faecal calprotectin
C. Diff toxins

consider sigmoidoscopy

90
Q

List four organisms that cause bloody diarrhea:

A

E. Coli 0157
Campylobacter
Shigella
Salmonella

91
Q

Name some causes of diarrhea that won’t cause bloody stool:

A

Cholera
Enterotoxigenic E. Coli
Viral infection - norovirus
Enterotoxins of Staph aureus

92
Q

In a patient with non-mechanical causes of back pain, what investigations would you want to consider?

A

Imaging - MRI
Calcium levels
ALP
Anti - CCP and Rh factor

93
Q

Name an aromatase inhibitor:

A

Letrozole

94
Q

Name a Oestrogen receptor blocker used in breast cancer and what may it cause?

A

Tamoxifen

endometrial hyperplasia - increasing risk of endometrial cancer

95
Q

How would you manage a patient with an STI?

A 
Accurate diagnosis 
Treat disease and prevent complications 
Bring back to test for cure 
Advise to contract partners 
Screen for other STIs 
Education on safe sex
96
Q

What is the investigation for gonorrhea and what is the treatment?

A

Nucleic acid amplification test - NAAT

  • throat and genitals
  • mid flow sample
  • swap (females)

Ceftriaxone
+
Azithromycin
- to cover for chlamydia as well

97
Q

What is the organism that causes syphilis, name some complications of it and what is the treatment?

A

Treponema Pallidum

CNS
Cardiovascular
VIsual

Dark Field Microscopy for diagnosis

Treatment:
- Penicillin injection

98
Q

What is the most common type of renal cancer? and where is a common spread of this too?
and how does it present?

A

Renal Cell carcinoma

Cannon ball metastasis to the lungs

Haematuria - frank 
Hydrocele 
flank pain 
palpable mass
fever
99
Q

Most common cause of bladder cancer? and name a surgical management of it:

A

Transitional

transurethral resection of bladder tumour (TURBT)

100
Q

What are the investigations into prostate cancer?

What are the management options for prostate cancer?

A

Rectal Examination
PSA levels
Transrectal ultrasound guided biopsy

Watch and weight 
Radiotherapy - directly to the prostate 
LHRH antagonist 
Anti - androgens 
orchiectomy
101
Q

What antibodies are involved in Hashimoto’s disease?

and what are the causes of hypothyroidism?

A

Anti - thyroperoxidase
Anti - perioxidase antibodies

Autoimmune 
Thyroiditis  
Severe Iodine deficiency
thyroidectomy 
Drug induced - amiodarone
102
Q

List some common side effects of Anti TB drugs:

A

Rifapamcin - red tears
Isoniazide - hepatitis
Pyramide - Hepatits
ethambutol - Optic neuritis

103
Q

Name some gait types:

A

Antalgic gait - painful gait

Apraxic gait - unable to lift legs

Ataxic gait - uncoordinated, wide base

Spastic gait - restricted knee movement

Myopathic - waddling, belly leaning out

104
Q

What is it called when you can see free gas either side of the bowel, allowing both walls of the bowel to be seen?

A

Riglers sign

105
Q

What is thumb printing on the bowel suggestive off?

A

Inflammation - oedema.

106
Q

How does a caecal and sigmoidal volvulus present radiographically?

A

Caecal - Embryo sign

Sigmoidal - Coffee bean

107
Q

What investigation do you want to carry out in the evidence of an Upper G.I bleed?
and what is your management?

A 
FBC - anaemia 
U &amp; Es - urea for upper G.I bleed 
Cross Match / Group and Save 
ABG - lactate 
LFTs 
Erect chest x-ray 
ABCDE approach 
- fluid resuscitation
- Blood transfusion <7 urea 
- Oxygen 
- Assess risk (Glasgow Blatchford) 
- endoscopy - banding, clipping, adrenaline, haemostatic powders 
\+
Terlipressin 
\+ 
Tazocin

**stop NSAIDS & Anticoagulants

108
Q

What is the definition of AKI? what is your initial investigations and what is your management?

A

Decline of renal excretory function over hours to days recognised by an increase in creatinine and urea.

