OTHER SHITE Flashcards
Which generation of antibiotics are used for meningitis? Give an example?
3rd generation cephalosporins.
Ceftriaxone.
What is another condition that causes meningism symptoms?
Subarachnoid haemorrhage.
How does TB appear on microbiology?
Caseating granulomas.
What is secondary prevention?
Aimed to stop progression of disease and manage symptoms.
What are four classes of antidepressants?
SSRIs, SNRIs, TCAs, MAOIs.
What are five risk factors for suicidal ideation?
Alcohol abuse, depression, anxiety, trauma, previous suicide attempt.
What is the mechanism of action of methotrexate?
Dihydrofolate reductase inhibitor.
What has to be taken alongside methotrexate in pregnant women?
Folic acid supplements - folate deficiency in the first trimester is teratogenic.
How does calcium gluconate work in the treatment of hyperkalaemia?
Protects the myocardium by reducing the excitability of myocardial cells.
What is the most common STI in the UK?
Chlamydia.
What is common in nephritic syndrome but not nephrotic syndrome?
Haematuria.
What does hyperventilation cause?
Respiratory alkalosis.
What is a feature of life threatening asthma in children?
Confusion.
What is used to treat sickle cell and how?
Hydroxyurea/hydroxycarbamide - Increases levels of HbF.
What are four things that make a UTI complicated?
Male, comorbidities, structural abnormalities, pregnant.
What are the XRAY features of RA?
LOSE:
-Loss of joint space.
-Osteopenia.
-Soft tissue swelling, soft bones.
-Erosions.
What is found on blood film for haemolytic anaemia?
Schistocytes.
-Broken RBCs.
What are the sympathetic and parasympathetic neurotransmitters in the skin?
Both ACh.
What is the difference between essential and resting tremors?
What causes them?
Essential - Worse on movement.
Resting - Worse at rest.
-Essential = BET.
-Resting = Parkinson’s.
What is the difference between the treatment of myasthenia gravis and Alzheimer’s disease?
Both acetylcholinesterase inhibitors:
-MG = Pyridostigmine/neostigmine.
-Alzheimer’s = Rivastigmine and donepezil.
What is the most common cause osteomyelitis in patients with sickle cell anaemia?
Salmonella.
What is the most common bladder cancer in patients with Schistomiasis?
Squamous cell carcinoma.
Which artery supplies Wernicke’s area?
Inferior middle cerebral artery.
Does PKD cause berry aneurysms?
Recessive - Doesn’t cause berry aneurysms.
Dominant - DOES.
What is the first line investigation of GCA?
ESR.
What type of memory loss presents in Alzheimer’s disease?
Short term memory loss, not long term.
What is the swiss cheese model?
Describes when each slice is a level of defence passed and many need to be passed to lead up to patient safety incident.
When is legionella suspected and how is it treated?
Severe CAP and exotic travel (Spain).
-Clarythromycin.
What are the two main bacteria involved in exacerbations of COPD?
H. influenzae (mc) and S. pneumoniae.
What is H. influenzae cultured on and why?
Chocolate agar as it is fastidious.
What is the most common skin infection?
Cellulitis of the lower leg.
-Calor, rubor, dolor, tumour, loss of function.
What are the most common causes of cellulitis?
Group A beta-haemolytic strep (S. pyogenes) and S. aureus.
What is the antibiotic treatment of cellulitis?
S. pyogenes/S. aureus - Flucloxacillin (benzylpenicillin if pyogenes).
MRSA - Vancomycin.
What murmur is heard is aortic stenosis?
Ejection systolic high pitched crescendo decrescendo murmur.
What murmur is heard in aortic regurgitation?
Early diastolic soft blowing murmur.
What murmur is heard in mitral stenosis?
Mid diastolic low-pitched murmur.
What murmur is heard in mitral regurgitation?
Pan-systolic high pitched whistling murmur.
What is a way to remember heart murmurs?
ARMS - Diastolic
ASMR - Systolic
-AR = Early, MS = Mid.
-AS = Ejectoon, MR = Pan.
What are the criteria of nephritic and nephrotic syndrome?
