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Phase 2a > OTHER SHITE > Flashcards

OTHER SHITE Flashcards

1
Q

Which generation of antibiotics are used for meningitis? Give an example?

A

3rd generation cephalosporins.
Ceftriaxone.

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2
Q

What is another condition that causes meningism symptoms?

A

Subarachnoid haemorrhage.

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3
Q

How does TB appear on microbiology?

A

Caseating granulomas.

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4
Q

What is secondary prevention?

A

Aimed to stop progression of disease and manage symptoms.

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5
Q

What are four classes of antidepressants?

A

SSRIs, SNRIs, TCAs, MAOIs.

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6
Q

What are five risk factors for suicidal ideation?

A

Alcohol abuse, depression, anxiety, trauma, previous suicide attempt.

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7
Q

What is the mechanism of action of methotrexate?

A

Dihydrofolate reductase inhibitor.

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8
Q

What has to be taken alongside methotrexate in pregnant women?

A

Folic acid supplements - folate deficiency in the first trimester is teratogenic.

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9
Q

How does calcium gluconate work in the treatment of hyperkalaemia?

A

Protects the myocardium by reducing the excitability of myocardial cells.

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10
Q

What is the most common STI in the UK?

A

Chlamydia.

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11
Q

What is common in nephritic syndrome but not nephrotic syndrome?

A

Haematuria.

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12
Q

What does hyperventilation cause?

A

Respiratory alkalosis.

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13
Q

What is a feature of life threatening asthma in children?

A

Confusion.

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14
Q

What is used to treat sickle cell and how?

A

Hydroxyurea/hydroxycarbamide - Increases levels of HbF.

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15
Q

What are four things that make a UTI complicated?

A

Male, comorbidities, structural abnormalities, pregnant.

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16
Q

What are the XRAY features of RA?

A

LOSE:

-Loss of joint space.
-Osteopenia.
-Soft tissue swelling, soft bones.
-Erosions.

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17
Q

What is found on blood film for haemolytic anaemia?

A

Schistocytes.
-Broken RBCs.

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18
Q

What are the sympathetic and parasympathetic neurotransmitters in the skin?

A

Both ACh.

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19
Q

What is the difference between essential and resting tremors?
What causes them?

A

Essential - Worse on movement.
Resting - Worse at rest.

-Essential = BET.
-Resting = Parkinson’s.

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20
Q

What is the difference between the treatment of myasthenia gravis and Alzheimer’s disease?

A

Both acetylcholinesterase inhibitors:

-MG = Pyridostigmine/neostigmine.
-Alzheimer’s = Rivastigmine and donepezil.

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21
Q

What is the most common cause osteomyelitis in patients with sickle cell anaemia?

A

Salmonella.

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22
Q

What is the most common bladder cancer in patients with Schistomiasis?

A

Squamous cell carcinoma.

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23
Q

Which artery supplies Wernicke’s area?

A

Inferior middle cerebral artery.

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24
Q

Does PKD cause berry aneurysms?

A

Recessive - Doesn’t cause berry aneurysms.
Dominant - DOES.

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25
Q

What is the first line investigation of GCA?

A

ESR.

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26
Q

What type of memory loss presents in Alzheimer’s disease?

A

Short term memory loss, not long term.

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27
Q

What is the swiss cheese model?

A

Describes when each slice is a level of defence passed and many need to be passed to lead up to patient safety incident.

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28
Q

When is legionella suspected and how is it treated?

A

Severe CAP and exotic travel (Spain).
-Clarythromycin.

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29
Q

What are the two main bacteria involved in exacerbations of COPD?

A

H. influenzae (mc) and S. pneumoniae.

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30
Q

What is H. influenzae cultured on and why?

A

Chocolate agar as it is fastidious.

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31
Q

What is the most common skin infection?

A

Cellulitis of the lower leg.
-Calor, rubor, dolor, tumour, loss of function.

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32
Q

What are the most common causes of cellulitis?

A

Group A beta-haemolytic strep (S. pyogenes) and S. aureus.

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33
Q

What is the antibiotic treatment of cellulitis?

A

S. pyogenes/S. aureus - Flucloxacillin (benzylpenicillin if pyogenes).
MRSA - Vancomycin.

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34
Q

What murmur is heard is aortic stenosis?

A

Ejection systolic high pitched crescendo decrescendo murmur.

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35
Q

What murmur is heard in aortic regurgitation?

A

Early diastolic soft blowing murmur.

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36
Q

What murmur is heard in mitral stenosis?