Stage 1: 1.5 - 2 x base line
Stage 2: 2 - 3 x base line
Stage 3: >3 x base line

Investigations:

  • urinalysis - blood, nitrites, protein: creatinine ratio
  • ultrasound of kidneys
  • U&Es
  • ECG - tall T waves and wide QRS complex
  • Immunocomplex screen

Management:

  • stop ACE and NSAIDs
  • IV fluids
  • Removal of obstruction
  • treatment of infection
  • Manage hyperkalemia: Calcium gluconate, Salbutamol, IV Insulin, calcium resonate

*consider Renal replacement therapy

109
Q

What investigation would you carry out for a suspected UTI/ Pyelonephritis and what is your management?

A

Urinalysis - nitrates, blood, glucose, wwc
Urine cultures - midstream - send in specific container
FBC - white cells
CRP
U & Es

Management:

  • don’t treat unless symptomatic
  • nitrofurantoin/ trimethoprim - men and non- pregnant women
  • removal of catheter
  • ciprofloxacin - upper UTI in men and non - pregnant women
  • gentamicin - signs of sepsis

*pregnant women and children always treated even if asymptomatic

110
Q

What is indications for renal replacement therapy?

A

Refractory Hyperkalemia >6.5
Refractory Pulmonary oedema
Refractory acidosis
encephalopathy - uraemia

111
Q

What test is done to establish diagnosis of Diabetes insipidus?
and what is your treatment?

A

water deprivation test - 8 hours.
followed by synthetic ADH - urine measure for osmolality

Desmopressin

112
Q

Management of CKD:

A 
Control blood pressure - ACE inhibitors recommended
Darbepoetin - synthetic EPO  
Phosphate binders 
Vit D supplements 
Bisphosphonates 
Renal replacement
113
Q

In a patient with suspected rhabdomyolysis, what is your investigations and management?

A

Creatine Kinase
U&Es - AKI
ECG - Hyperkalemia
urinalysis

management:
IV fluids
Mannitol

114
Q

What are the types of dialysis present?

A 
Haemodialysis 
Continuous ambulatory peritoneal dialysis 
Automated Dialysis 
- weight gain
- bacterial peritonitis 
- abdominal sclerosis
115
Q

What is Q - SOFA:

Define Septic Shock:

A

<15 GCS
>22 breaths
<100mmHg

2/3 for positive

Persistent low blood pressure (MAP <65) with a lactate >18mg/dL despite adequate vasopressors

116
Q

When is pyelonephritis actually diagnosed?

A

Fever + Bacteriuria
or
Loin Pain + Bacteriuria

117
Q

What antibodies are associated with hyperthyroidism Grave’s disease? and what can be some triggers for it?

A

TSH receptor antibodies
Anti - perioxidase antibodies

pregnancy
amiodarone

HLA DR3 - type 1 DM, celiac disease, Autoimmune hep

118
Q

In parkinson’s disease what investigations do you want to order and what is the treatment options?

A

DAT- SPECT MRI Scan

Bloods - copper, thyroid (rule out)
MRI - rule out vascular

Treatment:

  • L-Dopa
  • dopamine agonists - pramipexole/ bromicide
  • MAO - Inhibitors
  • Decarboxylase inhibitor

Deep brain stimulation

119
Q

What is the investigations into a sinister looking mole?

and what is the most common mutation?

A

Dermoscopy

Biopsy - ideally removal of the entire mole in doing so.

Sentinel node biopsy

BRAF

120
Q

How would you differentiate between Acute Cholecystitis and Ascending cholangitis?
How do you diagnosis this?

A

Acute cholecystitis:

  • RUQ pain
  • Fever
  • Leukocytosis

Investigation:

  • LFTs
  • US of gallbladder
NIL by mouth
Fluids 
Analgesia 
\+/- Antibiotics 
Elective cholecystectomy

Ascending Cholangitis:

  • RUQ pain
  • Fever
  • Jaundice
  • Rigors

Investigations:

  • FBC - infection
  • LFTs
  • MRCP
  • ERCP

Management:

  • Sepsis 6 management
  • ERCP to clear the CBD
121
Q

What are your investigations when someone presents with suspected gallstones, cholecystitis or cholangitis?

A

LFTs
Ultrasound

MRCP

ERCP - indicated if obstruction in the common bile duct

122
Q

What are your investigations and management of acute pancreatitis?