NephrItic:
-Haematuria, oliguria, proteinuria, fluid retention.
NephrOtic:
-Peripheral oedema, hypercholesterolaemia, hypoalbuminaemia, proteinuria.
Which artery plays an important role in erectile dysfunction?
Inferior pudendal artery.
What is secreted from the kidneys in response to fluid loss/hypovolaemia?
Renin.
What signifies severe aortic stenosis?
Low volume slow rising pulse.
What is the most common dermatological manifestation of IBD?
Erythema nodosum.
How does PTH affect phosphate?
Decreased reabsorption in the kidney - increased excretion.
What is Turner’s syndrome and what can it cause?
X chromosome only (not two) - Primary amenorrhoea (high FSH and LH).
How does salbutamol work?
Relaxation of bronchial smooth muscle cells.
What is a side effect of tamsulosin?
Dizziness due to dilation of venous capacitance vessels.
What is a history feature of non-eosinophilic asthma?
History of smoking.
What is the mechanism of action of ipratropium bromide?
Muscarinic acetylcholine receptor antagonist - bronchodilator.
What is the definition of bronchiectasis?
Permanent dilation of bronchi and bronchioles.
What does TLR4 do?
Senses liposaccharide on membrane of gram negative bacteria.
What do TLR5 do?
Senses flagellin (component of flagella).
Describe the serology of RA.
Anti-CCP = Specific.
RF = Sensitive.
What does Sjogren’s syndrome increase the risk of?
Non-Hodgkin lymphoma.
What is Felty syndrome?
Very rare extra-articular manifestation of RA:
-Splenomegaly, anaemia, neutropenia and thrombocytopenia.
What is a cardiac extraarticular manifestation of RA?
Pericarditis.
Describe legionella.
Gram negative bacteria.
How does cholera cause symptoms?
Cholera toxin deregulated ion transport in epithelial cells.
What enables leprosy to evade phagocytosis?
Mycolic acid.
Describe what is seen on gram film of meningococcal meningitis?
Gram negative diplococcus.
What type of respiratory disease is tuberculosis?
Restrictive.
How does Horner’s syndrome present?
Droopy eyelid, constricted pupil and lack of sweat on left side of face.
What causes Horner’s syndrome?
Pancoast syndrome - apex of lung.
Which type of lung cancer is most likely to be caused by smoking?
Squamous cell cancer.
How does sarcoidosis appear on XRAY?
Bilateral hilar lymphadenopathy.
What is polypharmacy?
Concurrent use of multiple medications by one individual.
What is concordance?
When the prescriber and patient enter a partnership concerning the use of medications.
What are five things you need to ask a new mother at a postnatal check?
1) Mental health and wellbeing.
2) Vaginal discharge and periods.
3) Blood pressure.
4) Exam if C section or scars.
5) Sex, contraception and family planning.
What are the benefits of breastfeeding for the baby?
Protection against infection, D+V, SIDS, obesity, CVD.
What are the benefits of breastfeeding for the mother?
Reduces cancer risk, T2DM, hypertension, osteoporosis, obesity and CVD.
When is a baby’s weight a cause for concern?
When it crosses the percentile lines.
Which vaccines are given to babies at 8 weeks?
-6 in 1 (Diptheria, hepB, polio, tetanus, whooping cough).
-Rotavirus 1.
-MenB1.
Which vaccines are given to babies at 12 weeks?
6in1 - booster 2.
PCV.
Rotavirus 2.
Which vaccines are given to babies at 16 weeks?
6in1 - booster 3.
MenB2.
What does the newborn heel prick test for?
5 days old:
-Sickle cell, CF, congenital hypothyroidism.
-6 inherited metabolic diseases.
What is herd immunity?
Protection of vulnerable people when enough of the people are immune thus preventing disease from spending.
What are the two depression identification questions?
-During the last month - feeling down, hopeless or depressed?
-During the last month - little interest or taking no pleasure in doing things?
When are post natal baby checks?
6-8 weeks.
What is a blood test for anaphylaxis?
Serum mast cell tryptase.