A

Mid diastolic low-pitched murmur.

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37
Q

What murmur is heard in mitral regurgitation?

A

Pan-systolic high pitched whistling murmur.

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38
Q

What is a way to remember heart murmurs?

A

ARMS - Diastolic
ASMR - Systolic

-AR = Early, MS = Mid.
-AS = Ejectoon, MR = Pan.

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39
Q

What are the criteria of nephritic and nephrotic syndrome?

A

NephrItic:
-Haematuria, oliguria, proteinuria, fluid retention.

NephrOtic:
-Peripheral oedema, hypercholesterolaemia, hypoalbuminaemia, proteinuria.

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40
Q

Which artery plays an important role in erectile dysfunction?

A

Inferior pudendal artery.

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41
Q

What is secreted from the kidneys in response to fluid loss/hypovolaemia?

A

Renin.

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42
Q

What signifies severe aortic stenosis?

A

Low volume slow rising pulse.

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43
Q

What is the most common dermatological manifestation of IBD?

A

Erythema nodosum.

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44
Q

How does PTH affect phosphate?

A

Decreased reabsorption in the kidney - increased excretion.

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45
Q

What is Turner’s syndrome and what can it cause?

A

X chromosome only (not two) - Primary amenorrhoea (high FSH and LH).

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46
Q

How does salbutamol work?

A

Relaxation of bronchial smooth muscle cells.

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47
Q

What is a side effect of tamsulosin?

A

Dizziness due to dilation of venous capacitance vessels.

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48
Q

What is a history feature of non-eosinophilic asthma?

A

History of smoking.

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49
Q

What is the mechanism of action of ipratropium bromide?

A

Muscarinic acetylcholine receptor antagonist - bronchodilator.

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50
Q

What is the definition of bronchiectasis?

A

Permanent dilation of bronchi and bronchioles.

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51
Q

What does TLR4 do?

A

Senses liposaccharide on membrane of gram negative bacteria.

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52
Q

What do TLR5 do?

A

Senses flagellin (component of flagella).

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53
Q

Describe the serology of RA.

A

Anti-CCP = Specific.
RF = Sensitive.

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54
Q

What does Sjogren’s syndrome increase the risk of?

A

Non-Hodgkin lymphoma.

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55
Q

What is Felty syndrome?

A

Very rare extra-articular manifestation of RA:
-Splenomegaly, anaemia, neutropenia and thrombocytopenia.

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56
Q

What is a cardiac extraarticular manifestation of RA?

A

Pericarditis.

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57
Q

Describe legionella.

A

Gram negative bacteria.

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58
Q

How does cholera cause symptoms?

A

Cholera toxin deregulated ion transport in epithelial cells.

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59
Q

What enables leprosy to evade phagocytosis?

A

Mycolic acid.

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60
Q

Describe what is seen on gram film of meningococcal meningitis?

A

Gram negative diplococcus.

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61
Q

What type of respiratory disease is tuberculosis?

A

Restrictive.

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62
Q

How does Horner’s syndrome present?

A

Droopy eyelid, constricted pupil and lack of sweat on left side of face.

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63
Q

What causes Horner’s syndrome?

A

Pancoast syndrome - apex of lung.

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64
Q

Which type of lung cancer is most likely to be caused by smoking?

A

Squamous cell cancer.

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65
Q

How does sarcoidosis appear on XRAY?

A

Bilateral hilar lymphadenopathy.

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66
Q

What is polypharmacy?

A

Concurrent use of multiple medications by one individual.

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67
Q

What is concordance?

A

When the prescriber and patient enter a partnership concerning the use of medications.

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68
Q

What are five things you need to ask a new mother at a postnatal check?

A

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.

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69
Q

What are the benefits of breastfeeding for the baby?

A

Protection against infection, D+V, SIDS, obesity, CVD.

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70
Q

What are the benefits of breastfeeding for the mother?

A

Reduces cancer risk, T2DM, hypertension, osteoporosis, obesity and CVD.

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71
Q

When is a baby’s weight a cause for concern?

A

When it crosses the percentile lines.

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72
Q

Which vaccines are given to babies at 8 weeks?

A

-6 in 1 (Diptheria, hepB, polio, tetanus, whooping cough).
-Rotavirus 1.
-MenB1.

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73
Q

Which vaccines are given to babies at 12 weeks?

A

6in1 - booster 2.
PCV.
Rotavirus 2.

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74
Q

Which vaccines are given to babies at 16 weeks?