A 
Amylase (3x normal is diagnostic) 
CT Scan 
Ultrasound of Gallbladder for stones 
MRCP 
ERCP - when able

Modified Glasgow Score - predicting severity. >3 suggests ICU intervention

Management: 
- IV fluid 
- Analgesics 
- Anti - emetics 
- Urinary output - measure organ dysfunction 
- organ Support 
\+/- Antibiotics

48 hours start eating

Further Management:

  • ERCP
  • Cholecystectomy
  • Alcohol removal
123
Q

What investigations do you want to do in suspected appendicitis?

A

Pregnancy test

Ultrasound

FBC - WWC

CT Scan

124
Q

What is your investigation and management of SJS and TEN?

A

Investigations:

  • Skin biopsy
  • U & Es - assess hypovolemia
  • ABG - mucosal involvement
  • Blood cultures - assess for infection

Management:
Remove causing agent/ Drug

IV fluids
- measure fluid output

Ophthalmology examination

Admit to ITU for burns

Protective dressings/ Bedding

Prophylactic antibiotics

IV immunoglobulins

125
Q

What is your management of psoriasis?

A

Patient advice - not infectious etc

1st Line: 
Emolients 
Vitamin D analogue 
Tar 
Corticosteroids

2nd Line:
Narrow Band UVB
Retinoid cream
Methotrexate

Severe:
Ciclosporin
PUVA
Ustekinumab

126
Q

List some drugs that cause postural hypotension:

A 
Ca2+ blockers 
ACE inhibitor 
Nitrates (sildenafil) 
Alpha -1 blockers 
Tricyclics 
Antipsychotics
Beta blockers
127
Q

What sign can be conducted to assess for SJS and TEN?

A

Nikolsky’s sign - exfoliation of the epidermis on gentle rubbing

128
Q

Medication that can cause a fall:

A

Diabetic medication - hypoglycemia
Postural hypotension medication
Benzodiazepines - lowered GCS

129
Q

What investigations would be useful to do when a patient has had a fall?

A 
Standing/ sitting blood pressure 
ECG - arrhythmias
Echo - valvular disease 
Blood glucose 
CT head - neuro
130
Q

What further investigations would you want to do into someone presenting with hypertension?

A 
ECG 
Lipid profile 
Renin: Aldosteronism 
U &amp; Es 
Uroanalisis - end organ damage
131
Q

What investigations would you want to do in hypothyroidism?

A

Thyroid function tests
Anti peroxidase/ thyroglobulin antibodies
Glucose levels - associated type 1 DM

132
Q

Investigations into hyperthyroidism?

A

TFTs
Auto antibodies
Ultrasound
ECG

133
Q

What investigations would you want to carry out on someone with anaemia?

A 
FBC 
Blood film 
TIBC 
Ferritin levels 
MVC 
Reticulocyte count 
ECG
134
Q

How do you manage AF?

A

Rate control - 1st Line: atenolol, verapamil 2nd Line: Digoxin
**HF only atenolol and Digoxin

Rhythm control - Flecainide Amiodarone
*Amiodarone only for HF

Anti-coagulation - >48 hrs consider 6 weeks course of anti - coagulation

135
Q

What scoring system is used to assess whether someone needs to be anti-coagulated?

A

CHAD2DS2VASc score

136
Q

How does LVH appear on ECG?

A

S in V1 + R in V6 = >35mm / 7 large squares

R in aVL = >11mm

137
Q

If FBC and Blood film have been done for anaemia, what other investigations would you want to consider?

A

B12
Folate
Ferritin levels
U & Es

138
Q

What additional assessments can be done into depression? and what is your management?

A

MMS
Thyroid levels
FBC

**always assess risk

Management:

  • SSRIs - Citalopram, fluoxetine
  • Counseling
  • CBT
  • review 2 weeks
139
Q

What investigations would you want to order in someone with palpitations?

A 
ECG 
TFTs 
CXR 
U &amp; Es - for electrolyte imbalances 
Troponins - if chest pain
140
Q

What are some risk factors for melanoma?

A 
Previous skin cancer 
Sun burn 
Previous lived abroad 
Immunosuppression
>5 atypical Naevi  
Family history 
Parkinson's disease
141
Q

What is the strongest predictor of the outcome of melanoma?

A

Breslow’s thickness

142
Q

What further investigations should be offered following a skin examination?

A

Dermoscopy
Skin biopsy - diagnostic excision of lesion for melanomas
Skin Scrapings

Phase 3 (50 decks)

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