In order to induce anaesthesia quickly what characteristics should the drug have in terms of its protein binding and lipid solubility?
Low protein binding - increase in free circulating drug.
Lipid soluble - can cross BBB easily.
Give and example of competitive and non-competitive inhibitors?
Non-competitive - cyanide.
Competitive - methotrexate.
What is the treatment of hyperkalaemia depending on ECG?
Changes - calcium gluconate.
No change - Insulin and dextrose.
What is Cushing’s reflex? How does it occur?
Raised ICP - Bradycardia, wide PP and irregular breathing.
-Brainstem ischaemia.
What is PT/INR?
Coagulation speed through extrinsic pathway.
Normal = 0.8-1.2.
10-13.5s.
What is APTT?
Coagulation speed through intrinsic pathway.
35-45s.
What is the treatment for hypocalcaemia?
Calcium gluconate.
Describe the murmur of HCM.
Ejection systolic crescendo decrescendo.
-Increased intensity with activity.
-Disappears on squatting.
During atrial fibrillation, what stops the ventricles from beating very fast?
Annulus fibrosus and AV node.
What is seen on blood film for multiple myeloma?
Rouleaux formations.
What does normal PT and abnormal APTT mean?
Haemophilia A, B and Von Willebrand disease.
What are the electrolyte abnormalities in tumour lysis syndrome?
Hypocalcaemia, hyperphosphatemia, hyperuricemia, hyperkalaemia.
What is seen on bloods in DIC?
Decreased fibrinogen, decreased platelets and elevated D-dimer.
How does C. diff spread?
Spores via faeco-oral route.
-These are resistant to heat and chemicals.
What is the vitelline duct?
Embryonic structure in the ileum, if it remains it forms Meckel’s diverticulum.
Which portion of the GI tract is more likely to perforate in a bowel obstruction?
Caecum as it has the thinnest wall.
Describe Barrett’s oesophagus.
Metaplasia from stratified squamous to simple columnar.
What best reflects synthetic liver function?
Prothrombin time (PT) and serum albumin.
What is the difference between Marfan’s and ED?
Marfan’s - decreased connective tissue.
ED - Impaired synthesis of type 2 collagen.
How is prostatitis and prostate cancer differentiated?
Prostate cancer tends to not be tender.
Name four things that can raise PSA in men.
Ejaculation, exercise, DRE and UTIs.
Why is levodopa used instead of dopamine in Parkinson’s disease?
Can cross BBB when dopamine can’t.
Describe the microbiology of meningitis.
S. pnuemoniae - Gram positive diplococci.
N. meningitidis - Gram negative diplococci.
Does a cauda equina lesion cause UMN signs?
No.
Why does COPD causing hypoxia cause polycythaemia?
As there is low oxygen levels, RBC production increases to counteract the effects to increase oxygen levels.
What is co-amoxiclav made of?
Amoxicillin and clavulanic acid:
-Clavulanic acid = Beta-lactamase inhibitor which increases the effectiveness of amoxcillin.
What are four features of tension pneumothorax?
-Reduced air entry.
-Tracheal deviation away from affected sides.
-Decreased tactile and vocal fremitus.
What is the most common valve disorder?
Aortic stenosis.
What are the lateral heart leads?
I, aVL, V5, V6.
What are the inferior heart leads?
II, III, aVF.
What are the anterior heart leads?
V3, V4.
What are the septal heart leads?
V1, V2.
Describe the serology seen in granulomatosis with polyangitis?
cANCA in 90%.
pANCA in 25%.
Which bacteria most commonly causes COPD exacerbations?
H. influenzae.
Which cancers cause lung metastases?
CRESP:
-Choriocarcinoma (uterus).
-Renal cell carcinoma.
-Endometrial carcinoma.
-Synovial sarcoma.
-Prostate carcinoma.
What is seen on blood film for TTP?
Schistocytes.
What is the management of G6PD deficiency?
Avoid precipitants.
Describe the step by step management of DKA?
- IV fluids.
- Insulin.
- K+ replacement.
- Identify and treat illnesses.
What is the most common cause of Cushing’s syndrome?