A

6in1 - booster 3.
MenB2.

75
Q

What does the newborn heel prick test for?

A

5 days old:
-Sickle cell, CF, congenital hypothyroidism.
-6 inherited metabolic diseases.

76
Q

What is herd immunity?

A

Protection of vulnerable people when enough of the people are immune thus preventing disease from spending.

77
Q

What are the two depression identification questions?

A

-During the last month - feeling down, hopeless or depressed?
-During the last month - little interest or taking no pleasure in doing things?

78
Q

When are post natal baby checks?

A

6-8 weeks.

79
Q

What is a blood test for anaphylaxis?

A

Serum mast cell tryptase.

80
Q

In order to induce anaesthesia quickly what characteristics should the drug have in terms of its protein binding and lipid solubility?

A

Low protein binding - increase in free circulating drug.
Lipid soluble - can cross BBB easily.

81
Q

Give and example of competitive and non-competitive inhibitors?

A

Non-competitive - cyanide.
Competitive - methotrexate.

82
Q

What is the treatment of hyperkalaemia depending on ECG?

A

Changes - calcium gluconate.
No change - Insulin and dextrose.

83
Q

What is Cushing’s reflex? How does it occur?

A

Raised ICP - Bradycardia, wide PP and irregular breathing.
-Brainstem ischaemia.

84
Q

What is PT/INR?

A

Coagulation speed through extrinsic pathway.
Normal = 0.8-1.2.
10-13.5s.

85
Q

What is APTT?

A

Coagulation speed through intrinsic pathway.
35-45s.

86
Q

What is the treatment for hypocalcaemia?

A

Calcium gluconate.

87
Q

Describe the murmur of HCM.

A

Ejection systolic crescendo decrescendo.
-Increased intensity with activity.
-Disappears on squatting.

88
Q

During atrial fibrillation, what stops the ventricles from beating very fast?

A

Annulus fibrosus and AV node.

89
Q

What is seen on blood film for multiple myeloma?

A

Rouleaux formations.

90
Q

What does normal PT and abnormal APTT mean?

A

Haemophilia A, B and Von Willebrand disease.

91
Q

What are the electrolyte abnormalities in tumour lysis syndrome?

A

Hypocalcaemia, hyperphosphatemia, hyperuricemia, hyperkalaemia.

92
Q

What is seen on bloods in DIC?

A

Decreased fibrinogen, decreased platelets and elevated D-dimer.

93
Q

How does C. diff spread?

A

Spores via faeco-oral route.
-These are resistant to heat and chemicals.

94
Q

What is the vitelline duct?

A

Embryonic structure in the ileum, if it remains it forms Meckel’s diverticulum.

95
Q

Which portion of the GI tract is more likely to perforate in a bowel obstruction?

A

Caecum as it has the thinnest wall.

96
Q

Describe Barrett’s oesophagus.

A

Metaplasia from stratified squamous to simple columnar.

97
Q

What best reflects synthetic liver function?

A

Prothrombin time (PT) and serum albumin.

98
Q

What is the difference between Marfan’s and ED?

A

Marfan’s - decreased connective tissue.
ED - Impaired synthesis of type 2 collagen.

99
Q

How is prostatitis and prostate cancer differentiated?

A

Prostate cancer tends to not be tender.

100
Q

Name four things that can raise PSA in men.

A

Ejaculation, exercise, DRE and UTIs.

101
Q

Why is levodopa used instead of dopamine in Parkinson’s disease?

A

Can cross BBB when dopamine can’t.

102
Q

Describe the microbiology of meningitis.

A

S. pnuemoniae - Gram positive diplococci.
N. meningitidis - Gram negative diplococci.

103
Q

Does a cauda equina lesion cause UMN signs?

A

No.

104
Q

Why does COPD causing hypoxia cause polycythaemia?

A

As there is low oxygen levels, RBC production increases to counteract the effects to increase oxygen levels.

105
Q

What is co-amoxiclav made of?

A

Amoxicillin and clavulanic acid:
-Clavulanic acid = Beta-lactamase inhibitor which increases the effectiveness of amoxcillin.

106
Q

What are four features of tension pneumothorax?

A

-Reduced air entry.
-Tracheal deviation away from affected sides.
-Decreased tactile and vocal fremitus.

107
Q

What is the most common valve disorder?

A

Aortic stenosis.

108
Q

What are the lateral heart leads?

A

I, aVL, V5, V6.

109
Q

What are the inferior heart leads?

A

II, III, aVF.

110
Q

What are the anterior heart leads?

A

V3, V4.

111
Q

What are the septal heart leads?

A

V1, V2.

112
Q

Describe the serology seen in granulomatosis with polyangitis?

A

cANCA in 90%.
pANCA in 25%.

113
Q

Which bacteria most commonly causes COPD exacerbations?

A

H. influenzae.

114
Q

Which cancers cause lung metastases?

A

CRESP:
-Choriocarcinoma (uterus).
-Renal cell carcinoma.
-Endometrial carcinoma.
-Synovial sarcoma.
-Prostate carcinoma.

115
Q

What is seen on blood film for TTP?

A

Schistocytes.

116
Q

What is the management of G6PD deficiency?

A

Avoid precipitants.

117
Q

Describe the step by step management of DKA?

A
  1. IV fluids.
  2. Insulin.
  3. K+ replacement.
  4. Identify and treat illnesses.
118
Q

What is the most common cause of Cushing’s syndrome?

A

Long term high dose exogenous glucocorticoid use.

119
Q

When someone with Addison’s disease is ill or has a fever what has to be done?

A

Double dosage of steroids.

120
Q

Which condition is associated with gallstones?

A

Crohn’s disease.

121
Q

What is the first line management of paracetamol overdose?

A

IV acetylcysteine.

122
Q

What is the most common causative organism of ascending cholangitis?

A

E. coli.

123
Q

What are the most common nephrotic syndromes in children and adults?

A

Children - Minimal change disease.
Adults - Focal segmental glomerulosclerosis.

124
Q

Which hormone do seminomas secrete?

A

hCG.

125
Q

Which dietary changes do people with renal failure need to do?

A

Low protein, phosphate, sodium and potassium.

126
Q

What are six risk factors for pseudogout?

A

Hyperparathyroidism, hypothyroidism, haemochromatosis.
Hyperphosphatasemia, hypomagnesaemia, hypercalcaemia.

127
Q

What are the side effects of alendronate?

A

Oesophageal reaction:
-Ulcers, erosions, strictures.

128
Q

Describe the blood findings of Paget’s disease.

A

Raised ALP, normal phosphate, normal calcium, normal vitamin D.

129
Q

How do extradural haematomas present?

A

Lucid intervals - a temporary improvement in patient’s condition following injury accompanied by deterioration of condition after.

130
Q

How do subarachnoid hemorrhages present?

A

Thunderclap headache, meningism (photophobia, neck stiffness).

131
Q

What is the prophylaxis for cluster headaches?

A

Verapamil.

132
Q

What is Uhthoff’s phenomenon?

A

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.

133
Q

Which TB antibiotic causes gout?

A

Pyrazinamide.

134
Q

What is incidence?

A

Number of new cases of disease in a population over a specified period of time.

135
Q

What is prevalence?

A

The frequency of a disease in a population at a particular point in time.

136
Q

How is GCA treated when affecting vision?

A

Urgent IV methylprednisolone.

137
Q

Describe the stages of the transtheoretical model of change.

A

1) Precontemplation.
2) Contemplation.
3) Preparation.
4) Action.
5) Maintainance.
6) Relapse.

138
Q

Describe the four stages of COPD.

A

Stage 1 (early) - FEV1>80%.
Stage 2 (moderate) - FEV1<80%.
Stage 3 (Severe) - FEV1<50%.
Stage 4 (Very severe) - FEV1<30%.

139
Q

When is menopause considered early?

A

Earlier than 45.

140
Q

Describe focal seizures of the frontal vs temporal lobes.

A

Frontal - Motor features ( Jacksonian March).
Temporal - Memory phenomena (deja vu), smell and taste hallucinations.

141
Q

Describe the bloods of Wilson’s disease.

A

High urine copper assay.
Low serum copper.
Low serum ceruloplasmin.

142
Q

What is a never event?

A

A serious, largely avoidable patient safety event which shouldn’t occur if preventative measures have been implemented.

143
Q

Describe the stages of hypertension.

A

Stage 1 >140/90 or ABPM >135/85.
Stage 2 >160/100 or ABPM >150/95.
Stage 3 >180 systolic or >120 diastolic.

144
Q

What is the white coat effect?

A

Discrepency of more than 20/10mmHg between clinic and ABPM.

145
Q

What are the vitamin K dependent clotting factors?

A

10, 9, 7, 2.

146
Q

Give an example of an alpha blocker.

A

Phenoxybenzamine.

147
Q

Describe the characteristics of Neisseria Gonorrhoea?