Long term high dose exogenous glucocorticoid use.
When someone with Addison’s disease is ill or has a fever what has to be done?
Double dosage of steroids.
Which condition is associated with gallstones?
Crohn’s disease.
What is the first line management of paracetamol overdose?
IV acetylcysteine.
What is the most common causative organism of ascending cholangitis?
E. coli.
What are the most common nephrotic syndromes in children and adults?
Children - Minimal change disease.
Adults - Focal segmental glomerulosclerosis.
Which hormone do seminomas secrete?
hCG.
Which dietary changes do people with renal failure need to do?
Low protein, phosphate, sodium and potassium.
What are six risk factors for pseudogout?
Hyperparathyroidism, hypothyroidism, haemochromatosis.
Hyperphosphatasemia, hypomagnesaemia, hypercalcaemia.
What are the side effects of alendronate?
Oesophageal reaction:
-Ulcers, erosions, strictures.
Describe the blood findings of Paget’s disease.
Raised ALP, normal phosphate, normal calcium, normal vitamin D.
How do extradural haematomas present?
Lucid intervals - a temporary improvement in patient’s condition following injury accompanied by deterioration of condition after.
How do subarachnoid hemorrhages present?
Thunderclap headache, meningism (photophobia, neck stiffness).
What is the prophylaxis for cluster headaches?
Verapamil.
What is Uhthoff’s phenomenon?
Transient worsening of neurological symptoms related to a demyelinating disorder such as MS when the body becomes overheated in hot weather, exercise, fever, saunas or hot tubs.
Which TB antibiotic causes gout?
Pyrazinamide.
What is incidence?
Number of new cases of disease in a population over a specified period of time.
What is prevalence?
The frequency of a disease in a population at a particular point in time.
How is GCA treated when affecting vision?
Urgent IV methylprednisolone.
Describe the stages of the transtheoretical model of change.
1) Precontemplation.
2) Contemplation.
3) Preparation.
4) Action.
5) Maintainance.
6) Relapse.
Describe the four stages of COPD.
Stage 1 (early) - FEV1>80%.
Stage 2 (moderate) - FEV1<80%.
Stage 3 (Severe) - FEV1<50%.
Stage 4 (Very severe) - FEV1<30%.
When is menopause considered early?
Earlier than 45.
Describe focal seizures of the frontal vs temporal lobes.
Frontal - Motor features ( Jacksonian March).
Temporal - Memory phenomena (deja vu), smell and taste hallucinations.
Describe the bloods of Wilson’s disease.
High urine copper assay.
Low serum copper.
Low serum ceruloplasmin.
What is a never event?
A serious, largely avoidable patient safety event which shouldn’t occur if preventative measures have been implemented.
Describe the stages of hypertension.
Stage 1 >140/90 or ABPM >135/85.
Stage 2 >160/100 or ABPM >150/95.
Stage 3 >180 systolic or >120 diastolic.
What is the white coat effect?
Discrepency of more than 20/10mmHg between clinic and ABPM.
What are the vitamin K dependent clotting factors?
10, 9, 7, 2.
Give an example of an alpha blocker.
Phenoxybenzamine.
Describe the characteristics of Neisseria Gonorrhoea?
Gram negative diplococci.
What is the mechanism of beta-lactam antibiotics?
Inhibit transpeptidation reactions needed to cross-link peptidoglycans in the cell wall.
Describe how to inform the DVLA for TIAs and seizures.
TIA - No driving for 1 month, don’t notify DVLA.
Multiple TIAs - No driving for 1 month, notify DVLA.
Seizure - Inform DVLA, no driving for 6 months.
Describe the creatinine rise in AKI.
More than 26mmol/L within 48 hours.
What is a feature of UC and not Crohn’s?
Pseudo-polyps.
Which electrolyte abnormality does Conn’s syndrome cause?
Hypokalaemia.
What is the treatment of chlamydia?
-Doxycycline 100mg BD (twice daily).
-Azithromycin 1g PO single dose then 500mg PO OD for 2 days if CI (pregnancy/breastfeeding).
-Amoxicillin 500mg thrice daily for 7 days.
How do sulphonylureas, SGLT2 inhibitors and DPP4 inhibitors work?
-Sulphonylureas - Lower blood glucose by stimulating insulin secretion.
-SGLT2 - Block reabsorption of glucose in kidneys.
-DPP4 - Prevent insulin from being destroyed.
Is aspirin used in gout?
No, usually ibuprofen.
When should a DEXA scan be offered?
-To those without FRAX score in people over 50 with previous fragility fracture.
-People under 40 with a major risk factor.
When can confidentiality be broken?
Risk to public safety.
Given consent.
Required by law.
How does De Quervain’s thyroiditis present and how is it treated?
Hyperthyroidism with painful asymmetrical lump.
Self limiting so usually supportive (analgesia and anti-inflammatories).
Describe the differences between an occlusion of the anterior and middle cerebral arteries.
Anterior - Contralateral hemiparesis/sensory loss, lower limbs more than upper.
Middle - Contralateral hemiparesis/sensory loss. upper limbs affected more than lower. WITH forehead sparing, dysphasia.
Describe the differences of symptoms of right and left sided heart failure.
Right - Ascites, peripheral oedema, anorexia, nausea.
Left - Poor exercise tolerance, nocturia, cold fingers, SOB.
Describe the differences between metabolic acidosis with and without compensation.
Metabolic acidosis (pH <7.35) without compensation is caused by a low level of HCO3, with normal PaCO2 levels (i.e, without compensation). If there was compensation, PaCO2 levels would be low.
Where is the fibrosis in the lungs in idiopathic pulmonary fibrosis?
Lower zone fibrosis.
What causes barrel chest and hyperinflated lungs?
Emphysema.
Describe the CHAD2DS2-VASC score and how is it calculated?
Calculated risk of stroke in patients with AF:
-1 point - CHF, HTN, 65-74, DM, vascular disease, female.
-2 point - 75+, previous stroke/TIA/VTE.
What is the most specific marker for acute liver failure and why?
ALT as AST is also present in other organs whereas ALT is almost exclusive to the liver.
What is the biggest risk factor for aortic dissection?
Hypertension.
Describe the blood scores of haemophilia.
Normal PT, prolonged APTT, normal INR.
What is the typical presentation of hemorrhoids?
Itching and irritation of the anal region.
What is another name for the storage LUTS?
Irritative symptoms.
What is the treatment for unstable angina?
GTN spray with CCB or BB.
What are three extra-articular manifestations of AS?
Anterior uveitis, autoimmune bowel disease, amyloidosis.
Describe Schober’s test.
Locate L5 vertebrae, mark 10cm above and 5cm below.
-Bend over as much as possible.
-Positive is less than 20cm.
Describe three features of AS on XRAY.
Bamboo spine, square vertebral bodies, subchondral sclerosis.
What are three features of good asthma control?
No night time symptoms, inhaler used no more than 3 times per week, normal lung function test.
Describe goblet cells in Crohn’s and UC.
Crohn’s - Increase.
UC - Decrease.
What scoring system is used to determine the risk of stroke after TIA?
ABCD2.
Describe how to calculate ABCD2 score.
A - Age (>60).
B - BP >140/90.
C - Clinical features (speech disturbance without weakness1 or unilateral weakness2).
D - Duration (10-59m is 1, >60m is 2).
D - Diabetes (1 point).
In IE, why is the tricuspid valve affected more?
It’s the first valve in contact with venous return.
Which LFT is linked with alcohol use the most?
Gamma-GT (GGT).
Which benzodiazepine is used manage alcohol withdrawal?
Chlordiazepoxide.
What are two dietary restrictions of HF patients?
Fluid restriction and reduced salt intake.
Describe the management of HF.
1st - ACEi and Bb.
2nd - Spironolactone.
3rd - Furosemide.
Which blood test abnormality does methotrexate cause?
Thrombocytopenia, anaemia, leukopenia (due to bone marrow suppression).
When there is dark brown urine after a fall, what does this indicate?
Rhabdomyolysis.