A

Gram negative diplococci.

148
Q

What is the mechanism of beta-lactam antibiotics?

A

Inhibit transpeptidation reactions needed to cross-link peptidoglycans in the cell wall.

149
Q

Describe how to inform the DVLA for TIAs and seizures.

A

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.

150
Q

Describe the creatinine rise in AKI.

A

More than 26mmol/L within 48 hours.

151
Q

What is a feature of UC and not Crohn’s?

A

Pseudo-polyps.

152
Q

Which electrolyte abnormality does Conn’s syndrome cause?

A

Hypokalaemia.

153
Q

What is the treatment of chlamydia?

A

-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.

154
Q

How do sulphonylureas, SGLT2 inhibitors and DPP4 inhibitors work?

A

-Sulphonylureas - Lower blood glucose by stimulating insulin secretion.
-SGLT2 - Block reabsorption of glucose in kidneys.
-DPP4 - Prevent insulin from being destroyed.

155
Q

Is aspirin used in gout?

A

No, usually ibuprofen.

156
Q

When should a DEXA scan be offered?

A

-To those without FRAX score in people over 50 with previous fragility fracture.
-People under 40 with a major risk factor.

157
Q

When can confidentiality be broken?

A

Risk to public safety.
Given consent.
Required by law.

158
Q

How does De Quervain’s thyroiditis present and how is it treated?

A

Hyperthyroidism with painful asymmetrical lump.
Self limiting so usually supportive (analgesia and anti-inflammatories).

159
Q

Describe the differences between an occlusion of the anterior and middle cerebral arteries.

A

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.

160
Q

Describe the differences of symptoms of right and left sided heart failure.

A

Right - Ascites, peripheral oedema, anorexia, nausea.
Left - Poor exercise tolerance, nocturia, cold fingers, SOB.

161
Q

Describe the differences between metabolic acidosis with and without compensation.

A

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.

162
Q

Where is the fibrosis in the lungs in idiopathic pulmonary fibrosis?

A

Lower zone fibrosis.

163
Q

What causes barrel chest and hyperinflated lungs?

A

Emphysema.

164
Q

Describe the CHAD2DS2-VASC score and how is it calculated?

A

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.

165
Q

What is the most specific marker for acute liver failure and why?

A

ALT as AST is also present in other organs whereas ALT is almost exclusive to the liver.

166
Q

What is the biggest risk factor for aortic dissection?

A

Hypertension.

167
Q

Describe the blood scores of haemophilia.

A

Normal PT, prolonged APTT, normal INR.

168
Q

What is the typical presentation of hemorrhoids?

A

Itching and irritation of the anal region.

169
Q

What is another name for the storage LUTS?

A

Irritative symptoms.

170
Q

What is the treatment for unstable angina?

A

GTN spray with CCB or BB.

171
Q

What are three extra-articular manifestations of AS?

A

Anterior uveitis, autoimmune bowel disease, amyloidosis.

172
Q

Describe Schober’s test.

A

Locate L5 vertebrae, mark 10cm above and 5cm below.
-Bend over as much as possible.
-Positive is less than 20cm.

173
Q

Describe three features of AS on XRAY.

A

Bamboo spine, square vertebral bodies, subchondral sclerosis.

174
Q

What are three features of good asthma control?

A

No night time symptoms, inhaler used no more than 3 times per week, normal lung function test.

175
Q

Describe goblet cells in Crohn’s and UC.

A

Crohn’s - Increase.
UC - Decrease.

176
Q

What scoring system is used to determine the risk of stroke after TIA?

A

ABCD2.

177
Q

Describe how to calculate ABCD2 score.

A

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).

178
Q

In IE, why is the tricuspid valve affected more?

A

It’s the first valve in contact with venous return.

179
Q

Which LFT is linked with alcohol use the most?

A

Gamma-GT (GGT).

180
Q

Which benzodiazepine is used manage alcohol withdrawal?

A

Chlordiazepoxide.

181
Q

What are two dietary restrictions of HF patients?

A

Fluid restriction and reduced salt intake.

182
Q

Describe the management of HF.

A

1st - ACEi and Bb.
2nd - Spironolactone.
3rd - Furosemide.

183
Q

Which blood test abnormality does methotrexate cause?

A

Thrombocytopenia, anaemia, leukopenia (due to bone marrow suppression).

184
Q

When there is dark brown urine after a fall, what does this indicate?

A

Rhabdomyolysis.

Phase 2a (15 decks)

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